VHS Home Health Care has rolled out use of mobile health units to its clients – under their doctors’ orders.
The mobile kit provides patients enrolled with VHS Home Health Care an automatic way to take readings and for nurses on the team to monitor patient progress in real time.
Tia Hunter, LPN, handles initial setup and monitoring for those using the unit.
“I set up the actual machines and show them how to use it. A nurse goes out first to start the care. Every patient has different orders from their doctor, depending on their diagnosis,” she says.
Equipment in the kit can record weight, blood sugar, oxygen level, blood pressure, temperature and heart rate. It includes a tablet to which each piece of equipment is Bluetooth-enabled and records and transmits the results. The home health team is alerted to the new updates to monitor the patient.
“If something is really off, I can go to their home. I can send text messages, video calls and reminders, all through the system. And they can do the same,” Tia says.
There also are educational videos available to the patients to help them better understand their care, like what are carbohydrates diabetics should or should not eat.
The VHS Home Health team began implementation of the kit in June. The monitored results also are sent to the doctor for assessment.
“The purpose is to try to keep them home and avoid hospitalizations,” Tia says.
It’s cost-saving and a game-changer for many of the team’s patients.
VHS Home Health Care helps individuals get back to living their best life by providing skilled care in the safety and comfort of an individual’s home. The team coordinates care with a patient’s doctor.
The team of professionals include nurses, therapists and social workers who will train and educate and individual and their loved ones to help the individual gain independence.
Research shows receiving care at home with home health services can effectively prevent hospitalizations and costly stays. It is typically covered by Medicare and most commercial insurances.
In honor of Women’s History Month, Virginia Health Services is shining a light on the pivotal role women played in the advancement of medical treatment on the Peninsula.
VHS was founded in 1963 and for the past 60 years has strived to be the provider of choice for senior living, senior care, rehabilitation, home health and hospice. We recognize the value of our location in Hampton Roads and its rich history, which includes contributions to the medical field. And we’re proud to partner with Fort Monroe to celebrate women’s contributions to nursing and therapy this March.
We asked Fort Monroe archivist Ali Kolleda to share some of the former Army post’s history of women nurses and reconstruction aides, who were the precursors to occupational and physical therapists.
“World War I was a big turning point for the medical field, and specifically women’s involvement,” Ali said.
The research extensively shows the integral role of women’s work in the Army, well before they were allowed to enlist in 1943.
Virginia Health Services continues the tradition of supporting women’s roles in providing care on the Peninsula.
Civil and Spanish-American Wars
Fort Monroe was a hub for the treating of wounded soldiers during the Civil and Spanish-American Wars. It was considered easy to access along the waterways, and was the only Union stronghold in the South during the Civil War.
At the time, Ali said, “Fort Monroe was lauded as ‘a miraculous climate that could cure disease,’ and the Hygeia Hotel was meant to allow wealthy people to convalesce and ‘take to the waters.’ Hygeia was named after the goddess of health.”
Nurses were treating malaria en masse and wounded soldiers from combat.
During the Spanish-American War, articles are written about how exemplary the nurses’ care is when treating soldiers returning from Cuba, Ali said.
There were between three and four hospitals set up at Fort Monroe during the Civil War. The complex included the Post hospital, a requisitioned the ballroom at the Hygeia Hotel, the then-Chesapeake Female Seminary, a tent Hampton Hospital (for enlisted soldiers) and a contraband hospital at the Fort’s entrance.
They were huge complexes with hundreds, if not thousands, of nurses running them.
“They’re called volunteer nurses through Spanish-American War,” Ali said. They were taught at medical schools and apprenticeships through hospitals. Many nurses were trained through the Red Cross.
A circular published during Civil War (possibly by Dorthea Dix) advertised for “matronly women, widows – women who don’t have dependents,” Ali said.
Ali said that changes, especially during times of war. Some women would follow their drafted sons and husbands to the post as nurses.
“Lucina Emerson Whitney followed two sons who were serving in the 67th Regiment, Ohio Infantry, which was sent to Virginia,” Ali writes based on Fort Monroe archived documents. “She was assigned to the Hampton General Hospital (of the U.S. General Hospital, Fortress Monroe) in June 1863 where she served for the duration of the war.”
During this time, black women could not enroll in the Red Cross. There is not a record of black women as nurses at Fort Monroe during WWI.
Black women were contracted during the Civil War at Camp Hamilton (Phoebus) as nurses. Harriett Tubman was at the Fort during Civil War to inspect the contraband hospital. She was offered the job as head nurse – “we don’t know if she came back because the war was over at that point. We know she was here for three months conducting the inspection,” Ali said.
Records at the end of Civil War (1870s) show that black midwives delivered children at the Fort.
