THE SUPERVISOR AT the home care agency handed me a new patient referral: Mrs. A, 58; fractured tibia; discharged home with a lower leg cast; secondary diagnosis, type 2 diabetes.
I walked up the sidewalk to Mrs. A's home in a well-to-do suburb and knocked on the door. No answer. A curtain in the front window fluttered. I knocked again.
An older woman with gray hair pulled back in a bun inched the door open. "Shhhh," she said. "Mrs. A doesn't want a nurse, but I insisted. Come in but be quiet."
I stepped inside. The walls of the living room were stacked 5-ft high with cardboard boxes, stuffed animals, and piles of magazines, telephone books, and old newspapers. The woman waved her hand in the air. "This stuff's all hers," she said.
"You must be her mother," I said.
"Yes. You're the first person who's been inside the house for months."
"Tell me what's going on."
"She tripped over a cord from a juicer she'd just bought at a garage sale and broke her leg. She always was a saver, but collecting all this stuff started 3 years ago after her husband died."
Meeting Mrs. A
I washed my hands in the bathroom and followed Mrs. A's mother into a cluttered bedroom. A moderately obese woman with short salt-and-pepper gray hair lay sleeping in a recliner beside a large stuffed animal. Mounds of cardboard boxes covered her bed. After I introduced myself, Mrs. A let me take her vital signs, check her blood glucose level, and assess her mobility. She accepted my help transferring to her wheelchair. "We're off to a good start," I said.
"I'm only doing it for her," Mrs. A said, pointing to her mother. "She's forcing me into a rehab center otherwise."
Mrs. A sat in a wheelchair in the kitchen with me while her mother moved some boxes from the bedroom into the garage. I talked with Mrs. A about her diet and reviewed her medications. She accepted my suggestion of getting a bath chair, hand-held showerhead, and elevated toilet seat.
I explained that having so much clutter around was a safety hazard, and she could fall again. I asked what things in the house were most important to her.
"My plush animals," she said. "I love them all." After much discussion, Mrs. A decided her old magazines and telephone books interested her the least. We decided on the next morning to start clearing the paper clutter.
On the right track
I left Mrs. A's home that day feeling positive about my initial visit.
On my next visit, Mrs. A seemed very anxious. She wheeled herself from room to room picking up an item from her stacks and placing it in a different location. After I performed a physical assessment and supervised her using her walker, she seemed to calm down. I asked about activities she enjoyed.
"I haven't done much since my husband died," she said. "I retired to take care of him. I used to enjoy stamp collecting, but I don't know where they are anymore."
After some searching we found Mrs. A's stamp collection. We also created a behavior modification contract that she and I signed. Mrs. A agreed to discard three cardboard boxes every week. My task was to spend 15 minutes each week helping her organize her stamp collection.
Clear improvement
The weeks that followed didn't disappoint. Mrs. A continued to recover from her injury. On each visit, the stacks of cardboard boxes along the living room walls grew smaller and the pathways in her bedroom grew wider. Mrs. A adhered to the treatment plan and shared her feelings of guilt and grief about her husband's death.
A month later, when the family was ready for discharge from our services, Mrs. A was walking with a cane and sleeping in her bed instead of the recliner. On my last visit, she handed me a plate of homemade oatmeal cookies. "I made these yesterday," she said. "Hope we finish quickly. I've invited a neighbor over for tea this afternoon."