|Home Sweet Home Care
“Does it still hurt?” Hedrick asks, lightly testing the Caesarean wound that opened up a few days after the young mother returned home from the hospital.
“It’s getting smaller,” Hedrick says, measuring the wound, which initially was 6 inches wide and more than a half-inch deep. As she changes the dressing and checks her patient’s vital signs, Hedrick keeps up a steady stream of conversation with Cathy while the baby’s teenage father listens to an i-Pod, rocking back and forth to the beat.
Chris Hedrick is one of 35 Johns Hopkins Home Health Services field nurses, each of whom carries a caseload of approximately 24 adult patients, covering Baltimore City and County, and Howard, Anne Arundel, Harford and Cecil counties. One of three nurses assigned to Harford, Hedrick makes about five home visits per day, up and down Route 40, Mountain Road, Route 24 and other strip mall-fringed suburban thoroughfares.
These are heady times for Hopkins Home Health, a part of the JH Home Care Group. It recently received top marks from the Maryland Department of Health and Mental Hygiene after an unannounced, exhaustive survey of its policies, procedures and practices. Home Health was found to have no deficiencies whatsoever. In the home health industry, that sort of record is all but unheard of.
Last year, Home Health nurses, physical and occupational therapists, social workers, speech/language therapists, and aides logged more than 14,000 patient visits. Nurses like Hedrick are sorely needed in the community because hospitals—pushed by insurance companies eager to cut costs—have been discharging patients “quicker and sicker,” since the early 1990s, says June Biggerman, clinical manager for Hopkins Home Health. Moreover, research shows that most patients recover better and faster at home, further fueling the flight out of the hospital bed and into the living room.
Like most nurses who gravitate toward home health, Hedrick has worked in a hospital (in a critical care unit) but prefers the independence, variety and intimacy of home health nursing. “In the hospital you are in and out of the patient’s room in a few minutes. It’s hard to hold a conversation because while there, you have so much to do,” she says. “When you are visiting them at home, you develop a relationship.”
But as with all relationships, there are challenges.
“She would heal a lot faster if she’d use Wound-Vac,” Hedrick says as she sits in her car outside the townhouse, documenting her visit by keying notes into Cathy’s chart on a laptop. Wound-Vac is a small device that applies pressure to wounds to promote blood flow and drains fluids and infectious materials. But it must be worn 24 hours a day, seven days a week. Cathy resisted it from the start.
Noncompliance is an old story for home health nurses. In the hospital, nurses and doctors are in charge, but once patients are back home, they don’t always follow medical recommendations. “I can’t force her to use the Wound-Vac,” says Hedrick, “but I can continue to educate her about how it will help her heal faster.”
Sometimes it’s difficult to see firsthand how patients’ living arrangements or lifestyles affect their health, she says, and to accept that there is nothing you can do about it. Today, for example, she needs to accept that Cathy plans to return to work at the end of the week because she needs the money, and that the baby is sleeping on the sofa instead of within the safer confines of the crib.
“When I started this job three years ago, I wanted to fix everything,” she says. “Now I know that I can’t.”
After visiting with Cathy, Hedrick calls on a new diabetic, teaching him how to use his glucometer and to recognize the signs of low blood sugar, a congestive heart failure patient recently released from the hospital, and another woman with an infected postsurgical wound.
Her final patient, an elderly woman with diabetes, dementia and respiratory problems, is being nursed by her adult son. “He takes great care of her,” says Hedrick. The woman is home again after Hedrick had her admitted to the hospital following a visit two weeks earlier. Both nurse and son are alert to any change in the woman’s condition that might require readmission.
“She’s coughing again,” the son says.
“Sit up, Sweetie, and let me hear what’s going on in there,” says Hedrick, listening to her lungs.
After the visit, as Hedrick sits in her car tapping away on her laptop, she calls the patient’s physician to let him know that the respiratory problems may be returning. Home health nurses serve as the eyes and ears of physicians, keeping them up to date on recovery and alerting them to potential difficulties.
Regular phone calls and monthly meetings with the other nurses in her geographic care group help Hedrick deal with the rigors of the job. Her main task, she says, is educating patients to care for themselves. But connecting—with patients, family members, physicians and her fellow clinicians—is really what the job is all about.