West Virginia’s Culture of Compassion in Transitional, Long-Term and End-of-Life Care
By Kristen Uppercue
Since the coronavirus pandemic began, many people outside the Appalachian region have showed an interest in relocating to more rural areas, including West Virginia. One of the main criteria for many people looking to move is access to quality health care amenities. While statistically West Virginians face some less than favorable health outcomes and some struggle to gain access to health care due to the rural terrain, the Mountain State is also home to several world-class health care systems and a culture that takes care of its own.
This is particularly true in the areas of transitional care, nursing homes, assisted living and hospice and palliative care. Sixteen percent of the state’s population falls in the age 65 and older category, and this group is expected to make up a quarter of the state’s population by 2030, according to a report by the West Virginia Department of Health and Human Resources, making these services a priority for the health care community.
Transitional Care
Transitional care refers to the service of transferring a patient from one level of care to another or one setting to another while supporting the patient every step of the way on their health care journey. Rather than leaving a patient and their family to adjust and navigate the health care system alone, transitional care specialists focus on making the process easier by educating patients on what to expect and what the next steps are as well as communicating with their various health care providers.
“Too often, a health care transition is a stressful, confusing or cold experience without much communication or support. We see transitional care as warmly and smoothly transitioning patients from one care provider or level of care to another,” says Larry Pack, CEO of Stonerise Healthcare.
With the considerable number of services and settings a patient may encounter, communication amongst different health care providers is crucial to ensure continuity for the patient, as well as reduced stress and decreased patient readmission rates. This is where transitional care providers like Stonerise come in.
Stonerise is a network of 17 transitional and skilled nursing care centers, therapy care, home health services and hospice care with a team of physicians, therapists, social workers, nurse practitioners, registered nurses and certified nursing assistants spanning all 55 counties in West Virginia and three counties in southeast Ohio. Stonerise is the only provider that owns and delivers short- and long-term skilled nursing stays at its transitional care centers in West Virginia, as well as full-scale home health and therapy service lines.
A Stonerise patient will receive one point of contact to work with across all service offerings, making the process easier for the patient while reducing stress and increasing communication.
“Stonerise is not just one stop on a health care journey,” says Pack. “Rather, Stonerise and other transitional care providers walk alongside the patient on that journey, ensuring they receive the care and services they need and know what to expect from the path ahead. We want care transitions, whether it’s coordinating with multiple specialty physicians or leaving a hospital stay, to be more certain, more human and more loving.”
For example, according to Pack, if a patient has recently received knee replacement surgery, they would talk with a Stonerise liaison that works with their hospital who would verify their insurance coverage and help them find a short-term stay at a transitional care center. The patient might engage in services like physical therapy, nutritional coaching or a cognitive assessment while preparing to go home. Then the facility’s care team would coordinate with the health team to prepare a seamless transition for the patient’s care plan to continue at home.
“Our mission is to get patients back to health and back to life,” says Pack.
Pack describes Stonerise’s process and care as being similar to the West Virginian culture the network was founded on.
“I think most West Virginians know how great a place this is to call home—that includes our natural beauty and, most importantly, our people,” he says. “Time moves a little slower here, and that’s a good thing for relationships. Stonerise is locally owned and supported by local team members. We truly are neighbors caring for neighbors. We see ourselves, our patients, their families and our team members as one very large family. Families care for one another and strive to keep one another safe. The same goes for our health system—we are a tight-knit community here, and everyone works together well. It’s not as fragmented as in other states.”
Long-Term Care Facilities
There are two primary types of long-term care facilities: skilled—commonly referred to as nursing homes—and assisted living, which are separated by the level of health care a patient may need.
Skilled nursing facilities feature multiple licensed health care professionals and specialists to assist the patients who reside there with their medical needs. These facilities typically accept Medicare, Medicaid, private pay and insurance. Residents of assisted living facilities also have access to licensed health care professionals but are typically more independent and need
occasional support from staff. These facilities typically accept private pay from residents.
“Though the type of long-term care differs in the level of skilled care provided, both offer tremendous opportunities for their residents to socialize, develop friendships, remain active, be entertained, go on trips and so much more,” says Marty Wright, CEO of the West Virginia Health Care Association (WVHCA), a trade organization that oversees more than 130 long-term care facilities in West Virginia.
The WVHCA’s member facilities care for more than 10,000 residents and employ more than 15,000 West Virginians. The association serves as the support and resource system for the facilities’ caregivers while educating the public on the benefits of long-term care in West Virginia and assisting providers in maintaining high standards of care.
“Throughout our history as an association, the mission has been to bring providers together to advance the quality and standards of care for loved ones entrusted to our member provider facilities,” says Wright.
