At-home health care support for every age range
by Elizabeth Bassett
Janet McCarthy has been with Franklin County Home Health Agency in St. Albans for 23 years, all but five of them as executive director.
Janet McCarthy’s 23-year career at Franklin County Home Health Agency began with a traffic jam.
“I was working as a nurse at the Medical Center Hospital of Vermont, now Fletcher Allen Health Care,” she says. “One day I got a call that my son was in the nurse’s office at his school in Georgia. There was construction on the interstate bridge over the Winooski River. One-and-a-half hours later I arrived at his school.”
That evening McCarthy scanned a St. Albans newspaper for job openings. “I wanted to work in the community where my family lived,” she says. Shortly thereafter, in October of 1989, McCarthy joined Franklin County Home Health Agency as an administrative nurse overseeing patient care. Five years later she became executive director, a position she has held ever since.
McCarthy was born Janet Lee in Washington, D.C., “so I am not a real Vermonter,” she says. “My father is from the Rutland area, and we moved there to be near his family.” She graduated from Mount St. Joseph Academy and earned her bachelor of science in nursing from the University of Vermont. Meanwhile, her high school sweetheart from Rutland, Michael McCarthy, studied at St. Michael’s College. “We continued to date during college and married in 1978 when I graduated,” she says.
She began work at MCHV as a floor nurse but soon added responsibilities in management and program development. With two young sons at home, she worked part time while Michael pursued his career in law enforcement. She was also working toward her master of science in administration at St. Michael’s. That was when she had her traffic-jam moment.
In 2012, Franklin County Home Health Agency was the county’s 10th-largest employer. With an annual budget of more than $7.6 million and 212 employees, the agency made 76,865 home visits. Of the 1,670 clients served, 775 were younger than 65. From offices in St. Albans and Enosburg, the nonprofit supports patients in their homes with an array of services, including high-tech nursing, telemonitoring, rehabilitation therapies, hospice and palliative care, birth and maternal child services, and long-term care.
Franklin County Home Health Agency was founded in 1969, “to help people recover from illnesses in the comfort of their homes.” Home health-care agencies evolved with Medicare in the 1960s. “Previously every town had a nurse who checked in on the sick,” McCarthy says. “They cared for patients and gave immunizations. Occasionally they even bathed the elderly. One of Medicare’s benefits was care within the home.”
Today Medicare and Medicaid provide about 92 percent of the agency’s funding. The balance comes from grants, donations, allocations from the 15 towns in Franklin County, and a small amount of private health insurance. “About 8 percent of the care we provide is unreimbursed charity care,” McCarthy says.
Referrals come from Fletcher Allen Health Care, Northwestern Medical Center, Northwestern Counseling & Support Services, doctors’ offices and clinics, three nursing homes in Franklin County, the Vermont Department of Health, and patients’ families and friends. Immunization and blood pressure clinics are offered at senior centers and other partner organizations. Otherwise the agency’s services are delivered in patients’ homes.
“Home care is a cost-effective tool within our health-care system,” McCarthy says. “Patients are able to return home from the hospital and often need access to trained staff.”
High-tech nursing allows patients on ventilators to live at home. “Only one nursing home in the state can care for patients on respirators,” she says. “Our skilled nurses can manage those patients.”
Because of the cost-effectiveness of home health care, the Legislature designated a nonprofit home health agency to serve each county in 2005. One for-profit agency also operates throughout the state. The nonprofits provide care for all patients, regardless of their ability to pay. Franklin County Home Health Agency is the designated nonprofit within that county, analogous to the Visiting Nurse Association — also a nonprofit — that serves Chittenden and Grand Isle counties. The Legislature mandated that a majority of board members at the nonprofit agencies be consumers or close relatives or friends of those who use home health care.
About a quarter of the agency’s employees work full time. Almost half are licensed — in nursing, physical therapy, occupational therapy, language and speech pathology, and other specialties. Ten managers form a leadership team reporting to McCarthy, many with numerous years of service. “I like to see people grow,” McCarthy says. “I want the agency to be a place where someone can learn and advance, spending a career here.”
