 Abledon Arnair is generously supported by Green Mountain Support Services to empower neighbors with disabilities to be home in the community. Other sponsorships include Washington County Mental Health, where hope and support come together. Hello and welcome to this edition of Abledon Arnair, the one and only program that focuses on the needs, concerns, and achievements of the differently able. I've always been your host, Lawrence Seiler. Arlene is off today. Thank you to our wonderful sponsors, especially Washington County Mental Health and Green Mountain Support Services. With us to discuss this important topic of nursing and people with special needs. What if you are a person with a special need and need extra nursing care? Where do we turn? With us to discuss that is Green Mountain Support Services. Why don't you guys introduce yourselves? Hi, my name is Christina Bell and I'm a registered nurse at Green Mountain Support Services. I primarily work with individuals with developmental disabilities. I also work with Tanner in the traumatic brain injury and adult family care programs. I've been at the agency for about a little over two years now. And you are? Yep, and I'm Tanner, a Catholic, also a registered nurse, and as Christina said I work primarily with the adult family care program, so older adults needing more assistance to live in their communities and individuals with traumatic brain injuries. So what is, okay, what is the missions and goals of Green Mountain Support Services and the nursing program? So our company focus is empowering neighbors with disabilities to be at home in their community. And so basically what this means is that as people progress through life and they need more and more services, it's our focus to keep people in a position where they can really have a say on what's going on in their life and really experience everything they want to and not have to rely on institutional support. When you say rely on institutional support, take me back, I know years ago there were especially in Vermont, Brandon State School and other institutions, how has nursing changed over those years and going into now? Yeah, I think, so first off I just wanted to reiterate that. If we make a mistake we can always go back. Yeah, that's fine. So us as nurses I feel as though our primary mission is to support the health and wellness of all the clients that we serve through Green Mountain Support Services, whether they have developmental disabilities or you know they're elderly and they have some sort of disability and our primary focus is to keep them in the home. And that's how it had been in the past with a lot of institutions that you know they would have group homes or they would have just a designated institution like the Brandon Training School where individuals were sort of grouped together and it was sort of this, you know they were all grouped together and together they would just be there in this one area and they were not, it was not reflected at so much as you know you're in your home, you're in your comfortable environment, it was more of sort of you know you have all these strange faces around in this you know big building and so we're mostly trying to keep people in their homes where they're comfortable, where they can sort of you know have that autonomy to be themselves. When we say being independent and being on our own, when you do them at nursing care what exactly does that mean and how does that work? As far as being independent we want to give people as many opportunities as they can to do everything that they can within their ability and then we ADL skills on down right? ADL skills even to where we come in as kind of more nursing-centered skills, we just want to make sure that all the support is there for that person to be as independent as possible. Describe support in this case. So for example if I'm outside of ADL say that there is more of a nursing type procedure like the first example that's popping to mind is say someone has a catheter that's something that is going to require an extra level of skill that most people that are providing just basic services aren't going to have so that's where we come in and we can coordinate with the physician that's prescribing this catheter or any other device. For those that don't know what is a catheter and certain devices that are used. So yeah for example a catheter would aid in people being able to fully drain their bladders. And go to the restaurant. Yeah and so and that just requires a certain skill set and that's our job to step in and make sure that the people supporting our client are educated and able to perform that procedure or not procedure but help them with those skills and do so properly and safely. Okay so you guys work with developmental disabilities and your developmental disability nurses. Is there besides nursing school because you're an RN right? Besides nursing school is there any other specific training that you go through being and working with people with developmental disabilities or you know in this case it might be dual diagnosed so can you explain some of that. Yeah so Green Mountain Support Services has a lot of different training opportunities not just for nurses but right across the board for everyone. We have a class that we take called therapeutic options with our great staff Marilyn Carter who teaches that and she basically talks about approaches to use with individuals with developmental disabilities. It might be a therapeutic communication technique. It might be communication strategies just to sort of make the person that does not have as much experience working with someone with developmental disabilities a little easier just things that you know we've all picked up on in the past things of that nature. I've also been offered through the agency to do a death doula certificate course through the University of Vermont so it's called a death doula course so that actually helps support the person who is in the middle of end-of-life care just helps them and supports them with that process and working with them to sort of make that process easier. It's called death doula. Death doula so doula is a Greek word it basically means I think it's helper or something along those lines so it basically assists someone in their end-of-life dying process. Since you said that what is your opinion being a nurse it's just an opinion question on you know there are certain now I know we're dealing with the opioid crisis and everything but there are certain drugs such as fentanyl dealing with