Category: Projects Spring 2017

I interviewed Julie at REAL Services, INC (Below is Julie, Front of REAL Services Building, REAL Services Logo):

Name: Julie

Age: 29

Occupation: Director of Client Services at REAL Services, Inc.

Summary: REAL Services, Inc. is an umbrella social services agency that has over 20 programs including elderly care, energy assistance, nutrition and transportation, and community action. Real Services has a partnership with Saint Joseph Health and Memorial while serving patients across 5 counties in Northern Indiana. Patients can privately pay for transportation assistance or, if applicable, use Medicaid coverage to get transportation to and from health appointments. Real Services assigns Case Managers to certain patients that need help, particularly with transportation. Volunteers and paid employees help with patient transport, but there is a limited amount of these volunteers and workers which limits the dates and times that can be offered to patients for transportation.

Key Insights and Quotes:

Real Services has a diverse, interdisciplinary team composed of various professionals including physicians, nurses, bus drivers, workers at REAL Services, community workers, and social workers. This advisory team has been working to create a more efficient way to transport patient to and from their appointments. Real Services has a moderately sized fleet of cars and vans to help patients transport. They have tried to implement taxis in the past but had a negative experience with them as the taxis were dirty and unkempt (not ideal for patient transport).  Finally, with the aging population (Baby Boomers), it is important to expect and respond to an increasing amount of elderly patients needing services.

“One patient said that the taxi driver was smoking in the car while driving the patient to the hospital.”

“We are looking into working with Uber, but we need more financial support to move froward with that.”

“While REAL Services does transport patients, but our transportation services operate within a very specific time frame which leaves some patients without transportation help.”

I interviewed a volunteer receptionist/clinical aid named Erik at the Sister Maura Brannick Health Center of the Saint Joseph Health System:

Name: Erik

Age: 24

Occupation: Volunteer/ Dooley Intern (Works as a receptionist and clinical aid) at the Sister Maura Brannick Health Center of the Saint Joseph Health System

Summary of Interview:

The Sister Maura Brannick Health Center provides services to those who are uninsured. Most patients are undocumented and Hispanic. While the center does occasionally give out bus passes, most of the center’s patients walk as they live close to the center. A lot of patients come to their appointments with family and friends.

Key Insights and Quotes:

The Sister Maura Brannick Health Center has recognized the issue of patient transportation within the Saint Joseph Health System and has worked with the University of Notre Dame to assign students to conduct a research investigation in order gain metrics on patient transportation need and supply. Because most of the center’s patients walk to their appointments, patient transportation is hugely dependent on the weather conditions with much lower attendance during the winter season.

The center is open late on Tuesday evenings to accommodate those patients who work during the day. The volume of patients is extremely high during this time.

Due to the center’s Hispanic population, the health center and transportation services in the area could benefit from having workers who know how to speak Spanish.

“Some inefficiencies arise when there is a language barrier between the patients and the center’s workers.”

“Attendance for appointments is much higher during the summer when the weather is nicer.”

“If a patient misses an appointment, there rarely is a follow up call to assess the reason(s) why the appointment was missed. We are looking into implementing follow-up calls in the coming months.”

I interviewed a patient in the lobby of the Our Lady of the Rosary Health Center of the Saint Joseph Health System (the patient requested to not be photographed):

Name of Patient: Rose (accompanied by her son Shawn)

Age: 72

Occupation: Retired (spends time reading, sewing, watching television, seeing her children)

Familial/Marital Status: Widowed. Rose does have four children. Her son typically helps her get to her appointments using his car on Monday afternoons when he is off from work.

Summary of Interview: Rose is an elderly, immobile patient in a wheelchair who typically goes to the health center once a month. Her son is a huge help to her as he has been taking her to all of her appointments over the past five years. Rose has chronic pain so it is important that she sees a doctor monthly in order to manage her pain and make any adjustments as needed.

Key Insights and Quotes:

While Rose has multiple children, she relies heavily on her son who supports her greatly. Without her son, she would have a much harder time getting to their appointments, especially because she is immobile. She works with the receptionist to schedule appointments almost exclusively on Monday afternoons if possible as that is the time of the week when her son if off work. Overall, while Rose is limited by her lack of mobility and time of the week when she can make it to the health center, Rose is able to keep up with her health. Rose is fortunate to have her son. Without her son, she would have a much harder time getting to her appointments.

