Innovation

Denise Giovanniello is innovating Pediatric Care for chronically ill children by taking children out of the ICU and providing them with 24/7 specialized care in the comfort of their own home. Her company, Milestones In Home Care, was founded in 2001 on Long Island, New York. Her home care services provide Good Health and Well-being, Quality Education, Reduced Inequalities, and Peace, Justice, and Strong Institutions by creating an innovative and fluid health care system that is focused on not just the patients’ health needs, but also providing a better quality of life to chronically ill patients that transcends their physical limitations.

Denise is able to specialize her care by being deeply involved in every patients’ case. Safety is her first priority for both the patient and the nurses. “I’ll refuse a case if I cannot staff it safely. Too many companies over promise and under-deliver.” By putting patients’ safety and well-being first, Denise has successfully empowered children all over New York to live a more fully engaged life.

Denise is helping to make the world a better place through her agency’s execution of the SDGs. Her agency provides proper care and inspires well-being through actively understanding patients’ care needs. By providing the opportunity for these children to go to school for the first time and be immersed into “normal” everyday life, she’s improving the quality of education and reducing inequalities. Milestones encourages peace, justice, and strong institutions through creating a flourishing company that’s changing the way others perceive and execute health care.

Inspiration

Denise Giovanniello grew up in Brooklyn, New York. She always dreamt of being a nurse, and from an early age began helping others. As a child, her grandfather struggled with ALS (Lou Gehrig’s disease), which is a motor neuron disease. ALS causes the neurons controlling voluntary muscle movement to deteriorate, stripping the patient of freedom of movement. Denise would bike to her grandfather’s house every Wednesday to help feed him. This sparked a love for helping those in need, something Denise decided to run with for the rest of her life.

Denise went on to study nursing and psychology at Fairfield University in Connecticut. When she graduated from Fairfield in 1988, she became a licensed nurse specializing in Pediatric Oncology in the Intensive Care Unit. The children that she worked with were chronically ill and would be confined to a hospital for the rest of their lives. In the 1990s, Denise, working on Long Island, cared for a young girl named Sonya: although she was chronically ill and confined to the hospital, she was full of life. She wanted to live beyond the hospital hallways. Denise and the other nurses started taking Sonya out to the movies and bringing her to dinner at their homes. Suddenly, Denise couldn’t avoid a hole in the pediatric care system. “This has to be done differently,” she says, “These children can be living a more normal life than just living in a hospital.” Together with her friend, Kelly Duranti, Denise set out to innovate the pediatric care system, founding Milestones In Home Care in 2001.

Overall impact

Traditional health care services require a chronically ill patient to live eternally in an ICU or other unit within a hospital network. These patients were either born with these diseases or suffered from severe accidents that permanently altered their way of life. When Denise founded Milestones, her mission was to restore a sense of belonging and importance in each of her patients, specifically by making patients a part of their family unit, with siblings, friends, pets, holidays, celebrations – and for most patients, school. Milestones employs highly qualified registered nurses (RNs), licensed practical nurses (LPNs), home health aides (HHAs) and personal care attendant (PCAs) to care for their patients. The short term effects of this company have allowed patients to be able to live their lives in the comfort of their home, rather than in the confines of a hospital room.

In the long term, this company is working to change the stigmatization that chronically ill children are terminally ill children. These children deserve to live a life outside of a hospital and should not be viewed as terminally ill. By changing the way health care is given to these children, Milestones is compassionately changing the perception of chronically ill health care. This has inspired multiple companies through the New York area to change the health care system, thereby creating an innovative system that is flourishing, scalable, and having a net-positive impact on society.

Since its founding, Milestones has contracted with 30 different school districts, allowing their patients to attend school with the aid of a full-time nurse. These patients will attend specialized programs in their community’s school district, and – in some cases – advance to higher education institutions like Hofstra University in Garden City, NY.

Business benefit

Milestones In Home Care has grown substantially since its birth over 15 years ago, expanding to a staff of 140 nurses with 9 full-time members. They have been able to do this through careful evaluation of patient needs and the company’s ability to safely provide services. Through word of mouth, both patients and nurses flock to be a part of Milestones In Home Care because of the agency’s ability to safely access patients’ and nurses’ needs and successfully deliver these services. The company has expanded throughout the New York area into three counties and 30 school districts.

Matching the needs of chronically ill patients in a home setting is incredibly difficult, and through a careful selection of nurses and financial accommodations, Denise has worked hard to actively deliver proper care to aid any patient who seeks her agency out. She sprouted a new market in home care, attracting new competitors like Homecare for Children. Despite the introduction of rivals, Milestones still leads in the market due to their core values that put the patients’ needs first above all else, and never asking for payments directly from the parents. Their revenue – stemming from insurance companies, the government, as well as school districts – has skyrocketed since the beginning, generating “$7-8 million in revenue” as well as a “$125-150k payroll every 2 weeks”. This income allows the company to hire more nurses and staff members, thus allowing more patients to benefit from this service.

The innovation benefits the business because Milestones does home care better than anyone else. The company genuinely believes that children deserve a fair childhood despite illnesses and they will help in any way possible to help them attain their dreams.

Social and environmental benefit

Milestones In Home Care benefits society on many fronts, but there are three in particular that we identified as a result of our interview with Denise. The first is that Milestones allows children with chronic and debilitating illnesses the opportunity to experience a somewhat “normal” childhood, and even supports them into adulthood. For example, it has allowed multiple patients to be able to attend university full time, resulting in both Bachelors and Masters degrees for patients who otherwise wouldn't have been capable of attending school and attaining a degree.

Furthermore, Milestones tends to a diverse and inclusive range of patients, and understands the different cultural obligations and sensitivities associated with in-home health care. For example, in the past Milestones has not only been able to accomodate a Spanish-speaking family with a Spanish-speaking in-home nurse, but in a case where a Pakistani family was in need of a 24/7 in-home nurse for their young son, Milestones was able to provide strictly (non-male) female nurses in order to abide by Pakistani cultural standards. These sensitivities are the starting points for creating a society that is more inclusive and considerate. Not only are they providing the necessary care the child needs, but Milestones’ treatment is holistic in the sense that it tends to the whole family’s needs: medical, cultural, and otherwise.

Milestones prides itself on working not only with the families they serve, but also as advocates on their behalf. When a new case is opened for a patient, Milestones evaluates the family’s insurance coverage (if any) and negotiates with these insurance companies to ensure competitive rates that will cover expenses and compensate their nurses. With new legislation passed under the Affordable Care Act, commonly known as Obamacare, Denise detailed to us how, while the insurance landscape has changed, they have increased their efforts in working with financially challenged families. Typically, families who can’t afford private insurance will be eligible for Medicaid, a government assistance program for low-income families and those with disabilities. With the introduction of “managed care” plans enacted under Obamacare, Milestones is now reimbursed just enough to provide care for patients covered under Medicaid, which is a victory for both the company and their eligible patients. Denise explained that while Medicaid doesn’t reimburse nearly enough for the agency to cover its expenses, these new managed care plans – as well as contacts they’ve negotiated with school districts for patients who can attend school – help them “recoup the loss on the Medicaid end”.

Interview

Denise Giovanniello, Co-Founder and CEO