end-of-life and cancer and certain challenges that people might have and euthanasia and all of that stuff is a history with that. Being a nurse what is your opinion on the death doula end-of-life situation and those drugs and that type of thing? I think it really depends on the situation and the person and the sort of their own opinion. My opinion is it's whatever is right and best for that person at that given time because every situation is going to be different every pain and comfort level is going to be different and there's a lot of stigma out there about you know pain relief and using those types of heavy euthanasia you know sort of pain relieving medications. As far as euthanasia goes and actually going through that process I've actually worked in the past at a home health agency and we actually had a patient that was going through that process and it was what they had you know wanted at the time and they felt that that was best for them they weren't going to get better. As nurses we're not actually it's out of our scope of practice to participate in that with a hands-on approach. We sort of are overseers of care but we can't really step in and help with that particular process but we can support the patient and make sure that they know where they are to support them and if they need to talk if they need you know some sort of intervention you know whether it be a heating pad or you know just sitting with them and listening to calming. If they're in hospice they want a great meal. Exactly. They want to eat candy chocolate cakes cupcakes whatever lobster whatever they want you know we're there to you know we're there to help them and then and you know and talk about the dying process and what things to expect and so yeah we do get we do get involved with all of that. Tanner do you want to do a question? Yeah and I think it comes down to the core of nursing is our real role is to advocate for either our patient or our client but to be able to do that we need to make sure that everyone is educated as to all their options as best as we understand them. Ethics. Very important. HIPAA certain types of ethics what in terms of your field in developmental disabilities what can a nurse do what can you do and the overstepping of like I'll give an example if you know can you have a relationship with the patient in terms of you know dealing with family and that type of thing. How does that work within ethics? It's kind of a tricky question one one because the nursing field is really really diverse and there's so many different avenues that you can pursue it as far as where you take care of clients as far as our setting we kind of have to get to know our clients and really be part of or not necessarily be part of but be aware of their everyday life and like know their interests so that we can advocate for them for the things that they are wanting to have happen. You mentioned HIPAA that gets kind of tricky because when you are out in the community you have to be careful what you say but what you say and this is especially true for like our service providers or people that are with the patient day to day to day they can't say go to a restaurant and say oh shoot I forgot your lactulose you're not going to be able to have anything dairy and it's just so just simple things like that that you might have in like a day-to-day conversation with like anyone in your family is like you it can be very easy to forget that this is still a client whose privacy that you have an obligation to protect and so abuse and nursing and you know nursing homes hospitals etc you told me off-camera that Vermont is strict on that how strict how has law changed regarding that this question goes to both of you guys how how strict has that been etc. So Vermont is a very very high advocate for particularly elderly and our younger populations especially absolutely and all individuals with disabilities so basically not just us as health care providers are what is called a mandated reporter which is someone that yep so it's someone that must report if they suspect any any kind of abuse you know whether it be bruising or things of that nature someone says something that they were you know maybe they were pushed or they fall down or something happens and there's maybe a little bit suspicion of abuse they are mandated to report that to the state of Vermont so basically that doesn't just encompass Tanner and myself as nurses it also encompasses the service coordinators that we actually work hand-in-hand with at the agency what is the service coordinator within your nursing situation so we we actually work with service coordinators quite quite frequently in the field they have about 15 maybe to 17 clients on their case loads depending on you know how that fluctuates basically they have a client that they specialize and work with and then we coordinate with them any sort of you know thing if they have any sort of special needs any you know care that they might need we coordinate that through the service coordinator so is the service coordinator does it act like an interdisciplinary team like you have several several coordinators to deal with any one person so we have oh how many would you say Tanner about 10 15 service coordinators per person or the agency so per agency we have around 10 to 15 and then they in turn have several different clients that they work with individually so though it's service coordination slash case management so they they work with what they have their familiar service coordinator or case manager if you will and then that person Tanner and or I can work directly with to say okay hey do you do you know you know when they're discharged from the hospital was and you know if there's any special care that we need to follow up with or you know where did this discharge no go from the hospital and so that's sort of how we we work with them okay let's talk more about the independence of people within the agency or the people that you work with so you know let's go more into that what type of independence do you really help them with like let's dive in yeah do you want sure and I feel it's that's a very personalized question and like it's different from person to person and just we really have very person-centered goals for each person what exactly is a person and so let's say I just have a client coming to mind like just being able to go on the community and go shopping without being really anxious or overwhelmed with the situation so that we can look at that and just see what steps need to be taken and have