Homecare health personnel even more vulnerable now

Homecare staff has always had some level of risk doing their jobs in unfamiliar territory on someone else’s turf, and they have always been underappreciated. They learn that they are there to educate, support, treat and advocate for patients while considering and respecting the patient’s lifestyle and culture. No easy task. It was never without risk.

In the ‘80s and ‘90s the administrators of Hartford VNA, which is now Hartford Healthcare at Home, realized their inner-city nurses were at risk.

There were gang wars, drugs, shootings and translation issues for non-English-speaking patients. This was when most homecare providers were not-for-profit regional visiting nurse associations, and making money was not their primary concern, though they did need to remain solvent. The Hartford VNA hired and trained salaried bilingual escorts from within the community to escort nurses in high-risk areas and to identify areas that were not safe to visit.

The agency fought tooth and nail for reimbursement for the escorts but needless to say no insurer wanted to pay for them, not Medicaid (whose reimbursement rarely covered the cost of the basic visit), Medicare or any for-profit insurer. Ultimately Medicaid did allow a small add-on for escorted visits, still not covering the cost.

What seemed risky and scary then is now compounded in so many ways, not the least of which is greater availability of lethal weapons. There were still many inpatient psychiatric facilities then, which have since closed, spilling a highly at-risk population into the community with limited resources and support, making the patients more desperate. Prisons are paroling offenders with ankle bracelets to halfway houses. While both of these approaches can be positive, nothing has changed for the nurses, physical therapists, social workers and home health aides going into the community to provide care to this population.​

It is tragic and terrifying that a visiting nurse had to lose her life in a horrendous way to bring the issue to the forefront. In my 40 years of home healthcare, I could not have anticipated this but probably should have.

Nurses and all staff need to be protected. They need to be given permission to say this is unsafe. They need permission because they will always want to go to patient with an identified need. Administrators, managers, supervisors and especially payors must find a way to insure this never happens again.

C. Nancy Culos, West Hartford

CT business-friendly? Rankings say no

The Tax Foundation released its annual report on the individual states’ business climate. Ranked from best to worst, Connecticut, as it has so many times in the past, came in near the bottom, at No. 47. Only New Jersey, New York and California ranked lower.

It is no wonder that businesses continue to leave our state and very few look to move here. A lot goes into the decision to expand a company, but one of the key considerations is taxation. No CEO wants his company or key executives to absorb unnecessary taxes in a state like Connecticut when better options are available elsewhere.

You would think the political leaders of our state, primarily Democrats, would want to make an effort to remedy this situation. They do not. In fact, the president pro tempore of the state senate, Martin Looney, has recently proposed a capital gains tax increase. He is the highest-ranking legislator in the state. Many will follow and support his proposal. Democrats seem thoroughly indifferent to the low business status of Connecticut. They dismiss the Tax Foundation report and others like it as irrelevant. Instead of making our state more unattractive to business, they should be finding ways to cut taxes and regulations, finding ways to help job creators thrive and prosper in Connecticut.

Kenneth L Boudreau, Farmington