Linda Bettinazzi was only about 24 when she received one of her first, and one of her most memorable, assignments with the Visiting Nurse Association of Indiana County.
She was given directions to the rural home of a man who needed follow-up medical care. But she couldn’t locate the man’s house and stopped to ask some people in front of a junkyard if they knew the man she was looking for.
“Yes, he lives back there in that wrecked school bus,” they told her. That case, Bettinazzi said this week, “really impacted me” about the need for home health care in the county.
She was later assigned to give visiting care to a woman who was critically ill following a stroke that left her comatose.
“They told me she was pretty much a vegetable,” Bettinazzi said. “She was tube-feeding, she could not move any of her extremities. She needed large amounts of care.”
Bettinazzi’s impression was that the patient, in addition to physical ailments, was having some psychotic reactions. Bettinazzi talked to the woman’s physician, who prescribed some different medications.
“I was taking care of her for several months and by the time she was discharged from (VNA) service, this woman — who had been psychotic, tube-fed and could not move — walked me to the car and hugged me and told me goodbye.”
Bettinazzi considers that case her “crowning moment” in her home health career, a career that ends today as she retires as president and CEO of the VNA of Indiana County.
VNA started 44 years ago as a program to care for sick people in their homes. It began with nurses, and then physical, occupational and speech therapists were added, along with medical social workers and home health aides.
It grew to include a hospice program and a palliative care program for the terminally ill; extended VNA, a private duty nursing service for people who want and need longer-term caregivers in their homes; Hopeful Hearts, a children’s bereavement program; and CareNet, whose volunteers visit and provide routine daily assistance like shopping, yard work and meal preparation for frail, elderly or disabled people who remain independent and in their own homes.
VNA of Indiana County is an affiliate of Indiana Regional Medical Center and has a board of volunteer directors who provide oversight. It started with only two people. Today, as Bettinazzi steps down, VNA has 145 staff members and more than 100 volunteers.
Between 600 and 700 families are receiving VNA of Indiana County care at any given time.
“We make about 70,000 visits per year,” and the VNA staff and volunteers drive more than 600,000 miles annually delivering that care, Bettinazzi said. Some patients are visited daily. Many others, on average, receive three visits per week.
In the past 18 years while Bettinazzi has been the organization’s director of hospice and its CEO, the VNA has served 50,000 patients with more than 1 million visits.
“That’s a lot of care for a lot of people,” she said.
Bettinazzi grew up in suburban Pittsburgh and worked in a bakery while attending the University of Pittsburgh, initially concentrating on political science and English. Her mother had a chronic illness and Bettinazzi had done a lot of caregiving by the time she was a teen. She applied to Pitt’s nursing school and was accepted.
“It was just the best decision I ever made,” she said. “I’ve been a nurse 40 years, and I’ve done every type of nursing. I started out at Presbyterian University Hospital … and worked there as a staff nurse. I taught nursing, I did public health nursing. I worked in a physician’s office. Then I had an opportunity to become a home health nurse in the mid-’70s. And I immediately found that was the type of nursing I was most drawn to. I just loved taking care of people in their own homes.”
She moved to Indiana in 1980, applied for a part-time job with VNA and worked as a staff nurse. Then the hospice director’s position became open.
“Hospice was always a real love of mine. … It was very appealing to me,” she said.
She was the hospice director six years before moving up to serve as CEO for the past 12 years.
During her tenure, Bettinazzi has seen many changes in the way home health care is delivered.
“Back in the ’70s and ’80s when visiting nurses were first becoming mainstream, it was more of a chronic care model,” she said. “It was almost all Medicare-provided. … It was a model that really worked for keeping people at home” and out of hospitals and nursing care facilities.
“Then, in the late 1990s, when we had the Balanced Budget Amendment, everything in the way home health was paid for changed,” and regulations changed, she said. “Now it’s an acute model of care, and we’re not allowed to be in there for a long, long time. We see patients when they’re sicker. We see them more quickly. … Now we’re not as much traditional Medicare as we used to be” and more of the care is paid for by private insurances.
When the VNA’s board of directors met this spring, Bettinazzi was praised for her role in advancing health care professions in the county.
When she became CEO, it was apparent there was going to be a shortage of health care professionals, especially direct care nurses, in America.
Bettinazzi invited everyone in the county who was involved in health care to come to the VNA to discuss strategies for dealing with that shortage.
“That meeting turned out to be the genesis of our Indiana County Health Care Careers Consortium,” she said.
Among other steps, the consortium successfully applied for a grant that for several years funded scholarships and training for several types of heath care careers. The consortium is still functioning.
Bettinazzi is also credited with enhancing the use of technology in VNA patient care. About 10 years ago, VNA was an early adopter of a home telemonitoring system that enables VNA patients to send their vital signs over the telephone to the VNA office.
“So now we have the ability to really know what’s going on with that patient seven days a week,” not just on days when a VNA nurse travels to the patient’s home, she said.
In 2010 Bettinazzi was the recipient of the Benjamin Rush Award, given by the Indiana County Medical Society to the layperson who had made an outstanding contribution to the health and welfare of county residents.
The cost of services VNA provides exceeds the reimbursements it receives, but as a nonprofit organization VNA can conduct fundraising.
“We have a very, very generous community in Indiana County that strongly supports VNA because in many instances we’re into our third generation of caring for family members and there’s a lot of appreciation,” she said.
“Health care in general has many challenges that we’re facing today, primarily that people need more care than there is reimbursement to provide,” she said. “And along with that is coming, on a daily basis, multiple new regulations that we have to adhere to. We are very highly regulated.
“The thing that has not changed is the patients,” she said. “No matter whether we’re using technology, no matter whether we can visit once a week or once a day, the patients still have the same needs that they’ve always had. I think that’s where everybody gets their satisfaction and their gratification to do the work that we do.”
Bettinazzi said she is most proud of the VNA staff and volunteers.
“No matter what gets thrown at us, no matter what change comes, I have a staff of people who rise to the occasion and do what needs to be done,” she said.
She’s also proud of recent patient care assessments reported to Medicare and satisfaction surveys from patients and their families. In those, VNA received excellent scores in a dozen areas, including survey questions asking if patients were satisfied with the care received, if the patient was treated with respect and if the patient and his or her family would recommend the VNA services to others.
In retirement, Bettinazzi is looking forward to having more time for her family and for traveling.
“And I’ve promised myself I’m going to write a book,” she said.
Succeeding Bettinazzi as the new CEO of VNA is Marion Nugent Cowan, who has been the organization’s director of hospice and palliative care.