This is file 56. This is Jean McMillen. I am interviewing Kathy Shortelle the Clinical Director for 25 years of the Salisbury visiting Nurses Association. She is going to talk about her job, the SVNA and anything else that she can think of pertaining to whatever. Today’s date is August 30, 2013.
JM:What is your full name?
KS:February 17, 1950
JM:Your parents’ names?
KS:Robert and Elizabeth Pierce
JM:Do you have siblings?
KS:I have 5.
JM:and they are?
KS:I have one sister Julie who is the oldest; then I have 4 brothers John, William, Michael, and Denis. I am the third in the line.
JM:Where were you educated?
KS:College of St. Anselm’s College in Manchester, New Hampshire.
JM:And your degree?
KS:I have a Bachelor of Science in Nursing.
JM:Why did you want to become a nurse?
KS:I had helped and observed a nurse taking care of my grandfather who was taken care of at home, quite a number of years ago before homecare was as vital as it is today. In watching her take care of my grandfather and the care that she was able to render to him and the comfort that it brought to my family, I thought that that was something that I wanted to pursue. So I became a Candy Striper in the local hospital and then went on to be trained in a nurse’s aide program and then came back to that through my college education. Just being able to help people and put the science of it together with how to fix things and take care of things and manage things, I found it fascinating.
JM:And you still do.2.
KS:Yes, I do.
JM:In the reading of the History of Salisbury Visiting Nurses Association, the first nurse came from Henry Street in New York City. Give me a little background on that please. (SVNA was founded in 1902 Ed.)
KS:They were like tenement houses, or settlement houses, that took care of people; they went out to the community into the apartment buildings and ran the clinic in the local areas. We had a very progressive thinker up in this area who went down to the Henry Street settlement to bring this person up here to work. She went around first by horse and then eventually by car to visit the homes and to take care of the ore mine workers and their families and the community at large. There was a home here for the mentally challenged people. (Dr. Knight’s School for Imbeciles)
JM:Who was the progressive thinker who started this?
KS:Her name was Rose Parsons (Mrs. Charles).
JM:And the nurse’s name was?
KS:Henrietta Van Cleft.
JM:I remember she hated the car.
KS:She loved the horse and hated the car.
JM:What is the focus of the organization? What is their prime reason for being?
KS:The main reason for the agency is to take care of people in the community in their home settings to render the care necessary to keep them in their homes and in the community and hopefully restore them back to their functional status to serve the community. It is to take care of the people here and maintain them in this environment.
JM:How have some of the programs expanded?
KS:We have embellished the wellness programs; we have always done well baby clinics; we’ve done blood pressure clinics; we did flu clinics in a small format. Now we have gone out to residences and businesses in the community. We have gone to the private schools; we do the local public schools as well. We offer flu clinics out there. We have done a movement class to help with the elderly with their balance to help reduce the number of falls and just teach them how to properly move and turn and maintain that balance without the risk of a fall or how to use the proper adaptive equipment to make concessions to that.
JM:Now when we were talking about this, you said something about home care being all inclusive. You gave an example of going into a home and looking in the refrigerator. Why would you do that?
KS:What we do is, you are not just taking care of the person, you are taking care of the home so you want to make sure that they are able to have the food that they need, have the food provided. If they can’t provide the food, we look into programs like Meals on Wheels that helps deliver already prepared meals to the home. It provides a lunch, a hot lunch as well as a cold bag for later in the day. We want to make sure that the patient has the proper tools to maintain their health in the home whether it be taking care of themselves, or taking care of their pets. You want to make sure that they have oil in the tank for heat in the house or that they have electricity or who is paying their bills. So we don’t just do the one physical thing; we are taking care of the whole person which means their physical wellbeing, their mental wellbeing, their emotional, spiritual wellbeing. We make sure that they have a medical social worker as part of the package or a therapist. We also act if they have a local church that they might belong to. Do they need their minister or Rabbi or whoever involved in their care; so that those people all make home visits. Obviously we need the permission of the patient to do all these things so we always ask them who else is involved or needed in their wellbeing because it is their whole comprehensive piece, not just their physical ailment that we are dealing with.
JM:This is 24/7?
