More than Meals

A Maryland county can thank an LPN for adding healthcare components to its Meals on Wheels program

By Bette Mooney

Meals on Wheels may be about providing nutritious meals to the at-home elderly who otherwise may not be eating healthy foods, but in Frederick County, MD, the federally funded program is also about caring and connecting with this population medically.

And an LPN there is the outreach worker who recognized the healthcare need and helped initiate a unique plan of action for Meals recipients.

Steven Stoyke, LPN, is a hotel food and beverage worker turned art teacher turned LPN. Based on his most recent years of experience as a charge nurse in a 170-bed residential nursing facility, he also has a knack for assessing home situations of older adults who frequently call for healthcare intervention.

It was less than a year ago that Stoyke responded to an ad for a project worker with Frederick County's Meals on Wheels program, which is part of its Department of Aging. Certain that his food handling background (he helped coordinate food services for one of President Ronald Reagan's inaugural balls) would be a plus in such a job, he also was aware that a nursing background was preferred.

NEED FOR INTERVENTION

Hired for the job, Stoyke almost immediately became aware that many of the Meals clients had difficulty handling key facets of their daily home medical regimens. This included operating diabetes-testing equipment AccuCheck, keeping track of medications and communicating with healthcare providers.

He gave as an example one woman in her 80s with mild dementia who was living alone and did not answer her door for the Meals volunteer.

Stoyke repeatedly tried calling her, then contacted the family, who found the woman on the basement floor with a pathologic hip fracture.

"I started looking at our clients from a nursing perspective and saw a huge void," Stoyke told ADVANCE. "Many clients are borderline [in needing full-time care]."

That's when he started keeping a log of what the volunteers reported back to him and his subsequent action.

Feb. 12, 2003: Mrs. Smith* called, asking that we cancel her meals. She appeared real shaky. After a brief conversation, the problem came out that she could not afford the meals versus paying for the meds she needs for her lupus. I reinforced the program's basic premise of providing food and then worry about the money. She agreed to stay in the program.

All of these older adults apply for the hot, midday meals because they can't afford to buy food or can't get out to shop for it, he elaborated. Clients are asked to pay $3 per meal, which includes cold food for a later meal that day, but people are not turned away because they can't pay.

Many also lack family support to check and interact for them. For some, the Meals on Wheels volunteer is the only personal contact they have on a regular basis.

Stoyke credits the dedicated Frederick County Meals on Wheels volunteers for determining the additional needs of their clients. Protocol requires that the volunteers maintain eye contact with each recipient when they deliver the once-a-day meal, so they serve as the eyes and ears of the program in reporting possible concerns.

"They assess for such things as odor, the client's eyes, skin tone and cleanliness of the home," Stoyke noted.

When the volunteers suggest that a further client assessment be arranged, Stoyke follows up, usually with a personal visit. With the approval of his supervisors, these follow-ups have developed into a beneficial liaison with other county departments, such as the Adult Evaluation and Review Service and the Mental Health Department's Social Services division, and Meals recipients' regular professional caregivers as well. Stoyke's daily logs indicate a diverse spectrum of needs and situations that beg for assistance.

Jan. 6, 2003: I found Mr. Jones* unable to work his AccuCheck machine. He has mild dementia and is unable to remember just how to do this. I try to work the machine, but the entire unit is too difficult to be utilized. The unit appears to have dead batteries. In addition, he has an entire table full of meds that I checked for dates, some of which look as though he no longer even uses — some pills conflict in doses and times for the same type of drugs. I went back to the office and called his caregivers to update them on his state of confusion. They said they would check on him.

Jan. 8, 2003: In delivering a meal to Ms. Davis' home I found a grossly obese lady who is unable to see her feet when standing at her work counter in the kitchen. She had broken a plate and didn't realize she had cut her toes. She is a brittle diabetic with a history of strokes. The doctor was called and her regular nurse was on her way. I cleaned and bandaged her wounds. The wound site had clotted when I left.

IMPROVING A GOOD SERVICE

"Meals on Wheels was a well-run program before I came on board," Stoyke emphasized. "Now we're enhancing it."

Stoyke's supervisors, Carolyn True, director of the Department of Aging, and Kitty Devilbiss, nutritional coordinator, have been his biggest advocates. The Department of Aging, in fact, "encourages me to go beyond my job description," Stoyke said.

He now initially assesses clients individually when they apply for the Meals program. "Because I am not their regular caregiver," he said, "I have to ask them if I can take their pulse, or go through their medications with them. It's like a freebie for the clients. I haven't been turned down yet."

Their physicians are equally appreciative of the extra effort made, he added, saying he has a "good relationship" with the clients' doctors.

Stoyke believes the medical connection with the Meals program is "just in its infancy" as to how far it can extend.

"The county is currently restructuring its entire program around this concept," he said. "Once we're in a new building, more emphasis will be placed on others doing the meal delivery scheduling and overseeing the volunteers." Which should free him up for other, more nursing-oriented roles, he added.

In fact, Stoyke already has begun branching out. He has become an at-large representative in the Department of Aging for the disabled, and is currently working with the Frederick city police department regarding elder abuse situations.

"The police department contacted me because I have access to other people who may be in need of these services," he said. "And it's illegal for the police to touch clients, even when the clients are violent, but nurses can."

COMMUNITY EFFORT

The innovative project worker's efforts have led to meetings with the county's Retired Seniors Volunteer Program (RSVP) – part of a network of national service programs that provides older Americans the opportunity to apply their life experience to meeting community needs. "They like what we're doing," Stoyke said, "and want to be a part of it."

Hoping to develop a program similar to Adopt a Highway, the Department of Aging's concept is to expand its services through an "Adopt a Route" plan with RSVP's help. The county's Meals on Wheels program currently delivers 1,000 meals a month to some 500 clients, but there is a waiting list because there are not enough volunteers. With RSVP's assistance, additional routes with paid delivery people could be opened up.

"We would develop a medical end to that, too," Stoyke emphasized.

Stressing that the new emphasis on medical needs in the Meals on Wheels program "just evolved É and mushroomed," Stoyke said he believes his LPN skills have helped contribute to that added dimension.

"What's interesting is what Frederick County has done with the situation," he added. "We're sort of rural, a bedroom community, and [county staff] are encouraged to wear more than one hat." He also gets satisfaction in knowing that the medical aspect of the Meals program has made it eligible for additional federal funding.

Stoyke foresees a separate division of nursing within the Department of Aging in the years to come. "I believe we'll see the entire concept evolve as the population ages," he said, "and we will become an even stronger link between our clients and their doctors in keeping them informed."

LPNs have many opportunities in this type of program, he added.

"I've even called the Frederick County Community College's nursing department to urge that nursing students work 12 hours a month delivering meals," he said. "It's a good way to mainstream people and segue students into needs and opportunities. The whole effort is kind of cutting edge for LPNs."

Bette Mooney is a freelance writer and retired editor of ADVANCE.

*Names have been changed.