When home wound (visiting nursing) care is needed with a foot wound

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[Transcript] -

D. PELTO: I have a special guest here from BAYADA Health Care, Kelly Malo, and we have been talking a little bit about how nursing and home nursing specifically can help people with foot wounds. I treat a lot of people in the office with diabetic foot wounds and sometimes people are just not able to do the care for themselves. So really my first question is, and thank you, Kelly, for doing this podcast with me, who really should be getting some type of home health care and what can you do for people with diabetes specifically in terms of their nutrition, their wounds, and things like that?

K. MALO: Thank you, Don, for inviting me to do this. Folks that should be using home care or those individuals who have a hard time getting out to the doctor on a weekly or biweekly basis for their wound care. So somebody who has a wheelchair, a cane, who needs assistance getting to and from the doctor’s office, so basically it is a taxing effort to get out of their home.  So that is somebody who can benefit from a home health nurse coming in and doing their dressings for them. Some of the things that we offer are based on the physicians prescription, how many times a week or times a day we would go in there, and then we would do a full assessment, a nutrition assessment, and really look at what you are eating, are you following the diabetic guidelines, and really making sure that you are getting the nutrition you need to help heal the wounds.

D. PELTO: Now before we started talking you mentioned that if we are unsure if your company is able to help or if you qualify for this, is there some type of assessment you can do? You can go in and look at their insurance, look at their situation, and you can really tell us yes this is a good option or no it is not a good option.

K. MALO: Sure. Yes, we can always do a safety assessment. So, Don, if you have somebody who does need to come into your office a couple of times a week or once a week for a dressing change, but they can do it themselves, but they are not sure if it is the right thing for them, you can call us up, ask us to go out to their home and we can evaluate if they are doing it right and if they can do it on their own and the best way. If they do not need us, then there is no cost to do that. If they do need us, then we will look at everything and take it a step further and set up a schedule.

D. PELTO: Now I think certain patients really need it. For example, if they have an infection in their foot and they are resolving from that or if they have a really longstanding wound on their foot that is just not healing.  A lot of times you may go in and find that they are walking on it more than they should be or they are not eating the right foods and they are malnourished. If somebody is malnourished, what are some of the options for that?

K. MALO: Well, we would look at that. We could work with our social worker, Elder Services, to help get them services to help bring food into their house – Meals on Wheels and such. We would work with a nutritionist to identify what extra foods they need to be getting into their system, protein for healing, and just really help them with those types of programs.

D. PELTO: I know a lot of people are “concerned” that their house may not be the cleanest and they are concerned about having someone come into their house and they are tentative about that and they think they can do the dressing themselves and they may have a vision problem, they may not feel anything, and they may have a personal assistant come in and they may think that personal assistant can do the dressing changes. When does it come to a point and how do you talk people through that and help them make that decision?

K. MALO: If you have an infection it can spread and it can take longer to heal and you really want a sterile environment where a nurse will come in and do that, really assess how that wound is being cleaned. It is great if you have somebody who can help, but it is not always the best option for your healing process and your quickness in healing. Having a nurse, like you said, maybe you are on that foot and you should have it elevated. We can tell if there is edema there that is getting in the way and come up with solutions besides just wrapping it up and bandaging it up. Maybe it needs some special equipment for wound healing. So having a nurse in the home can really speed things up and identify what extra steps need to be taken.

D. PELTO: And normally this is not an out-of-pocket expense for most patients. In Massachusetts anyway everyone has insurance so this would be something that they can get an evaluation and you would check their insurance and everything else.

K. MALO: And Medicare and Medicaid it is covered 100 percent; there are no copays.  Other insurances do have copays and we would identify that with the patient so there is nothing thrown at them unexpectedly.

D. PELTO: Thank you very much.

K. MALO: Thank you.