Every nurse should write memoirs of their memorable patients. Some of the stories I could tell from my home health nursing days you probably would never believe. Still others could only be appreciated by another health care professional that has spent some time in the “trenches” of home care. It’s not the health condition, but the environment and the personality attributes that often make the person memorable. This is the story of one such lady who was homebound with ingenuity.
“Miss Ella” was a large, matronly African-American lady around 72. She resided in a bustling housing project near downtown Lexington. Her neighborhood (aka. “the hood”) was located in subsidized public housing. Residents “came to life” around 3 p.m. in the afternoon. All our nurses made certain we scheduled our home visits in this neighborhood prior to 11 a.m. In doing so we could avoid being witness to drug trafficking, hustlers and other neighborhood riff-raff.
Miss Ella required close health care monitoring because of her diabetes and inability to see the markings on her own insulin syringes. For this reason, one of the services our agency provided was to pre-fill her insulin syringes, monitor her labs and redress a small wound she had developed on her foot. She had severe arthritis and therefore had managed to obtain a motorized scooter.
She was primary babysitter for a brood of grandchildren in her tiny 2-bedroom ground level apartment. Every morning she sent the older grandchildren off to school, watching as they caught the bus from the corner of her street. Every afternoon, she rolled to the front door waiting for the school bus to drop off her grandchildren. She dutifully watched to make sure they arrived safely to her apartment. They remained indoors (or closely supervised from her doorway) until their mother came to pick them up.
Miss Ella’s chief concern was to make certain her grandchildren didn’t become caught up in a life of crime from the negative influences of the neighborhood where she lived. She told me she wanted a better life for her grandchildren. She seemed apologetic that her financial circumstances had left her with few choices. I remember her as a kind, polite and respectful lady, teaching those same attributes to her grandchildren.
I sadly recall Miss Ella’s financial dilemma of whether she should use her limited resources to buy her medication or instead buy the groceries she needed. No patient should ever have to make choices like that. She took a variety of medications such as cholesterol lowering drugs, high blood pressure medications and a fluid pill in addition to her insulin and blood glucose monitoring supplies.
As nurses, we spent a good bit of time teaching Miss Ella the importance of monitoring her diet and keeping her blood sugars under control in order to help her wound heal and prevent further complications. We could of course tell by her 270-plus pounds, that once we were gone, Miss Ella was going to eat what she liked, what was available, and what she could afford.
Some days, we realize that, regardless of all that teaching and effort, a patient will just get a craving for fried chicken and nothing else will satisfy until they get it. Homebound status was no match for the ingenuity created by desire.
On one such day, around the first of the month, there was a temporary cash flow with the arrival of her Social Security check. I happened to be driving up Winchester Road, several miles from Miss Ella’s house on my way home from work. There was a very popular chicken restaurant chain about 50 feet from where I spotted her, close to 3 miles from home, doing the spend limit in that motorized scooter, with a large bucket of fried chicken tucked under one arm.
How could I resist laughing? Miss Ella technically met the U.S. Department of Health and Human Services criteria for homebound status in that she wasn’t driving—at least not an automobile. Homebound status and medical necessity criteria can be interpreted in different ways. Miss Ella had her own interpretation.
The language in the Health Care Financing Administration’s (HCFA) home health coverage guide, (HIM-11) states that a person may be considered homebound if leaving the home requires considerable and taxing effort. Absences from the home are acceptable, provided they are infrequent, of short duration or to receive medical treatment. Words such as “taxing”, “considerable”, “infrequent” and “short” may have very different meanings depending on the interpreter. Miss Ella won this battle of semantics. (I suppose I can appreciate how her intense craving for a bucket of fried chicken might be interpreted as an “emergency”, justifying her ingenuity in obtaining it.)
The next time I made a home visit to see Miss Ella, I admonished her, pretending to write her a speeding ticket. I asked her what she would do if she ran out of battery power on her scooter? Would she simply call Triple A for roadside assistance or a jumpstart? What if she had a flat tire on her scooter, what then? Could Triple A fix her flat? Did she have a spare?
It has been many years now since my nursing career changed course and I left home care. I’ve provided care for the homebound in 26 Kentucky counties; yet I’ll never forget this lady’s devotion to her grandchildren, desire to keep them safe and determination to protect them from their environment. I seldom ever drive up Winchester Road that I don’t remember Miss Ella. The vision of her speeding on her scooter, bucket of chicken in tow, will always bring a smile to my face.
If you’re a nurse with a funny story about one of your patients, please share (just protect their privacy by changing any identifying information.)
Pam Baker, RN
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