TOWN OF LOCKPORT – Keri Collins has a job that matters to a lot to stressed-out families in Niagara County.
The palliative care nurse spends weekdays on the road, helping residents with significant health problems stay in their homes as they convalesce or, in many cases, live out their last days.
“I love my job here. You’re making somebody comfortable being home,” said Collins, a caseworker for Niagara Hospice and its newest program, Pathways.
Collins, of Newfane, visits her hospice patients weekly, monitoring medications, helping with pain management and dispensing support and counsel to family caregivers.
Pathways is different. These patients have chronic conditions that can be managed, and often improved. The goal is to keep patients out of the hospital and emergency rooms. Collins sees them once a month and serves as kind of a quarterback for a team that includes staff from her office and the host of doctors that most of her patients tend to have.
Hospice Buffalo has a similar program called Home Connections.
“It’s really a lot of health teaching,” said Joann Stoll, Pathways director. “One of the big advantages of being in Pathways is that many of the folks have multiple doctors, agencies. There’s a whole satellite in there talking with each other, so as the case manager, the Pathways nurse brings it all into one picture.”
Collins, 39, took the long road to becoming a registered nurse. She worked for 16 years as a cook at Newfane Rehab and Health Care Center, and later as a home health aide for Niagara Hospice when her son, Chad, 15, was a toddler. Several years ago, she enrolled at Niagara County Community College to become a registered nurse. She did her clinical work at the Niagara Hospice House and the nonprofit agency hired her nearly four years ago after she graduated.
“Two of Keri’s biggest tools are a big smile and a big heart,” Stoll said.
What was it like going back to school?
It was big change being a student at my age, but I think the teachers had a lot more respect for you. We had that will to learn instead of being out partying.
To give you an example, you go in the home and somebody might be on 20 different medications because each doctor keeps adding medicines and nobody’s looking at the whole list. So our pharmacist reviews the list, consults with the case manager and says, ‘You might want to talk about getting rid of this medicine. It’s no longer really a benefit to the patient.’ You’re doing a whole assessment, but it’s nonchalant. You’re looking at what’s going on in the home for safety, too.
What team members can you bring in?
We do have a social worker. Some patients are unable to get out of the home, so we do have spiritual care (in many cases). There is a medical director and a pharmacist. We have a team meeting once a month. It’s nice to have the whole disciplinary team together. All of this is designed to better the patient’s care.
Usually, because 24-7 they’re with the patient. The program can ease some of the stress. They’re getting some of our ideas, and knowing other people are going through the same thing helps them understand they’re not alone. We have the tools and information to help them. As the time goes on, it does settle down. And, of course, we are available. They can call us anytime if they have a question.
When caregivers are tired and looking for strategies, what do you tell them?
That’s where we can get social work to come in and talk to them. And we try to involve as much family as possible, give them some ideas for caring for the patient: ‘When they’re napping, you nap.’ We also have volunteers who can come in and sit with the patient while they go out shopping for two hours. I have somebody who enjoys going to the casino.
You are dealing with patients who are very sick, and in some cases terminal. How do you cope?
We have plenty of support here. We have a great team of fellow nurses and bosses, and we do have monthly meetings with (a counselor). I’m also an active hockey mom and golfer, so I put a lot of my stress in those.
Yes. It gets better as time goes on, because you see the transitions, the struggle that goes on with a family sickness. Making them more comfortable helps them out.
Can you talk about a patient and family you’ve really been able to ease?
A man who had orthostatic hypotension (low blood pressure). He was really struggling with that. There was a lot of med changes. He loved to hug and kiss. The case was discharged because his needs were all met. … I’m a hugger anyway.