1. VOLUME 1 • NO. 2
CV"IsiTING NuRSE AssociATION
HOMECARE&J-IOSPICE
NEWSLETTER FOR PHYSICIANS AND MEDICAl COMMUNITY
Employee Spotlight
Six VNA Nurses Earn Che1notherapy Certification from 011cology Nursing Society
Visiting Nurse Association nurses
Joy Hulecki, Susan Haberlack, Lisa
Kearney, Millie Gowen, Delia Ellis
and Anne Marie Tranghese recently
received certification from the
Oncology Nursing Society to care for
patients receiving chemotherapy.
The two-day program, presented
by oncology nurse experts, provided
nurses with a comprehensive overview
of chemotherapy and biotherapy
and included information on newly
approved drugs to keep them apprised
of the latest developments in drug
therapy. The program covered current
and evidence-based content on
From left: Joy Hulecki, Lisa Kearney. Anne Marie
Tranghese, Millie Gowen andSusan Haberlack
principles, types and classifications of
chemotherapy and biotherapy, effective
ways to monitor patients receiving
chemotherapy and biotherapy, and
patient education on chemotherapy and
biotherapy side effects and symptom
management.
"Chemotherapy is moving toward the
outpatient setting. We expect more
therapy to be administered orally
in the future. The administration of
chemotherapy is being met in our
community, and with our new clinical
expertise, the VNA is better equipped
to support people in our community
who are receiving cancer treatment.
We will focus on patient education,
symptom management and improving
quality of life," said Hulecki, an ARNP
consulting with the VNA's oncology
nursing team.
VNA Welconzes Patient Care Managers Nancy Conroy and Nancy Baker
Nancy Conroy Nancy Baker
Registered nurses Nancy Conroy and
Nancy Baker have joined the Visiting
Nurse Association as patient care
managers. Conroy will oversee the
agency's cardiac, orthopedic, post-op
and internal medicine specialty teams;
Baker will oversee the agency's wound,
IV and pediatric specialty teams.
Prior to joining the VNA, Conroy
- who has more than 20 years of
nursing experience - was the assistant
director of nursing for HealthSouth.
Stephanie Vaccaro Ean1s Wound Care Certification
Stephanie Vaccaro, RN, wound
care nurse at the VNA, has earned
her wound care certification, making
her the second nurse on staff with
advanced expertise in wound care.
Vaccaro works on the wound care
team to provide specialized care
to patients with conditions such as
diabetic wounds and post-surgical
wounds. Together, tl1is specialized
team of nurses serves approximately
one third of the VNA's patients.
Vaccaro obtained her wound care
certification after attending a week-
long seminar in Ft. Lauderdale and
passing a wound care examination.
APRIUMAY 2006
Additionally, she worked for
more than 10 years at Indian River
Memorial Hospital.
Baker, who has more than 30 years
of nursing experience, relocated
to Vero Beach from New Port Richey,
where she worked at Gentiva Health
Services and Hernando Pasco
Homecare and Hospice.
The VNA will send
two more nurses to
a seminar in July to
receive their wound
care certification and
has plans to have all
of the wound care Stephanie J·accaro
nurses certified by year's end.

2. Think of the VNA When Your Patient ...
• has a medication change or any new • has a wound, skin tears, or other
area that is reddened or inflamedmedication ordered
• has a new order • exhibits behavioral changes, i.e.
cries frequently, sleeps excessively,
isolates self
• has recently fallen
• makes visits to the emergency room
• returns from a hospital stay • has loss of appetite resulting in
weakness and risk to integrity of
skin and overall health
• returns from a rehab or skilled care
facility stay
• makes frequent calls to your office
A Message from Dr. Cunningham ...
2
Dear Colleague,
As most of you are aware, effective May 17, 2006, I will
be relinquishing my position as medical director for
VNA Hospice of Indian River County to relocate to
Alabama.
Effective May 10, I will not be accepting any new
hospice patients. If you refer patients to VNA
Hospice, please plan to follow them through the
program. Also effective May 10, Dr. Richard Penly
will cover the Hospice House and hospice in-patients at
Indian River Memorial Hospital. As associate medical director for
VNA Hospice, Dr. Penly also is an available resource for primary physicians.
