Fulfillment. Joy. Heartache. As the executive director of a home health and hospice agency, it is these three heartfelt and very human emotions that continue to trigger my deepest satisfaction, as well as produce some of my greatest challenges. Nurses, therapists, and aides who care for patients in their homes face different working circumstances than their colleagues in hospitals or skilled nursing facilities. Those who provide care in the home work alone with patients and families. This contrasts sharply with the instant exchange and camaraderie that is intrinsic of an on-site hospital or nursing home team. Yet, while home care workers enjoy greater autonomy than colleagues who are facility-bound, they still remain accountable and connected to a remote healthcare team that helps to inform and support the care they provide.
Usually, the closest person to the patient among this team is the home health aide-an indispensable caregiver who embodies the true meaning of compassionate care. Countless times I have marveled at our home health aides' extraordinary ability to care for others no matter how uncomfortable, difficult, or sensitive the situation.
Florence, who has worked as a certified nursing aide for 30 years in both our home health and hospice divisions, manifests the compassion and commitment it takes to be a home health aide. In her words, Florence describes a typical day:
My day actually begins the night before when I call my patients to let them know what time I will visit the next day. I also review the plan of care for each patient I will see.
The next morning, my first patient is Mr. Ron (all names are pseudonyms), who I've already visited several times. Coping with Parkinson disease, Mr. Ron labors in bathing and dressing himself. Today is shower and shave day. During my first few visits, Mr. Ron was reluctant to let me shower him but has grown agreeable after becoming more comfortable with my presence. In fact, he now expresses how much better he can perform his home exercise program taught to him by the physical therapist when he is clean and showered.
After a short drive, my next visit is to Mr. Ken who suffers from memory loss. Though he cannot remember me, he always greets me with a smile and loves to tell a good story. Mr. Ken requires showering, dressing, meals, and exercise. After helping him to cleanse and clothe, I happily honor his request for some fresh air and accompany him on a lovely walk outside. Following our walk, I prepare a snack for Mr. Ken and remind him to take his medication. Every visit concludes with a call to Mr. Ken's daughter, who I provide with an update. After speaking with her, I move on to my next patient.
Ms. Kathy is a widow in her late 80s and was fiercely independent until 3 months ago when she was diagnosed with lung cancer. Although on hospice for a month, she is only now allowing me to provide personal care for her. While she showers, I wash her hair and back and then help her dress. Because she is very short of breath after her showers, I encourage her to rest while I prepare her lunch. After lunch, Ms. Kathy reminisces about her husband and family. We look at a few pictures of her children and she tells me what a wonderful life that she has led. For the first time since I have been caring for Ms. Kathy, she says that she is at peace with her diagnosis, but quickly stops there and states that she needs to rest again.
After tidying the kitchen, I ensure that Ms. Kathy is comfortable and safe for the rest of the day. Although we will review her plan of care during an interdisciplinary team meeting tomorrow, today I placed a call to Ms. Kathy's case manager to report that she is more short of breath than usual and her appetite is very poor. I also requested that she be visited by our social worker.
My last patient of the day is the most challenging patient in all the years I have been a home health aide. Ms. Susan suffers from dementia, is very paranoid, is bedbound, and incontinent. I never know if she will be cooperative or not with care. Today is not a good day for Ms. Susan. I explain every aspect of the care before I proceed. She curses throughout while trying to spit at and bite me. I understand that Ms. Susan has a disease and the aggression is not directed toward me but it is hard at times.
On my drive home, I think about the day's events and how I have made a difference. After I completed her care, Ms. Susan grabbed my hand and told me that she loved me. Ms. Kathy expresses her appreciation every day for the care and compassion our team shows her. It is then that I remember why I choose to come to work every day and that this is what I was meant to do.