Your generosity delivers care where it’s needed most
Funded by the generosity of donors, as well as special events like Art with Heart, Casey House’s community programs provide a variety of health care services for people living with HIV/AIDS throughout Toronto. Our experienced registered nurses and social workers visit clients in the comfort of their own homes to provide treatment, support and care. The team also partners with other agencies to provide care and outreach support at several clinics and on board the Sherbourne Health Bus. These programs bring HIV/ AIDS care to some of our city’s most marginalized people.
Thursday, 8:30 a.m.
Casey House RN Katherine Burress arrives at a community agency that runs a drop-in program frequented by her first client of the day. He is surprised to see her, his cognitive impairment making it difficult to remember appointments. Gently laughing off his apologies, Katherine escorts him in his wheelchair to a quiet room at the agency. She gets to work changing the dressings on several wounds that are not healing well due to his compromised immune system. As she works, they chat, continuing the thread of a conversation that has developed over the course of their three-times- weekly appointments, built on his gradually deepening trust.
Later, Katherine reflects on his care needs. “There are several very serious health issues that he could be managing at any given time, not to mention all the other hardships in his life. He could be seeing a specialist every day of the week. When we talk, I encourage him to refocus on the most pressing issue, one or two each day. It’s slow going, but we take it one step at a time.”
Before driving to her next appointment, Katherine calls a case manager at a partner agency to discuss a client referral. Outlining the clinical concerns, she confirms the date of his admission to Casey House.
Katherine pulls up to an apartment building, the home of a female client who is a mother of three healthy children. The children do not know of her HIV-status and so Katherine is always careful to arrive when it’s safe to talk. The client learned of her HIV-positive status shortly after her husband was admitted to Casey House. Years later, she has built a relatively stable life for her family. Still, she is frequently beset by depression and recurrent respiratory infections.
“People often compare their lives with HIV to what they had before,” Katherine later comments on the challenges facing this client, whom she sees roughly every two weeks. “They’ll say ‘I used to be so energetic, organized, healthy…’ I’m working with her to live in the present and value what she has accomplished; in this case, three healthy kids, a roof over their heads and the ability to better manage her health. My work includes helping her to focus on what she has achieved in spite of everything.”
Katherine arrives at her desk at Casey House, where she updates charts, checks in with the other nurses and makes more phone calls to clients and partner agencies, checking on the status of referrals and booking client appointments. She eats lunch as she works, and then heads out the door to the Sherbourne Health Centre.
Katherine boards the Sherbourne Health Bus, on which she and the Casey House community nurses deliver weekly care. Today’s stop is at the People With AIDS Foundation. In a little under two hours, she treats eleven individuals, making contact with over 40 more. The people she treats have a wide range of health needs, from infected wounds to unmanaged diabetes, heart disease, dental infection and more. Treating the immediate symptoms, Katherine will refer them to appropriate health agencies for follow-up. All will leave the bus clutching a pair of clean socks or underwear, vitamins, a bar of soap or shampoo. These small basics can be powerful supports in securing a measure of dignity and even preventing serious infections.
But the most important benefit of these stops without a doubt is connecting deeply marginalized individuals to care. “We’ll sometimes see a sign that a person is immune-compromised— maybe it’s a wound that’s not healing, or a longstanding sore throat or thrush, which can be signs of HIV. We’ll ask them if they’re positive and if they are, we’ll counsel them about what they need to manage right away because of their weakened immune systems. They may not be getting any care at all, so this is a first step.”
Two hours later, Katherine has seen the last client, tidied up, and consulted with the social worker on board as she entered records into the small laptop that is kept on the bus for electronic patient charts. These charts are maintained in the system at the Sherbourne Health Centre, so that when an individual returns, there is some continuity in follow-up.
Katherine knocks on the door of an elderly client who was recently discharged from in-patient care at Casey House, where he recovered from aggressive chemotherapy for his cancer. Only a few months ago, his survival was in doubt. With a great deal of support and encouragement from the interprofessional care team and volunteers for his complex clinical needs, he has been able to return home. However, his reliance on pain medications has led to escalated dementia and depression. Katherine gently chats with him, asking open-ended questions, listening reflectively and without judgement. The goal is to help him make his own choices.
“Lectures just make people defensive,” Katherine later explains. “it’s much more useful to acknowledge their struggles and then help them to refocus on what’s working, and what’s not. Change is never simple but it has to come from the individual if it’s going to be effective.”
Katherine arrives back at Casey House in time for weekly rounds and intake planning. These meetings involve the full community team, including the nurses, social workers, chief nursing executive and clinical manager, as well as the recreation therapist and massage therapist. Additionally, the team meets with the consulting psychiatrist each week. Because clients at Casey House have complex and overlapping medical and psycho-social needs, these rounds are invaluable in planning effective care, including managing the intake of new clients.
“HIV impacts all the body’s systems, and nobody can be an expert on everything,” says Katherine. “Rounds give us a chance to problem-solve and share across disciplines, drawing on our collective experience to ensure that the client is getting the best care possible.”
Back at her desk, Katherine updates charts, sets up appointments and checks in with clients for tomorrow. She knows it will be as busy as it was today, but there is more work to be done. She would have it no other way.
“HIV is really hard to live with, and we’re always going to be supporting our clients through difficult times. But our whole team also celebrates our clients’ successes, no matter how big or small. We know that without the support of Casey House, many of the people we care for would experience a lot more illness and suffering. I go home tired, but every day, I know I made a difference.”