On some mornings, when Elfie Lanugan arrives for her 6 a.m. shift, her patient is still sleepy and not ready to leave bed. The young woman she cares for is nonverbal, medically fragile and fully dependent on nurses and family for daily care. So Lanugan has learned to read the small signs: a turn of the head, a change in expression, a slight shift in the body when something feels off. She has learned something else, too: how to make her smile.
Sometimes Lanugan talks gently to her. Sometimes she brings out a favorite toy piano. Most often, she sings—children’s songs, wake-up songs, even lyrics she changes on the spot. “Every time I sing to her, she will smile,” Lanugan said. “I don’t know if she likes my voice or she finds it funny, but that’s okay, as long as she’s happy.”
That bond is at the center of Lanugan’s work with Towne Kids, a New Jersey and Massachusetts-based pediatric home care provider that supports children with complex medical needs at home. For nurses like Lanugan, the work is deeply personal: one patient, one family, one relationship built over time.
Lanugan first noticed a Towne Kids ad on Facebook while living in the Philippines. Months later, after stepping away from work while she and her husband focused on starting a family, she decided to send a message.
Before coming to Towne Kids, Lanugan had worked in operating-room nursing, occupational health and community-based preventive care. She later worked with a nongovernmental organization run by missionaries, providing health teaching, assessments and referrals for children in communities and schools.
Moving to the United States, she said, offered the possibility of building a life with her husband, a seafarer who spent long stretches overseas. When she arrived in New Jersey in March 2023, it was her first trip to the U.S. The first few weeks brought a new climate, a search for an apartment and training in pediatric home care—a different kind of nursing than she had done before.
Lanugan covered several shifts with different patients before settling into the case that has defined her Towne Kids experience. For more than three years, she has cared for a young adult with cerebral palsy, quadriplegia, developmental delay, seizure precautions, and complex daily needs. The patient is nonverbal and receives medications, tube feeding, and assistance with all activities of daily living.
Over time, Lanugan learned to notice the smallest changes. A head shake might mean sleepiness one day and discomfort another. A facial expression or movement of their right hand might tell Lanugan something was wrong. “After spending three years now, I know if something’s wrong with her,” she said.
The relationship with her patient’s family is one reason the work has become so meaningful. Lanugan said the family treats nurses with warmth and appreciation, remembering birthdays and holidays and thanking them every day for caring for their daughter.
Caring for children and young adults with significant needs has strengthened her confidence as a nurse, she said, because it requires patience, close observation and communication beyond words.
“It’s more challenging working with kids with disabilities,” she said. “They can’t tell you what they want or if they are in pain. But it makes me feel more confident with the work that I do.”
After completing her original contract, Lanugan chose to stay with Towne Kids. The schedule works well for her and her husband, who now works as an assistant mechanic. But the deeper reason, she said, is the relationship she has built.
“For me, it’s very fulfilling to be able to make a difference,” she said.