Sinking to her haunches to meet 96-year-old Bertha “Bertie” Garand’s gaze, Gifford Medical Center nurse practitioner Kim Ladue spends a few minutes in easy banter with Bertie and her spry 95-year-old husband, Leo of Williamstown, before listening to Bertie’s heart and lungs.
Ladue repeats the stance with 43-year-old Randy Sicely of Berlin, who, like Bertie, is in a wheelchair. An amputee, Sicely has an infection where his prosthetic leg rubbed his skin, creating a wound.
Ladue checks the wound to ensure it’s healing.
With Vivian Kill, a Parkinson’s patient, it’s a cough that has Ladue again hunching down and pulling her stethoscope from around her neck to take a listen.
“Vivian’s one of my favorite ladies,” Ladue confesses with a smile to the Strafford resident.
She follows each visit by jotting down notes, pulling up lab results on the computer and dictating her findings into the telephone to be typed as part of each patient’s medical record.
Older patients and younger, routine checkups and acute care concerns, reading lab reports and dictating … it could be a typical day for a Vermont nurse practitioner. But Ladue isn’t in the family medicine office at Gifford in Randolph that she used to call home. In fact, she’s not at Gifford at all. She’s at Rowan Court Health and Rehabilitation Center.
The Barre rehabilitation center and nursing home is just one of three long-term care facilities where Ladue now spends her days. Northfield’s Mayo Healthcare Inc. and Four Season’s Community Care Home for the Elderly are the others.
For the vast majority of long-term care facilities in Vermont, having a health care provider work right in the nursing home is a fairly novel concept. But spend some time with Ladue in her new workplaces and it’s hard to imagine life without her there.
Rowan Court, with its 96 beds, is where Ladue spends the majority of her time. She and Gifford family physician Ken Borie, who is Rowan Court’s medical director, see about 55 patients there for routine care and respond to all residents’ acute care needs.
Ladue has been there now for eight months. She shows off the bright, sun-filled facility as if it is her own, interacts with staff members as if she truly is one of them and is a welcome face to residents walking or wheeling along the wide, pale yellow corridors.
Her presence, say staff, has improved patient care through continuity, reduced unnecessary trips to the hospital and emergency departments, and boosted staff morale through significant nurse education.
“She’s a fantastic teacher,” says Dianne Gile, Rowan Court staff development and infection control coordinator. “I just can’t say enough about her as far as her teaching. She’s like this huge book you can go to get all these answers.”
And at a nursing home ranked first in the state for medical acuity (sickest residents) and where the average age is 81, answers are frequently needed.
“There’s a lot of things that have to be answered right away. (With Ladue) we have an immediate response,” says licensed practical nurse Vanessa Hosefros.
Under the former – more common – care model, getting immediate answers was more challenging. Health care providers balancing busy clinic schedules visit their patients in the nursing home far less frequently than Ladue is there. And at Rowan Court, reaching out to more than 90 patients’ individual physicians for help with an acute care question was challenging. Most often phone calls were traded back and forth between the nursing home and the physician’s office between patients or at the end of the day.
“She also teaches us, which I respect as a nurse,” continues Hosefros of Ladue and Dr. Borie, who also regularly visits.
Nurse education has focused around lab work, medications, diagnostic tests and how to assess when a resident needs to go to the hospital for more acute care.
And, says Assistant Director of Nursing Barb Powley, “The residents love her.”
“Awesome,” says Sicely of his experience with Ladue and the entire Rowan Court staff.
“Excellent,” agrees Leo Garand, who visits his wife, Bertie, daily. “Whenever we notice something, we tell Kim and we talk about it and there’s action. That’s why she (Bertie) is so well: the care that we have had here the last few months.”
For Ladue, a nurse for 32 years and a nurse practitioner for the last 12, her new role is a welcome change of pace and a chance to make a difference at an important time of life.
While all of her patients aren’t at the end of life, many are and Ladue’s found gratification in helping families understand their loved ones’ health status and care wishes. “This is another way to provide care that’s more humane and dignified for patients at the end of life,” says Ladue. “We can support them at the end of life and let them die peacefully.”
At the same time, Ladue is also suggesting preventative care that can be forgotten in the long-term care setting – such as mammograms, breast exams, colonoscopies and bone density scans for some residents.
“It’s about maintaining their level of health and improving it, so they can go on and enjoy the rest of their life,” says Ladue.
One way she is bettering residents’ quality of life is carefully reviewing and, whenever possible, reducing their number of prescriptions, which can be costly and come with lots of side effects and complications.
Ladue’s snapshot into nursing home residents’ lives is also a bit more detailed than that of a visiting physician.
“I get to see them in their own environment and see how they’re living and interacting,” she says.
Besides providing direct care, Ladue also sits in on family and discharge meetings, answering family members’ questions about their loved ones’ health.
“It’s amazing,” says Pam Woodworth, a nurse and wing manager at Rowan Court. “She’s in the building. The residents know her and trust her. They’re getting better care because she is so accessible. It also makes her much more accessible to our families, and our families are much happier.”
It’s a new standard of care that Woodworth hopes to keep at her beloved workplace.
“If Kim and Dr. Borie walked out of her tomorrow, there would be a huge, huge void,” says Woodworth.
As far as Rowan Court Administrator James Beeler is concerned, there is no going back.
“It’s a tremendous step forward for us,” says Beeler. “There is no way you can go back once you have a nurse practitioner in the house.”
