We viewed one overall phenomenon as the overarching category for all unique intentions in RHQIs: Handling a Situation When I Am Alone at Home and Probably Need Help Quickly. It was composed of five component phenomena: Taking Care of the Situation the Best I Could First, Giving Up on the Idea of Helping Myself, Seeking Quick Help for a Certain Reason, Seeking Quick Help in a Certain Way, and Seeking Quick Help from a Certain Person/Agency. PERS subscribers did not consistently use the PERS to reach help quickly. Although 13 of 19 subscribers had used the PERS to seek help, most had also used telephones in some RHQIs. The type of RHQI was implicated in whether subscribers used PERS to reach help quickly. Every subscriber who found herself down used the PERS to summon help. PERS use in other RHQI categories was markedly lower: (a) in 1 of 3 injuries after getting up from a fall, (b) in 2 of 5 unexplainable health problems, (c) in 2 of 7 explainable health problems, (d) in 1 of 8 household problems, and (e) in 2 of 4 disturbances of one’s peace. Ms. S. noted:
When people have fallen, they use it. They know they can’t get up. But when [a friend who was a PERS subscriber] had a heart attack, she waited 7 hours before she called for help. But I could sort of understand that. She wasn’t sure it was a heart attack. You wouldn’t want to call for help, unless you really needed it.
A key finding was that the realm of standby helper activity extended beyond assistance with daily tasks; in fact, standbys were the primary helpers in the majority of RHQIs. Participants viewed standby helpers as preferred RHQ helpers, and PERS subscribers asked standbys to serve as PERS list helpers. Indeed, instead of using the PERS to contact standbys who were PERS list helpers, some subscribers telephoned those people for help in RHQIs.
Although the goal of descriptive phenomenology is to capture the essence of an experience (Porter, 1998), engaging in dialogue about an experience can affect its nature. Participating in this study might have influenced intentions about handling RHQIs, but we believe that influence was minimal. Despite interacting with project staff about the PERS during monthly in-home or telephone interviews, 4 subscribers used telephones instead of the PERS to seek quick help for health problems and post-fall sequelae during the project.
Basic Descriptions of RHQIs, Help-Seeking Strategies, and Helpers
In the descriptions below, details about RHQIs include when it occurred, device(s) used to reach help quickly, and the helper(s) involved. Exemplars are presented with associated intentions for PERS subscribers and non-subscribers.
Finding Myself Down Right Here. When women showed us their homes, they pointed out exact locations, “right here,” when they had found themselves “down” after falling to the floor from an upright position or in one case after “slithering down” while holding onto a walker. These 31 RHQIs were of three types: (a) unable to get up after trying, but able to move away from the site (21 RHQIs); (b) unable to try to get up, but able to move from the site (8 RHQIs); and (c) unable to get up after trying and unable to move from the site (2 RHQIs).
With regard to Taking Care of the Situation the Best I Could First, most intentions revolved around efforts to get up or to a telephone. However, some situations were more complex than finding oneself down on the floor. Ms. G. set the scene that preceded her RHQI:
I put some pork chops on the stove and was opening the ice box when I went down. I knowed right there and then, “I got to get that burner out.” I knew I broke the hip, because I couldn’t hardly move. So I just scooted ’til I got the burner out, and then I got to the telephone [on the wall] and pulled it down to where I could reach it.
Although the above two scenarios differed based on the ability to get up, both women could move on the floor. Most non-subscribers to PERS tried to reach a telephone, although Ms. C.C. moved to a location where she thought others could see or hear her. Ms. D., who fell in a bedroom, called out to passers-by on the sidewalk while scooting to get to the telephone. Passers-by heard both women and contacted emergency personnel. Both Ms. C.C. and Ms. D. subscribed to a PERS after these RHQIs, which occurred prior to the project. PERS subscribers reported 10 RHQIs of this type, all involving use of the PERS help button.
Two women could not move when they fell; both had an accessible RHQ device. Ms. S., the only non-subscriber who had a home security system with a remote device, had it with her when she fell: “I tried to get up and it hurt too bad, my shoulder and my hip. I really couldn’t move. So I thought, ‘Well, I need help.’ [What did you do next?] I pressed this button.”
Women who were on the floor used various strategies and devices to reach help quickly, but they tended to contact standbys who were also preferred RHQ helpers. Ms. G. knew that her rural town had recently activated 9-1-1 and that she could get an ambulance by dialing it. Yet, in “awful pain” with a broken hip, she dialed the sheriff’s office, because a deputy was her cousin:
I called up here to the law. When he come in, he put the pork chops in the ice box. They said, “What hospital?” He just up and said, “Central.” That’s where I had all my surgeries, first one thing and another. I think he knew that. Then he called my son and talked to him from the hospital. He just knew who he was taking care of.
Before that incident, Ms. G. had planned to contact her son in an emergency; however, he lived 45 minutes away. After that incident, “the law” became her preferred RHQ helper.