“They were here,” Ali said, “but wouldn’t have been officially considered Army nurses in the Nurse Corps.”
Army Corps of Nurses
Army nurses are at Fort Monroe consistently from 1901, not just times of war.
“(Training) becomes formalized in 1901 at the end of the Spanish-American War when the Army realizes they need a permanent body of nurses,” Ali said. “The Army Nurse Corps is created at that point. Army nurses are contracted, not enlisted, so there are no benefits. They’re not considered veterans. They’re simply civilian women contracted as nurses.”
They developed a community on the post. Ali said Fort Monroe has community activity bulletins in the collections from the 1910s and 1920s that outlined who could swim at the community pool, and when.
Women, as nurses, were considered the equivalent of officers. They were accepted as a social part of the fort. At the end of WWI, with influenza ramping up, black women were allowed to enroll as nurses with the Army Nurse Corps through the Red Cross. They were assigned to certain posts in the Army, not necessarily at Fort Monroe.
Women enlist in Army medical unit
Women were open to enlist in 1943. Nurses’ quarters were constructed at Fort Monroe and nurses arrive in 1944. Women had their own barracks, mess hall, and were segregated from the male companies. They fall under the chief of staff for Army Field Forces.
At their time of enlistment, men and women received the same benefits and pay for the same rank. There were limitations placed on women for what rank they could reach until the 1970s. During WWII, their rank was usually captain or major.
The Army Corps of Nurses celebrated its 50th anniversary in 1951. The Fort Monroe collection includes medical unit lists of those women, souvenir menus and other items.
“(Women) become a very well-integrated part of the Army at that point, 1943 onward,” Ali said.
Ali shared an anecdote about Captain Elizabeth E. Steindel, who was chief nurse at Fort Monroe for about two years (1943-1945) during World War II. She was trained at Mercy Hospital in Altoona, Pennsylvania, and was commissioned as an Army nurse in 1942. She taught an accelerated course at the Fort Monroe station hospital to train nurse’s aides in 1945 – which sounds like a precursor to the CNA apprentice training currently offered by Virginia Health Services.
According to a newspaper article from the time, “the Monroe nurses get a certain amount of military drill and calisthenics.” The article also states there was “a staff of 12 handling a 139-bed hospital.”
Once Fort Eustis, Fort Story and Langley Air Force Base are established, the military dispersed medical stations around Hampton Roads.
The Fort Monroe hospital, which still stands on Ingalls Road, was converted to a clinic after the 1950s. Fort Monroe lost a lot of its operations, including maternity, which eventually was assigned to Langley AFB, Ali said.
The Women’s Army Corps (WAC) was inactive in 1974 and women were fully integrated into male units. By 1978, WAC dissolved into full integration in the Army.
Birth of occupational and physical therapy
Occupational and physical therapists also come out of WWI, then called reconstruction aides.
Near where the Hampton VA Hospital now stands was once the National Home for Disabled Volunteers, Ali said. It was a place for draftees to go to receive support for their “war neuroses.”
They were “asylum style hospitals; full-functioning communities for medical care,” though the underlying causes of mental health weren’t addressed at the time.
When the Army needed a demarcation hospital, it requisitioned the Hampton National Home and the veterans shifted to other hospitals in the U.S. Eventually it became General Hospital No. 43, which was geared toward mental health, shellshock and war neuroses, Ali said, to fulfill President Woodrow Wilson’s push to return soldiers to being “productive members of society.”
They added reconstruction aides, who were women trained privately through a hospital program and instituted programs to rehabilitate soldiers physically and mentally.
“It becomes the premiere neuro psychiatric facility of the Army” in Hampton, Ali said, and there were other locations.
One of the techniques the reconstruction aides used was weaving to help soldiers handle anxiety by occupying the mind. Programs were instituted and research was done that contributed to the occupational therapy program.
Occupational therapist Lois Clifford was assigned here in 1919 for the neuro-psychiatric hospital. She was trained occupational therapist and worked with soldiers with war neuroses. She was discharged from the Army with a “mental breakdown,” she calls it, and took time off for her recovery.
Clifford published a book on card weaving in 1947 and spent most of her life after her breakdown as occupational director at West PA School of the Blind.
The therapists fell under the Army medical department; no separate entity was created for reconstruction aides.
Virginia Health Services offers rehabilitation in its skilled nursing center units and outpatient physical, occupational and speech therapy. We recognize the important work women did as reconstruction aides to lay the groundwork for that field.
The chaplains who work for VHS Hospice can be considered chameleons. They slide into being listeners, confidants, conversationalists and organizers. The chaplains morph into what a patient needs.
