During the winter months, families often look for signs that their older relatives may need assistance to stay safe and independent in their homes.

Sometimes, they notice changes in their elders, but because things happen slowly over time, the full spectrum of difficulties may not be clearly defined. Declining personal hygiene, changes in housekeeping, sleeping or eating habits, unopened mail or unpaid bills, memory loss, signs of depression -- all are things that make it tougher for these family members to stay safe and independent in their homes.

So who is a concerned family member going to call?

At the top of many lists is the home health nurse, a trained professional who always works with other members of a home health team to keep Grandma in her home, all members of the home health team working as patient advocates.

But in reality, home health nurses aren't limited to elder care.

"We provide a wide array of services to both the infant and the geriatric populations," said Deb Santee, a home health nurse at St. Luke's Home Health Care in Sioux City.

In fact, ask a home health nurse like medical manager Santee or St. Luke's colleague Rorie Reynolds, a quality nurse, about their job, then stand back so as not to be drowned by the flow of medical information about what they do for their patients, from infants to the most senior of citizens.

Using their skilled nursing services, they may teach patients and their families about IV antibiotics at home, IV medications or provide disease process teaching to help keep patients out of the hospital, wound management and care, or pain control for cancer patients.

St. Luke's Home Health Care also has specialists on board, providing speech, occupational, physical and respiratory therapy, Santee said. Homemaker services are provided through Siouxland Aging where needed, offering some light housekeeping, meal preparation and laundry assistance. Home health aides also assist with bathing and personal care.

"We're just kind of a one-stop shop, We're not their primary caregiver, but we help to kind of support them and teach them so they can keep their loved ones at home," Santee said, stressing that it isn't the nurse's job to shovel sidewalks, change light bulbs or mow lawns, though such things have been known to happen over the years because of the close bonds that develop between nurse and patient. Unfortunately, the nurse's insurance doesn't cover these tasks.

Most home visits last about an hour or so. But some can take up to two hours, even with all the latest high-tech equipment at their disposal, Santee said. The person-to-person contact clearly trumps everything else.

"There's a lot of time with the patients and sometimes you're the only person that they may see at all," she said. "So it's also that socialization. It's a fine line between building trust and earning their respect, but yet not making them dependent upon you ... because we're not doing our job if we haven't talked about how to be independent."

Sometimes, it's impossible to not get involved with a patient, Santee noted.

"I think we've both done that a lot," she said.