Health

Sandra Doyon Case manager { Profile } S terling resident Sandra Doyon knows well two sides of caring for patients in the hospital. Doyon, who holds a bachelor of science degree in nursing, began her career as a nurse working in medical surgical and intensive care units, before transitioning to case management, first in the insurance industry and then at Milford Regional Medical Center. Doyon has worked in case management at Milford Regional for 17 years and today covers the intensive care unit and a telemetry unit. In a recent interview, Doyon shared how managing patients' care in the hospital and planning their transition home or to another facility is a challenge and a pleasure all at once. Q: Why did you get into case management? A: I think just because I got burned out (being a clinical nurse). In this job I still use my brain but I don't have to do the physical work and also I don't have to rotate shifts. Q: How does it compare to a clinical role? A: Working in the hospital, you actually feel like you're more a patient advocate. We work on the floors … I go to rounds, and then I meet the patients and the families. I still have the patient contact (but) not the actual hands on. It's a different kind of stress. A lot of families come in and have problems and they want you to solve them. Q: What do you like most about your job? A: If you can get them where they want to go and they're doing well, and everything runs smoothly and everybody's happy, then it's a great job. Q: What do you find difficult about it? A: Sometimes people think we're making (care) decisions but we have to explain, this is (their) decision. I always say, "This is the recommendation, but you can choose to do whatever you want." Sometimes physical therapy recommends short-term rehab and (patients) really don't want to so they go home. Sometimes they do well, and some- times they end up back here. Q: How has your job changed over the last 17 years? A: I think people are coming in more sick and people are living longer. We're seeing a lot of 80- and 90-year-olds and a lot more dementia patients. One of the big things is for families to get health care proxies … If there's no health care proxy, if you want to move a dementia patient somewhere, that becomes an issue. (With a health care proxy) family members can have a say in what's going to happen with their loved one. Q: How do you try to curb excessive readmissions, now that the Centers for Medicare and Medicaid penalize hospitals for them? A: We have a nurse who follows and tracks readmissions and she does home visits. Sometimes sick people are home and they come back and there's nothing we can do. But we find that a lot of people are non-compliant, with food, and (medication). Sometimes with meds it's (a money issue) so social workers try to get involved. And some people just don't bother to take their meds or they spend money on something else. Q: What do you enjoy about working at a community hospital? A: People tell me they're amazed that we're not owned by anyone, and we are a nonprofit. We may end up keeping a patient an extra day; we're not in such a hurry to get people out. A good discharge plan should prevent the (readmission), which saves money. I think a lot of insur- ance companies and organizations look at the short term. When I worked at an insurance company that was one of the frustrations, because sometimes I would try to get somebody out of a benefit if I did a cost- benefit analysis. We're here for the community and (we try) to do right by the patient, and hopefully the rest will follow. This interview was conducted and edited for length and clarity by Emily Micucci. 34 HEALTH • September 21, 2015

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