By Lt. Cmdr. Janice White, NC
Working in the Military Health system can provide opportunities to see the world and work in areas not common to civilian counterparts. However, one aspect of working at U.S. Naval Hospital Guantanamo Bay (USNH GTMO), on an isolated base on the coast of mainland Cuba, gives Navy Nurses and Hospital Corpsman the opportunity to provide care to patients in an arena that is familiar in the civilian sector, but unique in military medicine only to Guantanamo Bay – Home Health.
To set the stage, I need to provide a little history lesson.
Due to the political climate at the time, and in an effort to protect American citizens living on the base, the gates of the Naval Station Guantanamo Bay (NAVSTA GTMO) were closed in 1959, isolating the base from mainland Cuba.
At that time, there was a large Cuban workforce, primarily craftsmen and laborers, who chose to continue to work on base. When tensions between the two countries escalated in the early 1960s, the Cuban workers who commuted to the base suffered tremendous indignities inflicted by their fellow countrymen outside the boundaries of the base. It was during that time that many Cuban nationals chose to seek asylum on the base and continue working for the U.S. government, exiling themselves from their families and friends on the other side of the fence line. It was anticipated that this self-imposed exile would only last a few months or no more than a couple of years, and the Cuban nationals would soon be able to return to their homes in mainland Cuba.
Fifty-five years later, the gates of NAVSTA GTMO remain closed, and the last two Cuban national commuters retired in December 2012.
The Department of State eventually granted the Cuban nationals who sought asylum on base a special status – Special Category Residents (SCRs) – with benefits similar to those of active duty and retired military and their families.
SCRs are recognized throughout the base as the aging Cuban population, the base residents who made personal sacrifices to stand side-by-side with U.S. military forces to maintain operations at NAVSTA GTMO during a time of crisis. The SCRs live in military quarters, shop at the Navy Exchange, and are eligible for medical care on base and at military treatment facilities throughout the United States.
Over the years, the base SCR population has dwindled to less than 30 with an average age of 74, with the oldest being 93. They still consider themselves Cuban nationals, and though some speak English, their primary language is Spanish, and they refuse the leave the land on which they were born. All of the original SCRs are now retired, though a few of their family members continue to work on base.
The medical needs of this aging population increases every year. Because the SCRs have been granted healthcare benefits similar to active duty and retired military, the staff at USNH GTMO provides for their healthcare needs.
In 2000, to better meet these medical needs, USNH GTMO implemented a home care program (Home Health) to provide long-term care to this aging population in a cost effective, culturally sensitive manner. USNH GTMO is the only Military Treatment Facility (MTF) that maintains such a program, and the hospital staff enjoys the challenge of this unusual type of care. It has been accredited by The Joint Commission.
How does GTMO’s Home Health program work?
In an effort to provide the best and safest care possible, a holistic approach is necessary to assess each senior’s capabilities, medical condition and home environment. Upon initial admission into the program, a registered nurse visits each patient in their home and completes thorough nursing, functional limitation, and home safety assessments. A ‘plan of care’ is developed with each patient and their family members, or other caregivers, based on the provider’s orders and the findings of the in-home assessments.
As an extension of the Medical Home Port services offered by the hospital, the Home Health program medically case-manages the SCRs to ensure continuity of care and all preventive health and wellness measures are met.
Medical services, as ordered by a Licensed Independent Practitioner, are provided daily in each patient’s home by a skilled nursing staff which includes Navy Corpsmen, practical nurses and registered nurses. The hospital internist is the Primary Care Manager (PCM) for the SCRs. The program allows these elderly base residents to remain independent but still compliant with the recommendations of their medical provider.
A Home Health visit ranges from 15 to 45 minutes based on a patient’s individual care plan. If needed to facilitate wellness, an aide will help with bathing and other activities of daily living (ADL) as ordered by the PCM.
In 2010, the hospital expanded the Home Health capabilities to include a residential living facility to house SCRs who no longer have family or friends to care for them in their own homes, and no other safe option to live independently.
When the patients can no longer manage in their home environment, but do not need hospitalization, or services provided by a long-term care facility, the SCRs can move into “H4,” a residential alternative that offers non-medical support with ADLs.
Most seniors don’t need the services of a nurse. What they do need is someone to help out with the things they can’t reliably or easily do for themselves at home. H4 is a non-medical environment where caregivers provide companionship, supervision, light housekeeping, assistance with bathing, dressing, using the bathroom, eating, and getting around. Residents can purchase meals from the hospital or base galleys, or any of the restaurants on base.
Residents can choose how much, or how little, help they need on a regular basis. There are organized activities, scheduled transportation and ‘meals-on-wheels’ provided by NAVSTA GTMO, as well as laundry assistance. The Home Health staff provides medical home visits to H4 residents and others enrolled in the Home Health program.
Currently, there are four SCRs living in H4. The facility staff provides safe and compassionate non-medical care. Projects the staff has recently initiated for residents and other Home Health enrollees include ‘Silver Sneaker’ (an exercise program geared specifically for the elderly); ‘H4 Beautification’ (residents and community volunteers created flower and plant containers out of gigantic truck tires painted in multiple colors, and landscaped the area around H4); and an SCR Health Fair (experts in numerous disciplines provided information on healthcare, safety, and recreation).
The goal of the Home Health program is to improve the care provided to older adults. Its long term case management encompasses respect, inclusiveness, innovation and responsiveness by providing health maintenance and wellness initiatives. Nursing in Guantanamo Bay provides the hospital staff a unique opportunity to enjoy the challenges of providing long-term care in an unusual environment.