By Geena Monahan—For the North Star Reporter
After more than two decades caring for older adults in their homes, nurse practitioner Kaitlyn Ouellette has seen firsthand how difficult it can be for medically complex patients to navigate the healthcare system.
This summer, Ouellette, of North Attleborough, launched Harborstone Care, an independent home-based primary and palliative care practice serving older adults and medically complex patients in and around North Attleborough.
The practice brings medical care directly to patients living in private homes, assisted living communities, senior housing and rest homes, allowing her to treat people in the environment where they spend their daily lives.
“I wouldn’t say it’s one or two problems,” Ouellette said of why she started Harborstone. “It’s a lot of problems within a healthcare system that really doesn’t work well for most older adults. It’s very disjointed and super difficult to understand.”
Seeing the whole picture
Unlike a traditional doctor’s appointment, home visits allow Ouellette to gain a broader understanding of a patient’s health and daily challenges. Before she even walks through the front door, she’s already making observations.
“What does the yard look like? Do they have a car? How are they getting around?” she said.
Inside, appointments often begin with a detailed review of a patient’s medical history, medications and recent hospitalizations. Ouellette checks vital signs, performs physical exams and, when appropriate, cognitive assessments. She also spends time discussing a patient’s goals, support system and advance care planning.
“I reconcile every medication, bottle by bottle,” she said. “I make sure they know what it’s for and ask if they’re actually taking it.”
From there, each care plan is tailored to the individual. That may include adjusting medications, coordinating with specialists, involving family members or connecting patients with home services.
Ouellette said visiting patients at home often reveals challenges that aren’t visible during an office appointment.
“In a traditional primary care office, the person has to be feeling pretty good just to show up,” she said. “They’re dressed, their family has taken them and they’re feeling well enough to get there. It’s the best-case scenario.”
At home, she sees something different.
“You see the food that wasn’t eaten, or the lack of food. You see the bills that have piled up. You see medications that need help being organized,” she said. “You’re seeing real life.”
A lifelong calling
Growing up in North Attleborough, Ouellette found herself connecting with older generations from a young age. At 18, she began working as a home health aide while attending the University of Massachusetts Amherst, caring for a man with multiple sclerosis.
After graduating from nursing school, she spent five years working in psychiatry at McLean Hospital in Belmont before returning to geriatrics. She earned a Master of Science from the University of Massachusetts Boston’s College of Nursing & Health Sciences and became board-certified as an adult-gerontology nurse practitioner.
She then joined Commonwealth Care Alliance, spending 13 years providing home-based care for medically complex older adults. During that time, a personal experience reshaped her approach to caring for patients with serious illnesses.
After watching her husband’s mother die from ovarian cancer, Ouellette said she realized patients and families deserved more support while navigating the healthcare system, inspiring her to pursue additional certification in hospice and palliative care.
“We have to do better for patients,” she recalled thinking.
When she began building her own practice, Ouellette said Harborstone felt like the right name.
“I’ve always loved the ocean,” she said. “A harbor is a refuge from a rocky sea. It’s a strong foundation.”
Care close to home
Ouellette said some of the most meaningful moments of her career have come from helping patients remain safely at home while receiving care that reflects their wishes.
She recalled caring for a woman with end-stage chronic obstructive pulmonary disease who wanted to avoid aggressive medical interventions and remain comfortable at home. Despite hospitalizations, Ouellette worked with the patient’s family and medical team to honor those wishes.
“Anytime there was a hospital visit, she would say, ‘Call Katie,'” Ouellette said. “She’ll know what to do.”
Another patient, a woman in her early 40s with a brain tumor and little family support, was ultimately able to spend her final days in a safe apartment with her son.
“Looking back on it, it’s amazing that she died so peacefully,” Ouellette said.
Although end-of-life care can be emotionally difficult, she said helping patients receive the care they want makes those moments meaningful.
“It’s more difficult to watch patients struggle through the healthcare system without the appropriate support,” she said. “At the end of the day, you know you’re helping.”
Through Harborstone Care, Ouellette hopes to bring that same approach to patients throughout North Attleborough, Attleboro, Plainville and neighboring communities. The practice accepts Medicare and provides Medicare-covered home visits, advance care planning and chronic disease management. Patients are responsible only for the same costs they would incur during a traditional office visit.
“I grew up here, I’ve lived here the majority of my life, and this is a community I love,” she said. “I love running into people I know. It makes life a little more special when you’re caring for people you have connections with.”