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John Lawless, son of Evelyn Oppold Lawless, and Pam Westendorf at Hansen Family Hospital in Iowa Falls. Pam received the Lawless family’s scholarship that honored Evelyn’s long nursing career and then unexpectedly met her at the hospital.

Evelyn Oppold Lawless’ life was coming to a close and Pam Westendorf’s was just beginning when the two women met in a chance encounter last fall.

Evelyn, a 99-year-old farm wife who’d raised five children and found her passion in nursing, was admitted to Hansen Family Hospital in Iowa Falls on Nov. 10. She was weak, and was being tended to by nurses, nursing students and an instructor.

Pam, an LPN who’s working toward her RN, was one of those students. And she was looking for a sign. She wanted to know she was in the right place, doing the right thing.

As the nurses spoke with Lawless and her son, John Lawless, they learned she was a nurse.

“In fact,” John told them, “there’s a scholarship in her name to help young nurses.”

Pam looked at the computer screen. Evelyn Oppold Lawless. It was her $500 scholarship that had given Pam a start on her education after graduating from South Hardin High School in 2014. She told Evelyn about their connection.

“Her face lit up,” Pam said. “I will never forget that face, ever.”

The chance meeting was exactly what Pam had been waiting for.

“As a nurse, we always try to find a sign from God telling us that we’re in the right profession,” Pam said. “And that day I totally got a sign that that was where I needed to be. It’s crazy that one scholarship and one lady can tell me I’m in the right area. God gave me a sign.”

Evelyn Oppold Lawless nursing school portrait

Evelyn Oppold Lawless grew up on a farm, one of eight children. In 1938, and the height of the depression, she left home and enrolled at St. Joseph Mercy School of Nursing in Mason City. Inspired by her aunt, Lillian Oppold, who was a member of hospital nursing staff in Iowa Falls for 24 years, Evelyn was the first of her siblings to get an education.

In 1943, Evelyn married Harry Lawless. Shortly thereafter, he was sent overseas to fight in World War II. Evelyn headed to the San Francisco Bay area to work as a nurse in the shipyards where two of her brothers were stationed.

When the war was over, Evelyn came home to Iowa. She and Harry settled on a farm in Hardin County, north of Eldora. They had five children, and Evelyn continued with her nursing career, working as a private duty nurse, and also treating patients at the hospitals in Iowa Falls and Eldora.

She often talked about her love of nursing.

“She was very, very passionate about it,” said John Lawless, who lives in Ankeny after retiring from working the family farm. “Mom was a people person. She loved people. She loved meeting new people and she cared for people very much. That showed through not just in her nursing, but in her personality too.”

She exuded a love of nursing, inspiring both of her daughters to become RNs. A couple of nieces also went into nursing.

When she turned 90 in 2007, her children surprised her with a unique gift: a nursing scholarship in her name.

“Her reaction was tears,” John said.

About five years after the scholarship was established, the siblings’ money ran out. Rather than end the gift, Evelyn continued to fund it herself.

Every year, a $500 scholarship goes to a South Hardin High School student who intends to pursue a career in nursing. Ellsworth Community College attendance isn’t required, but many of the recipients have gone on to school there.

Pam received the scholarship when she graduated in 2014. “I don’t even know what drove me to nursing,” Pam said. “I’d always been a caretaker. So I thought I’d just go into nursing.”

She attended Ellsworth Community College (ECC) and last summer became an LPN. Now she’s enrolled in the ECC RN program. After getting her sign from Evelyn, Pam said she’s focused on figuring out what she’ll do next.

“I still have a lot of praying to do,” Pam said. “God has a plan for me, I just don’t know what it is yet. I’m waiting for another sign.”

In the meantime, Pam is working toward her RN, and spending quite a bit of time at Hansen Family Hospital. The hospital has a close relationship with ECC’s nursing program. Students are able to use the hospital to get experience they can’t get anywhere else.

“We love having students here,” said Christina Peterson, the hospital’s Director of Education. “It’s so much fun to see their growth. They are the future of health care.”

Clinicals at other hospitals aren’t nearly as hands-on, Pam said.

“I love coming here for clinicals,” Pam said of Hansen Family Hospital. “We go to other facilities, but we don’t get the freedom we have here. At other facilities we just go around with a nurse and watch what they do.”

***

About five hours after Pam and Evelyn met, Evelyn passed away. The women’s chance meeting gave Evelyn closure and it gave Pam a path forward. And now the story of their meeting is inspiring others to believe in the power of fate.

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The Iowa Hospital Association (IHA) and Iowa’s 118 community hospitals are disappointed with the results of today’s vote in the US House of Representatives on the American Health Care Act (AHCA). We have serious concerns that the proposed legislation would cause harm to vulnerable patients, the health care delivery system, the state budget and the state economy.

Nearly 200,000 Iowans have coverage under current law, enabling them to get the health care they need, when and where they need it. AHCA would eliminate coverage for tens of thousands of Iowans and possibly jeopardize coverage for patients with pre-existing conditions. Even employer-based coverage is threatened by language in this bill.

