As I began to write what I thought would be a poetic article, I paused to explore Robert Frost, the man. He is famous in this area for his poetry and for choosing a lifestyle of writing and taking walks in nature. He gave me a goal toward which to work.
I envision Robert Frost sitting in his Ripton cabin in need of long-term care and out of money (he is a poet, after all). My phone rings; it is a call from his case manager or doctor or home health nurse or even from Robert himself. Then I make a few phone calls but am unable to leave a message. He is out for one of his famous nature hikes, although he can't go as far as he used to and now rides an all-terrain scooter of sorts. Finally I get the man on the phone. He is not sure what I am talking about. “Choices for Care?” he asks.
“It is a Vermont Medicaid program for long-term care,” I reply. The famous scholar needs me to slow down and explain. “It is a Medicare project, a waiver to the state to provide long-term care in your choice of setting.” He is stuck on the word waiver. Nothing rhymes with that one. I change the subject. “So you write poetry?”
“A little,” he replies with a giggle. Silly nurse, he thinks.
Finally we agree on a date and time to meet. “I will be doing a clinical assessment,” I say.
“OK,” he says. He has learned by now I will say things he has never heard, and if he agrees, I will visit and give him more words he does not understand. Like most people, he is polite and a little lonely. A visitor would be nice on a snowy afternoon on the mountain.
Looking into his history, I review what I have of his medical records, home health OASIS assessment, nursing notes, doctor notes, and application. There is very little here, other than diagnoses, medications, generic and repetitive statements, and care plans—nothing about the man. I go on the Internet. Here is one guy I can search for on the Web.
He wasn't born in New England, after all. California? His dad died there of tuberculosis. I envisioned young Robbie losing his dad, hero, male role model. His mother had to support the family, to boot, so she returned to New England with the children.
I read through all the losses in his life. His children—a 3-year-old, a newborn, one died giving birth, one committed suicide. He lost his precious wife. Only later in life did he hole up in his cabin, where he could live with nature, write poetry, and cry silently and alone when the cold winds howled.
I had always thought of him as a Vermont native. I myself am not one and have been teased at times by the multigenerational natives. “Flatlander” I have been called. My husband is a fourth-generation Vermonter. He says that when we married I assumed his status as a “real Vermonter.” I do not push this to other natives; they would not accept this concession. So when I read where Robert has been—England, Massachusetts, New Hampshire—I cannot classify him as a native, but he does meet the residency criteria.
Financial eligibility is a quick review. Any assets or income for the famous poet? No surprise if I see small numbers. Many arrive at late life with pennies on the dollar. His taxes must be a bear up here, what with Flatlanders driving the property values up. He will still have to do the long forms and submit bank statements, along with accounting details for long-term care Medicaid eligibility. We will start that process if he is eligible by clinical assessment. I prepare the papers and fill in the forms where I can, and I consult my map to see where the cabin is. Reminds me of The Legend of Sleepy Hollow.
The maple leaves have fallen, and now the road is a swirl of red and yellow and brown. I go up, up, up the hill. What a place! Views far to the west, the Adirondacks in the distance. The road narrows and winds. Little bridges creak as I cross them. Funny how this road goes, first this way, then that, following a deer path perhaps. I keep stopping to check the map.
I think about the program I represent, Choices for Care, a new job for me and 11 other nurses in Vermont, one for each region and two for Burlington, the biggest city. We are paving new ground. We are all enthusiastic about helping Vermonters make a choice from among long-term care settings. The previous home-based Medicaid waiver was granted by “slots.” The funding depended on legislative action (Robert might call that an oxymoron). Now the Agency of Human Services of Vermont has gained the status to offer choices to all eligible citizens. In other words, when a client meets clinical and financial eligibility (nursing home eligible/long-term Medicaid eligible), they may choose to receive that care in a traditional nursing home, home, or residential care setting. These clients often are referred to as requiring skilled or intermediate-level care. They often choose home when they can. I'm sure Robert wants to stay at home.
I arrive at the cabin. My curious side looks at the little details—knickknacks, photos, plaques, awards, pets—as indicators of personality traits, glimpses of the life before old age. I notice smells, foods, and views out windows, wishing I could tap into the memories of when their children were born and died and married and had children. Wanting to know Robert when the whole world bought his poetry and we recited the poem “Walking through the Woods on a Snowy Evening” in English class. I want to ask him about his work, his life, his poetry. I found that many of the verses were impossible to understand, whereas others were so easy. But would he stoop to talk to me, a nurse, about poetry? Besides, I have only 2 hours to get this assessment done and then get back to the office.
He opens the door. He is shorter than I thought. Famous people usually are. He is a little shy or maybe wondering why this persistent nurse wants to visit him on a snowy afternoon. I notice the lack of female presence. This is a male cabin. His wife has been gone a long time. “Like yesterday” is how he remembers her. I get a little teary. We both laugh.
I run through the usual routine of questions. Are you able to perform the various activities of daily living? Any medical issues or memory/cognition problems? We discuss short-term problems, long-term problems, behavior issues, informal supports. I measure his level of care with the tools we were given and by my own experiences in acute care, postacute care, long-term care, insurance, home care.
I think how my own crooked path has brought me to the man who wrote about the path less traveled and how my career in case management has been a thread through it all. How when I was laid off in 1996 (nurses were never laid off), my personal devastation brought me to the most rewarding and exciting less traveled road of case management.
I review the worksheet. He meets criteria for the program. I fill out a transitional plan to get him started. We talk about case management agency choice, then personal care service choice. Then we discuss personal emergency services. Companion time. Adult day services. We discuss how, if it does not work out for him at home, he can go to a nursing home or residential care home if a bed is available. We discuss filling out the financial application and how that will be the next step. His case manager can help him with this.
By the end of our 2 hours he looks appropriately dazed by the forms, signatures, criteria, and protocols. He says he is glad he is the poet and I am the nurse. I tell him I like to think of myself as both nurse and writer and poet, except that my verses are not so perfect in meter and rhyme. My prose not desired by big publishers and scholars. I took one college course in literature. I am a slow reader. But I enjoy expressing ideas, sharing stories. Hearing a tale from a client is to me the ultimate sharing of two people in our small world. A poem without framework. A living impromptu moment of energy remembered only in our minds and so transient.
Robert's on the mountain.
Robert's on the mountain.
He's not coming down
Not coming down
Not coming down
Robert's on the mountain
Today
He's goin' for a walk
Down the less traveled path
Not coming down
Not coming down
Robert's on the mountain
To stay
Robert's goin' for a walk
Looking at a bird
Writing his words
Living up there today
Today
Robert's on the mountain
Now going to stay
Writing his poems
Welcoming the new day
Live in the present.
Stay where you are.
Robert's on the mountain
His choice is there.
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