The facilities are designed to make residents comfortable and build a sense of community. Often the interior of the facilities is similar to hotels, featuring exercise equipment, living rooms and other social gathering locations and even front porches with welcome mats and rocking chairs for some residents.
Prior to the pandemic, facilities offered activities such as crafting workshops, holiday parties, gardening, concerts, movie nights, dance parties, field trips and bingo.
Technology is also readily available within the facilities, which has been crucial throughout the pandemic in allowing residents to virtually visit with loved ones and providing additional services. For example, an unlimited music catalog allows residents to engage in speech therapy while singing along to familiar tunes. Residents can perform arm stretches by popping bubbles on a large touchscreen and work on dexterity while taking a virtual tour of their hometown, according to Wright.
“Each facility is different, and I encourage everyone who may be thinking about moving into an assisted living facility or having a loved one transfer into a skilled nursing facility to take a tour or visit a potential site,” he says.
The facilities allow for community building among residents and the health care workers they see every day.
“There is a spirit within our state that every stranger is family, and our long-term care facilities are reflective of this West Virginia kindness,” says Wright. “The individuals cared for in our facilities are instant family members, and the staff in our facilities are emblematic of the genuine, caring, good-natured spirit of West Virginia. Our staff members are caring for an old football coach, an elderly neighbor, a friend’s parent. Unlike anywhere else, West Virginians recognize the contributions and sacrifices made by previous generations and cherish those who made them. Anyone who chooses long-term care in West Virginia immediately becomes part of a close-knit community and family to caregivers.”
This sentiment has never been more evident than throughout the coronavirus pandemic, as health care workers continue to courageously and graciously care for their residents.
“Our caregivers not only showed up, but they did so with smiling eyes, gentle hands and kind hearts that residents so need during these difficult times,” says Wright. “Despite their own fear of the coronavirus and concerns about personal protective equipment shortages, our long-term care staff continue to do whatever they can to make days seem normal for their residents. They have been courageous, dedicated and loving individuals who go to work each day with the purpose of caring for their fellow West Virginians.”
Hospice and Palliative Care
Those providing end-of-life care, including hospice and palliative care, offer services focused on compassion and comfort to patients with life-limiting illnesses. While hospice and palliative care are similar and often intertwine, there are meaningful differences between the two services. Palliative care, which is also referred to as supportive care, is usually provided alongside curative treatment and can occur at any stage of a serious illness. Although the patient is not yet ready to enter hospice care—which typically occurs during the last six months of someone’s life—they are still in need of extra professional support to address pain symptoms, relieve anxiety and keep up with treatment for their chronic illness.
A patient enters hospice care when treatment is no longer curative and they are given a prognosis of six months or less. The hospice benefit focuses on making the patient and their family as comfortable as possible, while providing emotional and spiritual support as well. In hospice, the patient and family have access to skilled nurses 24/7 and a support system to help family caregivers coordinate services, run errands and be there with the patient.
“Hospice truly supports both the patient and the family. Our staff is there to help families work through hard emotions and get their affairs in order, and in that very difficult moment when a loved one passes, things are taken care of. It’s truly how I wish everyone could experience death, because hospice just makes it as good as that type of situation can be,” says Jessica Hall, director of communications and development at HospiceCare, who had first-hand experience with hospice and palliative care in the state while caring for a family member before joining the HospiceCare team.
HospiceCare offers 16 counties in south-central West Virginia its hospice services and seven counties its palliative care services. The organization also offers grief and loss counseling and Kids Path, a service for children coping with illness or loss.
In 2019, the Consumer Assessment of Healthcare Providers and Systems ranked West Virginia sixth in the nation for its hospice care satisfaction. According to HospiceCare CEO Chris Rawlings, West Virginia’s top care might be due to its structure. In the Mountain State, new health care facilities are determined based on a certificate of need, a regulatory mechanism that examines the need for more health care in an area. Because of this, the HospiceCare team is allotted a certain number of counties without having to worry about competing hospice facilities, which means all its funding goes toward caring for the patient rather than non-patient expenses such as marketing and liaisons. Rawlings also believes this better serves West Virginia’s rural areas because without the certificate of need, companies that may come in would not bring services to rural patients because of the high cost.
“In a more competitive landscape, rural West Virginians might not be able to receive those services because companies would have to reallocate resources to higher density and higher margin areas, leaving the state’s most rural populations underserved,” he says.
Rawlings also speculates that West Virginia’s strong community-centered culture contributes to the state’s top-notch care.
“West Virginians tend to be pretty empathetic and caring for one another,” he says. “I think we approach families like they’re our own, and we care for them how we would want our families cared for.”
