Help hard to come by

Editor's note: This is the first in a three-part series on home health care and support in the Valley. Parts 2 and 3 will focus on the programs available.

Graham Steel is rooted to her home in Riverside, but life is not easy for her.

Steel has been suffering from several serious medical conditions including Parkinson's disease, a bone disease, she is partially blind and has had nine back surgeries.

To put it simply, Steel needs help to manage daily activities and routine chores.

Steel has benefitted from the Home Health program based out of the Memorial Hospital of Carbon County, but recently that program has only had one worker servicing the entire county, although they have just hired a second certified nursing assistant.

The program is administered by Wyoming Home Services (WYHS) program which will be discussed in more detail next week.

Steel has received help from WYHS cleaning, taking a shower, cooking and medical issues such as filling prescriptions once a week. There is a review of the care needed every three months to decide what people are eligible for. Recently, it was decided that Graham didn't need standby care for taking a shower. Steel doesn't understand this decision.

It takes a team of nurses to make the determinations. The only nurses available are from the hospital and do not necessarily have specialization in home health care needs. One nurse sent to evaluate Graham was from the maternity ward and was not familiar with how to evaluate her needs.

If you can afford it, you can hire your own help and medicaid/medicare pays the assistants $12/hour. Those private nurses have to submit paperwork to be approved by the federal agencies. The payroll is managed by a company called Acumen Fiscal Agent.

"The problem is, you need at least two people active on the payroll and if you don't they take you off the program." Graham had two assistants at one time, but they "got burned out" on the job which requires a significant amount of driving to places as far away as Denver so that Steel can get the medical services she needs.

Steel has had one person providing assistance and has been in search of a second one. The agencies have been threatening to remove her from the service list if she cannot find a second assistant and have even said that the person currently working for her would not be paid if a second person is not on the payroll.

One thing that might help is not offered in Wyoming. It is the Consumer Assistance Care Program which is part of the Affordable Care Act and helps consumers' resolve questions about health coverage and insurance options.

Steel is allotted 75 hours a month for her home care, which is significantly more than the initial allotment. Her additional hours are due to the amount of driving necessary to make doctor's appointments, but it is hard to make that 75 hours cover two employees and all of the driving and waiting time necessary. Many days a trip to the doctor starts at 6 a.m. and ends at 10 p.m.

On overnight trips Steel pays for hotel rooms and meals for her assistants out of her pocket. A difficult task for Steel who is living on a social security disability payment of a little more than $600 per month.

After surgery, Steel has had trouble getting the services recommended by her doctors. "We don't have that up here. 'What are we going to do about that?' And I said well, we just don't do."

Until recently there has only been on physical therapist available at the nursing home in Saratoga. There are a couple at the hospital in Rawlins. It is hard for Steel to find transportation to therapists or to have them come down to her house.

Steel said she feels guilty that her last assistant basically wore out a car taking her to and from appointments and she has not been able to make it to all of her necessary doctors visits and therapy session for the entire year of 2014.

"We just don't have the facilities, and the next thing they tell me is you need to move to the bigger cities, and it's like, I don't want to move." Steel said. Dr. Dean Bartholomew at the Platte Valley Medical Clinic is one of the people who has suggested she needs to move. More about Dr. Bartholmew's thoughts on the availability of care in the Valley will be presented later in this series of articles.

In addition to her ongoing medical needs, Steel can no longer drive and has fears about what will happen to her and her four cats if she ever had to evacuate for an emergency. Steel is on a list of people that would need help to evacuate, but she is skeptical that emergency responders will be available during an emergency, and she will not leave her pets. She has been told taking her cats is not an option during an assisted evacuation.

She called the county health nurse during the flooding earlier this year to ask what services were available to her and was told there was nobody available to help in the Encampment and Riverside area. The Encampment police do not have a Home Alone program, something that is available from the Saratoga Police Department.

Steel's house has recently been vandalized. She does have exterior floodlights and security cameras, so she is hoping that she will be able to identify the vandals.

Steel has had help from unexpected places. Scott Kinniburgh, who works for WYDOT, not only helped her with an issue where a snow plow driver had piled snow in front of her house, but voluntarily gathered some friends and removed some trees from her property. With tears in her eyes, Steel said "I just want to thank him again for that. There was a day when I could have taken care of that, but I can't do that anymore."

When asked about why she feels so rooted in Riverside, Steel recalled the story of walking into her cabin for the first time. One of the first things she saw was a mural next to the fire place of a small house next to a pond. This is a scene that reminds her of her grandmother's house and paintings that hung there. In the bedroom she had an other-worldly experience where she could hear dance hall music and jubilation as she looked into an antique framed mirror. The next week, her father had the same experience.

After they bought the cabin they took the mirror down in order to make sure it was hung correctly and found that it came from Saint Louis in 1886. She said she thinks that it was brought to the Valley in a wagon. Before they hung the mirror back up Steel and her ex-husband placed a time capsule behind it for future residents to find. The cabin is a part of her and has been her home for 24 years.

Steel has a vision for a volunteer service in the Valley where people could sign up for a list and let people know if they need items from the grocery store or pharmacy. People who are already making a run to Saratoga could pick up those items and bring them down to Riverside and Encampment.

For Steel, an ideal home care situation would provide her with an assistant that has a vehicle and can drive her to appointments, sometimes on overnight trips, be able to help with housework, understand and be able to help with medical and insurance paperwork, light cooking, yard work and snow shoveling. "The other thing is to have somebody to call, just to talk to," Steel said. There are times that she just can't get out of bed and having somebody that can take care of some basic housework, even just to sit down and talk to.