This is the second in a series of stories profiling a Napa woman, Margaret Keane, and her experience with aging and hospice care. To read the first story, visit napavalleyregister.com.
Margaret Keane may be 91 years old and wheelchair-bound, but according to Keane “I feel stronger every day.”
Keane has congestive heart failure. She’s also faced a number of health issues including pneumonia, circulation problems and various infections.
Earlier this year, her primary care doctor convinced Keane to accept hospice care services from Collabria Care in Napa.
Hospice care is designed to serve those facing transitions of aging, Alzheimer’s disease and other serious illness or the end of life.
After becoming a hospice patient, Collabria Care hospice providers visit Keane, providing medical care, emotional and psychological support and other services. They include doctor house calls at her Napa home, an oxygen tank to help her breathe and regular pain medication.
In an interview for a story about Keane in the Napa Valley Register on Sept. 29, her son-in-law, Don Swigert, said that hospice care has made a big difference.
“It worked out great,” said Swigert, who is married to Keane’s daughter, Jane. “Frankly, I think her health has improved on hospice.”
Yet Keane recently faced a few bumps in the road. In early and mid-October, Jane and Don Swigert said Margaret, who lives with them, seemed to be declining. Mentally, she seemed to be a little out of it, they said. She had some digestion problems and suffered from nosebleeds.
“We were concerned,” said Don Swigert.
After consulting with hospice doctors, adjusting her pain medication and other changes, Keane recovered.
“She’s the bounce-back queen,” said Don Swigert.
“I am just feeling great,” said Keane, during a visit at her Napa home on Nov. 5. “I have more time to do my Bible reading and painting.”
Her art and her faith are both important to Keane.
The painter is best known for creating the renowned Big Eyes paintings. In 2014, her story was made into a feature film called “Big Eyes,” starring Amy Adams and Christoph Waltz.
She’s also a devote Jehovah’s Witness.
Besides her daughter and son-in-law and hospice staff, a significant portion of Keane’s care comes from a paid caregiver.
Two of her most recent attendants have been women from the island of Fiji, in the South Pacific. Her current caregiver is Ina Vosaicake.
Vosaicake came to the United States several years ago via an immigrant visa. Before that, “I worked at a hotel back at home and met American people,” Vosaicake said in a soft voice.
It was her first time to visit the U.S., she said. Compared to how large America is, Fiji is just “a dot on the map.”
Vosaicake also has friends and a niece who live in the Bay Area and provide in-home care services, she said.
In the Fijian culture it is common for family members to care for elders, said Vosaicake.
“That’s the way we live,” she said. “We love people. Back home we stay with our parents” as they age, she said.
Vosaicake said she’s happy to be living in California — especially Northern California. “I love it,” she said.
The people in Napa “are beautiful and friendly,” she said.
She joked about one Napa drawback – unlike from her home in Fiji, she can’t see the ocean. “I don’t like it,” she said with a smile.
Vosaicake had only been Keane’s caregiver for about three weeks but the two seemed to have already bonded.
Vosaicake is teaching Keane Fijian words like “hello,” “thank you,” “the food is good,” “beautiful,” and “please.”
The caregiver attends to many of Keane’s needs including toileting, sponge baths, eating and taking her medicine. She helps wheel Keane around the house in her wheelchair, making sure the long oxygen cords attached to a central tank don’t get tangled up.
Between baths and meals and other daily tasks, “We have a lot of laughs,” said Keane.
Vosaicake also reads scriptures to Keane. The two live in Keane’s large artist studio, which is an addition to the Swigert home.
The studio includes a small kitchen, large bathroom, painting table and room for a hospital bed for Keane and bed nearby for Vosaicake.
Vosaicake said before she met Keane had no idea she was a famous painter.
The artist said she’s encouraged Vosaicake to draw along with her. Vosaicake showed a painting she did of a dolphins and fish in the sea. “I used to love to draw when I was a little girl,” she said.
On her days off Vosaicake said she likes to walk and use an exercise bike on the patio. “I love to sing hymns,” she said. Vosaicake is Methodist.
Keane said the first thing she does when she wakes up each morning is “I thank Jehovah I made it through the night.”
“Then, she goes right to her table” to paint, Vosaicake said of Keane.
For breakfast, Vosaicake will make Keane her favorite soft-boiled eggs. Don Swigert brings her favorite cold-brewed coffee.
During the day she enjoys a snack of popcorn with some lime juice sprinkled on it.
Keane said she doesn’t experience much pain “unless I try to lie down” flat. “Then I can’t breathe and I get panicky,” she said. At night, she sleeps with her head elevated.
“She sleeps well,” Vosaicake said of Keane.
She takes pain medication every four hours. Vosaicake keeps a notebook noting each dose and time.
Jane Swigert said lately her mother has taken to telling stories of her family from long ago. Those memories are particularly vivid, she said.
“My whole family was peculiar,” said Keane.
Holding a small device that looks like something from “Star Trek,” Queen of the Valley Medical Center nurse Alice Fernandez aimed the instrument over a colleague’s wrist.
Almost like magic, a roadmap of veins was instantly projected onto her wrist. The veins, highlighted in a dark color, stood out clearly, illustrating where an intravenous (IV) therapy line could be started.
In October, the Queen bought six AccuVein viewers, and caregivers began using the “vein visualization technology” to illuminate patients’ veins when starting an IV therapy line.