To help bring patient care to an even higher level, the VNA has recently hired
three part-time medical directors to serve Sebastian, nursing homes/ assisted
living facilities and the Hospice House. Final interviews are underway for
a fu11-time medica] director, who will serve as a VNA Hospice "champion"
and oversee the hospice program. The full-time medical director will cover
the entire county, including home visits, Indian River Memorial Hospital and
Sebastian River Medical Center.
We hope to have our four medical directors on board by June 30. Thank you
for your patience during this transition period, as VNA Hospice continues to
work hard to ensure Htat each patient and family receives the finest hospice
care possible.
If you have any questions or concerns, please do not hesitate to contact me at
(772) 473-2978.
Thank you for supporting VNA Hospice and for allowing me the opportunity
to serve you and your patients.
Sincerely,
~~-
Richard Cunningham, D.O.
Medical Director, VNA Hospice of Indian River County
VISITING NURSE AsSOCIATION
Questions that Docto
About Artificial Nutritio
It is very common for doctors to
provide fluids and food to people who
are very sick or recovering from surgery.
This is called "artificial nutrition anc
hydration," and, like all medical
treatments, it can be helpful or harmfuJ
dependi.J;lg on the situation.
When there is no hope of recovery
from an illness or an injury, decisions
about artificial nutrition and hydration
at the end of life can be very difficult,
especially for loved ones. If the person
who is ill or injured cannot communicate
families can have different opinions
and be tom apart.
Q: What happens when artificial
nutrition and hydration is given to
patients who are at the end of life?
A: When someone with a serious, life-
limiting ilh1ess is no longer able to
eat or drink it usually means that the
body is beginning to stop functioning.
Artificial nutrition and hydration
will not bring the person back to a
healthy state.
Most doctors agree that artificial
nutrition and hydration can increase
suffering in patients who are dying

3. 1
s Frequently Ask ...
(Food) and Hydratio11 (Fluids) At the Ettd o
and no longer have the ability or
interest to eat food and drink liquids
themselves. Artificial nutrition and
hydration can add more discomfort
to a dying person's physical symptoms,
such as bloating, swelling, cramps,
diarrhea and shortness of breath.
It is important to remember that
the person's body is beginning to
shut down because of the disease
and dying process, not because of the
absence of food and liquid. There are
ways to ensure a person's comfort
at the end of life by treating dry lips
and mouth. VNA Hospice and
palliative care professionals are
experts in providing comfort
treatments.
Q: Is it considered suicide to refuse
artificial nutrition and hydration?
A: No. Everyone has the right to refuse
or discontinue a medical treatment. A
person at the end of life is dying, not
by choice, but because of a particular
disease. It is not considered suicide
to refuse or stop a medical treatment
that cannot bring back health.
Reminder
Registering your cancer patients
helps ensure that Indian River
County will continue to receive
funding from the American Cancer
Society to provide free transportation,
support groups and other services.
Cancer patients camlOt access these
services without first being registered
in the American Cancer Society
Q: What does the law say about
artificial nutrition and hydration?
A: Legally, artificial nutrition and
hydration is considered a medical
treatment that may be refused at
the end of life. If the patient is able
to make decisions, the patient can
tell his/her physician what he or
she wants. For patients who can no
longer talk about their wishes, some
states demand strong evidence to
show what the patient's wishes are.
When there is uncertainty or conflict
about whether or not a person would
want the medical treatment, treatment
will usually be continued. This is
why completing and talking about
advance directives is important - so
that there will be no doubt about
what kind of medical treatments your
patients would want or not want at
the end of life.
Source: 2006 NHPCO. Support is pro~·ided by a grant
from The Robert WoodJohnson Foundation, Princeton,
New Jersey.
database. Anyone in your office who
interacts with your patients can
register them. It's easy and only
takes a few minutes. Remember,
ACS cannot help your patients until
they know who they are!To request a
registration form, call Karen Lampert-
Riley at (772) 978-5560.
