Home health nurses keep track of elderly in the heat

Home health nurse Monica Coleman (right) sits with Sandra Randolph, 67, in her East Oak Lane home near a fan. Duringheat waves, visiting nurses such as Coleman check on their patients to make sure they are handling the heat well.
Home health nurse Monica Coleman (right) sits with Sandra Randolph, 67, in her East Oak Lane home near a fan. Duringheat waves, visiting nurses such as Coleman check on their patients to make sure they are handling the heat well.
Posted: July 09, 2010

The fan was cranked up high in the ovenlike living room when home health nurse Monica Coleman entered the East Oak Lane home Wednesday.

Coleman, 51, with the Visiting Nurse Association of Greater Philadelphia, was there to check on Sandra Randolph, 67, who had recently left the hospital after a bout with congestive heart failure.

Randolph had been unreachable by phone for the last week, so Coleman felt relief mingled with concern when her patient appeared.

On Tuesday, "it was too hot to breathe" outside, said Randolph, who was short of breath as she sat before a potted baby cactus.

By Wednesday, the thermometer on her first floor read 92. Randolph said she spent her time upstairs near an air conditioner.

With Philadelphia's heat breaking records this week, reaching the 100s before cooling off Thursday, the elderly, especially those with chronic medical conditions, are at high risk for heat-related illness and death. A West Philadelphia woman, 92, died Monday, the city's fifth heat-related death this summer.

The VNA has almost 1,500 homebound patients, half on Medicare. They are acute, chronically ill, and hospice patients. One-third live alone, and 70 percent are minorities.

When the weather gets unbearable, Coleman, a registered nurse for 30 years, worries most about her patients who had congestive heart failure or need kidney dialysis, she said.

Many are on water pills, which prevent fluid retention by ridding the body of excess salt and water. They can dehydrate people, leading to low blood pressure, fainting, and dizziness. The heat can also make them drink too much water, increasing fluid retention.

"Either way, you're going to the hospital," Coleman said.

For Randolph, the heat was not as much a danger because of her second-floor air conditioner. But she hadn't been taking her prescribed drugs for diabetes and hypertension, among others.

Randolph promised she'd get with the program, which includes uncaffeinated soda.

On a typical day, Coleman visits five or six patients, tracking about 30 at any time. Working for the association's chronic-care unit, she has gained the trust of patients such as Kitty Sass.

"Monica, it's about time you got here," said Sass, 90, who lives near Randolph in East Oak Lane. "You're the only person who can save me."

Sass is a woman who lives up to her name even though she's legally blind and can't leave the house by herself. To get out, she needs someone like Coleman, who comes by three times a week.

Last week, Sass was hospitalized for a mysterious rash and shortness of breath. Coleman was visiting to check on her medicine.

Like Randolph's home, Sass' place was sweltering, and without the hum of an air conditioner. All the windows were shut in the living room, where Sass sat. A fan was blowing.

"Well, why would I bring the hot air in?" Sass said when asked why she didn't crack a window.

But it's not true that closing windows keeps hot air out, said Jen Norman, assistant director of long-term access at the Philadelphia Corporation for Aging. Using a fan with windows closed creates a convection-oven effect and raises the temperature.

Older adults or people with health conditions have a harder time regulating their body temperature, Norman said. Many times their medications may keep them from feeling themselves overheating.

Back in the living room, Sass, sitting with her beagle-mix, Coffee, had a solution close at hand - an air conditioner in her basement - but "it's too exhausting to think about" taking it upstairs, she said.

"I don't mind the heat," she said. "I fare worse in the chill."

Later that day, Sass' niece rushed over and had that air conditioner installed.


Contact staff writer Brooke Minters at 215-854-2244 or bminters@phillynews.com.

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