Murray began by listening to Doherty’s heart, first from the front and then the back. Johanna gently took their client’s left arm and, looking at her watch, measured her heart rate. Finding things were normal, the students continued talking with her about such things as symptom identification and management and medication management. They also stressed that Doherty, like all patients, can be their own best health advocate which includes helping to identify questions to ask their provider.
“We assess their home safety, we do a medication check, we take their blood pressure, vital signs, we do depression screenings, anxiety screenings. We make sure they're on the right track - all that stuff,” said Brian Tong, a third-year student who has worked with senior clients at the Ferrin Street housing tower. “If they have any concerns, they can tell us, and then we can either relay it to their primary care physician or point them in the right direction.”
Tong found his visits to Ferrin Street invaluable because of where healthcare is trending.
“I think that healthcare is moving towards the home-based model for a lot of patients,” said Tong, a third-year student in the adult gerontology, primary care nurse practitioner track. “You know, a lot of patients, especially older patients, it's hard for them to get to their appointment. It's hard for them to get out of the house sometimes.
“I think the main advantage of these visits is you get to see their environment,” continued Tong. “You get to immediately evaluate: Is it safe? Do they have any hazards? Is the apartment sanitary? So, I think that it definitely gives you more information about a client’s living situation, their background, and it makes them more comfortable, too, because they don't have to go to a facility to get evaluated. They can do it in the comfort of their own home.”
Along with apartment visits, the Sleeper Center is leveraging a $3,000 grant from the MGH Nurses Alumni Association to establish a more permanent presence at the Ferrin Street senior housing tower. A wellness program is now up and running. Situated in the corner of the community room are supplies students will need for their visits – nurse’s bags, O2 sat monitors, stethoscopes, and blood pressure monitors. There’s also space where residents can meet with a nurse – a reminder of the Sleeper Center’s presence.
The outreach is typical of how the Sleeper Center is making a difference and expanding beyond the four walls of the Sanders IMPACT Practice Center in the Charlestown Navy Yard.
“It's important to get out into the community and bring our services to them,” said Kathy Sabo, Director of the Sleeper Center. “Students get out of the clinical setting and are seeing illness from a different perspective - in a client’s home.”
Sabo says students will discuss the same topics they would were the client at the IPC. The difference here is the vantage point – seeing up close how senior residents on a fixed income live with chronic illness. How do they get their medicine? How do they pay for their medicine. How do they live in their home?
“So, these home visits really give our students a clear picture of what it means to be a community dwelling individual who has one or two chronic illness and a low income to manage everything that's going on related to their health,” said Sabo.
The Differentiator
Enhancing the healthcare of Charlestown and Greater Boston residents – for free - has been the primary focus of the Sleeper Center since its inception in 2018. Support services are provided by IHP nurse practitioner students and are supervised by licensed nursing faculty. The Center specializes in helping clients with chronic illnesses – diabetes, cardiovascular disease, high blood pressure, arthritis and those who have suffered a stroke.
One of the main differentiators of the Sleeper Center to the other clinics is the time and undivided attention clients receive, not only in the frequency of their visits, but the quality of their time once they arrive.
“This is a real special place, it's like a diamond in the rough,” said Lisa A. Sims, a stroke survivor with diabetes and other chronic diagnoses who has been coming to the Sleeper Center for about five years. “I really feel like for that hour I have their full attention. It's all about me.”
Sims says not to take away from the care she receives at the hospital or from her primary care physician, but she doesn’t feel as though she’s always “heard.”
“I don't have that exact feeling like their devotion is right on me,” said Sims. “Because even though they’re sitting there, it seems like maybe they're thinking about their next appointment. When I come to the Sleeper Center, the hour is mine. And I really feel that when I'm talking, they're listening.”
Sims travels from Dorchester every week and appreciates the level of attentiveness IHP students provide.
“They’re teaching me things or reminding me of things so, it's a benefit to have this along with your primary care doctor,” said Sims. “Especially if you have specific chronic illness, it's very important because they notice things. They have written notes to my primary care doctor. It’s almost a midway between meeting my primary care doctor. I get to talk to them and rule everything out and then they give me ideas and suggestions on what might be going on or what I should do next.”
Housed in the Sanders IMPACT Practice Center on the Charlestown campus of the MGH Institute, the Sleeper Center provides the following services: primary care for adults and children, mental health counseling, postpartum and infant wellness, and Parkinson's Care Partner Support Group.
Eugene Flaherty comes to the Sleeper Center for his cerebral palsy and agrees with what Sims says about attentiveness and care given there.
“They have really, really good bedside manner which I suppose to an extent is something that you can teach but it's also the nature of the person,” said Flaherty. “So that tells you that the IHP and particularly the Sleeper Center does a great job getting great students in here.”
Students like Tong help make the Sleeper Center the attractive center for healthcare that it is. Tong says the benefits flow both ways – students gain considerable learning experience when it comes to taking histories and interviewing while clients gain social interaction and a safety net of sorts.
“Clients who need a little bit more care, those who either can’t afford to see their PCP every single week, or if their PCP is too busy, for them, going to the Sleeper Center is a stop gap,” said Tong. “The students make sure the medications are all up to date and see if there are any new issues.”
Tong says because the Center doesn’t prescribe medicine, it enables students to assess and manage myriad conditions.
“You kind of think about, ‘What are the interventions I can do right now for this patient without involving medications?’” said Tong. “I think it gives you a really good chance to practice.”
Kassandre Dardzinski is in the final semester of her family nurse practitioner degree and appreciated the time she was able spend with the Center’s clients.
“You could form a genuine connection and let patients bring whatever concern was pressing,” said Dardzinski. “When you have a scheduled visit at primary care, you have an allotted amount of time, usually 15 or 30 minutes, where you have a list of predetermined issues to address or they're there for a specific reason, and you just talk about that. At the sleeper center, we have a full hour with each patient. If a patient didn't have any concerns, their visit became a really in-depth health and wellness visit.”
From a student’s perspective, Dardzinski says she was able to focus on directing client conversations, bedside manner and giving physical exams. From a patient’s perspective, the Center is able to provide direction on maladies that pop up.
“Coming to a place like the Sleeper Center helps patients tease out what might be the next step for a new presenting issue,” said Dardzinski. “If you come in with knee pain, or with a vague symptom like stomach pain, we can help deduce what the next step should be in working the issue up with regard to labs or diagnostic imaging. As you get older and more health issues arise, it helps to have some place where you're not getting a bill every time you go there.”
