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How did you get into nursing and adult
day health nursing?
My father was a small-town general practitioner and
my mother was a nurse. Their work was fulfilling, so
it seemed like a good choice for me.
While I was teaching in the '80s, I realized how much
nursing had changed from what I'd originally experienced.
There was so much technology, including short stays
and very sparse staffing. It was difficult for the students
to give the kind of comprehensive care that they were
learning about and that I valued. It seemed that the
patients and nurses were unable to connect and both
ended up unfulfilled and frustrated. I felt it was time
to refocus, so I took some time away from nursing.
My local paper had an advertisement for a nurse at
the Senior Focus Adult Day Health Center. I had always
enjoyed working with elderly patients, so I called and
asked if they'd tell me what they did there. The nurse
said she would tell me if I'd come down and help serve
lunch. So I did.
It was amazing to see disabled, nursing home-level
patients in a community setting looking happy, receiving
nursing care and therapy while listening to speakers,
chatting in support groups with the social worker or
playing cards in the garden. I spent that day-and several
years-there. Eventually, I became program director.
We started a new Alzheimer's unit and then an Alzheimer's
support group for newly diagnosed patients and their
families. It was wonderful and rewarding to be part
of a program that offers so much to improve patients'
and caregivers' quality of life.
What is unique about adult day health?
What do you like the most? The least?
Adult day health is wonderful, really unique because
you see clients frequently over a long period of time.
You feel like you make a difference in their lives.
The whole team, including PTs, OTs, SWs, recreation
therapists and speech therapists, is in the same setting
providing comprehensive care. Professionally, it's supportive.
The only disadvantage to this kind of nursing is that
we're isolated from other nurses. Usually, there is
only one nurse in each center. I think home health nurses
experience the same thing.
Are there any favorite incidents you
remember?
Once, on a field trip to the beach in Half Moon Bay,
one of our patients said she had never seen the Pacific.
She [had severe disabilities] and had lived in San Mateo
for 40 years. She just wanted to touch the Pacific Ocean.
We carried her down to the shore and she was able to
put her feet in the water. I'll never forget the look
on her face.
Being able to provide the support for frail, elderly
patients to enjoy some of the ordinary things we all
take for granted is really rewarding. Also, being able
to help elders understand how to manage their chronic
diseases and avoid serious complications is rewarding.
We do a lot of teaching. We also can intervene in serious
situations such as abuse and neglect to protect our
patients.
Field trips are great and a challenge to change dressings,
administer meds and give oxygen, etc., away from the
center.
What is the Clinical Care Guidelines
Initiative?
While providing continuing education workshops for
center staff through the network, I became aware that
the level of care was different in different centers.
It seemed that something needed to be done to standardize
care. Eileen Lynette, NP, RN, and I decided to look
at standards of practice for the most common geriatric
problems that present the greatest risk for nursing
home placement.
The San Francisco Adult Day Services Network was able
to obtain a generous grant from the Richard & Rhoda
Goldman Fund so that we could develop the guidelines
and train center staff.
Subjects for the guidelines are: fall prevention, behavior
management, incontinence management, detection and treatment
of depression, medication management, management of
nutrition/hydration problems and management of chronic
mental health problems.
Ultimately, the guidelines will be distributed to all
the centers in San Francisco and we will be presenting
them at state and national geriatric and day care conferences.
Visit us online at sfadultday.org
What do you see in the future for geriatric
care?
Money is a huge issue with the state budget in such
disarray. We're nervous about possible Medi-Cal cuts.
It is more humane and cost-effective to put the money
up-front, keeping patients in their community rather
than in nursing home care.
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