some measured progress so in other words if they go to a mall they might sometimes they might be overwhelmed with the amount of crowds absolutely and a lot of stuff that we yeah a lot of people that we work with have fairly significant behavioral issues as well and so sometimes that is a big focus just being able to be empowered to go out in the community even though they're they're living in a moderately independent setting they still might feel very restricted as far as what they are willing to do like for example that I mean I mean for example you might work with a client and I've been overseas that has a problem like getting into a closed space like an airplane like how do you deal with let's say a 15-hour trip to Israel or 12-hour trip to Israel that I mean of course you can walk around in the plane and do things you know not stay with the exception of them telling you that you have to pass your seat belt but how would you deal if I was a client of yours or someone in the agency that needed your help how would you work with me let's say my wife and I how would you work with us getting up to that point in terms of that example yeah so in terms of that example we would work with the both of you together we might have you come in to the office for a meeting and just discuss your what's going on and your discomfort with the flying so to speak we might recommend some you know interventions maybe that you've tried in the past that have helped comfort you we might also work with if you have a psychiatrist or if you have a specialist or a provider that we can connect with and collaborate with we might work with them as well there might be some sort of a you know depending on your belief system there might be some sort of herbal supplement or some sort of a psychiatric medication that you might be able to take to help comfort you on the plane flight but there are other alternatives to that oh absolutely absolutely so music or yeah absolutely so if if you know like I said in the beginning if you know if you have things that have worked and you've tried in the past that you know maybe there is some soothing music or there's some aroma therapy now the example might when you work with a client might be person has to go take an MRI that closed space that machine you know that would be for me that that's difficult so those are things you probably will absolutely absolutely and I've heard of people actually going in with earbuds and listening to some music prior to that particular procedure and that was really comforting because they could listen to a song that was something that they'd always listen to that sort of calm them down what are the things that we do you work with the person other independent yep so we we actually we actually work directly with our shared living providers so that explain what a shared living provider is sure so our shared living providers are individuals that are contracted through our agency who share their homes with our clients so it's not a group home setting it's not a group home setting whatsoever all of our all of the clients that are obtained services from Green Mountain support services have does Vermont have group homes or mainly shared living providers it's shared living providers we've pretty much since the closing of the training of the brand in school it's been we've had the shared living provider dynamic which is amazing because explain what that is sure so it within the community shared living providers who are just people like you and me they basically get background checks through the agency and they're contracted if they pass to you know go ahead and have a particular client whether they be traumatic brain injury adult family care or the person with developmental disabilities they would go into their home and they would live there so and that's what they're called as a shared living provider sharing their green mountain support services would would they go to the family's house to see if it's appropriate first they do they they actually do they go on the service coordinators that would work with the particular client coming on they would go in and they would check the home and they would have our administrative staff go in and do a home inspection so and I'm not really sure as far as the the home inspection process Michelle could speak better to that but they have to go through rigorous home inspection process so they want to make sure the capacity is there and if there's handicapped accessible needs that those are those are there in place your take on more independence I just think it's really it's a wonderful setting having someone being able to open their their home to someone because I mean not only do does a client have a lot of support already just set up right when you get there because it's a already set and functioning home but they are also involved in everything that families typically doing and so I think everyone client included is really invested in just the that family dynamic and so they're involved in a lot of every and everything they're doing what exactly what is family dynamics in terms of this case I in there and definition of I'm my definition is family dynamics it's just like you're in everybody's problem is yours and your problems is everybody's and so everyone's there to support each other and whether that is waking up make sure everyone my gets breakfast and is getting out the door to their appointments or all that stuff or dealing with the emotion that like holidays will bring up like a lot of times like holidays can be really hard for people especially if you're away from your family and having that that new network of support and again that other family dynamic is there to catch people and they need a little bit of a boost what what okay what is some misconceptions around the nursing field when you work with the Valmore disabilities that might not you know you know based on the regular nursing field yeah so we actually just had a nursing meeting not too long ago at GMSS where we were discussing how our particular field of nursing is a weird field of nursing we all we all related it what do you call that we we all just sort of called it a weird field of nursing because it's not your typical hospital nursing and it's not the generalized home health nursing and it's sort of we don't really have sort of a label so to speak I whenever I put down you know what type of nursing I do I consider it more of a community health nursing because I'm I'm I wear many hats so you don't want to say on a resume to Valmore disability