“This helps us find veins in almost every patient,” said Fernandez.
“Instead of spending 30 minutes at the bedside” with a patient with hard-to-find veins, when using the vein finder device “you’ll spend five minutes,” said Fernandez. “It really is easy.”
The vein finder instrument uses harmless near-infrared light to clearly project the anatomy of the veins and valves onto the surface of the skin.
According to the manufacturer, AccuVein, the device increases the likelihood of a successful first-stick by 92 percent.
For patients, it means fewer ‘pokes’ and therefore, less pain. According to AccuVein, pain experienced by patients is reduced by 39 percent.
“Sometimes it’s difficult” to find a vein to start an IV, said Isaac Slaughter III, an RN and nurse manager at the Queen.
“Nobody likes stabbing people with a needle” due to a hard-to-find vein, he said.
According to Koreen Olson, RN, director of adult services at the Queen, this technology reduces anxiety and discomfort, especially for patients being treated for kidney failure and cancer whose veins may be more withered, or individuals whose veins are difficult to locate.
Even though most patients avoid watching the start of an IV, when the vein viewer is used, “There is definitely a ‘wow’ factor for both our caregivers and our patients,” said Olson.
“Caregivers can find the patient’s vein much faster, even in the most challenging situations,” she said.
The vein viewing systems can be used on patients of all ages, skin and body types.
The hand-held, non-contact systems are being used on several units throughout the hospital, including in all inpatient units such as the acute rehab center, as well as in the outpatient surgery and procedures center, the operating room, labor and delivery and the neonatal intensive care unit (NICU), officials said.
Similar vein viewing technology from another manufacturer is already being used in the emergency department and oncology infusion center, officials said.
In addition, because these vein viewing systems have such a high success rate, caregivers at the Queen are less likely to have to “escalate” care by calling in a special team to insert a peripherally inserted central catheter (PICC) line, which has a higher risk of bloodstream infection, said the news release.
The hospital is currently only using the vein viewing systems for more complex situations like starting an intravenous therapy line prior to drawing blood from patients in the hospital.
“At this time, we are not using (it) for outpatient blood draws, which tend to be more straightforward,” said Queen spokesperson Christina Harris.
The retail price of the device, including training, is $5,500 each, but prices for health care group purchasers may vary.
“It’s definitely worth the investment,” said Fernandez.
Napa County hopes to take advantage of recently passed Proposition 68 to buy the 850 acres of hilly, oak-sprinkled land it leases from the state for Skyline Wilderness Park.
State Sen. Bill Dodd, D-Napa, plans to introduce legislation that would authorize the state Department of General Services to negotiate with the county on a sale price. Whether the two parties could reach a deal is another matter.
Simply to have an opportunity to negotiate with the state for the land, the county needs a bill to pass the Legislature and win the signature of governor-to-be Gavin Newsom.
“There’s always a possibility that something happens that’s out of our control,” Dodd said on Monday. “But as I sit here today, given the past history and what’s going on, I would expect it to pass.”
The bill will probably be introduced in the Legislature at the end of the year, Dodd said. Then it would proceed through the various legislative steps during 2019 and, if successful, would become law on Jan. 1, 2020.
Skyline Wilderness Park is along Imola Avenue southeast of the city of Napa. It has 25 miles of trails that lead to hills with views of the Bay Area and the Napa Valley. One popular hike leads to tiny Lake Marie.
Napa County leases the land from California for $100 annually. The 50-year agreement that began in 1980 expires in February 2030, and the county has long sought to buy the land. Park advocates have voiced concerns that the state’s long-term plans there may not include a park.
The county sees an opportunity over the next few years. Proposition 68, the $4 billion bond measure passed by voters last June, will make competitive grants available for parks. That’s a potential funding source for Skyline purchase money.
Skyline could be owned by either Napa County or by the Napa County Regional Park and Open Space District, the county’s proposed 2019 state legislative platform says. The county as a condition of the purchase would ensure that the land is used as a park in perpetuity.
Napa County has tried to buy the Skyline land before. Legislation passed in 2010 authorized negotiations between the state and county over Skyline.
The county had an appraisal done to arrive at a sale price, but state General Services wanted to submit its own appraisal. It never did so and the legislation expired in January 2015, county Open Space District General Manager John Woodbury told the Napa Valley Register in 2016.
State Sen. Lois Wolk, D-Davis, introduced legislation co-sponsored by then Assemblyman Dodd in 2016 authorizing the resumption of negotiations. But the bill died and Wolk left office that year.
The state Department of Hospitals is creating a master plan for its five hospital campuses. Given Skyline is adjacent to Napa State Hospital, the state in 2016 didn’t want to sell the park land before knowing if the hospital would expand.
Whether a similar dynamic will play out this time remains to be seen.
“That’s really going to be the challenge for us in the next few years,” Supervisor Ryan Gregory said during the Nov. 16 county legislative subcommittee meeting.
Napa County’s position is the Skyline land has never really been a part of Napa State Hospital, Deputy County Executive Officer Molly Rattigan said.
Dodd said he doesn’t know of any pending state plans to use the Skyline land for Napa State Hospital. Selling the land to the county would support the state’s policy of encouraging parks and open space in communities, he said.
Skyline Wilderness Park is run on behalf of the county by the nonprofit Skyline Park Citizens Association.