People describe Marcia as kind, easy-going, and friendly. Even though she is non-verbal, she has a way of letting people know when she’s happy or sad. Suddenly, Marcia started to act differently. She was having problems eating and was easily agitated. Concerned for her well-being, a member of our nursing team came to evaluate the situation and knew immediately something was terribly wrong. Marcia was quickly taken to her physician, who discovered that she suffered from severe cataracts. She hadn’t been eating her food because she couldn’t see it. She was agitated because she couldn’t enjoy the outdoors, something she loved to do. Imagine how frightening it must have been to slowly go blind, but not be able to express that to others. Thank goodness a nurse was there.
For people with intellectual and developmental disabilities (IDD) who have multiple chronic conditions and a complex medication routine, a nurse can mean the difference between life and death. Koinonia’s nurses are our clients’ advocates for quality healthcare, and they improve healthcare outcomes by reducing medication errors, updating medical records, training direct support staff, and advocating for clients with their healthcare providers. Nursing care coordination is essential to integrating information and services of a highly fragmented healthcare system, especially for vulnerable individuals with co-morbidities and difficulties expressing themselves.
At least 60% of the people supported by Koinonia have more than five chronic diagnoses and see multiple specialists, averaging 5-20 healthcare visits per year. They also average 5-10 medications daily, more than the average nursing home patient. While Koinonia’s Direct Support Professionals accompany our clients to medical appointments, our valuable nursing team provides the necessary medical expertise to serve as advocates with other healthcare professionals like doctors, hospital staff, doctor office staff, and pharmacies.
Since the beginning of the COVID-19 pandemic, our nurses have worked tirelessly to advocate for our clients over the phone and remotely. They speak with each shift at the hospital and are constantly monitoring the health of our hospitalized clients. The hospital staff is not knowledgeable of the individual’s normal baseline, which can lead to people being sent home prematurely, further risking their health. With every shift change, a new group of hospital staff must be educated by our nurses on what is normal or baseline for our clients. Any orders from emergency room staff are not always communicated to the next nurse during shift changes. Our nurses advocate on behalf of our individuals to make sure all information is passed along to each healthcare worker. They also educate them that the person is not returning to a skilled nursing facility, but rather a group home. Many times, hospitals assume they are being discharged to someplace that has 24-hour skilled nursing care. Once discharged, they re-train the home’s direct support staff on any needed supports or orders.