The chaplains divide territory among Virginia Health Services’ seven nursing and rehabilitation centers. They also serve patients in-home. They meet terminally ill patients wherever the individual is most comfortable.
Admission to hospice care is done in consult with an individual’s physician. It is for individuals who have a terminal prognosis with six or fewer months to live. An individual may live longer than that and remain in hospice care.
Hospice provides a holistic approach to end-of-life care. A team that includes nursing staff, social workers, therapists, dieticians, volunteers and others support individuals to maintain their dignity and comfort through their end of life.
That team also includes the chaplains, who work as team as well in supporting one another and the individuals they serve. The team is led by Bereavement Coordinator Lee Jewett. This interview was conducted with Jewett, Marguerita Wimberly and James Jackson. Dr. Richard Croxton joined the team to cover Walter Reed and Lancashire nursing and rehabilitation centers.
What is a hospice chaplain?
There’s a difference between a pastor and a chaplain, Jewett explains.
“A chaplain is like in the military, the person that whether a soldier is an atheist or whatever, they can come to this person and talk. And they won’t feel as though they are going to have a chaplain’s dogma pushed upon them. Now if the person wants the dogma, then James, Marguerita and I are thrilled to share that,” Jewett says, “but we want them to know that we’re there to hold their hand to encourage them and tell them that it’s going to be OK. … Like a fellow pilgrim, walking them down this final pathway that they’re going through and helping them.”
Getting to know individuals
The chaplains for VHS Hospice introduce themselves in an initial assessment and explain the program. The conversation focuses on getting to know an individual and “meeting them where they are,” said Wimberly, who serves as a part-time chaplain and social worker with VHS Hospice.
“You find out their religious backgrounds, if they are a part of any religious organizations. And you find out their spiritual needs. Then you try to gear your interactions with them to where the need is,” she said.
Bishop James Jackson says hospice chaplains are “Swiss Army knives.”
“That’s something I really feel wholeheartedly about that part of our calling is,” Jewett said. “I’m a Baptist, Christian and devout just like Marguerita and James are, very devout within their Christian belief system. But when I come in, if a person’s a devout Christian, I’m all on it and just thrilled to pieces and energized by it.
“But if they’re not, you know, to a NASCAR fan, I’ll be a NASCAR fan too. Yes, Yankee fan? Yes. To a bookworm, I’ll be a bookworm you know, as best as possible. So, I try to make myself as well rounded as possible so I can relate to many as many people as possible.”
Jackson also has a degree in psychology.
“I also put (the individual) in the aspect of thinking of it from a mind perspective. OK, this is going to happen. This is what you should do when this happens,” he says. “It’s OK to be upset, it’s OK to cry. It’s OK to have these types of things, because that’s how the body engages on what is going on.
“But it’s not the end all be all. So, they could with me, get the best of both worlds. They get the psychological aspect, but they also get the spiritual ramification as well.”
Jackson says the VHS Hospice chaplains try to meet monthly as a group.
“If for nothing else but to just come together, talk with one another, talk about different strategies, different things that are going on, you know, kind of lift each other spiritually, because we’re dealing with people every day with problems, issues and concerns. And then we too have issues and concerns as well. It’s all about that iron sharpens iron mentality,” he says.
Bereavement support from VHS Hospice extends about a year after an individual passes. The chaplains make an initial call and assessment. Jewett handles the follow up, keeping careful track on a spreadsheet of getting communication to the family. It also spreads to the nursing and social worker staff to offer comfort. There are calls, cards from the staff and bereavement coaching letters.
“People can get at least a couple calls of comfort and know that we care about them,” Jewett says, “and that we’re here for them.”
Walking the path
The hospice team is there for the individual and their loved ones through the end of someone’s life, providing dignity and comfort.
“Sometimes death is OK for people, if they feel like everything is going to be good in the afterlife,” Jewett says. “Sometimes death can be very scary for a person. Sometimes death can be very painful for a person and that’s really what hospice tries to prevent.
“But sometimes death can be extremely worrisome, like, wow, what’s going to happen with my family now because, you know, I’m the patriarch or the matriarch and everything revolves, has revolved around me? So, we’re kind of there to try to be sensitive to whatever emotional, spiritual needs that might be presented by whichever particular patient.”
“To have the privilege to do something that makes you happy, and that pays your bills, that’s like the best of both worlds. I don’t know why you’d work anywhere else or do anything else,” she says.
Focus on individuals
The role allows her to focus solely on an individual.
“The thing I love about home care is it’s you and your patient one-on-one,” Funkhouser says. “That patient gets 150% of your attention, 150% of your effort and it’s just you and them. No other outside distractions or pull to your focus.”
