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Columbia’s School of Nursing brings primary care to patients


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  • As part of Columbia University School of Nursing house-call service in Washington Heights, nurse practitioner Marie Carmel Garcon, left, has been making regular home visits to Iris Brady Boteler for a year. Photo: Natasha Roy




When Iris Brady Boteler needs a checkup, she’s stuck. It’s physically difficult for the 101-year-old to leave her home and go to her doctor’s office. Instead, Boteler’s nurse practitioner, Marie Carmel Garcon, comes to her Fort George Hill home every three months to perform a checkup on her.

Garcon checks Boteler’s heartbeat and blood pressure, and inquires about any health issues that may have come up recently. If Garcon herself can’t take care of the issue, she’ll call a doctor in her network who specializes in taking care of the specific problem.

Garcon doesn’t only serve Boteler. She has 100 patients she sees in their own homes as part of the Columbia University School of Nursing’s house calls service, ColumbiaDoctors Primary Care Nurse Practitioner Group. Garcon provides the same primary care that patients would receive in a doctor’s office.

The program, which started a little over a year ago, primarily serves seniors in Washington Heights. Columbia Nursing’s associate dean of clinical affairs, Stephen Ferrara, said the practice started in part because the school was aware that several people in the area had a difficult time accessing primary care in a traditional setting.

“It’s about accessible primary care, and we know that if we’re able to tend to our patient’s needs in a rapid way, then it tends to cut down on unnecessary hospitalizations and actually helps unnecessary hospitalizations,” Ferrara said. “It also potentially could reduce the amount of time that somebody’s hospitalized if the hospital knows that they’re being discharged to a level of service that could provide care for them in the home setting.”

The house calls program essentially brings the primary care provider’s office to patients.

“We’re talking about things like diet and exercise while prescribing medications for them, being able to order lab tests or even X-ray tests in their home to keep them healthy and keep them well where they’re most comfortable,” Ferrara said.

Before the program was even established, Ferrara had reached out to Garcon about her being the first nurse for the program. Garcon, who has been a nurse for 30 years, has worked in several areas, including bedside and outpatient care.

Garcon is the program’s only nurse practitioner thus far, but Ferrara said they are looking to add more nurses. “Right now we’re committed to this community, and we’re also looking on expanding staff to be able to care for those residents,” Ferrara said.

For Garcon, house calls aren’t simply about ensuring patients’ physical needs are taken care of — she addresses social and psychological needs as well. “It’s a trusted relationship, I would say,” Garcon said. “Once you get into the program, they see me as their, not only provider but as a friend, as a family member. Somebody they can trust, somebody who’s really an advocate to them.”

Garcon goes above and beyond to show her patients she cares. When they need to go to the emergency room, she is right there waiting for them so they can see a familiar face, and when she visits a patient for a regular checkup, she’ll pop in to catch up with her other patients in the building.

Many of her charges don’t have family who visits them, Garcon said. So instead, she makes it her business to see to their overall wellbeing. She arranges for some patients to have hairdressers, meals and more come to their home. It’s an aspect of her care her patients appreciate.

“She keeps track of me, and I let her know everything,” Boteler said. “She’s like family now.”

Boteler’s niece, who lives with her, updates Garcon on Boteler’s state. Other patients, like 84-year-old Lona Fluker, who said she does well living on her own, call Garcon when they encounter problems. Garcon taught Fluker how to use her iPhone to make FaceTime calls, and she also sets alarms and reminders for Fluker to take her medication and remember appointments.

“It’s really comforting,” Fluker said. “I respect her. I look up to her as a nurse practitioner.”

Fluker said she her relationship with Garcon is both professional and personal.

“Sometimes you don’t get both of those things — professional and nice, too,” Fluker said. “And she has both. She’s definitely professional, but also she looks at you as a patient and a friend. That’s the only way I can describe her.”

And the admiration Garcon’s patients have for her is reciprocated.

“You have that connection, that trusted relationship, and that’s the part that I love,” Garcon said.





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