KS:We do 24/7 hours a day, 7 days a week. 365 days a year. We offer the potential for whatever they might need. We do home care; we also have a hospice program and we also have what we call home assistance which is a supplement to what the insurances will pay for so the patient would obviously have to pay privately for the home assistance but it is an additional piece to make sure that the patient has the proper personnel in their home to ensure that they are safe and able to remain in their house. The whole focus of home care is to keep the patient at home, so we are not putting a social worker in the house to determine whether they go to a nursing home eventually. Our focus is to keep the patient where they want to be in their own environment, on their own schedule, without having to fit into a program of when they get pills or when they get their meals or whatever. If they can stay in their own home with the insurance paying for the bulk of what we are going to do that ensures usually the people get better quicker.
JM:They get better faster because they are in their own environment and more comfortable, and they are not frightened.
KS: Correct, and they have their mental wellbeing is a huge part of getting better. They can have their pets around them or their family members or their grandkids coming and going. Their grandchild sitting on the bed reading them a story when they are recuperating, that is all the better.
JM:These are all things that are so important. There is a reason why you have the school nurse in the school, and that is because…
KS:We have been committed to putting our personnel through our agency up at the school forever. The other schools in the area have hired their own nurses through the Board of Education of those individual schools, but it has worked out very well. One reason that we do it is because we are the Salisbury Visiting Nurses and we have a grammar school here in town. They align with that piece that the nurse would go up part-time. The nurse would usually would go in only in the morning and be there only a few hours. We put what we call a certified health aide in there in the afternoon to sort of oversee anything else that might happen or to be able to call on us if they needed help. You did not need that fulltime person; however, the situation has evolved where you have more kids with diabetic issues, or asthma, or medication needs, food allergies, or they might be a little bit physically challenged or whatever else they need, special equipment or adaptable equipment to get through their day in the classrooms. All schools now have put in a fulltime nurse in the piece. We have contracted with the Board of Ed of Salisbury to put a nurse up there full time. It has been a huge benefit to the school system. I think just for peace of mind for the parents, knowing that the school nurse is on site; the teachers have peace of mind that they don’t have to deal with it. If there is a problem in the classroom they can send a child to the nurse, and we have been blessed with the nurses who have been up there.
JM:Could you name a few of the nurses who have been up there? I remember Phoebe Storms.
KS:Dot Sherwood and Marion Romeo, both were longstanding employees of the agency. Sharon Day was part-time up there and part-time being a field visiting patients. That was a really vital piece because her day comprised being up at the school in the morning, and often times in the afternoon she would be making home visits to the same family that might have physical issues or needs of the child at school. So she would go out and visit the parents of a child in the afternoon in the home environment. That was a huge benefit to the families and the kids to have that quality of care for what they need. We have since had Martha Fitzgerald who became a full time school nurse. Now we have and are blessed with Mary Cadman who is up there full time.
JM:Now you said something about private funding for this Home Assistance. How do you get your money for that?
KS:The families pay part of it. Individuals pay themselves an hourly rate. We put personal care assistant in the house. We have a director who goes out that evaluates the home situation, what the needs of the patient are, what the family are looking for, sometimes it is a companion, and sometimes it is somebody to help with bathing and homemaking and meal preparation. It might be a 24 hours situation where they have several different people. We also have the ability to put a live in care giver in place should they want to just hire a one person. The issue with that is that that person has to be guaranteed at least 6 to 8 hours of sleep a day. Oftentimes that can happen, but if you have somebody that has a lot of needs, one person is not going to be able to handle that.
JM:Who is the director who goes in and does this assessment?
KS:Her name is Brenda Fife. She is a full time Director of the Home Assistance Program. She does all the evaluations. She goes out to talk to people in the community about what her program is able to do. They take patents to appointments. They often will supplement the certified health aide. The insurances will pay for a nurse to go in, a therapist, and a home health aide to go in for a couple times a week for an hour. The families then decide if they want additional help so they will purchase 3/6/8/hours of extra help from the Home Assistance Program. Brenda does the on-site evaluation and talking to the family just to see what their needs are and what the interest is of what they want that person to do. She is very good at aligning the proper care giver with that patient, just from her assessment of the patient. The people that she hires, she actually does an on-line evaluation where they have to answer questions; it is almost like a psychological testing to see whether or not they are really appropriate for caring for elderly people or a home-bound patient.
JM:It is a special gift. It is not something that I could do.
KS:It is a special gift. So we want to make sure that these are people that really have the personality and the demeanor to handle a confused patient, a person who is repetitive without losing patience, that type of thing. I think everybody is tested in different ways. People become teachers, and handle 40 kids.
JM:That I could do!
