Kno-Wal-Lin Home Care and Hospice: Donna DeBlois, Executive Director & VP of Community Health

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An affiliate of Pen Bay Healthcare in Rockland, Maine, Kno-Wal-Lin Home Care and Hospice (KWL) is a 44 year old organization that cares for 300 home care patients, 50-60 hospice patients, and more than 200 private duty patients on a daily basis. KWL is Medicare certified for home care and hospice and also state licensed as a private duty provider. The organization has about 150 employees.

Donna DeBlois is the Executive Director of KWL and Vice President of Community Health for all of Pen Bay Healthcare. She has been with the organization for ten years. Donna also represents the New England states on the Board of Directors for the National Association for Homecare and Hospice.

Changing Needs in Home Care

DeBlois has been in home care for twenty-eight years. “The type of patients we care for now are significantly sicker now,” she says. “The average length of stay in a hospital is about three to four days, so they come home very unstable with multiple needs.”

The primary population served is elderly, with an average age of 72. DeBlois says the pediatric population has grown significantly in recent years, however. “We have a very strong pediatric team here,” she says. “We have developed a really nice relationship with the emergency department because a lot of the kids we take care of are very sick and their primary physicians may be located closer to a tertiary hospital which is an hour and a half drive from us.”

The role of homecare, however, is not to be with a patient long-term. They work to teach the patient to be independent, make sure they have the knowledge necessary to take care of their own needs, and then move on to the next patient. “We’ve done very well with this. Our patient satisfaction scores and quality of care outcomes exceed national benchmarks,” says DeBlois. KWL has been a member of the Homecare Elite for the past four years.  The Homecare Elite is comprised of the top 25% of all Medicare certified homecare agencies in the country.  Drivers for this distinction are financial outcomes, quality outcomes and patient care outcomes. “We also have a very low level of personal care services because we use a lot of occupational care services to get patients back to where they need to be.”

Growing Use of Telehealth and Technology

KWL’s home care program is designed to be short-term assistance for those recovering from acute illnesses. They currently have seventy-five telehealth units and are working on expanding the program. The compact, portable devices can be installed in a patient’s home using existing phone lines. This allows doctors to analyze vital signs – including weight, blood pressure, pulse, and oxygen saturation – without travelling to a patient’s home. If there are signs of trouble, a nurse can visit the patient in their home to check on their condition. The telehealth units allow patients to recover in the comfort of their own homes while keeping in touch with health professionals who can monitor and educate them about their conditions.

The devices allow them to reach more patients, more efficiently. “We have the pleasure of serving four island communities,” says DeBlois. “We either get to them by ferry or US postal mail plane.” Because KWL is a rural agency serving the coast of Maine, home of many peninsulas and harbors, they have embraced the use of technology to reduce cost and gain efficiency.  For example, their clinical record is paperless and Polycom is used to reduce travel to meetings.

Facility Expansion

A new, 7-bed hospice house is being planned by KWL. The house, built on the model of a New England farmstead, is intended for those with perhaps a 7-10 day life expectancy. “It will look like, act like, and feel like a home, but the guts of it will be a nursing home, which is a requirement for an efficient hospice facility,” says. DeBlois. “This will certainly broaden the scope of what we already have.”

Other Growth

Another aspect of the services provided by KWL that DeBlois sees expanding is taking care of patients with palliative care. “Those who have a terminal, life-threatening illness and are still receiving treatment, or have a life expectancy of a year or more—patients who are still receiving chemo or still fighting with end stage heart disease—that palliative care is something we’re embracing,” she says. “We are the very first healthcare system to implement POLST in the state of Maine.”

POLST is Physician Orders for Life-Sustaining Treatment. It is a national movement, designed to improve the quality of care people receive at the end of life. More common in nursing homes, it is now moving into the acute care realm of healthcare.

“We’re really excited about it,” says DeBlois. “There are some huge opportunities here. The other opportunity I see for home care within the realm of healthcare is really about chronic care management. Hospitals and systems are looking at accountable care organizations, the role home care will be in keeping patients at home and reducing hospitalization. First, they want to reduce admissions, and second, keep patients from ever going to the hospital to begin with. Home care has a huge role in that.”

Political advocacy

“As the lowest cost provider within the healthcare continuum, the role of homecare and hospice will continue to grow as we move to reduce healthcare costs.  Patients can be managed at home rather than incur the cost of an acute admission for exacerbations of certain chronic diseases, such as, congestive heart failure, and diabetes.  Grass roots political advocacy on the part of all providers promoting the voice of homecare and hospice is necessary to guarantee that we our industry is included in decisions regarding health care reform. I would encourage all provider agencies to join their state homecare and hospice associations, as well as their national associations for guidance in this process to insure we all speaking w/ one voice,” says DeBlois.

-by T.M. Simmons

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