08/10/2010 09:40 am ET | Updated Nov 17, 2011

Elder Independence: A Nurse-Driven, Community Approach

A Nurse-Driven, Community-Based Approach to Aging Independently

As a registered nurse caring for elder residents who live in a windswept apartment complex along the Far Rockaway boardwalk in New York City, Joann Walsh has a distinct advantage: she passes them in the hallway and elevators every day.

"Sometimes you see someone in the hallway who doesn't look as good as usual," says Walsh, who maintains a second-floor office and sees patients throughout Sandcastle Apartments on Seagirt Avenue. "I'll engage them if I can, see how they're doing. It makes it easier for us to reach out to people--and for them to reach out to us--because we're here on site."

Joann is part of Visiting Nurse Service of New York's Congregate Care program, a community-based model that serves more than 338 housing sites throughout the Greater New York City area and brings care directly to elderly, disabled and chronically ill individuals who live in such multi-unit settings as adult homes, senior housing, assisted-living facilities, public housing and private apartment buildings.

A dedicated nurse like Joann is assigned to the housing location and, in addition to seeing patients who are VNSNY clients, provides all residents with access to health education and information, blood pressure screenings, flu shots and other health services and resources. The model focuses on prevention and helps active seniors remain healthy and connected to their community, leading to a greater sense of independence and well-being.

"A congregate care site is true community health nursing," says Joann, who's been a congregate care nurse for 26 years. "We're here, we have a presence in the building. People come in and out of our office all the time--for information, for blood pressure screening, if they don't feel well, if they have a cut. It's a big plus to this community."

Congregate care nursing is ideally suited to the high-density population of urban areas like New York, where you can find in the larger population countless small communities that develop around cultural traditions and migration or vocational concentrations--all with unique needs and many similarities, such as the prevalence of chronic conditions.

In Harlem, which The New York Times has dubbed "an epicenter of diabetes," VNSNY Nurse Mary Braithwaite started a diabetes support group project in 2005 that supplemented the regular health lectures, discussions and screenings she offered. In Chinatown, where a large concentration of seniors are aging in place, congregate care helps alleviate the constant threats of isolation and depression and can help bridge the cultural barriers that too often translate into barriers to health care.

Among the myriad sites where congregate care takes place are naturally occurring retirement communities, or NORCs, a growing phenomenon throughout New York City and the United States as the population ages. Though not specifically built for the elderly, NORCs are residential buildings or neighborhoods that have organically grown to house a large percentage of senior residents. There is enormous potential for improving health care by working within NORCs to assess risk and increase preventive care--so much so, in fact, that we will be looking at NORCs much more closely in a future post.

The focus on age-friendly communities is more salient than ever these days, with the baby boomer population swelling the ranks of the aging. In New York City, the number of residents age 65 and older is expected to reach 1.35 million by 2030, up 44 percent from 2000. According to a recent New York Times article, the New York Academy of Medicine has gone to the City Council and the Bloomberg administration for financial and political support to enhance city life for seniors. And last month, the World Health Organization launched the Global Network of Age-friendly Cities to guide communities around the world in creating urban environments that help the burgeoning elder population remain active and healthy participants in society.

For Joann Walsh and residents of Sandcastle Apartments, New York's age-friendly environment begins at home, with neighbors--in this case, a registered nurse in Room 2A, Building C--looking in on neighbors. Joann recalls one resident in particular, a noncompliant diabetic whose poor health had come to the nurse's attention. The resident had turned away others' attempts at assistance when Joann, in a last-ditch effort, walked through the corridor and rang her doorbell during a winter blizzard. "I told her I walked through this blizzard just to see her," Joann says. "She felt bad for me and let me in."

Joann found the resident suffering from physical and mental effects of dangerously high blood sugar, an apartment in complete disarray, and piles of untaken medications. Through gentle coaxing and regular visits, Joann got the resident on the path to better health, taking her medications and monitoring her blood sugar.

"When I come into someone's apartment, I'm like a detective," Joann says, identifying one of the great values of community health care: the opportunity to assess the home environment and gather vital information about how people live. "If I see a bottle of medicine here and another bottle of medicine there, in a far corner, I'll check and make sure they're taking their medications properly. I'll look in the refrigerator and get a sense of whether they're eating well. There are definitely a number of people for whom we've been able to really change their lives for the better."

New York is preparing for a time in its near future--20 years, according to some predictions--when its population of seniors will be equal to its population of school children (as opposed to the 1950s, when children outnumbered seniors, 2:1). Many of these older New Yorkers will want to age in place, living in their own beloved apartments. As VNSNY nurses can attest--as well as thousands of New Yorkers living in congregate care facilities--a great way to age independently is in the midst of a supportive community.

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