KS:You want to make sure that for the quality of care that we are expecting, and our agency has always had very high standards of what we want people to do. We take great pride in the people that we train and orient. We also take all these people in for the first visit. We don’t just say to them, “This is where the house is and go.” We actually take the person to that first meeting to make sure that things get settled. We also show them what we want them to do and run through the plan of care that we expect them to follow through on. It is really our taking responsibility and making sure that these people are appropriately placed. We want peace of mind for the family.
JM:It is a wonderful service, having been through it slightly; it is a wonderful service and a great comfort.
KS:We don’t want people to have to worry. If you are a daughter that lives in New York City and you want to get a caregiver for your loved one up here, you don’t want to have to go to your job every day and 50,000 phone calls with issues, problems and concerns. You want your loved one to know that they are settling in, and it does take a little bit of time. Everybody has to adapt, but once that caregiver gets in place and the repetition of them coming back is there, I think it is a huge comfort for that person that works or has to go out. We are sort of the sandwich generation taking care of their own kids, and taking care of their parents as well. You can go off to work or whatever duties that you have and peace of mind knowing that your loved one is cared for.
JM:I wish I had had that with my father because I would get phone calls at school, and I was torn. What do I do? I can’t leave my class, they have to be at such and such a place and I am supposed to handle this other issue. It was very stressful.
KS:It is interesting because you drive by neighborhoods that said “Drive like you live here” so that people aren’t speeding. I have always interviewed people when we want them to be personal care assistants or home health aides Would I want this person taking care of my parents? Is how I look at it. Either they are going to be able to do it well, or they aren’t cut out to do it. Because there are other jobs but this job really requires a gentle touch and nice word; not snapping and rough on people. You have to be firm as well.
JM:My father could be a real piece of work at times, and if you weren’t firm with him, he would walk all over you. We privately got a lady who was great for him, and it worked out very well. But it was done privately; it was done through no agency because my dad lives in another state. How much I wished he had lived in Connecticut because I knew what the services were here and at that point they were ever so much better.
KS:The other piece to that is when you have the agency involved in taking care of the patient, we put the home health aide in, the nurse that is responsible for that household with a therapist or whoever is the lead discipline in there they are responsible for making sure that the plan of care gets followed through, that the person is not just watching TV, but that the patient is getting their bath done or their shower done or their skin care done or that they are brushing their teeth or they are getting out for a walk or that somebody is reading to them if they want to be read to. We are responsible for that person so we want to make sure that the plan of care gets executed, that the care is done by standards that we expect them to be done by, and that the family has peace of mind in the process. You have a nurse overseeing that caregiver. That the caregiver is not just running amuck in the house; you need the supervision.
JM:Tell me a little bit about Hospice. Who runs that?
KS:We have a separate director, Donna DiMartino, who we are extremely blessed with having. She has a great wealth of information and expertize for caring for the end of life patient. She does training for our professional staff as well as our home health aide staff. She also does our tiers; under Hospice you can have a nurse, health aides, social worker, but part of the program is that you have a team in place with a spiritual director, and a medical director who will oversees us. We have a pharmacy person on the discipline team who helps us looking at meds and what is most effective for this patient, or this medication might have an adverse effect with this medication. So we might have to change things. We also have the volunteers who actually sit in the house with the patient; they don’t do hands on care, but they can read to the patient, they can hold hands, they can chat, they can fix a meal, and they can go grocery shopping for that loved one. They can be with that patient so that the family member can go out to the movies or something.
JM:That is so necessary, as a caregiver 24/7 you need a break. You need to get away from it because it can be all consuming. I only did it for a short period of time, but it swallows you if you don’t have back-up. You have to have to have back-up that you trust, and that is something that doesn’t come automatically. You have to develop it and it is something that I found with taking care of my husband that this organization was wonderful and they were there for him, but also for me. Even after he passed away, you came back to see how I was doing which meant a great deal. Because I personally have been involved with 2 different systems, my dad in one state and my husband in this state, I can make comparisons and you’ve got it hands down!
KS:That is good to know. We are very proud of what we do. The other piece to Hospice now because it is a whole new program, Hospice follows through with the family members for 13 months; so that is a nice piece of reassurance to have. Sometimes it is nice for the patient to know that when they are gone, somebody is going to be following through with their loved one for 13 months: home visits, home calls, cards, the volunteers go back to see the family members. It doesn’t just turn off; once the person has passed on, it just doesn’t stop the concern and the follow-up and the care that that loved one gets. We always do the whole package of the whole family, not just the patient in care. So if the wife or the kids or grandchildren we are also there for them and to incorporate them in the piece of getting the patient better. In Hospice care it doesn’t end when we discharge the patient. We continue with the 13 months; that is a real comfort. I have had a number of patients say to me when we admit somebody to Hospice,” Just to know that my wife is going to have somebody checking on her after.” Because that is a real concern and it really eats at people, having to wonder what is going to happen to my loved one when I am gone.
