Yes, I see that having a nurse visit regularly is necessary and good for a portion of seniors with chronic conditions. But it's not something that all seniors need or want.
Two problems stuck out for me in reading this. One was the quote, "Despite the years-long relationships, she’s not turned her patients into highly effective self-caregivers. Everyone we see admits to missing their medicine or making bad diet decisions or slacking on exercise routines. Graefe just laboriously pushes them to make slightly better decisions on the margins." Well, slightly better is good, but is it good enough? One wonders if scaling up this project system-wide before larger-scale trials are implemented is going to be worth it.
The related problem is the one the article hints at from the trial period: this kind of home nursing care is ripe for big money-making. The implementation of a program like this must be seriously considered.
My experience is with my own elderly parents (96 and 87). They may be unique in that they both have all their mental faculties, which is the most important thing in keeping people both out of hospitals and out of nursing homes and relatively healthy: they understand and adhere pretty well to their medication and exercise regimens. But there's only so much you can do for your health at a certain age. My mother had breast cancer five years ago, my father landed in the hospital with flu and pneumonia this winter (despite having had both the flu and pneumonia shots). They're both type 2 diabetics.
When my father was released from the hospital in February, I made sure to arrange for a nurse to come visit 2-3 times per week: this is 100% covered by Medicare. I was there for the initial visit, and I was extremely impressed with the nurse and her advice and listening skills. It made my father determined to do his breathing-machine exercises and daily walks more rigorously--but only because he wanted to be done with the visits and get rid of the nurses. Within two weeks they agreed they didn't need to come any more. We had also arranged for a senior assistant to come three times a week for errands, housecleaning, etc. They fired the agency after two visits, because they felt they didn't need this, and they value their privacy. So much for help.
What if you're a lousy self-care giver with a chronic condition and your doctor orders home nursing visits ... but you don't want them? How much of this is going to be foisted onto seniors or ordered without sufficient cause?
I'm on the fence here about how this should be done. I was immensely grateful to Medicare for paying for a nurse to come visit my father when I could no longer stay in town. But even though he's very elderly and diabetic, he really doesn't need someone to come check up on him now that he is over his major illness. Who gets to determine that?
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