“I come to Our Lady of the Rosary to feel better and reduce pain.”

“Buses are hard and cold. I wish that the bus was more comfortable.”

“I feel warm and safe in my son’s car. I really appreciate his help.”

My team tried contacting the South Bend Public School Bus System to learn about how they manage the transportation of students to and from school. We were not able to contact people who worked in the busing system and turned to other resources to learn about how public schools approach the organization of busing routes.  A public school system organizing the transportation of students across various regions and districts is similar to how a hospital may organize their transportation fleet to transport patients to and from their health appointments. Here is the information and online link to the public school system that we used to gather our information: The Rosemount-Apple Valley-Eagan Public Schools website is located here: http://www.district196.org/

School Bus Organization:

• Parents receive a postcard before school starts each fall showing bus stop locations, bus numbers, and times to take children to school
• School bus drivers do not have the authority to change bus routes or student pick-up/drop-off locations
• Bus stops are typically located at least three blocks apart
• Up to 25 students may be assigned to a bus stop
• Routes are established so no student rides the bus for more than 75 minutes one way (preschool students may not ride the bus more than 45 minutes one way)
• All decisions regarding school bus system organization center around providing safe and efficient transportation for students

Important Insights:

• Proper and even spacing of bus stop locations and times improves efficiency and uniformity among the school district’s busing fleet
• Establishing a maximum time that a student may ride the bus helps prevent long and burdensome bus rides for children (adapted for preschoolers to have an even shorter ride) – this can be applied to patients, having a shorter maximum time for elderly patients that other patients
• The overall goal of the school bus system is to ensure safe and timely rides for students (providing safe and timely transportation is something that all transportation service should strive for)
• The school bus system consistently assesses bus routes and stops and are flexible in making changes to make the system more efficient

I asked an elderly, immobile patient at Our Lady of the Rosary Health Center of the Saint Joseph Health System to view several images on a iPad. Once the patient viewed the images, I asked her to express her thoughts, feelings, and experiences with me. Below are the images I showed the patient, along with the patient’s responses:

   – Patient felt comfortable seeing this image. The patient associated this image with the final destination and a place where the patient can go for help and relief from suffering. Patient was happy to see this image and felt a sense of satisfaction.

 – Patient did not like this image primarily due to the fact that the patient felt that buses were uncomfortable and even dangerous. Patient has tried to take buses to places in the past but has not had good experiences with them. The patient expressed that, due to the patient’s immobility (wheelchair), buses present a huge challenge and sometimes cannot accommodate the patient in an immobile condition.

   – The patient was elderly and did not have a smart phone. The patient was entirely unfamiliar with this image and was not interested in learning more about it.

 – The patient found this image to be fairly neutral. The patient has used taxis in the past, but for transportation to a health center. The patient also cited the cost of taking a taxi as a reason for avoiding this method of transportation.

 – The patient felt best upon viewing this image. The patient expressed that this is her favorite method of transportation. While the patient cannot drive, the patient consistently has the help of family members who help the patient get to places, including health centers.

The patient was accompanied by a younger family member who facilitated the patient’s response to the above images. It was interesting to see how favorably the patient felt upon seeing the health center building, associating the picture of the building with help and healing.

Daniel Thompson and I participated in an immersion using the Transpo Bus Services in South Bend to see how a patient living near Notre Dame’s campus could get to the Saint Joseph Regional Medical Center if he/she has an appointment there. We initially got on the bus at bus stop “5” (see below) near the Martin’s Supermarket behind Notre Dame’s campus.

Once we arrived to the University Park Mall, we had to transfer buses in order to proceed to the Hospital.

Including the time it took to wait for a transfer bus at the mall, it took Daniel and I a total of around 57 minutes to get from the Martin’s Supermarket to the Saint Joe Regional Medical Center.

The trip felt long and a bit tiresome, which is valuable information to know considering the condition of a traveling ill patient. The cost for us was free as Notre Dame students. If we were not students the cost would be $2.00 to get to the hospital. The buses were punctual;however, we did not perform a return trip from the hospital back to Martin’s. While the bus drivers were kind and the seating was fairly comfortable, Dan and I talked about how taking the bus, as an ill and/or elderly patient, could be physically and mentally challenging and, in some time-sensitive situations, unpractical.