JM:Because all of the business of the death, the grieving, the funeral, and then what? It is a chasm; it is just a big empty chasm, and nobody cares. I don’t have any family so I know what it is like. It just ends, and yes, you have got friends but there isn’t anybody checking to see “Are you all right?” “Are you eating?” “Are you getting out?” “Are you doing anything for fun?” That’s the part that, my husband wasn’t in Hospice, but that is the part that was missing for me. I was able to take care of myself because I wanted to but it is a piece that is extremely important.
KS:The other piece to know is that it depends on age how people can get out. If you have an elderly couple and the spouse is not physically able to get out, he/she becomes very reclusive so you want to make sure that that doesn’t happen to the person. We also offer bereavement groups and there will be one starting up in the fall again. We do it usually in the fall and in the spring; people don’t want to come out in the winter as much, but it is for anybody that has the need. We really advertise it to our Hospice patients through our groups that we follow after somebody has passed on. We make sure that they have it, but anybody in the community it is open to. It is a really valuable tool; we did it originally it was going to be every couple of weeks, and the group decided that they thought it would be beneficial to do it every week so the facilitators adjusted their schedules so that they could meet weekly with the group that had decided that that was what they would like to do. It becomes what is best for the group as a whole.
JM:The groups change?8.
KS:The groups change all the time. Some people come back; they need to come back for that support, and it is there. It doesn’t mean that ok you have had 6 weeks of bereavement group and then you are done. Some people really need it as an ongoing support so it is available for anybody. The other piece we do is we do a program through the local library on End of Life Issues which was a huge plus for the community. This fall we’ll be doing another group on End of Life Issues. There is a local woman in Cornwall Susan O’Brien who is has done a book on end of Life. She and our Hospice Director Donna diMartino are coordinating these programs over a period of time. The first one is September 10, 2013, @ 5:00 at Noble; that’s going to be an open forum for a discussion that is going to be opened up with the use of this woman’s book but also with Donna’s expertize and helping people discuss it. It is tough to know how to approach and how to open the discussion, but it is wonderful to be about to have a comfort level to have this discussion. So it really is helping to ease people’s familiarity in the community with how to deal with this.
JM:I have a funny story. We had the lady that came to talk to us about End of Lie Issues, and she had her list. We had everything done, and she finally in frustration said, “Well, I bet you don’t have your cremation case.” Foster said, “Go into the den Jean.” I brought out his cremation case that his nephew had made for him. She said, “You’re prepared.” But we, because of the age difference between my husband and I and his four children being my age, we had discussed a lot of this because we are both very realistic people. We had Plan A if he goes first, Plan B if I go first, and Plan C if we go together. We had a comfort level; I don’t think his children had the same comfort level that he and I had, but it worked out beautifully. It really did. Now I would like to go on to something else. Do you have other organizations like Family Services or the Bissell Fund that work with you?
KS:We have our social worker in our building with Salisbury Family Services. When we were at the railroad station, Barbara Tobias was the town social worker also was in the building with us a couple days a week. Right now we have Patrice McGrath who is the town social worker; we work very closely with her. We often go to her, we admit a patient and the patient might have issues with being able to pay for their medication or how do I manage from 2 pills to 40 pills. They have been in the hospital with cardiac issues so now their meds have multiplied. They have trouble meeting the needs of the finances so we will often go to Patrice to see if there is funding available which she can help us with. She does fuel assistance, medication issues, and medical issues. We are very lucky in this town to have the Bissell Fund, which was started years ago (See tape #49A house #17 Mary Barnett & Betty Haas Ed.), but it is there for medical issues for people. In other towns we work closely with the town’s social workers and in all the towns we service, we do service 13 communities in the Northwest corner of Connecticut- all of Region #1 plus Goshen and Norfolk. Each of the towns is different; the Cornwalls are divided up into 3 different areas; depending on the post office box so they become three instead of one Cornwall. We work very closely with the town social workers so whether it is for hearing or hearing aids or glasses or medication or transportation, we do have to tap into the town social workers.
JM:But it is there.
KS:Yes, it is there and they are very generous…we have never had an issue when you present the case, the concern, and the needs of the families in the communities, the social worker are always very ready to respond.
