NORQUAY, Sask. – The stethoscope dangles from her neck like a piece of jewelry as she drives from farm to farm checking the hearts, lungs and well-being of her elderly home-care clients.
Arlette Howard is one of two home care RNs who will make up to 28 visits this day to clients in and around Norquay for the Sunrise health district. A third nurse rotates into the schedules to allow workers time off each week.
The day starts for Howard at the Norquay health-care centre, the local hospital that houses the home-care service. Here she will check phone messages and grab the only coffee break of the day before heading out in her mobile office, a Chevy Cavalier. It clocks an average of 100 kilometres each day and contains a back seat full of dressings, vitamins, latex gloves, syringes and charts.
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On her morning visits, she fills pill dispensers, checks vital signs and examines legs for signs of swelling. Chest physiotherapy on a male client becomes a 15-minute workout on the living room couch, with Howard rhythmically tapping his back like a bongo drum.
This therapy lowers the risk of lung infections like pneumonia, she explained. That means less time in hospital and more time at home, one of the goals of home care.
“We’re keeping these people as independent as we can so they don’t end up in the long-term care facilities,” Howard said.
Mainus Tetlock helped bring home care to the district 20 years ago. Today, he and his wife May are both clients.
Much has changed since those early days when limited services like house or yard work and personal care were offered, he said. Tetlock was unaware of the present variety offered, from meal preparation to nursing, until he needed more help himself.
“It’s changed a lot,” he said.
Daily service includes chest physio for Tetlock’s lungs damaged from years of smoking and farming, and ensuring daily medications are placed into seven-day pill dispensers for the couple.
With 260 seniors in Norquay alone, the departure of the town’s only full-time doctor and the closure of emergency and observation beds this spring, Tetlock knows how necessary the service is.
“It’s there when you need it,” said Tetlock, who has remained out of hospital since he started receiving home care last summer.
Clients are not charged for nursing services, but pay $6.25 an hour for personal care, homemaking or meal preparation.
Nurses must update their training in cardio pulmonary resuscitation every two years and take assault training, said Howard, citing potential risks from clients suffering from dementia.
Howard, a nurse for the last 18 years, dreamed of this career from childhood.
“I wanted to help people and make a difference,” she said.
Howard lives in Norquay, where her husband works as the town foreman. Days can be long and day care virtually nonexistent so she relies on grandparents who farm nearby to care for her children.
Home-care clients are added and others discharged each week, with nurses usually visiting hospital patients within 24 hours of their discharge. Heavy workloads can mean longer days and overtime for nurses, but there are few options.
“We don’t really have a choice,” she said. “If we didn’t see them, they would have to go to the hospital and tie up beds.”
This day, she will change dressings, trim nails, check the blood sugar levels of diabetics and check in on a terminally ill patient living at home.
At one site, a dog stretches and rises slowly as she approaches. Howard is wary, mindful of past bites from other less friendly farm dogs.
Inside the modest bungalow, a client eats breakfast while home-care aide Donna Lee Olson prepares meals and washes dishes.
Plates of meals are stacked inside the fridge, ready to be warmed in the microwave, while a slow cooker prepares a chicken and carrot dish.
Olson will spend a few hours here to help the client take his medicine from a locked toolbox and ensure he eats and bathes.
“I like the one-on-one. It’s better than in the nursing home,” said Olson of the work.
Howard agreed, saying the job is rewarding.
“You’re facilitating and making these people be able to function at home for as long as they can,” she said.
At each home visited, Howard asks the client if they have experienced any shortness of breath, dizziness or digestive trouble.
One woman, who hesitantly points out a new skin mark, is told to make an appointment to see her doctor.
“Never be embarrassed to ask us a question,” she tells her. “You can show us anything.”
Meticulous charting ensures a continuity of care, said Howard.
Everything is charted, from pulse rates to pills dispensed. At one site, Howard struggles to get an assortment of sizes, colours and shapes of pills into the tiny dispensing compartments.
Most know her or her family, or see her at church, and talk quickly turns to local news and a recent funeral in the district.
One male client enjoys verbal sparring with Howard, teasing her about being late and reminding her of his appointments in town within the hour. Despite such complaints, he conceded the home visits are beneficial.
“I’d rather have it here, it’s better for me,” he said.
At Howard’s last stop of the morning, smells of chicken and fried potatoes fill the air of an elderly couple’s tidy farmhouse. The husband, alerting her to a change in dose on one of the prescriptions filled this week, appreciates having Howard filling their pill dispenser.
“This way, we know we’ve got the right pills,” he said.
The pair, who travel to town weekly to have their blood checked for heart conditions, plan to move there in the coming months. For now, they manage on the farm where they have lived and worked since the Depression years.
At noon, Howard holds an impromptu meeting in a client’s driveway in town with home care nurse Livia Dahlin, who offers to take on some of her cases that afternoon.
Howard said nurses take different routes and patients each week to view cases with “a new set of eyes” and to keep the job challenging. This day, she plans lunch with her colleagues but she often grabs a bite between home visits.
Howard knows most of her clients well enough to know their daily routines and tries to schedule visits around them whenever possible.
“I feel like I am a guest in their home and I want them to stay active in the community,” she said.
Most clients are waiting just inside an open door when Howard arrives, eager to share a concern and receive a visitor.
“People are just so happy to have you come to their home,” she said. “I’ve never had a case where I didn’t feel welcome.”
