When Lorraine Kaplan broke her hip this spring, there was debate about how much she could improve after she got out of skilled nursing. Because Kaplan, 89, was now in memory care for dementia, her family didn’t know whether to continue the care home to provide physical therapists to build her strength, as well as people to help with caregiving for wounds, or continue hospice care to make her comfortable.
The Kaplan family uses the new St. David’s HealthCare at Home and St. David’s Hospice & Family Care to evaluate Lorraine Kaplan through the hospice program, which determined that it was not yet time for hospice care because she could still improve physically. After that, HealthCare at Home began scheduling home health visits for physical therapy, nursing care and even music therapy.
“We needed someone to work with her and someone who could communicate with the family as well,” said her sister-in-law Patricia Kaplan, who is the administrative coordinator for St. David’s HealthCare at Home. “My husband and I couldn’t be there for every visit. We were really looking for someone we could rely on for what they were seeing.”
The Kaplans said the hospice evaluation is good because they now know the signs to look for that would alert them when it’s time to make that transition from home health to hospice. “It’s a very emotional decision for a family,” Patricia Kaplan said.
Lorraine Kaplan has made improvements since receiving home health services that are covered by Medicare or insurance, and has learned how to safely use a walker sometimes instead of a wheelchair, improve her range of motion and build her strength.
“There’s a lot of coordination that goes on at a high level,” Patricia Kaplan said. “They are on it. My husband sleeps much better at night.”
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St. David’s HealthCare operates eight hospitals in the Austin area and is in the process of building a behavioral health hospital in North Austin, as well as an acute care hospital in Kyle and one in Leander. The health system’s expansion into home health and hospice care began when St. David’s parent company HCA Healthcare bought a majority stake in Brookdale Health Care Services from Brookdale Senior Living last year. Locally, Brookdale Home Health and Hospice Services was renamed St. David’s HealthCare at Home and St. David’s Hospice & Family Care this June.
“For St. David’s is a much closer partner for us to work with and enhances our ability to move patients to the right side of care,” said David Hufstutler, president and CEO of St. David’s HealthCare.
Although people who are at St. David’s hospitals will still have a choice of hospice or home health providers when they are released from the hospital, Huffstutler said this expansion under the St. David’s brand allows for better coordination and ideally faster transition to these levels of care rather than waiting in the hospital for lower levels of care to become available.
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Huffstutler said there are plans to expand these two new sectors of care for St. David’s. “We will work with Brookdale to do this by investing together, increasing staff, expanding geographic locations or redistributing staff to ensure we can meet the growing demands we have.”
The Brookdale team has been providing home health and hospice care since 2013. “We have a very full-time staff,” said Robin Nanelli, director of hospice for St. David’s Hospice & Family Care. This change doesn’t mean the only patients she sees will come through St. David’s Hospitals, just like when she was Brookdale, she didn’t just care for people in Brookdale senior living facilities.
A big part of what they will do is educate families about the different level of care and services available under each program, Nanelli said. For a hospice, this includes social work, symptom management, music therapy, chaplain services, nursing, medications and equipment. St. David’s Hospice and Family Care also fulfills last wishes for its clients, such as a brisket cookout, a visit with a miniature horse, a visit to an ice rink, or one more time playing the trumpet with a high school orchestra.
Nunnely also teaches people that if there is improvement, they can leave hospice and go to home health care, or if they are receiving home health care, they can transition to hospice when the time is right. Like home health, hospice is also covered by Medicare insurance.
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