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Dome - Home Care at 40,000 Feet

Dome October 2013 VOL 64
Issue No. 8

Home Care at 40,000 Feet

Date: October 1, 2013

Johns Hopkins Home Care nurse Lou Ann Rau will travel thousands of miles to escort patients home. Here, she poses with the medical supplies one patient might require.
Johns Hopkins Home Care nurse Lou Ann Rau will travel thousands of miles to escort patients home. Here, she poses with the medical supplies one patient might require.

As she approached the security checkpoint at Dulles International Airport recently, Lou Ann Rau was considering the liquids in her carry-on luggage. The Johns Hopkins Home Care Group nurse was toting medical supplies, including liquid infusion medications, necessary to care for her patient en route to his home in the Middle East. She also carried an official letter, obtained earlier by Johns Hopkins Medicine International, which explained why she merited a medical exception to usual cabin restrictions.

What will I do if they don’t accept it? she recalls wondering. How will I give him the care he needs?

The authorities waved her through without incident. During the past year, Rau has learned that caring for international patients who request private duty services can include security pat-downs, shifting time-sensitive medication regimens across multiple time zones and spending as many as 14 hours in the air at one time. To ensure patient safety, she must also carry with her five to seven days’ worth of any medications or supplies the patient may need.

She considers it one more professional challenge. During her 18 years at Home Care, the staff education specialist has helped launch initiatives that reduce readmissions, such as a remote monitoring system, and traveled with a Johns Hopkins team to assist Gulf Coast recovery efforts. Last year she helped establish Home Support, a new division of Home Care, to assist international patients with such services as private duty nursing, personal care, cooking and companionship.

When Home Support received the first request for a nurse to personally escort a critically ill patient back home, Rau took the assignment. It was her first time out of the United States caring for a patient, and it proved to be dramatic. She and her patient traveled by ambulance from Johns Hopkins Bayview Medical Center straight to New York’s John F. Kennedy International Airport. They were the last to board a commercial airliner that was completely filled. The patient needed to be lifted over other rows of passengers in order to reach his seat.

Rau spent the next 14 hours constantly monitoring his vital signs, administrating medications and fluids to stabilize his condition and turning/repositioning him for pressure relief. Once on the ground, she debriefed the patient’s local care team on his diagnosis and treatment plan, current condition and medical requirements. Within a few hours, she was on a plane back home. Sometimes, the assignment requires nurses to spend up to several weeks settling the patient in with the local care team.

Rau says such private duty assignments are merely another version of home care nursing, which always lacks the reassurance of a supply closet around the corner. “Home care nurses are different … we’re used to working with what we have,” she points out. “We’re the MacGyvers of nursing.”

—Cymantha Governs


Johns Hopkins Home Care Group provides the following services for international patients:

  • Prescription fulfillment for outpatients, their family members and travel companions
  • Skilled private duty nursing and medication management at patients’ temporary homes including home infusion therapy, wound care, injections, pre-appointment work-ups and vaccination administration
  • Personal care by certified nursing assistants and companions
  • Nursing escort services back to home country and transition to local care team
  • Home health services including physical or occupational therapy and dietary management
  • Medical equipment for home use including oxygen and respiratory equipment, wheelchairs, beds, supplies and custom-ordered items