Ascension St. Vincent’s offers personalized care for patients at home

Nurse practitioner Heather Ledford at Ascension St. Vincent’s travels to patients’ homes to give personalized care when they are unable to leave the house.

They say home is where the heart is, and for some Ascension St. Vincent’s patients with complex conditions, home is also where they receive timely, personalized medical care.

Advanced age, chronic illnesses or a disability can lead patients to become homebound, creating roadblocks to accessing routine medical services. According to the Journal of the American Medical Association, as many as 4 million adults are completely or mostly homebound. They are generally older and tend to have more than one complex health condition, such as cancer, diabetes, lung disease, heart failure or cognitive issues.

For patients unable to go to office appointments, Heather Ledford, a nurse practitioner for Ascension St. Vincent’s internal medicine doctor Markus Sonntag, MD, brings care to their doorstep. From providing routine vaccinations to addressing home safety to arranging mobile imaging services, Heather works with patients and their families to identify their unique medical needs.

“We noticed some of our older homebound patients were missing medical appointments because they couldn’t find a friend or family member to take them,” Heather said. “By bringing care to their home, it gives them more control over their health.”

For decades, Dr. Lee Jeter, 82, a retired radiologist, has lived with post-polio syndrome that causes progressive muscle weakness, making it difficult to leave his house. Dr. Jeter said the ability of the Ascension Medical Group St. Vincent's Primary Care - Orange Park to deliver care at home reminds him of how doctors used to practice medicine.

“When I was in medical school, a physical examination was very important,” Dr. Jeter said, who served the Orange Park community for over 25 years. “Heather is one of the major factors that’s improving my quality of life.”

Dr. Jeter’s wife, Judy, said receiving medical attention within the familiar surroundings of their home has improved her husband’s well-being. “He’s much more comfortable and feels better about himself and what he’s doing,” she said. “I see a difference in his stress level, and he’s getting excellent care. And it’s better for me because the responsibility was on me to try and arrange for transportation.”

In addition to providing a better patient experience, Heather said home visits have helped reduce hospitalizations. “We’ve developed a team model with Dr. Sonntag where we closely monitor patients, identifying those who may be experiencing a medical decline and intervening before emergencies arise.”

Twice a week, Heather visits patients’ homes throughout Clay County and some parts of Jacksonville. She spends about 10 hours driving each week, but the time is worth the effort.

“It's been a blessing being a patient advocate, stepping up and facilitating patients’ healthcare needs,” she said. “Whether it makes a huge difference or a little bit of a difference, it has meant the world to me.”