How did you get into this work?

When I graduated in the mid-'70s, San Francisco was a hotbed of community work and collectives. We helped set up many services at that time, such as food co-ops and free clinics. I lived in a commune, but at one point wanted to get into a more structured life while continuing my support of the public sector. I found out about Pace University, where I could get a degree in nursing, and that was perfect for me.

Basically, I answered a want ad in the San Francisco Chronicle. It suits me so well, I can't imagine myself in any other setting. It's my dream job.

All my interests from the '70s are incorporated in this work. I utilize the expertise of a health care team to help solve health problems and provide the highest quality of care in a community, communal setting.

We have about 50 to 65 people, aged 30 to 98, who come every day. I get to spend a minimum of five hours with them. We address health care needs by taking the long view and observe subtle changes that other health care providers might miss.

What is the role of the adult day health nurse?

The adult day health registered nurse specializes in the care of elders and frail adults with chronic illnesses who are at risk for premature institutionalization. Our nurse-patient relationship is unique and different from acute care management.

We are part of the great continuum of care, but there is no model that describes accurately what we do. The home care model perhaps comes closest. This work can be isolating and we want to provide support to those nurses doing this work. We refer to other providers and we have to abide by Title 22 [state] regulations and work with families. We pull the whole system together.

What are some of the challenges you find working in adult day care?

I've been trained to decide what actions are needed as a nurse practitioner, but on occasion I refer things such as blood tests to a private physician and sometimes that doesn't get honored. That gets frustrating.

We can comprehensively address issues such as depression, dementia and medicine compliance easily. We also have a lot of information about our clients, and providers don't always work cooperatively with us.

We had a man who lived alone and was seen as a mainstay in his family, for example, but he was quite demented. His only diagnosis from his semiretired physician was Alzheimer's, but I could see only a multi-infarct dementia. He also had hypertension, but was not on any medications.

The man had been a smoker for 60 years, but there was no mention of COPD. No one picked that up or his advanced dementia until he came here. We were able to refer him to a geriatric-sensitive physician and to have his medical issues addressed.

Decision-making and change also can be slow for this population. A provider may be anxious to start an antidepressant or respite care. We can take the time to let our clients feel comfortable with their decisions.

What languages do you communicate in and what are the challenges of working in a trilingual environment?

We primarily speak English, Russian and Cantonese. Our staff also speaks Spanish and Tagalog, with a smattering of other Chinese dialects.

The challenge is that we have to go through a translator to speak with some of our clients. I can ask some basic health questions in Cantonese or Russian.

Multiethnic backgrounds mean different cultural values. Many don't consult with just one provider. Chinese clients see natural healers or acupuncturists, while Russian clients might see neurologists or urologists. Some may go to health food stores or other providers for alternative treatments. We look at the whole picture.

Anything you'd like to add?

The thing about adult day health is that it is in itself a community. I work as part of a team that works together to create our welcoming environment. It's ideal to have clients who want to be here. We are unlike other health care settings. Our clients are not a burden. We have ongoing activities and coming here becomes part of what they do.

I'm a nurse in a community health care system that includes relationships and connectedness and, for me, that's ideal.