On a raw, rainy day, Elaine Nettis, 84, arrived for what was supposed to be a routine appointment to monitor her migraines at the Jefferson Headache Center wearing wraparound sunglasses. The stress in her life was through the roof, and she'd awakened at 4 a.m. with a terrible headache. Even the gloomy spring light was too much for her sensitive eyes.
The first person to greet her was Marianne Waller, her "health pal" from Penn's Village, a community organization that helps seniors such as Nettis stay in their longtime homes. A year ago, Waller volunteered to accompany Nettis, a widow, on medical appointments. Waller serves as moral support and scribe for a woman with a sharp mind but a complex set of medical problems that includes joint and back pain, heart issues, osteoporosis, and celiac disease.
They greeted each other like old friends and headed for the crowded waiting room. Before she met Waller, Nettis was used to going to the doctor by herself. In fact, she'd often played Waller's role with her friends. But she has found it a comfort to have an advocate. "It's turned out to be a wonderful experience," she said.
Nettis' appointment that day with nurse practitioner Rachel Seligman was a long one. Seligman had to update a new computer system with all the medicines Nettis takes, and she had to try to figure out why the migraines, fairly well-controlled for months, were back with a vengeance. The obvious culprits were the spring's crazy weather and stress: Nettis' daughter was hospitalized after suffering a stroke during surgery for a brain tumor, and Nettis herself, an artist, was preparing for a show of her work. Migraine sufferers, Seligman explained, thrive on stability.
Nettis was very much in charge of her appointment. She understood her medicines, and she asked good questions. Waller sat beside her quietly taking notes. At the end of the visit, she asked for clarification on how Nettis should take a migraine medicine that Seligman hoped would break the new cycle. She promised to type up a new list of medications for Nettis, who is not computer savvy. Waller would recap the visit with Nettis the next day to make sure she remembered Seligman's instructions.
This was Seligman's first encounter with a health pal. Trained as a geriatric nurse practitioner, she was an easy sell. "It's very important to have another set of eyes and ears," she said. "I think it's a fantastic idea."
Nettis, who was amazingly cheerful for a woman with a bad headache and a seriously ill daughter, added that it was also good to have another brain in the exam room. "I wish I had had you years ago," she told Waller.
Penn's Village is one of around 200 similar organizations around the country that help people who may not have family members nearby age in place by linking them with volunteers and reputable service providers. Stella Buccella, another Penn's Village volunteer, drove Nettis from her home near the Philadelphia Museum of Art to Jefferson that morning and picked her up afterward. Some volunteers just visit or help seniors with technology. Penn's Village has about 275 members. A full membership costs $600 a year. Limited funding is available to help low-income residents with dues.
Executive director Jane Eleey said she's heard of about six other villages with programs like health pals around the country, though none in this region. Penn's Village launched its program about two years ago after researching what others had done. It currently has eight health pals with two more in training.
Nettis was Waller's first primary client. Waller, who is 75 and in good health, has worked in medical settings and is now a personal historian, writing people's life stories for them. She also backs up another health pal whose client needs lots of help.
Waller lives near Rittenhouse Square. A neighbor convinced her to volunteer. After meeting one of her clients, Waller walked back to that neighbor's house and said, "I have to tell you how filled with gratitude I am that you got me into this. It's just a great way to help people."
A side benefit for her is that she's learning a lot about local health providers and she's become friends with Nettis, who sometimes takes her to lunch after appointments.
Waller said she learned during her training to stay quiet during the medical visits. She asks questions only if it is obvious that her client isn't understanding something.
Brooke Salzman, medical director of Jefferson Geriatrics, is on the advisory board of Penn's Village. Her practice has suggested health pals to several patients, she said. "Not everyone is open to the idea of a stranger sitting in on their visits," she said, but others like it when someone else takes notes, helps them navigate the health system, and reminds them that they planned to ask certain questions. "They're making sure that the doctor communicates well with the patient, that the patient understands what the plan is," she said. "I think it's really helpful."