Every Monday at 8:30 a.m. sharp, registered nurse Judy Lydon knocks on the door of Mary Lou Eugly’s apartment at the Quarry Hill extended care community in Camden. Eugly, a lively 93-year-old with a crackling personality, admits Lydon for a half-hour visit, which typically includes help with a shower, a check of vital signs, setting up a week’s worth of medicines and a general assessment of how she’s getting along.
Eugly has lived in the independent living section at Quarry Hill for 12 years, first with her husband, and since he died a few years back, on her own. She enjoys an active lifestyle that includes playing bridge with her neighbors, writing short stories, keeping up a lively email correspondence, having friends over for dinner, and going into town in the Quarry Hill van for shopping and restaurant meals.
Still, Eugly has some significant vulnerabilities. She has diabetes and must take a daily insulin injection. She checks her blood sugar every day, too, and has to pay close attention to her diet. The diabetes makes her more prone to problems such as urinary tract infections, poor circulation, swelling in her feet and legs and other conditions. She’s fallen in the shower. She also must take a variety of oral medicines, on a strict schedule, four times per day.
“It’s easy to get overloaded when you get older,” she said during a recent visit. “What I would do without Judy, I don’t know.”
Despite these medical frailties and her advanced age, Eugly doesn’t qualify for home visits from MaineHealth Care at Home, the local visiting nurse agency that gets paid by Medicare, Medicaid and private insurance policies. That’s because her status is generally stable and she’s able to be out and about in the community. Medicare would only cover the served if she had an acute health care problem and was homebound. She’s not low-income enough to qualify for Medicaid; even if she were, MaineCare, as Medicaid is called here, has restrictions of its own.
So instead, Eugly pays the Camden Area District Nursing Association its standard charge of $25 for each weekly visit. If she couldn’t afford that much, she could pay less, or nothing. The agency serves the elderly residents of Camden, Rockport, Lincoln and Hope.
“It has always been our philosophy to provide nursing care regardless of ability to pay,” said Lydon, who is the agency director as well as one of the two part-time nurses who work there.
Rather than relying on Medicare and other payors to cover the cost of visiting aging residents in their homes, the Camden Area District Nursing Association, established in 1920, is wholly funded through private and municipal donations.
“[The Camden Area District Nursing Association] serves the needs of those who ‘fall through the cracks,’ of our healthcare system,” reads the annual appeals letter that went out to potential donors last week. “We receive no State or Federal government funding to support our mission. We rely instead on the generous contributions of individuals, local charities and, to an increasing limited extent, contributions from the towns which we serve.”
Nursing at the community level
As communities across Maine work and plan to meet the needs of rapidly growing populations of older residents, community-based nurses could play a key role. These aren’t the dwindling ranks of state-employed public health nurses from the Maine Center for Disease Control, whose job includes tracking disease outbreaks and meeting the needs of new mothers and their infants, but nurses who work at the hyper-local level to provide the supportive, preventive and affordable care aging Mainers need to stay healthy and safe at home.
Community nurses once were common across Maine. Now, only vestiges of this local workforce remain.
In the town of Harpswell, east of Brunswick, retired intensive care unit nurse Peg Johnson, 75, has been making free home visits for 20 years or longer. Originally “sworn in” as a volunteer parish nurse for the local Methodist church, Johnson said, she now visits anyone on the islands and peninsulas that comprise the town.
“I live in a community where many people are not church-goers,” she said.
Accordingly, she rarely brings religion into her visits.
“But I do get involved in their spirit of hope,” she said.
Johnson said there are a few other church-based nurses in Maine, some paid and some volunteer, but each position is different and there is no overarching organization.
The majority of Johnson’s word-of-mouth clients are elderly and frail. She performs the services a trained family member might — sets up medicines, checks blood pressure, changes dressings and assesses general well-being, suggesting changes to improve health and safety. She’ll sit with the ill and dying while other caregivers take a break. She advises people on whether to contact a physician or visit the nearest emergency room, and she makes referrals to all kinds of home services, from affordable handyman services to Meals on Wheels.
While she’s not deeply religious, Johnson is guided by a sense of mission.
“It is so satisfying to help people, and they’re so grateful,” she said.
She never accepts any payment for her services.
Farther up the coast in Belfast, public health nurse Samantha Paradis is paid a part-time salary of $28,000. The funding for her position is covered largely by the town, with the balance picked up by Waldo County General Hospital and local donations. Paradis is not making home visits and is instead focused on developing a county-wide aging-in-place plan to coordinate services and resources for all older residents. Local EMT and other providers are pinch-hitting for home visits as needed.
“There just aren’t enough hours to do this planning work and also make home visits,” Paradis said, and her time right now is better spent developing a long-term strategy that likely will include nursing visits, transportation, home repairs and other support services.
An upcoming meeting on Oct. 26 in Waldo will attract municipal leaders and others from across the county to kickoff a needs assessment in every town in Waldo County.
Strengthening the community nursing network
The nurses in Camden, Harpswell and Belfast all work in different ways to meet the needs of their communities. There are other community-based programs in Maine, including district nursing agencies in Rockland and Boothbay and a freestanding public health program in the inland community of Dexter. As low-profile and far-flung as they are, they represent an important piece of the solution to caring for aging Mainers in their homes and communities, according to nurse Laurie Harding, who leads the Upper Valley Community Nursing Project based in Lebanon, New Hampshire.
Harding was a presenter at the recent Summit on Aging hosted by the Maine Council on Aging at the Augusta Civic Center. She also is a member of the Tri-State Learning Collaborative on Aging, which seeks to share experience and develop aging-related collaborations across Maine, New Hampshire and Vermont.
Harding’s program has helped nine communities in her area to develop nurse services, including church-based parish nurses, nurses on the municipal payroll, nurses funded partly through private donations and other models. Most have started as very part-time positions, with some nurses working only four hours per week at the beginning.
“But it hasn’t taken long to develop a caseload,” Harding said, and at this point, several of those communities are employing half-time nurses for about $30,000. In addition to making home visits, some nurses offer clinics after church or in the local library, where they check vital signs, consult on medications, provide diabetic foot care and more. They make extra visits when someone has been ill or comes home from a hospital stay, discuss end-of-life options with elderly residents and their families, connect clients with home services and collaborate with Medicare-funded agencies and other providers.
While it’s hard to prove that these interventions directly prevent medication errors, injuries, illness and hospitalization, Harding said the expertise and TLC provided by a nurse is proving a powerful tool in helping communities support their aging residents.
“You get a really big bang for your buck when you have a nurse,” she said.
Her project is gaining visibility, Harding said, and she is glad to talk with groups in Maine about the best way to add community-based nursing to their aging-in-place plans.