Home-Based Wound Care: Insights on Challenges and Rewards

I am from a small town in St. Landry Parish, Louisiana, bordering the Atchafalaya River. No high school, no red light, no McDonald’s.

I am the ninth child in a family of 15 children. Family is very important to me. Before I started on my career path at the age of 22, I had 2 preschool age daughters. After 2 semesters of college I had my third daughter.

I graduated with an associate degree in nursing from LSU in Eunice and did a 6-month internship at University Hospital—“Charity Hospital”—in Lafayette. Really wanted to work in the LSU system but I refused to start a job that would interfere with my family. But my dream was to someday return to the hospital to serve the indigent, uninsured, and underinsured.

I spent the first 20 years as an RN as a home health nurse making visits to the homebound population. During those years I became interested in wound care as I cared for many patients with chronic wounds that would not heal and really affected the quality of life of these patients. I became familiar with the products available to me, which back then were only hydrogel and maybe an alginate. Then I was introduced to negative pressure wound therapy (NPWT) and it could be done at home. It was then that I found my passion in the medical world.

I thought back to my clinical rotations and remembered this ER nurse who pushed around a cart with some supplies and she had a blow dryer as one of her tools. My first thought was that she had job security—who in the world would want to do that? I gave her a call about 13 years into my career and said “I want to be just like you.” She became my very good friend and mentor.
Back to school to get a BS in Nursing at Northwestern State University in Natchitoches. Graduated with BSN in 2004. I finally applied for WOCN education program at MDAnderson in Houston.

Combating Delayed Healing and Preventing Amputation

Once I had CWOCN credentials I started consulting with home health agency for wound and ostomy care. Then I realized there was a delay in obtaining MD orders for wound care patients, which in turn delayed wound healing. I noticed many of the patients with diabetic foot ulcers had amputations. Once I completed my training as WOCNurse, I looked back and realized that many of the amputations could have been prevented.

I saw a need to be able to change orders in a timely manner to improve quality of care for my patients. So I went back to school for advanced practice nursing with prescriptive authority, which I completed in 2013 at the age of 53. I graduated with my MSN as an adult clinical nurse specialist and was finally able to return to University Hospital to provide care to the indigent population. 

Throughout my career I developed a passion for ostomates. My mentor, Marie-Lynn Martin, encouraged me to open an ostomy clinic as this was one of her dreams as an WOC nurse. The third outpatient ostomy clinic was opened in my clinic in 2016. My mentor and another WOC nurse agreed to work part-time in the clinic to help with the ostomates and train my nursing staff in caring for ostomates.

My choice of becoming a clinical nurse specialist was appropriate for my WOC nurse education and my desire to be a specialist in the world of wound and ostomy care.

The Advantages to a Mobile Wound Care Practice

I chose to make my practice mobile, which allows me to bring advanced wound and ostomy care to the patient. I saw the need for this since the beginning of my nursing career. Many patients cannot leave their homes even for basic health care needs. The obstacles preventing patients leaving home include lack of caregivers in the home for assistance with transfers, the costs associated with bringing to patient to the providers office, and many more factors.  

The provider also gets the big picture in why the patient is non-adherent—a label unfairly attached to many patients.

Many patients cannot afford a Medicare supplement insurance and with the astronomical cost of a simple wound clinic visit which increases the co-pay of the visit deters the patient from seeking advanced wound care.

My practice serves the rural population and there are not many, if any physicians, who specialize in wound care. Most physicians in the rural areas do not have time or resources to make home visits for any type of care.

My practice is a multi-specialty practice because of the identification of many services needed in the population I serve.

My referral source is primarily home health agencies. As the word of my practice gets into the the health care community, the referral source is rapidly changing.

I am so fortunate to be able to bring advanced care to patients in their home. I get to connect with providers in the area as well as the pharmacist, who plays a huge part in the care of the patient. My first love in my nursing career was home health care to the geriatric patient population.

I then grew to love the indigent population and veterans. Providing care to this population in their homes is the realization of my dream that started many years ago. The following quote pretty much sums up my career:

“Find a job you enjoy doing, and you will never have to work a day in your life.”

―Mark Twain

The Future of Home Health

I really believe health care is moving to the home. I have had the pleasure of treating over 400 patients in their homes since my practice began 2½ years ago. I am proud to say that many of my patients have healed with 12 weeks excluding the patients who have extensive wounds that require collaboration with a multidisciplinary team. I am fortunate to have relationships with many specialists including podiatry, vascular, cardiovascular interventionist, primary care, gastroenterologists, colorectal surgeons, trauma surgeons, general surgeons, and even the hospital-based wound clinics.

If I could (and I will through my practice) change 3 things about health care for my patient population, here’s what I would change:

1.    Increased access to care for wound and ostomy patients in their own environment. (Louisiana Medicaid does not cover my services in the home.)

2.    Restructure Medicare Advantage plan to cover more services

3.    Require every home health agency that treats my patient population to have at least one WOCN who is passionate about wound and ostomy care and can work with the WOC provider to ensure better outcomes for my patients. This ultimately improves the patient’s and the nurse’s quality of life.

I was the “older student” in most of my college graduations as I did not begin my studies until I was older and had young children to care for while studying for exams.

I finally graduated with MSN-Adult CNS in 2013 at the age of 53. My advice to adults considering taking the first step towards a higher education is to remember that in 5 years you will be 5 years older. You decide if you have a happy, fulfilling life. In 5 years you can change the future of your life.
 
Laura is the owner/founder and lead provider at Acadiana WOW (Wound and Ostomy on Wheels) in Lafayette, LA. Laura’s practice covers the Acadiana area of Louisiana.

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