Devoted to Care

With her patients - primarily Dominican nuns - praying for her regularly, Debra Pfeifer, RN, figures she's "definitely going to heaven."

The community health nurse is part of Comprehensive Care Management (CCM), which recently opened its Program of All-inclusive Care for the Elderly (PACE) center inside the motherhouse of the Sisters of St. Dominic Convent in Amityville, NY.

The managed care company, the nation's largest PACE provider and a member of the Beth Abraham Family of Health Services headquartered in the Bronx, is the first company on Long Island to offer a PACE program on-site in a religious congregation.

Community Welcome

A separate entrance to the motherhouse allows members of the community access to the facility. Having the CCM PACE program on premises allows the aging sisters to maintain their routines, including daily prayer, while receiving personalized medical care and participating in activities of their choice.

The program provides on-site access to a medical team of physicians, nurses, social workers, physical and occupational therapists, among others.

"It's an interdisciplinary, holistic, preventive approach," said Kathleen Kadel, BSN, RN, site director for the CCM Amityville program, which took several years to develop. Kadel spent the year prior to the launch "walking the floors," getting to know the 104 sisters in the motherhouse and their culture. "It's been very rewarding."

CCM PACE retained many of the same nurses and physicians employed by the motherhouse to ease the sisters' transition to the program. Pfeifer, for instance, was co-director of nursing for 11 years at the motherhouse before becoming the first nurse for CCM.

"With approximately 43 sisters currently participating in the program, having on-site medical care is a huge advantage," Kadel said. "The sisters and other registrants from the community have everything they need here, without going to a nursing home."

The average age of the nuns is 90.

Catholic Education

No stranger to nuns, Kadel is a product of Catholic education. Taught by Dominican Sisters through eighth grade, she was instructed by Sisters of St. Joseph in high school and again by Dominican Sisters at Molloy College in Rockville Centre, NY. "They've always been a part of my life!"

Sister Elizabeth McGarvey, OP, LCSW, (known as "Sr. Beth") councilor for health and retirement for the Dominican Sisters of Amityville, worked 21 years in a hospital. She said, "Kathleen and I work very well together because I understand a medical model and the whole managed care situation."

Kadel brought a wealth of contacts and connections when she joined CCM more than 2 years ago. Born and raised in Long Island, she worked at various home care agencies on the island and understands the Medicaid and Medicare culture.

"Long Island is just accepting managed Medicaid programs," she said. "It's a whole culture change for the hospitals and physicians. There's still a stigma. We need to educate physicians, hospitals and nursing homes and make it more comfortable for them. They're afraid they'll lose their autonomy or we won't provide all the care that's needed."

Before CCM was established in the motherhouse, the sisters' family members had to arrange for transportation for all off-site doctor visits. Now, with primary care physicians providing care on-site daily, if members need to see a specialist off-site, the program provides an ambulette and a health aide, if necessary, to take members to and from appointments.

"We used to have to coordinate everything," said Sr. Beth, a member of the six-member leadership team of this worldwide order dedicated to education and healthcare. "Because our own sisters are aging, it got harder and harder to get drivers."

Still Ministering

An adult day care program provides a variety of activity options, including everything from a book club to t'ai chi to pet and art therapy to a DJ birthday party.

"Anything to get them up and moving so they don't isolate themselves in their bedrooms," Sr. Beth said. "The day program area also has triage so if someone got sick, it's like a mini emergency department."

Since the program is open to the outside public, Pfeifer said, "some new faces will come into [the sisters'] lives and they'll be able to share their stories with these other people."

Interacting with laity in the day programs "gives the sisters a sense they are still ministering in their 90s, so it's great," Sr. Beth said.

The program also allows the sisters to visit museums, attend ballgames, and even enjoy the simple pleasure of an ice cream truck for the first time. On Memorial Day weekend, staff took the sisters to witness the aerial stunts of the famous U.S. Air Force Thunderbirds.

"It was wonderful to see sisters in wheelchairs with earphones to muffle the sound meeting the young men by the airplanes," Sr. Beth said. "The sisters loved it and the guys did, too."

Accommodations

Kadel and Sr. Beth and others adjusted a typical PACE day to accommodate the nuns' lifestyle, which tends to be "regimented" and dedicated to religious activities, Sr. Beth said.

For the sisters, the daily plan of care, for example, revolves "around the hours they worship," Kadel said. "They attend mass daily at 10:45 a.m., so between 11 and 11:30, things can be pretty quiet. You don't schedule appointments with the doctor, but there are services and therapeutic reaction for all other community members."

Kadel said the nuns "are used to socializing with people who also are sheltered. So you approach them very sensitively. You're probably more careful of being politically correct at all times."

Yet Kadel and Pfeifer both appreciate the nuns were not always sisters. "They will rely on their religion to give them comfort," Kadel said, but "from a physical and psychological perspective, they are just like us."

Like in the general population, some members of this elderly group of sisters have memory deficit from diseases like Alzheimer's. "It breaks your heart to see the most educated sister with a PhD to be admitted with dementia," Kadel said. "From what I can see, it doesn't matter how high your IQ is or how educated you are."

Because consistency is so important to a confused sister, Sr. Beth is grateful for the PACE program because it "allows continuity with familiar faces so [the sisters] don't have different staff members approaching them."

Close Quarters

The sisters live in very close proximity - "like college dorms," Kadel said - and share bathrooms, so nurses must stay hyper alert for the spread of infection. "With their comorbidities and their age, [the sisters] are very susceptible. A virus will go through an entire floor."

The nuns also are clustered so one aide can take care of up to 10 patients "so you really need to be very cognitive if someone has a virus or pink eye or the swine flu. You have to immediately think it could go into an epidemic."

Having lived together for 40 or 50 years in the convent, the sisters become like a family.

"They do socialize with their biological family," Kadel said, "but it's not like living with someone daily over the course of your entire adult life. Biological families come to visit, but many sisters unfortunately don't have any brothers and sisters left because they are so old."

Some of the nurses caring for the sisters had them previously as teachers, Pfeifer said. "It's touching to see the students who had the nuns previously come year after year to visit them."

The sisters become like family to the staff and vice versa, Pfeifer said, "so it's difficult. It's not like you take care of a person, they get better and go home and you don't know what happens to them after that. The hard part is you work with them day in and day out and actually watch them die when their time comes."

Despite the pending loss, Kadel and Pfeifer feel very fortunate. "I just feel like this is where I am supposed to be," Pfeifer said.

Kadel considers her position "the most rewarding I've had in 30 years of nursing. My personal plan is to retire from here. I was lucky enough to find a job where my philosophy of life, religion and caring for people all come together in this unique program we provide."

Kathleen A. Waton is a frequent contributor to ADVANCE.