Bringing Care Home

For millions of house-bound elderly and vulnerable patients in America, the home nurse is a lifeline of care and personal connection. In this series of photo essays, underwritten by Kindred Health, we present an intimate portrait of these unsung heroes, their daily work and lives, and the special bonds they form with their patients.

Half Nurse, Half Counselor

With a background in psychology, and a passion for the emotional side of care, Mike Culver makes a lasting difference in his patients’ lives.

Mike Culver’s flash of inspiration to switch gears from psychiatric care to home nursing came in the form of an attacking pit bull. “I was going to rooming houses and random parks to meet patients. I loved the work and still love psych, but as I got a bit older and had kids and found myself in violent and dangerous situations, I thought maybe it was time to move on.” Now, he laughs as he shares one of his favorite things about his current job: “Honestly? I can tell people where I live.”

To meet or talk with Mike is to experience that rare person who is exactly where they’re meant to be, the place where they can do the most good and be their best self. For him, that happens to be the moment when patients are at their very worst. “When their family doesn't know what to do, they don't have somebody that's really available. When things are really bad, I can try to help them navigate it. And I obviously, I can't fix everything that's wrong, that's not real life. But I can at least help them get a grip on their situation, understand what's going on, and try to make the best decisions for themselves. That's a real honor to get to be that person.”

When their family doesn't know what to do, they don't have somebody that's really available. When things are really bad, I can try to help them navigate it.

On a recent visit, Mike spent time with Bob, an elderly patient whose daughter and wife have passed away and is now, as Mike explained, navigating his later years mostly alone. He helped Bob with his mobility, tenderly examined his toenails, and set up a podiatrist visit. Mike considers Bob a success story. “He was discharged with a wound on his leg that the doctors said wouldn’t heal. They said, just try not to get it infected. We ended up healing it in a month and a half doing what we thought would work. His family was really grateful and that built trust to keep working with us.”

True to his roots, Mike views his job as “half nurse, half counselor” and has come to value the emotional side of what he does even more than the technical side. “Blood pressures and that stuff, that's great, you can have medications delivered, you could have an automatic blood pressure cuff. You can do a lot of that stuff, but we help take some of the load off emotionally. We get to take that stress off them. If you think about it, there’s really nothing more stressful than the potential for death or dying.”

Investing at that deeply personal level creates bonds that far outlast the length of a visit or period of care. Mike shares the story of Felix, a patient he hadn’t seen in six months. Felix had a fall and ended up back in the hospital where the staff asked who they should call. “He just kept saying, you got to call Mike, you got to call Mike my nurse. It’s sad, in a way, but shows the connection we can have with people.” He’s also had family members call him when former patients pass on. “They just buried a parent or grandmother but still reach out just to say ‘thanks for being there for her.’”

In the thick of the day-to-day, the rush from one appointment to the next, it can sometimes be hard to see the bigger picture. But Mike seems to have it firmly in his sights. “When I was a kid, I used to work on a farm and at the end of the summer, you could see all the vegetables, right? You could see all the stuff that your work did, you had a physical thing in front of you. And this is the first nursing job where I get to see real positive long-term results. Seeing people that can walk that were bed bound before. Seeing someone gain strength and independence again. That’s pretty good from where I stand.”

Happy in the Scrum

For Brittney Braasch, home health is “the ultimate team sport” – and she has all the elements it takes to win.

When her supervisor recommended Brittney Braasch for this profile, he happened to mention a “fun fact”: she coaches and plays rugby in her free time. Anyone who knows rugby, and Brittney, probably wouldn’t be at all surprised. It’s a sport that requires a ton of grit, agility, 360-degree awareness of the playing field, and complete and utter dedication to the team – qualities Brittney has in spades and brings to her work every day. 

Brittney is a registered nurse out of the Kindred at Home branch in Portland, Maine, a fast-changing, rapidly diversifying coastal city. After following a path to nursing blazed by other women in her family, Brittney was drawn to home health for the independence it allows, and the accountability that goes along with it. “It's just you in a home with patients trying to figure things out and advocating for them and talking with their doctor.” Having a referral or a diagnosis on paper doesn’t tell you much about a patient, she points out, until you figure out how to speak their language. “You can’t walk in with a script and be successful.”

When asked to recall a particular moment when she felt she made a life-or-death difference for a patient, Brittney’s competitive nature becomes clear. “For me, the most satisfying thing is the patient where you walk in and they’re like, ‘You’re not going to teach me anything I don’t know.’ Winning those patients over and flipping the script and seeing them make the changes you recommended without them even knowing is a really great feeling.”

For me, the most satisfying thing is the patient where you walk in and they’re like, ‘You’re not going to teach me anything I don’t know.’

