Erin Struemph likes to think about the big picture.
Even when she was a student at nursing school, she felt a pull toward public health.
"There are so many options for nurses, and a lot of times we do get really siloed into that bedside hospital, acute clinic setting," said Struemph, who is the program director of Missouri's Healthy Children and Youth Program and Medically Fragile Adult Waiver Program.
After graduating, Struemph first worked as an intensive care unit nurse. She recalled one of her patients being "one of the sharpest, most hilarious patients" she has ever known. However, because of the young man's complex medical issues, her colleagues made assumptions that nearly changed the way he was treated.
"It really made me realize how specialized and focused care for these (patients) are," she said. "While you're in a hospital setting, it's really hard to know absolutely everything about a patient and their day-to-day care."
However, once a patient is discharged, it is the private duty nurses, parents and caregivers who will be providing day-to-day care. Supporting at-home care for patients with serious or complex medical needs is where one can make a larger impact, Struemph said.
As a result, she decided to join the Missouri Department of Health and Senior Services and has overseen both the children and adult programs for two years. As manager, she oversees service coordinators who carry out assessments for the initiatives among other staff members, she said. These coordinators evaluate the needs of patients at the latter's homes and refer them to available resources.
The Healthy Children and Youth Program provides in-home services to Missouri residents with special health care needs from birth to 21 years old. These individuals need to be enrolled in MO HealthNet, the state's Medicaid plan. These services include private duty nursing, advanced personal care, case management and others, according to the health department.
Similarly, the Medically Fragile Adult Waiver Program allows people eligible for private duty nursing under the youth program to continue receiving those services after they turn 21, according to the health department. While both programs are under MO HealthNet, it is Struemph's team that operates them, she said.
Before the establishment of the adult waiver program, there was not a public program or service in Missouri to meet the nursing needs of participants who aged out of the youth program, Struemph said.
"The Medically Fragile Adult Waiver is the only one that continues to provide private duty nursing level of care," she added.
Participants in the past were able to go to college, hold full-time jobs and travel because of the services they received from these programs, she said. From fiscal years 2021-23, the youth program served more than 1,000 children each year, while the adult waiver program provided service to nearly 200 adults each year.
So far, she has been working toward standardizing processes statewide and developing resource manuals for the programs' network of service providers enrolled in MO HealthNet, Struemph said.
Moreover, she and her team have been transitioning to a more electronic environment, especially after the COVID-19 pandemic. By switching from mailing documents back and forth to moving more of the programs online, processing time for the programs has gotten shorter.
"We've really been able to dive into enhancing our processes to be more electronic and just streamlining everything," she said. "If we can improve those, that then trickles down to services for our participants."
Joe Gamm/News Tribune photo: Erin Struemph explain the details that go into providing services for Missouri's medically fragile adults. Struemph, the state's manager of Healthy Children and Youth and Medically Fragile Adult Waiver programs, said hundreds of Missouri residents rely on the programs' authorization of nursing services.
Joe Gamm/News Tribune photo: Erin Struemph explains the details that go into providing services for Missouri's medically fragile adults. Struemph, the state's manager of Healthy Children and Youth and Medically Fragile Adult Waiver programs, said hundreds of Missouri residents rely on the programs' authorization of nursing services.
Joe Gamm/News Tribune photo: Erin Struemph explains all the details that go into providing services for Missouri's medically fragile adults. Struemph, the state's manager of Healthy Children and Youth and Medically Fragile Adult Waiver programs, said hundreds Missouri residents rely on the programs' authorization of nursing services.
Joe Gamm/News Tribune photo: Erin Struemph explains all the details that go into providing services for Missouri's medically fragile adults. Struemph, the state's manager of Healthy Children and Youth and Medically Fragile Adult Waiver programs, said hundreds Missouri residents rely on the programs' authorization of nursing services.