Several women who had frequent falls went through a process of determining which standby was a preferred RHQ helper for falls. For her first fall, Ms. Z. felt fortunate that her neighbor’s cleaning woman “had the training and didn’t have any trouble getting me up.” Those neighbors moved. When she fell again, she called her daughter and son-in-law, who lived nearby and helped her daily, but “He’s had back surgery, and he couldn’t lift me. She couldn’t get me up, ’cause she’s not very big. So she called a neighbor to help us.” The daughter encouraged Ms. Z. to consider a PERS and facilitated a subscription. However, Ms. Z. listed her granddaughter, who lived nearby, as the first responder: “She is strong and could help me get up”—perceptions that were borne out during two later falls. Although she relied on her granddaughter as a RHQI helper, Ms. Z. continued to view her daughter as her preferred RHQ helper.
Realizing that I Might Not Be Alright After Falling and Getting Up On My Own. These 15 RHQIs involved either finding that I am bleeding or having pain or swelling where I fell. Most of these RHQIs were reported by non-subscribers, including Ms. B.: “I had seven bad falls inside of probably 2 years, and I didn’t break a bone.” She had “hollered for help” by contacting her granddaughter, whose roommate was “an ex-nurse”: “They came and took me to emergency three times. I had stitches, and I’ve got one scar. Her roommate patched me up time and time again, at least four times.” Ms. B. telephoned for help a few times, but she did not want to bother her granddaughter at work. She often waited for her to drive by after work, leaving the porch light on as a signal: “That light was on for them to stop all the time.”
Ms. R., a rural non-subscriber, moved a chair from its usual position and fell while trying to sit in it to answer the telephone. Her son was calling, and he wanted to come when she told him she had fallen. She declined his help; she thought she was alright. But when “a knot came up on my head big as a lemon,” she called her nearby daughter, who came over immediately:
She wanted to take me to the hospital [medical center 25 miles away]. I said, “Sallie, there’s usually nobody going to the hospital at this time of night.” So I said, “I’m going to call Dr. B. [local physician].” She told me to press on it real hard for 5 minutes and put an ice pack on it and let it stay 30 minutes. Said, “I’m on call, but I be at my home number, too. If you need me, you call me.” So Sallie stayed here ’til I took the ice pack off. It [the knot] started going down a little bit. Dr. B. said, “Tell her she’s gonna have an awful headache in the morning.” And I did. I had a slight headache for 2 or 3 days.
Of the 3 PERS subscribers who reported a RHQI of this type, only Ms. A.A. used the PERS when she was in pain after a fall. Ms. B.B. said, “I hit my head on a brick and had a bump and a sore place.” She called her hired helper, who “came every day for 3 or 4 days to put ice packs on it.”
Realizing that Something I Cannot Explain Is or Could Be Wrong With Me. Participants reported 22 sudden health-related situations when they did not understand what was happening. PERS subscribers used the PERS help button in 2 of the 5 RHQIs they reported. Otherwise, both subscribers and non-subscribers used the telephone to reach help quickly. Non-subscribers reported 17 RHQIs of this type, and they contacted a family member or friend for help in 14 of those incidents. In 10 RHQIs, the helper took the woman to the emergency department (ED) or the physician’s office, whereas in 2 RHQIs, the helper called 9-1-1. Ms. U. called her son when she looked in the mirror and realized she had “a black eye.” He was distressed because they had agreed she would call 9-1-1 in an emergency, but she did not perceive it as an emergency:
I had no pain. I looked a mess, but it didn’t bother me. I thought it would go away. I didn’t think 9-1-1 could do anything. I wouldn’t have gone to the hospital if they [son and daughter-in-law] didn’t take me. He thought it was a stroke.
Ms. U. was hospitalized overnight for “high blood pressure.” Her son promised that in the future he would come to the hospital immediately if she went to the hospital by ambulance: “He enlightened me by saying, ‘Mom, they can help you quicker than I do.’ I answered, ‘You’re right. That’s the way we’ll do it.’” Later, when Ms. U. realized she had taken “an extra blood pressure pill,” she called 9-1-1. The medics “checked me over and said everything was fine.”
Aside from Ms. U., Ms. B. was the only other non-subscriber who contacted a health care provider about an unexplainable problem. She had a history of “that heart bit. It’ll bang real hard and feel like it’s going to stop.” One night, “I couldn’t breathe good when I went to lie down.” She called her physician: “He said it could be ‘congestive heart’. He said, ‘Go to the emergency room,’ so I did.” She drove to the ED instead of calling her granddaughter (preferred RHQ helper) to avoid “worrying her in the middle of the night.” After that, Ms. B. said that her granddaughter urged her to “‘call 9-1-1 to save time and call me, too. I’ll be there first.’ I suppose if something happens that I need to have help bad, I’d call 9-1-1. I never have had to.”
