Tracy Enfinger
hospital, home health and clinical. The home health setting allowed me to meet many wonderful
people and care for them in their home which allowed for more time to address their needs. My
most memorable patient in the home health setting was an elderly lady that was approaching the
time in her life to enter into nursing home care. My reflection on this experience highlights my
I met a sweet lady, who I will call Mary, not long after becoming a home health nurse. I
was a specializing in psychiatric home health nursing and Mary was a dementia patient so she was
added to my case load Mary had many diagnoses and in addition to the dementia. Mary also had
congestive heart failure, hypertension, diabetes, atrial fibrillation with coumadin management,
neuropathy, macular degeneration, depression, paranoia, and she was frequently falling. Marys
dementia was not severe, in fact she seemed to have a rather good memory.
Marys home was a single wide mobile home that had a handicap accessible porch and
ramp. Upon entering her home It was clear to see that Mary had a problem with hording. The
pathways were barely big enough to pass through, and I would have to remove clutter just to find
a place to sit. The windows were covered with blankets so that no light from the outside could
come in and more importantly to Mary no one could see in. The home smelled of urine, was
extremely warm, and Mary had a bug problem. Florence Nightingale (1960) states, fresh air, light,
warmth, and quiet are vital to a patient. Mary did not have the most idea environment for health
Mary had no living family members and was being cared for by herself and a team of home
health professionals that included a nurse, a physical therapist, and a home health aid. The nurse
was responsible for management of Marys health needs and medications. The physical therapist
was helping Mary to build strength and balance with biweekly exercise sessions. The home health
aid gave Mary a chair bath and helped her change into clean clothes two times a week. This team
was keeping Mary in her home and out of a skilled nursing facility.
Getting to know Mary I realized that as hard as she tried to cover up her memory defecate
and her fear of being at home alone, these were very real safety concerns. Though Mary wanted to
remain in her home it quickly became clear that this was not the best setting for her. In addition to
Marys medical needs, which were very serious in nature, Marys mental health was posing a threat
that was equally as serious. One time I arrived at her home to find her at the mailbox, she appeared
to be dressed like a man in a heavy coat, scarf, hat and heavy boots. I asked her why she was
dressed this way, it was July and very hot outside, Mary replied I cant let them see me outside
of my house or they will come in and steal my medication. I asked Mary who they were, she
replied I dont know. Mary then explained she has been being watched and robbed on a regular
The home health care of Mary went on for over a year and at case conferences we often
spoke of how much better off Mary would be if she was living in a nursing home setting and our
concerns for her safety. No one wanted to approach this subject with Mary due to the fact that she
so desperately didnt want to leave her home. She had become a Grandmother like figure to us and
we cared deeply for her and her well being. Over time I had asked Mary why she kept her home
so cluttered. Mary said for two reasons, first if Im falling I will have something to grab on to,
secondly I need to keep my valuables hidden away. She infect would hide her medicine box in her
dish washer and often her purse would be under her bathroom sink.
I tried to have discussions with Mary about the risks she faced living alone with her medical
conditions, while at the same time trying not to set off her paranoia and increase her fear of the
people that are watching her and stealing her things. I tried to educate her on importance of having
a life alert system to summon help if needed and avoiding tele market type calls and scams targeted
at the elderly. Mary did not cook and it seems that Marys primary diet came from a local church
group that delivered one meal every day. Mary wouldnt budge , she wanted to remain at home.
As more months past Mary began to call rescue squad more frequently with various
complaints. She would be treated and released only to be back on the rescue squad in another day
or two. I finally decided I needed to have a talk with Marys primary care physician as well as case
management at the hospital to work toward placement in a nursing care facility for Mary. After
explaining my concerns to her doctor and the case manager at the local hospital a plan was put into
place. The next time Mary presented to the hospital she would be staying.
I thought the process would be speedy but it ended up being drawn out for weeks. Mary
was sent to two different hospitals, ones with senior care units for dementia patients and then
finally placed in a nursing home. I felt a since of relief but at the same time felt as though I had
taken part in betraying Mary by helping facilitate her placement in a nursing home. The guilt I felt
brought me to tears at times. I put off going to visit her for fear she would be angry. Finally I
decided enough time had gone by and maybe she had enough time to settle in to her new life. I
went for a visit. Flowers in hand I presented at the nursing home to see Mary. I was advised of her
room number and sent on my way. I didnt find her in her room, that was bright and cheerful, but
she was in a group room sitting playing cards with some other ladies laughing and glowing. She
looked up at me and tears filled her eyes and she reached her hands out to hug me while she was
introducing me to her new friends as her best nurse ever. Mary said she had been afraid she would
never see me again and also asked about the other team members who had become her family.
Mary was thriving, she had gained weight and had color to her cheeks, her mind was sharp and
see seemed more normal that ever. I had made the right decision.
Looking back on this I would have acted sooner and I realize that I knew what I needed to
do all along but the guilt of taking away a persons independence blocked my judgment. In the end
the very things I was helping my patient facilitate the very things that were contributing to her
declining health and instead of making her made she ended up idolizing me for helping her help
herself. Dewey (1938) states that while we cannot learn or be taught to think, we do have to learn
References
http://digital.library.upenn.edu/women/nightingale/nursing/nursing.html Kearney-
Company.