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Spotlight Q&A: Dr. Steven H. Landers

The new head of the state's VNA Group, the largest nonprofit visiting nurse association, talks about home care, geriatric patients, and community-based medicine.

Dr. Steven H. Landers

Dr. Steven H. Landers in June became chief executive of the century-old VNA Health Group, the state’s largest nonprofit visiting nurse association. Landers comes to New Jersey from the Cleveland Clinic, where he directed home and community care services for that highly regarded provider of integrated healthcare services.

A family physician and geriatrician, Landers, 37, is a graduate of Case Western Reserve University School of Medicine and has a master’s in public health from Johns Hopkins University. He did his residency at University Hospitals of Cleveland and his fellowship in geriatric medicine at Cleveland Clinic. Founded in 1912, VNA has 500 community health nurses and more than 1,700 employees across the state, providing home care, hospice and community-based care to more than 120,000 people a year, from infants to the elderly.

Question: How does last week’s Supreme Court decision upholding the Affordable Care Act affect VNA?

Answer: It means we’ve got a really bright path ahead. We’re in the business of helping people stay healthy at home, particularly people with serious chronic illness and mobility limitations, and that’s a big part of the solution to how we address health reform.

Q: Why did you go into primary care?

A: When I started my medical training I was enrolled in a program called “the primary care track” to teach medical students how to be leaders in primary care, which was supported by the Robert Wood Johnson Foundation. From day one of medical school, that program provided me with special experiences and leadership training in primary care and public health. We actually started seeing patients in the primary care clinic in the first week of medical school as part of that program, which was unusual. Most medical students spend the first two years in the anatomy labs and chemistry courses. So I probably wouldn’t be doing what I’m doing now if it wasn’t for that wonderful Robert Wood Johnson Foundation program that was supporting my medical school at the time.

Q: What drew you to geriatrics and home care?

A: I started doing home care and home visits as a family doctor. I fell in love with home care and it just turned out that most of the people who needed care at home were older patients. So I wanted to become more of an expert in the healthcare issues they presented. Seniors represent a lot of our history, the fabric of our country. I’ve taken care of many World War II veterans and their survivors, people who built this country, so it’s a special field to be in. That said, I found that older patients are a lot like younger people: they have hopes and dreams. .

Q: Why attracted you to the VNA?

A: It is exciting to wake up every morning and focus on, “How do we keep people healthy at home and healthy in the community?” That is the commitment of the VNA, from making sure moms and babies that are at risk get the help they need to succeed at home, to having health centers available to people without insurance, to our really strong home care and hospice program. These things are so attractive to me as someone who is really interested in public health and community health. I have a deep respect and admiration for the Cleveland Clinic and what they do in hospital care, but what really excites me is: how do we find ways to help people stay home? That is what the VNA is all about, and I couldn’t be more thrilled to be a part of it.

Q: New Jersey’s Medicaid program funds the majority of the state’s nursing home care, and the state is trying to help more seniors age at home rather than in nursing homes. What will this mean for VNA?

A:Our programs, from home nursing to home health aides to case management to care at the end of life with hospice program, line up well to support the state initiative to move more of the long-term care to the home environment. We are day by day figuring out how to do what we do better and more efficiently and using new care teams and new care models to be able to help older and disabled people in New Jersey stay home. We welcome the challenge to be a part of the solution.

Q: According to the Dartmouth Atlas, spending on end-of life-care is higher in New Jersey than nationally, and we spend more days in the hospital, see more specialists and use less hospice and palliative care. What is your view of this?

A: I can tell you that in medical training by and large, and in nursing training for that matter, we don’t all become experts in dealing with end-of-life care and helping people through that. Different parts of the country are on a different timeline in how they come to approach that. But I’m seeing a lot of very promising signs, in terms of welcoming partnerships for the hospice care we provide. I’m seeing an interest and an open door from the various hospitals and physician groups to work collaboratively to improve end of life care. The key thing to keep in mind is that these are difficult discussions and difficult issues even for the experts. We’ve got to keep trying to figure out what the patient needs most and what is going to help the whole person, not just one part of the body or another. As we think about that more, and realize that people want comfort and quality of life and to be able to stay at home and in the community, they are going to start to make different choices and different plans for care at the end of life.

Q: New Jersey’s population is aging, and the vast majority of people want to age at home and avoid moving to a nursing home. Is this feasible?

A: I’m an optimist. I see a lot of the emergence of new care models and new technologies, such as mobile aps and monitoring concepts, that are going to help us find ways to keep more people at home as they age. There are certainly a lot of big challenges: we’re already struggling with our current group of older patients with chronic illness, let alone 70 million baby boomers. But I think there is a lot of room for innovation. It’s not just what there is now, it’s what can be. When you look at the more innovative things going on, you can imagine us really rising up to be able to provide that home-based delivery system. Federal health reform didn’t get down to addressing long-term care issues and helping people age at home, and we have to look at this. All the medical care and nursing care and rehabilitation care doesn’t mean much if your basic needs aren’t met -- if you are not safe at home and have help, if you need help with basic things like getting dressed or eating, which all falls into the long term care realm. If we continue to realize that we have to do things differently and promote innovation, we will be in decent shape.

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