Melinda Morgan, on adult day health nursing

By Bree LeMaire, MS, RN
June 5, 2003

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.