JM:Salisbury is a very unusual community because whether it’s the visiting nurses, or the volunteer ambulance, or the fire department, if you ask, you receive.
KS:Right, the churches always rally around. We have a food pantry here as part of family Services that is very well received and utilized. So yes, we are very blessed. We also work with Owl’s Kitchen and the Fishes & Loaves in Canaan in trying to get food items and things of that sort for people.
JM:Then your food pantry here is separate from Owl’s Kitchen?
KS:Yes. We have our own food pantry; and people do ask us about Owl’s Kitchen also, but we have a pretty significant storage which is part of Family Services that Patrice handles. So the food items and the paper towels, the toilet paper needs and all that are meet.
JM:Tell me about Pat Trembly?
KS:Pat Trembly came in 2009 and she just left in April of 2013. She was our Executive Director. Right now Michelle Gorat who was our Chief Financial Officer has now become our Executive Director. Michelle has a wealth of medical knowledge and expertise. She worked at Sharon Hospital prior to coming to us in the financial department and came to us as our financial guru. Then with her expertise the board felt that she had the knowledge of the home care piece and the interest of the community at large to help run the scope of the Salisbury Visiting Nurses. It is constantly evolving, but you know we used to just cover the town of Salisbury; but gradually we have expanded out to Canaan, Sharon, Falls Village, and now we are down into Cornwall, Kent, and Goshen with patients. Where ever we get the referral if it is a town that we service, and we can take care of the patient at home and everybody is on board, then we go with it.
JM:Tell me a little bit about the board. How many are on the board?
KS:There are currently 15 people on the board. They are representatives from all the different towns, primarily Sharon, Canaan, Salisbury and Cornwall at this point.
JM:What does the board actually do?
KS:The board oversees and helps guide us; they are looking at our financial interests, but they also help with direction of the needs of the community, the people we serve, and how we can serve the community better at large. They do fund raising, research, marketing that we do to see how else we can expand our scope.
JM:Before I ask you about the Nightingale Award, is there anything that you want to add the SVNA that I haven’t covered?
KS:No I think you have been pretty comprehensive on what we do; I think you have covered all the details of everything we’re looking to do.
JM:Now I want specifically for you to tell me about the Nightingale Award.
KS:The Nightingale Award was a very nice recognition of me. It was voted on by the Executive Director and my peers at large. It is an award that was developed originally down in the New Haven area to recognize nurses within the hospital setting; it has now expanded out to nursing homes, clinics, the medical professionals at the prisons in the state that do wonderful work, and in home care as well. It has expanded into the Hartford-Litchfield territory out of the New Haven area. They felt it was a good recognition of people that have done significant work, leadership work, community work, patient care, interest of the patient first, that type of thing in recognizing individuals. This year there were 114 of us recognized at a dinner in early May and it was held in Hartford. I was deeply honored to have received the award, but also to stand with the people who were also honored. I was fascinated by the people that even work in the prisons that you never even think of the medical staff to take care of people in the prisons, and the nice things that they do for people, especially somebody that is at the end of life, or they are very ill, or something. They do the little things that mean a lot. The person that all they wanted was some chocolate. This person made sure that they brought in something chocolate every day to give to this person that was in Hospice care in this prison. I was more fascinated with the scope of all the people that serve the community at large in the state. We really do have all different areas; some people are in pediatrics, home care, Hospice, clinics that they do dialysis units so it covers all different areas. It is just not hospital setting anymore; it is all the different places where nurses go. It is amazing to me the number of jobs that are out there and the differences in what everybody does.
JM:When you think medical, you think nurse.
KS:Right, but it is all different levels not just working in a hospital and taking care of people in a bed. It is the little things that you do for people in the clinics, the food pantry and things of that sort. I was very honored and deeply touched that I was recognized by this town.
JM:Your peers appreciate all that you do.
KS:I appreciate what they do. We really are a team and a very dedicated and caring group. It is not just an 8 to 4 job here. I just completed evaluations and said to several people that staying here until 4 5 or 6 o’clock at night, taking phone calls, going out to see people. If you get a phone call at 4:45, I am still on the road but I am going to see so and so because I was just concerned about them yesterday and I think I am going to follow up today. It is not just doing one thing, it is the care and concern and that is what you want from the medical profession. You want people that care; it is not just an 8 to 4 job and punching a time clock; it is the heartfelt caring.
JM:Kathy, thank you so much.11.
KS:Was this OK?
JM:It has been a wonderful interview.
JM:You done good, lady!
KS:Well, I never know what people want or what to say about it.
JM:You have done beautifully.