Home Visits

On August Thursday 19th, we all pile into two cars to visit the different facilities that elderly people in the Norwalk area frequent. "We" consist of one attending, three first-year residents, one medical student, and two Princeton Fellows who work at the Norwalk Community Health Center. The attending had spent the previous half hour describing the different places our patients may be receiving care depending on their age and insurance. She mentioned that the elderly patients that pass through the clinic actually fit a very small segment of the elderly population. We discussed senior centers, rehabilitation centers, adult daycare, and nursing homes and the types of patients that might be found at each location.

Our first stop is at an adult daycare. The grassy area right outside the building is filled with slides, swings and other outdoor play equipment that one might find in a preschool yard. I comment, "Aren't those a bit too small for the adults?" Of course those play-sets are not for the adults, but rather for the preschool kids who come to visit the seniors once a week. The adult daycare center serve as a place were live-at-home adults who need constant care (many, with Alzheimer's) could go to during the day, while their relatives/primary caretakers could go to work. Apart from providing food, entertainment, and a social atmosphere, the staff at the daycare also monitor the state of the seniors. They provide showers, helping the seniors once a week to wash themselves. The caretakers at the daycare also alert health-care providers to deterioration of the senior's health or mental state.

As we enter the main common room, we see a lot of seniors sitting around, many with walkers. The senior population is severely skewed to the female gender. The attending turns to one of the male residents and asks, "you are still single, right?" Over to one wall, we see one of the seniors reclining on one of the couches. The attending comments this particular senior spends most of her time there and probably suffers from paranoia. We leave the common room and tour the rest of the facility. After meeting some of the daycare's staff, we head out to the next location.

We drive to a senior center which is based in a former school. We arrive as a bus pulls away. The seniors usually end their day at the center around 3:30. The center, similar to a YMCA, serves as a place where able seniors can find activities to occupy their time. There is a large room for group exercises. The many volunteer opportunities include meals-on-wheels, mentoring, etc. There are also message boards with postings for field trips (to casino, shopping centers to name a few). A couple of filled bookcases out in the hallway make up a free-for-all library: one can take any book and add any book at will. We step into a room to speak with four women who are playing a game of Mahjong before heading out. The attending mentions that the seniors that use the center often are able to afford to go to their own private doctors.

The last facility we visit for the day is a nursing home. A former patient, “Edward,” greets the attending doctor by calling her my lady and kissing her hand. We spend over an hour talking with Edward, learning about how he got to his present circumstances. Edward has a severe form of sickle-cell anemia. His college years were interrupted by bouts of illness. He went back home to California and lived by himself for a while. However, a sickle-cell crisis brought him back to the East Coast, where a majority of his family had moved. When his family could no longer take care of him, Edward spent some time living in a home for psychiatric patients, a place he did not like. Luckily, he was moved to the nursing home a year or so ago. Although, at 35, he is one of the youngest people at this facility, he seems to have embraced it as a sort of home for himself. He goes out of his way to help the other patients and eagerly befriends everyone. At the same time, he does not sugarcoat his situation. According to Edward, he is constantly in pain enough to know that there are different flavors of pain. Despite his difficult situation, Edward projects an open, and even happy, outlook on life.

Too often, the profile of the typical geriatric hospital patient or the nursing home patient paints our view of elderly people. Our visit to these different facilities opened us to the wide spectrum of elderly people in our communities, and their varying levels of health and independence.