While blood pressure cuffs and thermometers might help evaluate their clients' medical needs, ESMV nurses Patricia Cornell, Renee Johnson and Gail Sendecke lean most on their listening and observation skills.

Cornell, Johnson and Sendecke are among the 25 registered nurses at ESMV who consider the mental and physical health of their clients when they are recommended for specific services, like a personal care assistant or homemaking services to stay in their own home or a move into a nursing home if that's the more appropriate environment.

 "The common thread for the three of us is that no matter what program we work in, we do medical assessments of individuals where they are at," Sendecke said. "If a consumer is in crisis, we'll do whatever it takes in order to see them. We are at heart good medical detectives who visit our clients in their homes to see with our own eyes and ears how they are doing."

 "What make a medical assessment different from a social work assessment is that when we visit, we look at a client from a medical perspective," Cornell said. "We review a client's medications and make sure they are being taken properly. We assess other warning signs and symptoms, like fall risks or other home safety issues. We do screenings for services that only a nurse can clinically recommend for Mass Health recipients."

Cornell has been with ESMV for more than 17 years. She works on a six-person Home Care team where she provides medical expertise to five care manager colleagues who are trained social workers.

Renee Johnson works in ESMV's Care Coordination Department.She is most often called on to help determine whether a client either needs nursing home care or, conversely, is able to leave a nursing home with home care supports.

Gail Sendecke, who has been with ESMV two years, helps to evaluate clients for personal care assistant services offered to low income elders and those who  are on  Mass Health with a disability.

Given the value they bring to the agency's mission, it's hard to believe ESMV didn't always have registered nurses on its staff. Cornell was one of the first hired when the need was realized.

"I have seen firsthand the evolution of how the agency has come to really rely on our distinct skill set," Cornell said. "Initially all the Home Care nurses sat together but separately from the care managers they were assigned to work with. Now each nurse is assigned to a team of five or six social workers and the team sits  together. This model has really improved communication and our overall effectiveness."

Adds Cornell, "If I see that a medication is not being taken or needs to be adjusted, I will report that first to the consumer and perhaps an engaged family member. If the situation warrants it, I might even raise my concerns with our Protective Services department. As nurses, our opinions carry the weight of medical training."

The nurses may be asked to see a consumer who could benefit from a home health aide but keeps refusing the offer of services. Sometimes it helps if they can talk to a nurse.

Cornell was recently called in to see a frail elder who was living alone in the community and refusing services. Younger family members were supportive but they still couldn't get him to accept services and knew he was at risk of ending up in a nursing home.

"Because I only do two visits a day, I had the time to spend with this elder and help him see that we were trying to help him stay in his home," Cornell said. "We suggested that a homemaker could come in three days a week to get him up, showered and dressed and make him breakfast and that by accepting lunch from our Meals on Wheels program, someone would be checking in on him mid-day. We suggested that a Lifeline phone would keep him connected to emergency services. We also suggested a referral for at home physical therapy a few times a week to help him stay active.

Added Sendecke, "What people often don't realize is that in a situation like this, a son or daughter, a niece or nephew, who may already be providing care, could be eligible to get paid $14.12 an hour through MassHealth to be their family member's formal personal care assistant if the elder is low income. Spouses aren't eligible but other family members are."

Johnson said what she loves most about her job is that it draws on every aspect of being a nurse.