oh yes I do I do want to say that I have that right on my resume but we're sort of working as a team in with all different clients whether they be developmental disabilities because Tanner and I cross-train so we're working with developmental disabilities we're working with traumatic brain injury patients and adult family care so we consider ourselves in the community nurses with all of those populations how does that work since you said that you're working with traumatic brain injury describe what a traumatic brain injury is and how does your nursing deal with that so basically a traumatic brain injury is usually related to some type of trauma that car accident either car accident or it could be other what sometimes there is an extended period where there's a lack of oxygen to the brain and certain parts of the brain are damaged but it typically results in people having kind of a poor like impulse control I one of the beautiful things I love about people with traumatic brain injuries is you never have to wonder what they're thinking about you because they will be more than happy to let you know whatever's on their mind and it's it's it's really refreshing I know a lot of people are kind of taken aback when they get very open blunt and honest answers and questions but it's it's wonderful encountering someone that doesn't have that filter necessarily in place just because you don't have to to guess and that's just it's a wonderful view into a very honest world and so one that doesn't really stand on I guess societal norms if that's okay well when we say that since that you say societal norms what are some of the misconceptions around people with special needs when you first meet them because you're in a nursing field so things we are normal okay yeah we're considered normal and we should be part of society but what are some norms in terms of I just from just from some of the feedback I've heard from out in the community I think there's a lot of fear involved with with community members because they don't they just understand so they fear the unknown and what they don't know about and what they're not educated about we actually had a story where one of our one of our staff members working out in the field was working with one of our clients and one of our clients was sort of abrupt and you know was calling out really loudly in a store and one of the the shoppers in the store was actually pretty vocal about you know the fact that she was raising her voice in the store and our staff member sort of said well you don't really understand this person you know it has a disability so and and was sort of like they were not as understanding and fearful because they didn't understand so what so because they didn't understand what actually happened with that customer in the store with the customer saying anything else I don't think they said anything else I think that was the extent of the interaction but I just think it's it's sort of the lack of the lack of exposure and the lack of you know because we have to remember that because in the past there was that sort of institutionalized feel that individuals might not have been in the community as much and now they are so so we just need to keep educating folks on you know tenor your take on that question was some misconceptions yeah and I think a lot of comes back to like people don't typically have exposure to people that have different disabilities and I think so often we're raised on this ideal of being polite not pointing things out and I mean I remember when I was younger I was told like it's not polite to stare and so like I think out of this or point or even question or say why is this the case with this person I think just out of our kind of ingrained and kind of built up desire not to feel uneasy or not to point out something that we feel is different that the public in general tends to ignore a lot of people disabilities just because we don't want to bridge that gap we don't we don't really feel comfortable growing in that moment because we're just busy like trying to look as normal as we can do and so I think I think people are kind of trying to be polite to a fault and it's just something that people need more exposure to and once people start seeing say a person in a wheelchair or sitting in a wheelchair instead of seeing a wheelchair coming down the street and how they need to politely avoid the situation interact with that person like are people sometimes afraid with interacting with people or they just don't know I think it's more just than not knowing it can't I think it can be intimidating for a lot of people just because I mean you're just I think a lot of people are really afraid of offending someone that has been living with a disability their whole life and they forget that they've been dealing with this for a lot of times their whole life and so they know they're aware being a nurse have you ever had to interact with the police or anyone else of authority and if so how does that deal within your field like if it gets to a point where you have to involve with the police department you know medically because I know the police now are trained or be getting more training with the people with developmental disabilities can you explain so I personally have haven't had to work with any anyone from the law any sort of law professional I know that there have been service coordinators in the past that I've had to work with persons from the law police officers I think there's a lot of explanation that goes along with that it's really difficult because we have to get multiple individuals involved because again we can't violate that HIPAA so we have to be really careful and there's a whole team approach to that so in terms of team approach historically how has that changed and how is that getting better through the nursing field working in teams yes no and I feel at least speaking with our agencies we do have a lot of people involved in that one person's care like we have the service coordinator we have nursing we have program managers and clinical directors that are all making sure everything's going the right way and that attention is being focused where it needs to be and if it doesn't go the right way then you go back to drawing board yeah and but then we one of our big roles just court coordinating with different providers whether that be primary care providers or psychologist or site psychiatrist or neurologist or whatever the situation is that is kind of kind of blooming at the moment that's what we we get the support from