A nurse practitioner (NP), like the ones at Centrica Care Navigators, visits patients wherever they live. That’s often at their home, or in a care facility like our own Centrica Rose Arbor Place. They check in on how patients are doing, and, if necessary, revisit the patient’s medication plan to make sure it is appropriate for their current needs.

One day in September, Chris, a Centrica Care Navigators NP for the last five years, drove from patient to patient. Some were brand new to her, and others she had seen several times in the past. Every patient gets the same level of attention and care. Most of the time, Chris said, her job is simply to talk with people.

“You’re almost like a detective, trying to find out how the hospice condition affects the patient,” she said.

Answering questions to start the day

Her first stop of the day was at the home of a 95-year-old woman for an initial appointment; what Chris called a “get-to-know-you” visit. The woman’s daughter, who was her caregiver, said she contacted Centrica Care Navigators after her mother’s doctor suggested it was time to think about end-of-life care.

Her daughter called Centrica Care Navigators and answered a few questions, summarizing her mother’s condition. After that first interview, a care team was assigned, including Chris as the NP, and an hour-long visit was scheduled.

The woman was living with her daughter and the daughter’s husband. They had been helping the woman for years as her dementia progressed; though the woman was able to answer Chris’ questions, she responded slowly.

Together, Chris, the patient, and her daughter and son-in-law reviewed the woman’s last few weeks of care.

The woman’s son in law mentioned that she had soreness in her shoulder; Chris carefully moved her arm to find exactly where it hurt, and reviewed the records at Bronson Hospital, where the woman had previously been a patient.

They discussed options for appropriate treatment and settled on a medication that would help with the soreness. Chris ended the visit with a promise to return in a few weeks.

It’s important to recognize what’s most important for the patient and their family immediately, and also to consider the future, Chris said. With that patient, it was clear the shoulder pain was the primary issue. That’s what she focused on first.

“You have to figure out who you need to be for that family,” she said. “Let us get to know them, and we’ll have a better understanding of where we’re going.”

A good support system

In her second visit of the day, Chris needed to be a voice of support for the patient’s wife. She sat in the living room of their house, waiting for their granddaughter to return with a freshly groomed dog. In the back of the house, her husband moved from the bathroom back to the bedroom, where he crawled under a thick blanket.

Chris checked on him — his breathing, if he was staying warm — and also talked with the patient’s wife. Chris asked if there was a “support system,” like neighbors and friends. She said there was: in addition to her granddaughter, who lived locally, a nurse lived above them, and other family were just a phone call away.

She also said she wasn’t sure how she would be able to handle her husband’s death when it happened. Chris said her Centrica Care Navigators team was there to support her. Her social worker could help her find resources if they needed transportation to visit a doctor. Her chaplain would be available to talk about spiritual matters.

Over the course of a typical month, Chris visits with about 100 patients in southwest Michigan. They are all face-to-face meetings. That’s something that makes Centrica Care Navigators unique in the hospice care space.

“Families like to see who they are working with, who’s giving the ‘orders,’” Chris said, though she emphasized that the nurse and the Centrica Care Navigators team is a partner with each patient and their caregiver. The intent is that everyone is up to date on any changes in a patient’s condition, and knows the next steps that will be taken to provide the patient with high-quality compassionate care.

Nurses and nurse practitioners

Though the titles are similar, nurses and nurse practitioners — both are part of the team at Centrica Care Navigators — have different responsibilities. While both work with patients individually, nurse practitioners are able to assess, diagnose, and prescribe medications to patients, while nurses need an NP or physician to order a prescription.

That means that part of Chris’ day, usually toward the end of her shift, is spent talking with nurses to make sure their patients are getting the right treatment.

“The questions are often about symptom management: what are they on, what can be done,” Chris said.

In the afternoon, Chris visited a patient who was very familiar with the treatment he was receiving. His wife was a former nurse, and while the patient lay on a bed in his living room, the patient and his wife told Chris what they had noticed since her last visit.

They noted that the patient was “seeing some declines overall.” In order to continue to receive Medicare hospice benefits, a patient’s hospice physician and regular physician must certify that the patient has a life expectancy of 6 months or fewer.

“We do as many visits as necessary,” she said. “We want to make sure we devote appropriate time to each task instead of trying to do everything at once.”

The overall goal for every member of the hospice care team, Chris said, is to help patients feel comfortable and respected during their time in end-of-life care.

“It’s more about the quality, not quantity, of days,” she said.

Discover more about the Centrica Care Navigators care team here on our website, join us on social media, or call us at 269.345.0273.