HOMECARE & HOSPICE
Cardiac Connection
By providing physician-recommended
medical services at home, including
blood draws and intravenous therapy,
and by communicating with physicians
and patients to make sure the VNA
stays on track with the physician's plan
for the patient's progress, the Cardiac
Connection program can prevent
patients from being hospitalized or
experiencing a deterioration of their
cardiac condition.
The Cardiac Connection program
begins with a physician's referral, which
is followed by an intake meeting with
the patient to develop a patient profile,
including medical history, current
medications and the patient's physical
needs and medical requirements. The
information from that profile, along
with the physician's orders, guides the
VNA team in developing an individualized
plan of care for each patient.
From that point, the VNA oversees
the patient's home care plan, arranging
for any special medical equipment to
be delivered to the home, helping the
patient connect with appropriate
community partners, scheduling nurses
and other professionals to visit on a
regular basis to record vital medical
information and to provide medical
services, while offering a wealth of
educational resources to help patients
manage their condition.
VNA
CARD1AC
CONN~CT10N
Your heart partners
3

4. VNA Hospice Distributing Free Copies ofFive Wishes
VNA Hospice is distributing complimentary copies of
Five Wishes, an easy-to-use tool to help your patients plan
how they want to be cared for in case they become
seriously ill. The legal document lets your patients and
their families know which person they want to make
health care decisions for them when they can't make
them, the kind of medical treatment they want or don't
want, how comfortable they want to be, and how they
want people to treat them. Five Wishes is unique among
all other living wills and health agent forms because it
looks to all of a person's needs: medical, personal,
emotional and spiritual. To request copies of Five
Wishes for your office, call Teri Robotti at (772) 978-5545.
Care Plan Oversight (Medicare Reimbursement) Updatefor ARNPs and PAs
From the Association ofHonze Health Industries ofFlorida
Effective Jan. 1, NPPs may now
"perform home health CPO (G0181
Physician supervision of a patient
receiving Medicare-covered services
provided by a participating HHA)
even though they cannot certify a
patient for home health services and
sign the plan of care."
• The certifying physician and the
NP must be part of the same group
practice
• NPs who are nurse practitioners or
clinical nurse specialists must have
a collaborative agreement with the
certifying physician
PHYSICIAN FEE SCHEDULE
(FEE ALLOWED 2005-06)
Fort Lauderdale
Miami
Rest of Florida
$57.50$60.29$54.94
Code G0179 (Re-Cert)
Fori Lauderdale ;;;;;~$~7~6~.1:4____Miami $78.88
Rest ofFlorida 72.01
Code G0180 (Cat)
Fort Lauderdale ;l--;;;;;;;~~$iL~?]~.6~5Miami $132.26
Resl f.!(Florida $121.98
Code G0181 (CPO)
physician signing the plan of
treatment
• The physician certifying the plan
must provide regular ongoing care
under the same plan of care as does
the NP billing for CPO
• ARNPs can bill for CPO, PAs cannot
separately bill for this service
• The NP providing the CPO must
also have seen and examined the
patient, must integrate the care
with that of the physician, and not
function as a consultant limited to a
single medical condition
Since NPs may not certify or
re-certify patients, can they sign• Physician assistants must be under
the general supervision of the '-------------------' interim orders in com1ection with their
Physician Contacts
This newsletter was created to provide a forum for VNA home health
care and hospice information and education. If there are specific topics
that you would like to know more about or see presented in the newslet-
ter, please let us know. We appreciate and welcome your feedback!
Karen Lampert-Riley
Physician Liaison Manager
(772) 978-5560
kriley@vnatc.com
Teri Robotti
Physician Liaison
(772) 978-5545
trobotti@vnatc.com
Carrie Duprey
Physician Liaison
(772) 978-5571
cduprey@vnatc.com
CPO activities? While there is no direct
answer from CMS on this question,
the Association of Home Health
Industries of Florida staff believe that
this new authorization for NPs to
provide CPO services must include
the authority to sign orders incident
thereto (except for cert and re-cert
which are specifically reserved to
physicians), otherwise it is a useless
grant of authority.
~ 1Y Visiting Nurse Association
Home Healrh Care & Hospice
www.vnatc.com
Uc. # HHA21276095 I HPC5038096 I HHA21387096l
4 1110 35TH LANE • VERO BEACH, FL 32960