No place like home for care

Health agency helps elderly where they live

Clockwise from top: Patient Tony Fitzpatrick exercised in his Medford home as physical therapist Carol Bickford (left) and nurse Diane Paparo observed; Fitzpatrick's wife, Mary, laughed as he walked with some help from Bickford; a device on Fitzpatrick's finger checked his oxygen level. (PHOTOS BY JODI HILTON FOR THE BOSTON GLOBE)

As Nicole Baxter opens the door to the modest but cozy apartment lit by midday sunlight, Coco runs to greet her.

Baxter, a visiting nurse, pets Coco, a Burmese cat with glowing green eyes, and murmurs in between her ears, "How you doing today, Coco?"

Coco's owner, Ellen Belden, watches as her 9-year-old companion welcomes her visitor.

Today, Belden, who pets Coco with hands gnarled from years of battling rheumatoid arthritis, has a bandage on her left arm, and Baxter quickly takes notice.

"What happened here, Ellen?" Baxter inquires, while reaching into her blue medical bag for a stethoscope. Belden explains that Coco climbed up her back to reach a high shelf and caught her arm on the way down.

"I've got to cut her claws," Belden says.

The two continue to exchange casual conversation as Baxter checks Belden's blood pressure, interjecting frequent questions about Belden's health and ailments into the easily flowing dialogue.

The routine is part of Baxter's twice-monthly visit to Belden's residence in the assisted living community Country Club Heights in Woburn.

Baxter is a nurse with the Visiting Nurse and Community Health center, and Belden is one of her regular patients.

The company, which was founded in 1898, is based in Arlington and serves 22 communities in Eastern Massachusetts.

A staff made up of 85 administrators, nurses, social workers, and physical therapists, among others, works in tandem to provide healthcare to elderly community residents in their homes - a practice that has been at the heart of the organization for 110 years, said Karen Breehey, head of marketing, public relations, and development.

"It started with nurses walking from home to home," Breehey said, adding that the organization came into its own during the flu epidemic of 1918. "They worked side-by-side trying to save one life at a time."

Now, Breehey estimates, the health center's clinicians make 45,000 visits a year. And the company will soon begin providing end-of-life hospice care, the first company to offer such care in Arlington.

Unlike many other large healthcare providers, the visiting nurse center remains a nonprofit organization - even going so far as to offer free care to those without health insurance.

"Our focus is the best delivery of care for our patients as possible," said Christine Dixon, CEO of Visiting Nurse and Community Health. "Our reimbursement is based on how well our patients do under our care."

More than 85 percent of the health service's patients are 70 or older, Dixon said, and many have been discharged from the hospital but are having problems functioning at home.

Clinicians will visit the home as often as necessary not only to provide care for the patient, but to teach family members or caretakers the best ways to ensure the patient's safety and comfort.

"It's about the continuity of care, with the goal being for the patients to remain in their home," Dixon said.

Another clinician, Carol Bickford, calls her job as a visiting physical therapist the "best kept secret" in healthcare.

"The nicest thing is you get to meet really interesting people," Bickford said, "and you get to go into their homes and see exactly what they're dealing with."

Clinicians keep track of appointments via a laptop computer system, which the health center launched in October 2007 after a five-year process of entering paper records into a database.

Now, not only do clinicians have flexibility in scheduling home visits, they also have the patient's entire medical history on the laptop as well, making it easier to provide specific care catered to each patient's needs.

"The flexibility is wonderful - we have so many working mothers here," Bickford said.

Along with being able to schedule joint visits to patients with other clinicians, Bickford said the support the center provides to traveling clinicians is unparalleled compared with her previous experiences working in a hospital setting.

"There's this real attitude of give and take, and of team support. It's very unusual," Bickford said.

The Visiting Nurse and Community Health center's approach to healthcare differs in part from that of a hospital or doctor's office, Bickford said, because clinicians enter a patient's home when providing care, immediately establishing an intimacy often lacking in other venues.

"The patients are in their comfort zone, and we're coming in as the outsiders. They help us bring us into their world," Bickford said. "It's very easy to create a friendly caring relationship where the patient feels comfortable telling us things they might not tell a doctor."

One of the main differences between a hospital setting and the care that a home health service provides, Dixon said, is the ability of the clinicians to assess the entire person, and not simply treat one specific health problem and then discharge them.

With the comfortable setting and the one-on-one care, patients and clinicians often engage in a dialogue that can help clinicians put their finger on what is ailing the patient - whether it be physical, mental, or social.

"It's a total picture of healthcare," Dixon said. "It's not only the quality of caring but also the listening to a generation that doesn't always get listened to."

Breehey estimated the company takes around a $15,000 loss each year by providing free healthcare to those who cannot afford it.

With overflowing emergency rooms and a shortage of beds in hospitals, however, Breehey said the company's patient numbers are rapidly increasing.

The commitment to the quality of care rather than profit seems to trickle down the line, as well, Bickford said - clinicians take pride in being "problem solvers" who focus on the best possible solution to a patient's problem instead of the cheapest one.

"It's imbued in the organization, that the number one priority is that we provide the patients the best of our ability, and that provides us the freedom to really get creative," Bickford said.

"If the insurance isn't going to cover it, and this patient needs it, by golly we're going to get it."

As baby boomers teeter on the threshold of old age, Dixon fears a healthcare industry already stretched too thin will not be able to handle the surge in need.

Bickford said the best part of the job is seeing former patients out at the grocery store or on the street, beginning to reclaim independence and mobility.

"It's not glamorous or sexy, but it's incredibly rewarding," she said. "You are affecting people's lives. . . . We are working with everybody's family, and that makes it just really cool."

Sarah Metcalf's e-mail address is smetcalf22@gmail.com.