VNS Health's Elsa Lam on the Future of Home Care

Elsa Lam is the Vice President, Regional Patient Care Services at VNS Health. In her role, Lam has found so much that the company’s nurses and clinicians find rewarding about the work. They are a lifeline to those they serve. She knows personally that one of the best feelings in the world is seeing a patient out on the street proudly telling how much better they feel.

1. What are some major challenges and trends impacting the healthcare industry lately?

The need for home-based healthcare has increased in recent years. This growth is exciting, given how integral home health is in keeping people healthy and its ability to reduce hospitalizations, especially among our growing senior population.

In my role, I’ve found so much that our nurses and clinicians find rewarding about the work. They are a lifeline to those they serve. It takes a special personality to work in home health, but anyone you meet in home care has a deep passion for what they do. It is not for everyone, but once you fall in love with it, you never leave. I know personally that one of the best feelings in the world is seeing a patient out on the street proudly telling you how much better they feel. That’s something you don’t get when working in a hospital. It’s that one-on-one interaction that keeps so many of us committed.

As a home care organization, naturally, we are working with our patients in their home environment, where they are most comfortable, and having that unique perspective enables us to see what obstacles might keep them from living safely in their homes. Our clinicians can consider this when creating each patient’s care plan, ensuring they receive the care and support that will enable them to stay healthy in their homes. And it’s not just patients — home care clinicians provide education and guidance to family caregivers. This education is critically important: Even something as simple as teaching a patient and their caregiver how to manage medication can make a difference and lessen the chances they end up in a hospital.

However, along with the growth, there will sometimes be challenges. Across the healthcare industry, whatever the field, I think all of us feel the squeeze of staffing shortages as the demand for specialized caregiver skills increases.

At VNS Health, we have doubled down on our mission to better serve our patients. We are doing that by fostering a diverse workforce and providing enhanced support to our clinicians. Home health is a unique specialization; visiting multiple clients in their homes on any given day comes with opportunities and obstacles that are quite different from working in a hospital or clinic. For starters, safety is always a priority. We ensure our nurses have the necessary tools to stay safe and secure while in the field, as they often work in some of our area’s toughest and most vulnerable communities. An example of how we address safety is by providing clinicians with safety training, and we have an app to communicate safety alerts. We’re always mindful of ways we can provide more protocols and services to keep our clinicians safe.

2. What keeps you up at night when it comes to some of the major predicaments in the healthcare industry?

Providing home healthcare in New York is tough and rewarding, as we work in distinct and diverse communities, many of which have cultural traditions that can impact their health. Collectively, our VNS Health clinicians speak more than 50 different languages. That ability to communicate is important in several ways: It helps us quickly build trust with those we care for and helps ensure that our teams deliver the highest quality care. Our clinicians take a holistic view of health; in addition to medical care, they frequently link patients with social services and community resources. As public health nurses, they are especially passionate about advocating for vulnerable members of the community who might have trouble understanding the healthcare system or traditionally have lacked access to care.

Home care workers understand better than anyone that the health of a patient is not a stagnant set of numbers. Many factors impact our health, including economic forces, housing and food insecurity, access to education, and much more. Without taking these social determinants of health (SDOH) into account, you can never get a full picture of the health needs of an individual or a community. SDOH factors can put a patient at higher risk of ending up back in the hospital. In our case, many of those we serve simply don’t know what resources are out there or may be unable to access them. You must dig into a patient’s needs – do they have a phone? Or even internet access? Addressing basic needs is often necessary before anything else can move forward. In our experience, care coordination is the key to our success in providing holistic care to patients that meets all their needs. 

Our coordinators can address the big picture while managing the details of care delivery, including helping patients navigate the complicated channels of the healthcare system.

One area where there is room for improvement is the ability of providers and leaders nationwide to better prioritize and recognize SDOH. Some entities, including CMS, could be doing a better job incorporating SDOH into their decision-making and when rolling out Value Based Purchasing (VBP) Models of care. For VNS Health, from day one, incorporating SDOH into our care has already been a key part of our mission when our organization was founded 130 years ago by America’s first public health nurse, Lillian Wald. In our case, our mission and its focus on social determinants of health has always been a strength for our organization and has enabled us to better serve our patients, including those that otherwise might fall through the cracks.

3. Can you tell us about the latest project that you are working on and what are some of the technological and process elements that you leveraged to make the project successful?

We are steadily testing and incorporating various innovative technologies in our daily work with our clinicians. Testing these tools remains key because we need to ensure the technology we introduce is accessible and easy to understand for our clinicians. Technology should help them do their work with more ease rather than adding to their workload.

For example, we recently completed testing a “My Home Care App” and are now rolling it out to all our home care clinicians. The app will let patients know when their nurse, therapist, or social worker is arriving that day, provides updates on future visits, and connect them with health information and other resources. Family caregivers can monitor the app as well. Home care is all about staying where you are most comfortable and at ease, and these kinds of tools make providing home care easier by improving accessibility and simplicity for patients.

4. What are some of the technological trends which excite you for the future of the healthcare industry?

The pandemic opened our eyes to the potential and power of telehealth. Even relatively simple tools that remotely monitor someone’s weight, blood pressure, blood sugar, and other vital signs from afar can help maximize clinicians’ time and alert them more quickly when something is not right, reducing patients’ risk of hospitalization.

" The app will let patients know when their nurse, therapist, or social worker is arriving that day, provides updates on future visits, and connect them with health information and other resources. Family caregivers can monitor the app as well "

Again, to maximize the benefits of these technologies, the entire healthcare ecosystem needs to recognize the importance of evolving and meeting the diverse needs of our communities. Tools like these are critically important if we want to protect and save the lives of some of the most vulnerable, but they can come with a significant dollar cost, and entities like CMS are still somewhat behind the curve in adequately reimbursing telehealth technology.

Another new tool I’m excited about is a wound care app we are working on and developing for our clinicians. Wound care is a huge part of our Home Care and Hospice programs. More than one out of every three patients we see has a wound of some kind, and many of these are complex wounds that have difficulty healing. This app is powered by artificial intelligence. When loaded on clinicians’ smartphones, it makes it much easier for them to document and track patient needs and their healing progress. With the app dashboards, our specialized wound care nurses can consult virtually with home care nurses and other clinicians and see for themselves when a patient needs more advanced wound care, including attention from a physician.

VNS Health is one of the first home healthcare organizations in our part of the country to use this type of wound care app, and we are steadily introducing it to more clinicians within the organization and training them on how to use it. It is great to see the results of this app in action and envision ways we can use it to better provide care to those who need it most.

I’m seeing this trend accelerating. New nurses coming into the field of home healthcare are bringing new energy, new ideas, and new efficiencies into the practice. One of the great things about home care is a one-on-one relationship that transcends a patient simply following rules set by a physician or pharmacist. The passion I see in today’s recruits for home care is remarkable. This comprehensive, innovative approach to care—delivered in the home, where people most want to be-is exciting.