Being realistic about what you can achieve is just as important, she says. Brittney recently visited a long-standing patient who, despite every effort to change her ways, still smokes and eats more junk food than is good for her. Where others might get frustrated, Brittney stays focused and hopeful. “She's come a long way as far as her diet. She is definitely a success story. But there are some things you're just not going to change. You have to learn how to pick your battles and do what you can.”

Brittney’s next visit presented an entirely different challenge. Velma (pictured in the top photo) is a remarkable 108-year-old who lives alone in her own home where a recent fall sent her to the hospital. “We haven't had her before, which is shocking. I don't think she has even had home health before, which again, is shocking. She's pretty impressive.” While Brittney would like to move her from her old rocking chair to something safer to get in and out of, she knows better than to push it. “I mean, she's 108 so I'm okay with her telling us she's not going to do it!”

According to Christopher Sylvia, executive director of the Portland branch, Brittney’s winning ways come from not only being a strong clinician but bringing “a common-sense, down-to-Earth approach to her patients which they tend to appreciate, rather than the big-word medical expert jargon that can intimidate many patients.”

The pandemic tested the strengths and limits of every home health nurse, and Brittney was no exception. When the first wave hit Portland, she was asked to be the Crisis Response Clinician for the branch, a role she took on without a second thought. “A lot of the other nurses have kids so you don’t want them to be seeing all the COVID patients. I didn’t so was happy that it was me.” Whether in the midst of a pandemic or “normal” times, however, being able to rely on her team members means everything to Brittney. “All of our nurses, we've all been here for a pretty long time. I think that speaks a lot for the collaboration we have and the trust in each other that we have. You definitely can't succeed alone. It's the ultimate team sport.”

A Passion for the Field

The pandemic got Jen Francouer out from behind her desk, reminding her why she became a nurse in the first place. 

In her 17 years at Gentiva and now Kindred at Home, Jen Francouer has steadily risen in the ranks. Hired as a per diem RN, she moved into being a manager of clinical practice, got promoted to director of clinical management for her branch, and in 2020 was recognized as the national clinical manager of the year. Despite all that, she’s now transitioning back to being a nurse in the field full-time. “It’s strange to say, but during COVID I fell back in love with just being out on the road doing patient care. I missed why I became a nurse to begin with.”

Jen works out of the branch office in Fall River, MA, the city where she grew up. Like many of Fall River’s residents, Jen’s parents are Portuguese immigrants. “I've been immersed in that culture since I was a baby. So I can understand how humble Portuguese people are, how hardworking they are. And they can appreciate somebody that understands that culture being in their home, because I can speak Portuguese.” That cultural awareness has helped Jen tune in and empathize more deeply with patients who find themselves anxious and isolated, whether by language or other circumstances beyond their control.

It’s strange to say, but during COVID I fell back in love with just being out on the road doing patient care. I missed why I became a nurse to begin with.

When COVID first struck, Jen was overseeing all the field clinicians in her territory but quickly realized she was most needed in the field. Like every home health nurse during that time, she witnessed the struggles and strain on so many elderly people who were trapped in their homes. “You see firsthand how frightened these patients are, how much they didn't want to go to a doctor's office, or couldn’t because it was closed. You have 80- and 90-year-olds who don’t have an iPhone or know how to FaceTime. They can barely even explain what their symptoms are never mind trying to get a video up to then see their physician.”

With her patients unable or unwilling to visit a hospital, Jen came to fully appreciate the critical role technology can play in supporting home care – and the degree to which Kindred At Home is ahead of the game in putting that technology in nurses’ hands. With her background in cardiac care, Jen naturally became a super-user of the new non-invasive cardiac assessment specialty program (MyNICaS™) when it was rolled out last fall. “There’s so much technology in hospital facilities, but we know from research that patients do better, rehabilitation-wise, at home, where they're comfortable, where they know their environment. Now, we have cardiac monitoring, the Safe Strides@ balance program for therapists, compact devices we can carry around in our trunk that together can make such a huge difference in keeping patients out of the hospital.”

Jen is also quick to note that, whether in the midst of COVID or not, nothing is possible without the support of her team. Not only is the team-based model critical for coordination of care, she says, but it’s something patients notice and appreciate. “If I walk in and say, ‘I spoke to such and such. I heard you started an antibiotic.’ They know we're talking about them, so they feel important. There's conversations being had about them and the changes that are going on. It makes them feel like they're just not patients but that they're actually people we care about.”

I ask Jen if there are lessons or takeaways from this strange, difficult year-and-a-half she’d like to carry forward into her life. “I'd probably say never assume what you see at face value is true. And that would include patients, that would include co-workers, that would include yourself. So what they present to you, even though they may say that they're okay and they're doing well, it might not be the truth. Just maybe taking the extra step and spending the extra time with people to hear them out on a personal level can help everyone.”