The bill would also repeal enhanced federal funding for Iowa’s expanded Medicaid coverage and impose a cap on federal Medicaid funding, creating even more stress on Iowa’s budget. In addition, while the proposed legislation rolls back the Affordable Care Act’s (ACA) expansion in coverage, it retains Medicare cuts to Iowa hospitals that helped pay for that coverage.

The US Senate should not rush the legislative process on this flawed proposal or on any measure aimed at repealing and replacing ACA, but instead take all the necessary time and deliberation to make needed changes that ensure meaningful and affordable health care coverage for thousands of Iowans. A contingent of Iowa hospital representatives and IHA staff will be in Washington, DC next week and IHA looks forward to a continuing dialogue with the Iowa congressional delegation to support hospitals in fulfilling their mission of providing quality care to their communities.

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Update: It appears the House will vote as early as Thursday on the heavily amended American Health Care Act, making it more important than ever for Iowans to contact their Representatives. Despite numerous changes, AHCA still undermines progress made under the Affordable Care Act and would leave thousands of Iowans without coverage. IHA is joined by virtually every provider and patient advocacy organization in the nation in opposition to this bill.

The US House of Representatives is still considering the American Health Care Act (AHCA), a legislative package to repeal and replace parts of the Affordable Care Act (ACA) and make major changes to the Medicaid program. A vote could occur yet this week. Iowans should contact their US Representative and ask him NOT to support AHCA if it comes to the House floor for a vote.

Changes to AHCA continue to be discussed, including an amendment that would create a “limited waiver option” for states to opt out of essential health benefits and community rating requirements in an effort to lower the cost of insurance. Even with proposed “high-risk pools” that would theoretically (and temporarily) assist individuals with pre-existing conditions (who otherwise will no longer have coverage under AHCA), these changes would worsen, not improve, AHCA, legislation that hospitals and health care providers in Iowa and across the nation did not support from the beginning.

According to the Congressional Budget Office, the AHCA is expected to increase the number of uninsured by 14 million in 2018 compared to current law and by 24 million by 2026. The largest savings would come from reductions in federal outlays for Medicaid ($880 billion) and the elimination of the ACA’s subsidies that help people afford health insurance ($673 billion).

Approximately 200,000 Iowans could lose their coverage while the state would lose billions of health care dollars.

AHCA is a step backwards that threatens the health of vulnerable Iowans. Contact your Iowa Congressman today!

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The uninsured rate among veterans less than age 65 declined by nearly 40 percent during the first two years of the Affordable Care Act (ACA), according to a new study by the Urban Institute with funding from the Robert Wood Johnson Foundation.

The uninsured rate fell from 9.6 percent in 2013 prior to ACA, to 5.9 percent in 2015, according to the report. Approximately 429,000 veterans gained coverage, and the gains were broad-based across demographic groups.

Among veterans ages 45 to 54 and those who served in the era between the Vietnam and Persian Gulf wars, the uninsured rate dropped by almost 50 percent.

Before the ACA’s implementation, nearly one million veterans — almost one in 10– were uninsured, the study said. By 2015, the number of uninsured veterans fell to 552,000.

While many veterans have access to healthcare through the Department of Veterans Affairs, not all use or qualify for these services, the report said.

The study found that Medicaid expansion also helped to lower the uninsured rate for veterans. The uninsured rates in 2015 averaged 4.8 percent in expansion states, compared to 7.1 percent in states that didn’t expand the program. Iowa is one of 31 states that have expanded Medicaid.

For veterans with incomes up to 138 percent of the federal poverty level and eligible for Medicaid in expansion states, the uninsured rate dropped by 43 percent.

Veterans’ families also benefited from ACA, the study said. Using data from the 2013–2015 American Community Survey, researchers found uninsured rates for veterans’ spouses dropped from 9.2 percent in 2013 to 5.5 percent in 2015 and from 4.5 to 2.9 percent for their children.

Among black and Hispanic veterans, uninsured rates fell from 10.6 to 6.5 percent and from 11.0 to 7.1 percent, respectively, by 2015.

“The coverage provisions of the ACA have led to a 40 percent decline in uninsurance for non-elderly veterans,” said Katherine Hempstead, senior adviser at the Robert Wood Johnson Foundation. “Expansion of Medicaid in remaining states would increase those gains.”

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Craig Morgan (center left) with some members of his care team: (left to right) Chelsea Apland, a Friendship Ark Homes coordinator; Gina Smith, RN; Carrie Adams, BSN, RN, clinical supervisor for cardiac rehab, and Andy Nichols, a Friendship Ark Homes supervisor.

Something was clearly wrong with Craig Morgan. Those closest to him could sense it. He wasn’t himself. He seemed tired and confused.

Craig, unfortunately, couldn’t really explain what he was going through. A resident of Friendship Ark Homes (FAH) in Ames, Craig is an adult with intellectual disabilities. While his communication skills are limited, he’s an endearing guy, agreeable almost to a fault. His response to any question is often, “Yeah,” accompanied by a big smile.

His well-being depends on those who know him best being able to read his moods and actions, and, by doing so, help others provide Craig what he needs.