VHS Home Health Care helps get individuals back to living their best life by providing skilled care in the comfort of their home. The home health team contracts physical, occupational and speech therapists through VHS Rehabilitation as part of Virginia Health Services’ spectrum of services.
The VHS lines of service give individuals the best access to their care needs regardless of where they live in southeast Virginia.
Because of the nature of skilled home health care, time is often determined by insurance. Funkhouser says, “You really need to pack in as much as you can in those sessions to get as much potential and gain and recovery of function as you can.”
The supervisors make an initial visit to open a care plan and create goals with the individual. The treatment plan is rolled out to the clinical team.
“Everybody is focused on giving the patients what they need. You hope that by the end of your time with them, you’ve met the goals for your patient.”
The team’s consistency allows individuals to see the same faces, “which is always better for overall patient recovery,” Funkhouser said.
Status changes can be identified and dealt with quickly when you and your team members know a patient. And the more you see them, the more they get to know you.
“When I’m with them, I give them as much as I can in the time we have,” she says.
Being a PT
Funkhouser knew she wanted to be a therapist since she was a teenager. She observed the therapists who worked with her father after he had major open-heart surgery.
That exposure to therapists in the hospital inspired her to be a therapist. She volunteered in high school and then went to school for therapy.
She spent 20 years in a hospital setting before working in home health settings a decade ago. She joined VHS Rehabilitation about six years ago and started with VHS Home Health Care a few months after it launched in 2015.
Working with VHS Home Health Care and VHS Rehabilitation put Funkhouser “in an optimal position to do what I do best, and that’s get wrapped up with the patient and get them better.”
It’s rewarding. There is independence and autonomy for the clinical team in providing quality care to the individuals VHS Home Health Care and Rehab serve.
“Here, everybody is focused on giving the patients what they need,” she says. “You hope that by the end of your time with them, you’ve met the goals for your patient.”
The passion for patients and for the job come through in Funkhouser’s voice.
“At the end of the day, I feel like if it’s a job you really like a lot, you tend to give a lot of yourself to it,” she said. “It’s just a win-win.”
Virginia Health Services is shining a light on our team members. We want to spotlight the roles our team members play to support individuals to live their best life and showcase the VHS culture. With National Nurses Day on Friday, we are spotlighting VHS Home Health Care nurse Tia Hunter.
She had done some one-on-one visits with patients as a certified nurse assistant (CNA), but hadn’t conducted skilled visits.
A nurse since 2009 — she’s getting ready to take her boards after graduating RN school with Medical Careers Institute — Hunter said she trusted her friend’s suggestion to work together for VHS Home Health Care.
“I love it,” Hunter says of working as an LPN with VHS Home Health Care for the past year and a half.
“For me, I like having that one-on-one with the patient. I’m not rushed; I have that time to focus. And I’m reachable to them.”
Hunter said nurses see on average five to six patients a day.
Day in the life
VHS Home Health Care serves the Peninsula, Gloucester and Southside. Hunter said where patients live factors into a day’s schedule to account for the travel time.
She said she always has been drawn to senior care.
“I just love them. I think they’re so cute. … My grandma passed and I wanted to know her so bad; I get that when I see my patients,” Hunter said.
The culture at VHS Home Health Care is patient-based.
“For me, I like having that one-on-one with the patient,” Hunter said. “I’m not rushed, I have that focus time, I’m reachable to them.”
Working with patients in-home pairs physical, speech and occupational therapists from VHS Rehabilitation with the clinical team at VHS Home Health Care.
“I think it’s a great place to work,” Hunter said. “… We have a good staff. (The clinical team) communicates well with the therapists with VHS Rehab. It’s rare to find a team that blends this well as a whole.”
The team comes together under the leadership of Cheri Brnich, Kelly Cofield and Donna Marchant-Roof, who is the executive director of VHS Home Health Care and Hospice.
“I genuinely just love our management,” Hunter said of Brnich. “I’ve never really had a boss like Cheri. She genuinely cares about us and how we’re doing, are we OK, even outside of work. … It’s very rare you find a company that somebody cares about you as a person. She values us as employees.”
The team of nursing staff, therapists, social workers and other individuals develop a care plan to return an individual to their best life.
Hunter takes pride in the “aha moments” that get the individuals she works with back to where they want to be. As individuals usually see the same team of clinicians, if there is a change in status, it can be determined quickly.
“When we’re in the home, sometimes we can stop them from having something happen and could save their life,” she said.
Calls, Google reviews and hearty thank-yous stay with you long after the home health care period ends, Hunter said. “It’s so appreciated.”
The quality of care and consistency of the team is also appreciated.
“Going into a home, sometimes even just 45 minutes, it changes their whole day,” Hunter said. “They love it.”