Ms. C., a PERS subscriber, explained that although she needed “help quickly” for several incidents after abdominal surgery, none was “an emergency” warranting use of the help button:
I’ve thought about you ladies down through this all. Every once in awhile, I think, “Well, there’s their famous question: Did you need help quickly?” And I thought, “Those [home care] nurses were a wonderful help-quickly.” If I worried about something, or something didn’t seem quite right, I called them. They were right here.
Knowing Enough About This Health Problem to Know What Help I Need Now. In addition to RHQIs they could not explain, participants reported 17 RHQIs with which they had some prior experience that suggested the need for specific treatments, involvement of a specific RHQ helpers, or both. During her first episode of atrial fibrillation, Ms. F. used her PERS “to reach my daughter” at work. The daughter called 9-1-1, according to Ms. F. When the problem arose again, Ms. F. called her daughter at home rather than using the PERS:
It was a Saturday; I knew I could get her. But I guess I didn’t think it was as serious, and we knew what to expect. We’d been there, done that before. So we just kind of did it ourselves.
Other women had lifelong problems that were usually minor but could get “out of hand,” such as too much “mucus,” “phlegm,” or “nosebleeds.” Others dealt with “flare-ups” (or potential flare-ups) of chronic “constipation,” “bile duct spasms,” “heart trouble,” or “high blood pressure.” Ms. Q. was the only woman who failed to contact a helper, but that did not trouble her. Her “heart was racing really bad,” but it began to “settle down.” Compared with prior episodes, “I was not that bad off, really. I’ve had those spells all my life.” Two women who were taking warfarin (Coumadin®) had “a bloody spell” due to a minor injury; they knew they were at risk for excessive blood loss. Ms. H.H. was connected to her nephew-in-law via a pager; she knew he was at home next door, when she “kicked off a toenail”: “I was able to get to the telephone...[while] grabbing up something to wrap around it.” Ms. V., a former paramedic, was dicing vegetables: “I cut my thumb a little bit. It bled, but I knew my pressure points, where I had to poke and to hold my arm up, and I did that.” She reached for the telephone and called a neighbor for help.
Facing an Unexpected Urgent Household Problem. These RHQIs included: (a) six problems with appliances or alarms, (b) five structural or access problems with the home, (c) three personal safety hazards, and (d) one pet-related problem. Ms. M. shared a RHQI story that had occurred the day before the interview. It illustrates these intentions: Taking Care of the Situation the Best I Could First; Giving Up on the Idea of Helping Myself; and Seeking Quick Help (a) for a Certain Reason, (b) in a Certain Way, (c) from a Certain Person/Agency. The narrative also illustrates the life-world descriptor of Having Quick Help From Them Here When I Needed It. Ms. M. shared:
That carbon monoxide thing just kept a-goin’, up high right next to the ceiling. I couldn’t get up there and get it down. I tried to knock it down with my cane, but I couldn’t do it. Betsey [daughter, preferred RHQ helper] was at the lake. I didn’t know what the heck I was going to do. I went out on the porch and if anyone was walking down the street, I was going to ask them to come in and tear the thing down. A woman was parked in front of my house, and I said, “I need help.” She just got in her car and rolled off. That’s when I thought, “I’m going to have some help from somewhere.” I hated to do it, but I called my son-in-law, Doug; he soon got here. He helped me a lot. Said, “You better call the fire department. Find out if there’s carbon monoxide.” They came and carried an apparatus around. Decided something was wrong with it. Doug went and bought one that plugs into the outlet. They said it was more safe.
Ms. M. was a PERS subscriber; if she realized that she could have used the PERS to contact emergency personnel, she did not say so. When the interviewer commented on the hesitancy with calling the son-in-law, she said, “I don’t like to bother anybody unless I have to.” For Ms. M., as for most women, life-world linked to RHQIs was characterized by coming to terms with bothering someone because I really had to do it.
Realizing That Someone or Something Is Disturbing My Peace. Four women reported 6 RHQIs when their serenity was disrupted. During a conversation with project staff the day after someone threw a brick into her picture window, Ms. D.D. said:
Things are pretty quiet around here, until I got that awful scare yesterday.... But things happen when you old, you feeble, and you Black. What else can you do about it? [Well...] You can’t answer that truthfully (shared laughter). [I can listen.] Well, it really upset me pretty much, at my age and in my condition. I couldn’t fight back.
Ms. D.D. had used the PERS to reach the police, as she had done for a similar RHQI prior to the project. During Interview 1, she described the PERS dispatchers as “the people in the know” and said they were her preferred RHQ helpers, especially “if someone frightened me badly.” When Ms. H. was still a non-subscriber, she called 9-1-1 when strangers knocked on her door. Later, when a neighbor’s visitors pounded on her house during the night, she called 9-1-1 again, despite the fact that she had a PERS by then. When presented with a similar incident a second time, both Ms. D.D. and Ms. H. used the RHQ device with which they had prior success.