Case Study 7.4: The Case of the Widow who Desires Independence

Mrs. Blundell is an 82-year-old widow. She is fiercely independent; however, she lives in a rural area and is no longer able to drive because of a problem with macular degeneration. Her only child, a son, is an engineer working in Saudi Arabia. Mrs. Blundell has a cardiac condition requiring specialist care. However, the nearest cardiologist who accepts Medicare patients is in Central City, a metropolitan area 70 miles away (the Medicare affiliated HMO reimburses physicians at less than customary fees so local specialists no longer accept these patients). There is a daily bus to Central City that Mrs. Blundell could take.

You are a nurse practicing in the primary care clinic that serves the needs of Mrs. Blundell and others like her. You have noted a growing problem with access to specialist care for your elderly patients.