At a time of life when many women are winding down their careers, Mary Lenzini, president and chief executive officer of the Visiting Nurse Association of Southeastern Connecticut, says she still has work to do.

"I know I'm closer to retirement. But I'm having such a good time," she laughs.

"We're not where I want us to be yet, and I love to come to work. I love to see [our mission] unfolding."

Lenzini, who will be 64 this summer, says she sees a world of possibility in the changing health care climate, and the growing awareness of the benefits of caring for people in their homes.

Home is a word that resonates in her heart.

She recalls a happy childhood in coal-mining country — Carbondale in southern Illinois — with her four brothers and one sister. "It was a very loving upbringing. We had a good time as a big family. We didn't have a lot of money, but we had a lot of good guidance."

Her family was invested in their community; her mother, especially, was active in their schools and served in leadership positions on school building and other committees. "Our whole lives growing up, we saw her sense of community service," she says.

Her father, an engineer who had emigrated from Italy, had a deep appreciation for education and the opportunities it offered in this country. He pushed his children to excel. She says she still shared her grades with him into her twenties, while pursuing her bachelor's degree in nursing on the G.I. Bill at The American University in Washington, D.C.

Leaving high school, she had wanted to become a doctor. "But the prevailing attitude among guidance counselors at that time was: 'You'll leave [the profession] to get married and have babies, so why take up a space in medical school?' " She entered St. Luke's Hospital School of Nursing in St. Louis, Mo., instead and graduated in 1968. Looking back, she's doesn't regret her choice. "I think I'm much happier. I knew I'd always work as a nurse but somewhere along the line, it became a profession for me. I knew I wanted to grow in it."

After nursing school, she joined the Navy Reserves and enrolled in the Graduate Women Officer's School in Newport, R.I. "I'd never left the Midwest, never seen the water," she says. "I loved it."

From 1968-70, she was the orthopedic head nurse at the Bethesda Naval Hospital in Maryland. She describes serving during Vietnam as an invaluable, but intense, work experience.

"People were being Medevaced in, we received patients so quickly. But in the military, you get to do what you need to do," she says. "It was a heady thing, being 21 or 22 years old and in charge of a 40-bed ward of Marines."

Coming to Connecticut in the late 1970s, she joined the Groton Public Health Nursing Service.

"We had come from Maryland, which had a very organized county health system. Connecticut didn't have one. It was very parochial; every town had its own."

She completed her master's degree in geronotology at the University of New Haven. She says something clicked when she made the move into administration, as supervisor of clinical services at the East Lyme Nursing Association. "I loved the idea of health planning, of impacting things on that level."

As she rose through the ranks, she noticed redundancies among the various visiting nurse services. "It seemed so inefficient; each paying the expense of licensing, the annual audit. We needed buying power too, to be able to seek out better benefits for our employees."

She and Suzanne Ballard, director of the New London Visiting Nurses, began pushing for a more coordinated approach. In time they got their wish.

The New London and East Lyme groups joined to form the Shoreline Visiting Nurse Association in 1988. The VNASC, as it exists today, reflects the merger of the Groton Public Health Nursing Service, Waterford Public Health Nursing Service, Shoreline and the Stonington Visiting Nurse Association. Lenzini, the agency's first president, has served since 1996.

The road to consolidation was bumpy at times.

"It was tough. There was one point after we merged, when the phones weren't working and I sat down and said, 'We took these perfectly good agencies. And ruined them.' "

She said the hardest point for her came when the nurses decided to unionize.

"I didn't think we needed a union. I thought we had planned a really good agency with good benefits. But there was a lot of uncertainty and nervousness."

She describes the administration's relationship with the workforce today as "very collegial," and speaks highly of the staff. "We have an extremely dedicated, skilled nursing staff. And we have a great, stable group of paraprofessionals."

Looking ahead

As people age, she says, the right kind of support is key. Not only are people living longer, they are living longer at home. "People used to think that you got old and then you went into a nursing home. But the statistics show that only 5 percent of people over 65 are in a nursing home at any point in time. There aren't many who need 24-hour care."

Last year alone, the VNASC served 3,387 patients in 20 communities. Their number of home visits tallied nearly 140,000.

Lenzini says she is excited to see more assisted living options developing as the need emerges. She says a forward-thinking spirit has prevailed at the agency, too. "In 1994 we became one of the first to use computers in the field. That was big."

The VNASC's affiliation with Lawrence & Memorial Hospital is one relationship that Lenzini believes will advance the delivery of local health care. She serves on The Best Care Coordinating Council, which "as the name suggests, is tasked with improving the consistency of care across all settings," according to Bruce Cummings, hospital president and CEO. "Patients with chronic illness are often readmitted; it's a challenge all across the country. This is a wonderful opportunity to improve consistency and coordination, from the doctor's office, to the hospital, and into the patient's home."

Transition coaching is one tool that can target the three most important predictors of readmission, Lenzini says. At discharge, a nurse consults with the patient to make sure they 1) can get their prescriptions, 2) have made follow-up appointments, and 3) they know how to identify potential problems.

"It sounds so simple," she says. "But the research shows these are the things that help people recover at home."

The VNASC also recently applied for and won a Pfizer grant to examine home health management of chronic and multiple

chronic disease.

"So much of the medical field is focused on specific disease management," she says. "There is a huge body of knowledge that no one is really synthesizing. What are the challenges, for example, for someone who is living with cardiac or respiratory disease as well as diabetes. We've got to get better at developing a plan of care for that population."

While the VNASC is focused on day-to-day care, Pfizer's role is analytical. "They're looking at the metrics; it's a whole different level for us," Lenzini says. "It'll affect every patient we touch."

Patient-centeredness is a quality that Mary Lenzini exemplifies, say those who know her.

"Mary is a nurse to her core," says Ann Branchini, academic dean at Three Rivers Community College in Norwich and chairwoman of the VNASC board of directors. "At the center of everything she does, is, 'What is best for the patient?' And she's committed to the less-served, to getting people what they need."

In 1987, Lenzini helped to co-found the soup kitchen at Second Congregational Church in New London, which is held every third Saturday from 9 a.m. to 2 p.m. She calls the problem of homelessness "a driving factor in anything I do." Last year, the VNA provided $750,000 of free and subsidized care to those with limited or no insurance.

"At the kitchen, I get a sense of what people are facing," she says. She adds that one of her grandsons learned how to set tables there. "There's something very spiritual about sharing a meal, about having that connection," she says. "And then there's the Italian part. I love to cook!"

Lenzini is also a familiar face at the New London Homeless Hospitality Center, where she serves on its board of directors.

"She's very engaged in helping us think through our health initiatives," says Catherine Zall, executive director. "And she understands our challenges as a nonprofit."

Zall also says Lenzini is great at harnessing resources for specific needs.

"She helped us start our foot clinic, and think about it — for a homeless person, feet are pretty crucial. The day we have that clinic, the line is always out the door," she says, adding, "Mary goes way beyond what we expect of a board member, or even a volunteer."

Branchini echoes that sentiment: "What separates Mary — and I think the secret to her success — is that she really understands her commitment. She lives it. There's no

better way to say it."