Taking Time to Lend a Hand: Remembering the Elderly during Winter Months

My firsthand experience working as an RN in public health has exposed me to issues faced by the elderly here in the United States. This population tends to be a silent group; their needs often going unheard by the Health Professionals who care for them.

I recall getting a referral to do a home visit for an elderly woman. The visit was a result of her recent visit to our local free health clinic. She had presented with third degree burns to both of her shin area. The health clinic sent me the referral order to evaluate her burns and ensure she could adequately care for them. I found her living in an old 2 story home that her family had owned since she was a child. Upon my immediate arrival, the house was clearly in horrific condition. It had no heat; the kitchen floor had sunken down to exposed ground. I could not walk into the kitchen. She had no working water or bathroom and she slept sitting up in an old dirty chair in the living room. She urinated in cups, strewn throughout the living room causing a strong urine stench. The smell no longer offending her, but to new visitors, became almost intolerable to stand. 

I determined the severe burns she had developed were a result of living in an unheated home; relying only on an old unsafe portable heater. It's exposed metal wires turned a fire red when turned on. I could see my breath in her living room. It was mid-December and down in the low 30's. In her attempt to get warm, she had not felt her legs touching the exposed heater wires due to numbness. I could barely feel my frozen fingers as I tried to re-dress her wounds in this place she warmly calls home. 

During my visit, I determined she had no food or the ability to even cook a meal, if she had enough food. She fondly told me of the local church who stopped in maybe 1-2 times a week and brought her a meal. She did not tell me how she coped between their visits and I assumed she went without. She was a thin, obviously undernourished, frail woman. The years of hard work showing on her face; yet still holding tight to her dignity and pride. She never uttered one word of complaint of her circumstances. During my initial visit working in public health, I try to gather a lifetime's worth of information in a short couple hours. I rely heavily on non-verbal communication versus what I am verbally told. I have determined this is one of the biggest problems with our current healthcare system. I see a lot of these issues are not easy for individuals to pour out onto a stranger they just met. I feel like a detective, pulling bits of information to come to a conclusion of the person I am working with. I am a RN, but most of my work is related to social needs that ultimately impact one’s health. I am very driven to always view the entire picture; as I know well, I can't get her burns healed without helping the other issues at hand.

Upon reviewing her finances, she gets a monthly social security check, but lacks transportation or the ability to go to the bank to cash it. A local neighborhood man extends his generosity and aids her monthly but charges her almost half of her check! I often find this with the elderly; their lack of independence makes them a huge vulnerability target to those who look to take advantage of them. I estimate if I can somehow fix it so she doesn't have to rely on him, she could afford heat and food. She outright refused accepting my offers to bring her back a hot meal that night. After I left her home, I went to the grocery store and picked up a loaf of bread, a jar of peanut butter, a case of bottled water and a bottle of hand sanitizer. I came back to her home and set the bag down telling her I needed to leave this in case she needed it until my next visit. My instincts tell me, she will eat after I leave, as long as I do not make this a big deal. 

During my visits with her, I explained different resources I could refer her to. Every time, she would adamantly refuse to discuss alternatives. At times, we are visionaries that help lead others in need to a path they otherwise would not have found. Her location, had the perfect housing community, newly built for the lower-income elderly population. I knew that she loved that home and it was where her family lived, where she grew up and I could see the strong emotional ties to this home. I respected that in developing my plan on how to assist her. I felt sad knowing I had to report her living conditions to the city. The city would surely condemn the home she loved so. Clearly, she was living in an unsafe environment, with little resources to aid me in fixing them. My only recourse was to work on setting up the resources she needed and relocating her to a safe environment, as close as I could to the home she did not want to leave. 


Upon reviewing her records, she had been seen by our local ER several times and actually hospitalized a couple of times. This angered me, at how our current health system lets a case like this fall thru the cracks. If the local health clinic hadn't given me that referral to check her burns, I feel she would have died in that home way before her time.

Her case took a lot of work and ended on a positive note. The city did condemn her home and we did relocate her right across the street in a new apartment, so she could look out her window and see the area she grew up in. Her finances were organized to allow her social security to directly deposit into a bank account and auto-pay her utilities. She did not have any family or caregivers, which led to her being scammed by the helpful neighbor who charged her almost $300 a month to cash her check. Although, he was very upset of the end of his scam and his threats to me fell onto silenced ears. I set-up a local hot meal delivery based on a sliding income to bring her a hot meal 5 days a week.

Six months later, I dropped by for my final case visit. I found her sitting at her kitchen table looking fondly out the window to the neighborhood she grew up in. She took my hand and with tears welling up in her eyes, she thanked me for taking the time to help her. That she now understood how dire her living environment had gotten and she was so happy in her new apartment. That the relocation could have been elsewhere, but that I had worked hard to keep her in the area she loved so much. I built a network of support for her to reach out to for the future, her social security caseworker, the local bank branch manager, the meal delivery staff and her apartment Manager. This is the key for continued support for the elderly or those who lack the ability to care for themselves entirely. I knew if I did not build this for her and ensure everyone was committed to this, her outcome would be poorer despite living in an improved environment.

This story is not a rare case. I have personally experienced hundreds of other stories related to the elderly, where their impairments make them vulnerable. It is hard for us to understand the obstacles they face. Imagine having a fear of falling with every step you take and how this alone would impact your ability to manage your life. Remove all of the people who support you or help you in times of need. Who could you trust to not take advantage of your limitations?

It starts first by educating others about this. Think about your neighborhood.... Do you have an elderly individual living alone in it? If you do, make a commitment for this new year to make a difference in someone else’s life. Stop by their home & let them know you are visiting the grocery, would they like anything picked up? Examine the non-verbal communication and the environment they are in. Spending the short 15 minutes just talking to them and showing them that they are important will make a difference. Imagine spending day-in and day-out alone with no one to talk to and nowhere to go. The impact of feeling important in another person’s life can dramatically improve their mental outlook.

Pledge this year to impact another life in some way - Together we can make a difference.



If you need help locating local resources that provide assistance to those in need, visit our website at: www.AskaNurseNow.info  A RN will provide you information, to support those in need.


Angi McElfresh, RN, BHSA
www.AskaNurseNow.info
"Your Pathway to Wellness"

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