“Craig is eager to please. He’ll always say ‘yes’ and can feign understanding whether he has it or not,” says Andy Nichols, a supervisor at FAH who has known Craig for years. “That’s a big part of working with Craig in the community – helping him understand and helping others understand him.” This was vitally important when Craig was brought to McFarland Clinic and then to Mary Greeley in early August.

“His spirits were fine,” says Nichols. “He was a little more confused than normal and over the weekend had become very weak and tired. We thought he might have pneumonia.”

From McFarland, Craig was sent to Mary Greeley’s emergency department for immediate tests. It wasn’t pneumonia. Craig had experienced a heart attack.

Diagnosis and Big Decisions

Craig was admitted to Mary Greeley’s intensive cardiac care unit (ICCU). The next day, he underwent an angiogram performed at Mary Greeley’s cardiac catheterization lab by Iowa Heart
cardiologist Dr. Ravinder Kumar.

Kumar discovered that all three of Craig’s major heart vessels were seriously blocked. He had suffered what’s called a NSTEMI (Non-ST elevation myocardial infarction). It is sometimes called a silent heart attack. Conversely, a STEMI (ST-elevation myocardial infarction) is an immediate emergency type of heart attack.

Heart bypass surgery was considered the best option, but Craig’s family and FAH caregivers felt that he wouldn’t be able to understand the recovery and rehabilitation requirements of such invasive surgery. Doing the surgery was as potentially dangerous for Craig as putting him through it.

A decision was made to monitor Craig’s condition, to treat it medically and not surgically. That decision was promptly reconsidered after Kumar visited Craig the next day in the ICCU.

“He was miserable,” says Kumar. “Just sitting up on the side of the bed would make him exhausted. There’s no way we wanted him going home feeling like this.”

Kumar spoke to a colleague, and Craig was transferred to Des Moines for a high-risk stenting procedure to open his blocked arteries, with the help of an Impella heart pump during the procedure. (Mary Greeley’s cardiac cath lab can perform stent procedures but does not have the Impella device.)

Rehab Challenge

Carrie Adams, BSN, RN, clinical supervisor of Mary Greeley’s cardiac rehabilitation center, was surprised when she ran into her old high school friend Andy Nichols in the halls of the hospital that day in August.

“One of my guys had a heart attack,” Nichols told Adams.

A few weeks later, Adams met that guy. It was Craig, who had been referred to Cardiac Rehab after his surgery. In these cases, a patient is generally referred to the rehab service closest to their home.

When Adams received the referral details and realized who the patient was, she knew to call Andy. That local connection was important because Adams and Nichols had an instant trust. Their conversation was the beginning of a coordinated effort to help Craig.

It is not unusual for the cardiac rehab staff to make accommodations for patients, but because of his cognitive abilities, Craig posed a new kind of challenge.

“It’s pretty individual for everyone,” says Adams of the Cardiac Rehab program. “We’ve had competitive athletes and people who have never stepped on exercise equipment in their lives. You’ve got to make it work for all of them.”

Making it work for Craig was personally important to Adams, who has a close relationship with a nephew who has special needs.

Cardiac Rehab at Mary Greeley usually involves small classes of people going through a prescribed set of exercises while wearing heart monitors. Rehab can last several weeks. Could Craig handle this? Should he receive treatment on a one-on-one basis, or be part of a regular group? Would being in a group be too busy for him, too much stimulation?
Nichols assured Adams that Craig could handle it all.

“The goal is to progress the exercise without making it too difficult,” says Adams. “Craig does a lot of active outings and we wanted to make sure he could get back to doing those things without Friendship Ark staff having to constantly worry that they were pushing him too hard.”

Recovery Plan

It was decided that Craig would benefit from being part of a regular rehab class. A slightly shortened 12-session course of treatment was planned. Because he had had falls at home, it was also decided to limit Craig to seated equipment. FAH coordinators Cassie Shivers and Chelsea Apland attended classes with Craig. They provided encouragement and helped cardiac rehab staff work with Craig.

“We would ask him ‘Are you OK?’ ‘Is this too hard?’ ‘Is this really easy?’ ‘Does your chest hurt?’ ‘Is it hard to breathe?’ Yes or no questions for the most part,” Adams says. “We couldn’t have done it without his helpers.This really was a team effort, with our staff working closely with staff from Friendship Ark to make sure Craig got what he needed.”

Friendship Ark staff echoed those sentiments.

“In the 10 years I’ve been with Friendship Ark and working with Craig, this was the most exemplary health care experience he’s had,” says Nichols. “The cardiac rehab staff
paid very close attention to him and got more out of him than any medical professional ever has since I’ve known him.”

In October, Craig finished his therapy. “We wanted him to feel like part of the group, and he did,” says Adams. “Other patients would ask him how he was doing and they cheered when he graduated. I loved seeing that. It was really sweet.”

Craig is back home at Friendship Ark, keeping busy with regular outings, or crocheting and jigsaw puzzles. Did he enjoy his cardiac rehab experience? You already know that answer. It’s a big smile and, “Yeah.”

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