It’s a little like stopping by a friend’s house to say hi and check in on them.
Each week, Centrica Care Navigators registered nurse (RN) case managers make the rounds of patients in their homes or care facilities — and often, both — to review their health conditions and to offer a friendly face.
Sometimes a visit is brief, when a patient is resting or isn’t in the mood to talk. At other times, patients are excited to have a conversation while the case manager checks their blood pressure and asks if they’re feeling any pain. Either way, the key for case managers is to make that one-on-one connection, to do what they can to help their patient’s day be less full of pain and stress.
On one spring morning, RN Case Manager Ashley Millward was able to visit all her patients in one place, Park Village Pines, an assisted living facility in Kalamazoo. She sees about 12 to 15 patients overall in a typical week and has about a half-dozen patients living in Park Village Pines.
Checking in with patients
Case managers often visit patients multiple times a week, and help one another out if a patient needs a little more attention. The day before, another case manager’s patient fell, and Ashley made sure she was feeling OK during her stop at the facility. She was; Ashley said she would mention that to the patient’s case manager.
Then, Ashley began visits with her own patients. The first patient of the day was being pushed in a wheelchair by her daughter as their time together came to an end that morning. The patient said goodbye to her daughter, then she started talking with Ashley as the nurse checked her blood pressure, her oxygen level, and her heart rate.
Ashley reminded her to be careful as she moved around, as she was 96 years old. She laughed, surprised that she was that age.
As part of the day’s activities at the facility, patients were creating bouquets by adding plastic flowers to a cup. Ashley sat for a few moments and helped the patient find the flowers she liked before stopping at the tables of some of her other patients, ones Ashley had visited earlier in the week. It’s all part of helping patients in any way they need, Ashley says, and not just offering medical services.
“It’s nice when we get to join in with them (as people),” she says. “You develop a relationship with patients and their families.”
A visit at home
RN Case Manager Kelly Flagg has some patients in facilities, but she also often visits people who are in their own homes. Like Ashley, Kelly checks vital signs and makes sure their medication is well-stocked. She also does what she can to make them comfortable.
Her first stop of the day was with a woman living with dementia. The patient showed Kelly pictures of her great-grandchildren and sat patiently while Kelly measured her arm circumference (to estimate her weight), got a blood pressure reading, and took a quick glance at the patient’s store of medications and supplies like incontinence pads.
“I look at their vital signs, but more I look at the patient themselves to see what kind of care they might need,” Kelly says. “It’s all about communication and ongoing relationships.”
Later in the day, Kelly traveled to a home of a woman caring for her husband, who was lying on a portable hospital bed covered by their grandson’s Star Wars bedsheets. The man’s wife knew precisely which medications he had been taking, and how long he had been using them.
That makes the visit much more effective for nurse practitioners. It helps them understand if a particular medication is useful for a patient, or if it should be removed or changed out for something else.
After all the visits with her patients, Ashley recorded updates on their condition for Centrica Care Navigators. She also contacted caregivers for each patient to keep them up to date. Families ask about their loved one’s vital signs, their mobility, and if they’re eating, among other common questions, she says.
She uses a booklet provided by Centrica Care Navigators called “When Death Is Near” that describes stages of dying and how a patient might look and act at those times. Helping people understand the end-of-life process is another service that case managers provide.
“There’s a lot of anxiety, and asking, ‘Is this normal?” Ashley says. “There is a lot of education for most families.”
For Kelly, educating patients and caregivers is another aspect of relationship-building.
“When I talk with a patient, it’s not, ‘You need to do this,’ but, ‘what can we do to help you live?’” she says.
Discover about Centrica Care Navigators here on our website, join us on social media, or call us at 269.345.0273.