whichever area really needs to that it needs to come from and make sure that those other providers are aware that there is a situation because a lot of times they have hundreds of clients that they're working with as well health care and the budget opinion question how how does that change or because I know health care a lot of things are being cut and services for people with disabilities are being cut how does that change within your field of disabilities it makes it more challenging to say I'm sorry if I'm asking the right question yeah absolutely it definitely makes it more challenging what I've seen most recently is a lot of cuts with home health services which makes it and why is that only because of the funding for home health has decreased substantially which is very surprising because it seems like that's the way the future is looking is to have more individuals in their home there's a lot of you know dynamic dynamics with politics and the funding with our current government leadership that is trickling down and is affecting that particular home so home health home health is a better way of looking at things rather than putting persons in nursing homes correct absolutely so if if we want to to compare some of the institutions we had for individuals with disability intellectual disabilities we can kind of in the same way compare that to nursing homes for the elderly right well nursing homes at some point were taking or can take people that aren't older age if you're absolutely if you're going through some medical thing and you're 16 17 years old a nursing home might take you depending on a situation good and and and also just you know I feel like the home back to the home health piece is that's really what Tanner my job is to make sure that there those services are in place and they're in place the way that they need to be and they should be for the type of care that's being provided in the home we're also we're also there at the agency to make sure things that don't get missed we actually had a hospital that had forgot to write a discharge note and home health services were not in play put in place order wise and they should have been so we followed up with that and the home health's in place now the orders there so we're good and you know we just we're really good at picking up on if something's missing and we need to sort of put that puzzle piece in place tenor we only have a couple minutes left but yeah do you have any other to add to that and I feel like anytime you're keeping someone out of a hospital setting is gonna be beneficial for unless they need it exactly and I feel like a lot of the issue we're seeing especially in this area of the country is there's just a big lack of nurses available and so I think their staffing is always gonna be a big issue and and if people are continually going into the hospital for every little thing where it could have been managed at home then we're just putting more stress on the system me like hypochondriac type of thing I need to go in the hospital I need to go in the hospital because you're wasting you're wasting cities money yeah or even just having nurses available like myself and Christina or just home health to do quick visits I am very concerned about this I need a nurse to come and look at it and we can give a quick assessment and give our assessment to their primary care provider so that they can either say yeah like we need you to go to a hospital or no I think you'll be okay let's give it a couple days do this and that and then we'll re-evaluate them okay last thing before we address the phone number and what's the difference between level one level two and level three care or is there like ways of putting it like a level three care facility you know because I know we want to keep the person in the home but let's say they cannot be there what a certain way to looking at it I'm kind of yeah yeah so we don't really we don't particularly work with levels of care it's more of it's more of looking at the person as an individual and seeing what their strengths are and their weaknesses and you know figuring out the big picture as far as what you know what aspects of your health do we need to focus on do we need to get physical therapy involved do we need to get occupational therapy involved do we need to have you see a neurologist or how do we you know how do we go about making your life better and easier and healthier in the home in the home absolutely well I guess yeah our big role is like if there is like if someone is questioning whether they are in like an emergency situation or not they can we're there to kind of take in what the situation is as they describe it and then advice as far as well can I can I just say one more thing I just want to say that I I really enjoy working with all the populations that we serve whether they be with intellectual disabilities adult family care or traumatic brain injury and GMSS is an excellent place to work for I'm actually a member through them of the developmental disabilities nursing association which is a great resource and I'm actually going to their conference this year which I'm really excited about so sorry you're you want to say anything else about agreement with support services it's just a it's a wonderful place to be and coming from the I came from a hospital setting and you didn't like that person I I really loved it actually the the schedule is really hard it's very easy to get tired and depleted and a little hospitals deal with 73 3 to I've worked in hospitals yeah I was doing the 3 12 hour shifts a week and I mean I I really appreciated that schedule my family did not and so is really trying on them and trying to find a balance there was just it was more than I could ask but coming to Green Mountain support services has just been better schedule they're so accommodating they are and I consider them my family and I've been working with them for about eight months on that no family yes on that note would like to thank you for joining us for more information on three months for services where can they go they can go to gmssi.org and you can their phone number yes 028887602 repeat that one more time please that's 802 8887602 this program is sponsored majority in part by Green Mountain support services and Washington County mental health Ableton on air is generously supported by Green Mountain support services to empower neighbors with disabilities to be home in the community other sponsorship include Washington County mental health where hope and support come together