Visiting Nurse Association of Northern New Jersey

My mother wrote this to help ease her grief and pain as the VNA’s extreme lack of caring has forever affected our loving memories. My father’s last week especially was filled with such extreme pain and terror for him.
May 30, 2016
I’m writing this letter because I don’t want miscommunication or incompetence to prevent another suffering person from getting prompt help. Although we were told that hospice’s purpose was «comfort,» it was anything but for my husband. He died last Tuesday morning, May 24^th, after a five-​plus year battle with stage IV lung cancer. Just before Christmas, he had had two pleur-​x catheters inserted in his lungs at Memorial Sloan Kettering Hospital in order to drain the fluid that was building up in them. We were referred by Sloan Kettering to Visiting Nurses Association of Northern New Jersey, which arranged for a daily visit from a nurse who drained the catheters. The main nurse assigned to my husband was conscientious and caring, but when she was not on duty, some of the «on call» nurses were either nasty or incompetent. For example, when the dressings were soaked one night, we called the VNA and were told to just cover them with more gauze and bandages. We knew that could cause an infection, so we managed to contact the main nurse via telephone, and she talked us through changing the entire dressings.
The previous Thursday, May 19^th, I notified my husband’s local oncologist of my husband’s increasing pain and agitation, and told the VNA nurse that we wanted to transfer to the hospice section of the VNA home nursing agency. The doctor prescribed morphine, and the nurse told us that she would have paperwork sent to the doctor for his signature the following day, but that we were considered enrolled in hospice from that moment.
Although we started to give my husband the morphine, it worked for only 2 – 3 hours before he again began to writhe in pain and scream for help. He did this for a couple of hours before another dose of morphine would begin to work. This continued throughout the weekend, despite daily visits from a substitute nurse, until about 3am Monday morning, when we again telephoned the «on call» nurse to plea for help. She said, «Why don’t you give him Xanax?» We said, «We don’t have Xanax in the house.» She said, «Don’t you have the kit?» We have since learned that a kit containing both morphine and Xanax should have been delivered to our house within a day of enrolling in hospice.
On Monday, our local oncologist, who had never received the hospice paperwork, prescribed Xanax, which was given to my husband twice along with the morphine and calmed him immediately, before he passed away Tuesday morning. We should not have had to wait five days for the kit, which arrived Tuesday night, fourteen hours after his death. By the way, as I write this on May 30^th, I am looking at the hospital bed and oxygen tanks in my living room, which, I’ve been told by others, should have been picked up the next day. The VNA hospice was supposed to take care of that as well.

As we cared for our frail elderly parent, our family’s experience with the VNA NNJ was often distressing and frustrating.
The deeply bureaucratic management at VNA NNJ appeared to be seriously disconnected from care staff in the field. Visiting home care helpers were frequently harried and illogically scheduled. No– shows and late cancels were not unusual as were disruptive changes in staff and timing of home visits. On occasion we endured periods longer than two weeks during which no home care visits took place at all. It was clear that chronic under-​staffing was the source of some of this disorganization.
The equipment issued by VNA NNJ was sometimes notably substandard. An undersized hospital bed with damaged enamel surfaces was hazardous and inadequate as were a series of bedside tray tables with sharp peeling laminated edges. Replacing these with acceptable equipment required repeated telephone calls.
On occasion, phone conversations with administrative staff at VNA NNJ were characterized by dismissive and condescending attitudes, hardly what one might expect when dealing with families anticipating the death of a loved one. Multiple attempts to reach upper management to resolve problems were fruitless; we never succeeded in making contact with anyone in the executive offices.
The claims that VNA NNJ makes in its promotional material about the level, quality of care and range of services offered falls markedly short of what is actually provided. One can only conclude that Medicare funded palliative/​hospice care as delivered by VNA NNJ is largely driven by the bottom line rather than concern and compassion for human needs.
Families who engage with VNA NNJ because they have no other options for palliative/​hospice care in their area should be prepared to advocate strongly and consistently for their loved one.
On a positive note, the hard working and devoted visiting nurses were almost without exception intelligent, caring, responsible and highly professional in spite of the very trying circumstances of their place of employment. We wish them well and express our thanks.

Our two nurses were poorly trained and didn’t know how to schedule visits. They don’t fill out paperwork properly and missed visits without calling.

We’ve been with this service for several years, but should have dropped them sooner. Missed appointments with no call, failure to order/​deliver medical supplies on schedule, and lack of attention to detail when providing service. For example, the latest nurse was installing a different size catheter than shown on the VNA computer records. The explanation given by the nurse was: «that’s the size being installed when I took over». Asked the nursing supervisor for a new nurse, and she took no action. We finally dropped them when they missed their appointment on January 2^nd, and didn’t return our phone calls until January 6^th. The explanation given, with no apology, was that both the nurse and the supervisor were on vacation that week.
So far we are very pleased with the new service provider, and see an obvious improvement in both the administration staff and the assigned nurse.

If the services you need can be found elsewhere, run far far away from this VNA. Rude, incompetent and argumentative are not qualities to be relished when providing essential health services to the elderly. Long story short, in order to resolve my most recent issue with this outfit, I had to speak to the Comptroller as she was the highest level of authority available in the building at the time. While I was assured that my issues would be addressed and my problems fixed, she can not give me back the three hours of my life that I wasted dealing with ignorant fools.