Program keeps seniors out of hospital

As the warm light shines through the solarium of Alice Okerstrom’s assisted living unit at Parkwood Manor, nurse practitioner Charline Hooper gets ready to take the centenarian’s blood pressure.

That’s when she notices a bruise on Okerstrom’s arm.

“Do you remember hurting yourself?” Hooper asks, while she pulls out a blood pressure testing kit.       

“No, it’s just one of the things that comes with old age,” Okerstrom replies with a chuckle.

At the tender age of 106, the senior and longest living resident at the Coquitlam care home is still spry and full of energy.

But it hasn’t always been that way.

Okerstrom spent much of 2014 battling heart failure, checking into the hospital numerous times over the course of the year.

“It was cruel,” she says of her repeated stays.

So after the last visit in November, the folks at Eagle Ridge Hospital came up with a plan that would not only keep Okerstrom out of the hospital, but improve her quality of life.

The soon-to-be 107-year-old was signed up to a unique program offered by Fraser Health called the Frail Elderly Nurse Practitioner program.

Launched in the spring of 2013, it involves nurse practitioners (NPs) working with physicians to provide routine and urgent care for homebound patients in their own homes.

Essentially, the NPs are going old school and doing house calls.

There are 136 patients enrolled — including 96 in the Tri-Cities – and the program is also available in New Westminster and Burnaby.

According to Fraser Health, the results from the first year are positive.

Data on 34 patients enrolled for at least one year indicate a reduction in ER visits by seven per cent, in hospitalizations by 16 per cent, and in length of hospital stays by 17 per cent or 4.26 fewer days.

Fraser Health also estimated the net reduced cost per patient is $3,673.

And Okerstrom might be one of the best examples of the program.

Since she was signed up at the suggestion of hospitalists at Eagle Ridge last November, she hasn’t made a trip to the emergency room since.

“I was willing to try it and it’s a wonderful service,” Okerstrom tells the Tri-Cities NOW during one of Hooper’s visits, adding her family is also happy with her participation in the program.

“It made a difference to my life.”

In the case of Okerstrom, Hooper, who is one of two NPs in the program, drops by about every six weeks for a regular checkup, which includes the basics like checking blood pressure, heart rate and breathing to make sure Okerstrom’s lungs are clear.

“As much services [as] we can bring to the person, we do that,” Hooper says, adding she sometimes drops in on Okerstrom a few extra times just to see how she’s doing.

“Stable is a big achievement in our program, because with chronic disease, we’re not looking for a cure, we’re looking for keeping you as well as you can be.”

Dr. Nick Petropolis, a family physician with the Fraser Northwest Division and lead for the program, believes NPs provide a great way for patients to have really good care in their home and still connect with their GPs.

“I’ve found my patients I could never get to … they now have a great practitioner going to their house and not only providing the care I would, but they’re able to dig deeper and learn more about their patient because they see them in their own home,” he says, adding if there is a situation out of the scope of the NPs, he’ll be contacted to help.

He suggests the program could be done in every community, noting results show it helps patients avoid getting sick and being hospitalized.

Back at Okerstrom’s apartment, the patient and nurse continue their discussion about her ongoing care in a visit that will last about half an hour.

Okerstrom is doing well enough to get out and take part in chair yoga and tai chi.

“Last year I wasn’t able to,” she says.

Hooper says the home visits have helped her patient gain the confidence she needs to manage her condition on her own between visits.

“Really, you’ve been managing well,” she tells Okerstrom.  

And the patient is quick to point out it’s her nurse who’s helped her on her way.

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