Franklin County Home Health Agency “telemonitors” 31 patients in their homes. “The monitor transmits a patient’s weight, blood pressure, blood-oxygen level, and pulse via telephone,” McCarthy says. “It is programmed to ask questions tailored to the patient: for example about chest pain, medications, or shortness of breath.” A nurse interprets these measurements and can respond to changes. “The nurse can schedule a home visit, often avoiding an expensive trip to the emergency room.”
“Sometimes weight gain, rapid pulse, or elevated blood pressure can be attributed to yesterday’s stresses or indulgences,” McCarthy says. “Through daily monitoring a patient can see how behavior affects health and take more personal responsibility.”
The Vermont Department of Health operates the federal WIC (Women, Infants, and Children) Program. WIC supports low-income pregnant women and mothers with young children but does not offer home-based services.
Judy Ashley is district director for the Vermont Department of Public Health in St. Albans. When Ashley applied for her job in 1999, McCarthy was on the hiring committee. They have been friends and colleagues ever since. She calls McCarthy “one of the best educators around.”
“Some women in our WIC clinics ask for additional services,” Ashley says. “We refer them to Franklin County Home Health Agency for childbirth education, lactation support, and help in the home for mothers with their babies and young children. Public health and home health are natural allies. Janet and I strategize and problem-solve together. I can call her about any issue; she is a great sounding board.”
Both Ashley and McCarthy have served on the board of Northwestern Medical Center. “Janet is a great partner and collaborator,” says Jill Berry Bowen, Northwestern’s CEO (and a nurse), who adds that she and McCarthy recently reviewed their respective organizations’ strategic plans. “Janet puts people first in everything she does. Her background as a nurse is invaluable. She is genuine and caring. It is great to have Janet as chair of the personnel committee of our board.”
The Franklin County Home Health Agency was one of the first Medicare-certified hospice programs in the United States. “Using pilot programs in several Vermont communities, Medicare was able to see that quality, cost-effective care could be delivered in home settings,” McCarthy says. “This set the stage for Medicare to reimburse hospice care.”
The agency offers hospice and palliative care in patients’ homes, nursing homes, and residential homes. It also participates in Start the Conversation, a statewide public-education initiative that encourages Vermonters to educate themselves and plan their end-of-life care.
Taking care of things at the agency is also important to McCarthy, who begins her days by walking the halls with a cup of coffee. “I poke my head into offices,” she says. “It is important for me to connect with people, feel the pulse. Then I check my email and voice mail and look at the day ahead. I spend a lot of time in meetings.”
McCarthy has retained her nursing certification. “Every once in a while I get to visit patients,” she says. “The staff delights in making sure I conform to the dress code, have all the equipment I need, and know where I am going.”
She and Michael had a third child, and now all three sons are grown. In winter McCarthy enjoys quilting; in summer she gardens. After 12 years as a state trooper and 19 years as police chief in Swanton, Michael has retired. “We spend time together in the garden. He’s learning the difference between a weed and a vegetable,” she says. “I’m pleased to say that he’s educable!”
Her profession is very different from what it was 10 years ago, “even one year ago,” McCarthy says. She wonders about the future as the health-care universe becomes more sophisticated and centralized. “One the our strengths of our agency is that we are nimble and can respond quickly to change. I worry that we may lose this responsiveness as the system gets bigger and health care gets more standardized.”
“The commitment of our employees never fails to humble me,” McCarthy says. “In January when it was minus 20 degrees, our nurses figured out how to keep their car batteries warm overnight. ‘What will happen to my patient if my car won’t start?’ one asked. She arranged back-up transportation, just in case.”
Human relationships are the constant. “When you walk into someone’s home, you walk into a life. It is an intimate and very powerful experience,” McCarthy says. “It is a privilege to witness and share that.” •