Moving to WordPress

Because we needed the features and functions that the WordPress blogging software offers, we are "moving" our blog.  The new URL is --

http://supportforhome.wordpress.com/

If you found us first here, thank you.  Please do "come with us" to the new site.

You can start with our newest article, A Few Good Mentions

Best wishes, Bert

So They're Not Accredited, But They Are

At Support For Home In-Home Care, we think know we are pretty darn good at providing home care to our clients, whether they are seniors who want to age in place or folks recovering from surgery or people with disabilities who need help with Activities of Daily Living (ADLs).  We also know that we are still learning -- and we intend to be in that mode for as long as we are in the senior care industry!

One of the firms that we have no problem learning from is Accredited Nursing, in Southern California.  Barry Berger heads the operation, but we also have a lot of contact with Neil Rotter, who knows more about ethical marketing than just about anyone else we have met.  These two folks, with whom I have the privilege of serving on a committee of the California Association for Health Services at Home (CAHSAH), are truly leaders in the home care and home health arenas.

What makes that so?  Well, one of our major issues with some other home care agencies is that their focus is all about the specific home care services that they provide.  For us, at Support For Home, our focus is one the comprehensive plan of care for our clients that goes beyond our services to include home safety, home health (including skilled nursing and physical therapy), durable medical equipment and so forth.  We provide -- any home care company provides -- only a slice of the overall "pie" that represents a client's needs.

Accredited Nursing "gets it."  They provide a wide variety of services -- check out their Web site, linked above -- but they also focus on, as we do, protecting the client and the client's family, by being the employer of record for their caregivers.  That means the family does not have to worry about taxes, workers compensation, unemployment insurance, liability insurance and so forth.

So, if I live in the Sacramento region and need home care, I am calling Support For Home.  If I'm in the LA area, you can count on the fact that I am talking to Accredited.

Best wishes, Bert

The Second Hardest Job: Professional Caregiver

Since we started Support For Home In-Home Care, we have consistently said that the hardest job in the world is that of the family caregiver.  From the beginning, we were aware of the fact that over 60% of family caregivers die before the person for whom they are caring.  We still firmly believe that, from our own families' stories, as well as working with our clients and their families.

When the business began, my folks needed some support to stay at home safely and with a high quality of life.  Over the past few years that need increased, and my two sisters up in Oregon were fantastic about ensuring they got what they needed.  Unfortunately, both of my parents passed away this year, but the hard work and devotion of my sisters were critical to helping them and the rest of us through that experience.

Even before our home care agency was rolling, my co-owner's experience was a critical learning experience.  Her father had a stroke in his early 90s, and her mother was the primary caregiver.  Her mother was younger, but the stress on her, physically and emotionally, were dramatically apparent, including developing Diabetes.

But, if being the primary, family caregiver is the hardest job in the world, being a professional caregiver / Home Care Aide, is a pretty close second.  That is so not just because of the duties that Home Care Aides perform.  It is also true because they choose to work with, to support, folks that they know have a high probability of losing at some time in the future.  Perhaps that loss will be to s skilled nursing facility or to a family home in a different location or -- the worst loss, of course -- the death of the client.

Professional caregivers know this, not just on the level of statistics and probability, but on a very personal basis.  When we interview the professional, experienced Home Care Aides that we want for Support For Home, one of the questions we always ask goes something like, "Why and how did you become a professional caregiver, and, after you learned how hard it is, why is this still your profession?"

The typical answer we get back, with sincerity, from the folks we tend to hire, is, "But this job isn't hard!  I love what I am doing."  Those same wonderful people will tell you -- have told us -- when someone they are caring for dies, "You never, ever get over it."  And, we know they do not get over it.  But their passion for caregiving carries them forward to the next or their other clients.  With grieving, yes, but without a loss of passion.

We would love to tell you their names and their stories, but privacy for both the employee and the client prevents that.  We will find a way.  But in the meantime, thank you to every single person who has taken care of a Support For Home client the way they should.  No, thank you to every professional caregiver out there who has worked at any other agency and made a positive difference in the lives of seniors and others who need help living at home. You have the second hardest job in the world.

Best wishes, Bert

These Aren't Scams, They're Comedy Bloggers

So, after reading my 9,427th email sent from everywhere from Algeria to Zimbabwe, telling me that a very small investment -- just a show of good faith, really, will secure my share of an unclaimed treasure worth $7,832,451.09, I have decided that these are really not scams at all.

I am now quite certain that these folks are simply fellows looking to become comedy writers for Conan's new show -- or maybe Leno's old, new show.  That part is not clear to me.  What is clear is that these are not simple scammers from Russia or Africa or North Dakota (well, I suppose some of them could be from North Dakota).  A few of them may be from Goldman Sachs.  The grammatical ability seems to match.

But clearly, they are not seriously inviting me to send over $50,000 to secure my good fortune.  I mean, for goodness sake, they must know I run a home care company, so there is no way I've got $50,000!  There is an old joke, about a New England dairy farmer who won the lottery.  He was asked what he was going to do now that he was rich.  "Well," he said, "I guess I'll just keep on dairyin' until it's all gone!"  He might as well have been in the senior home care industry.  :-)  If you are not doing what you are doing for passion, you are doing the wrong thing!  At Support For Home, it's all about passion -- for our client's and their desire to age in place -- in their own homes.

So, keep those emails coming guys.  When you are working 24x7, a little laughter goes a long way.

For the rest of you, if you don't agree with my theory, I've learned about $4,000,000 in Confederate money that we can split, if you just send me $50,000.  I need the money up front to send to this guy in Ukraine from whom I just heard who has a sweet deal for me.

Some People Understand It's About Passion

So, Support For Home is all about senior care and helping folks live at home by providing assistance with their Activities of Daily Living (ADLs).  Then why am I so excited about CopyBlogger and GuestBlogging, by Jonathan Morrow?  As far as I know, he has not written anything about elder care or health care reform or dementia.

Frankly, it is very simple.  Jonathan Morrow has passion.  You see it in his writing and you hear it in his videos.  His passion is about helping folks like me, who have the need to communicate about our own passions. 

In my case, it is the passion that led my co-owner and I to leave senior management positions at Intel Corporation.  We left to start a business in an industry that our own parents' stories told us was hurting.  We knew we were never going to make as much money as we did at Intel.  We did not care.  We had learned about the need so many seniors had for support of their own passion -- aging in place, in their own homes.

Jonathan Morrow is not trying to sell me turn-key social media / social networking marketing solutions tailored to the home care industry.  He is trying to help me -- and many others -- communicate my own passion and message.  I love it.

If you have passion and a message, check out what Jonathan has to say.

Best wishes, Bert

Isn't There Enough Stress at a Hospital?

In our last article, the co-owner of Support For Home let off some steam about healthcare costs.  Turns out she is not through with observations driven by her son's need for medical treatment and tests.  Here she goes again!  Bert

Nobody goes to a hospital to relax.  It is already a place where tension exists, just because it's a hospital.  So, shouldn't hospital staff understand that and take some care not to add unnecessary tension?

I was sitting in the waiting "hall" for my son to get a stress test today, after his MRI yesterday -- the results are not back yet, so another 5 points of tension.  The fire alarm along the hallway went off -- beep ... beep ... beep ... -- and lights started flashing.  It did not really sound like a fire alarm that I am used to, but it clearly was coming from that system.  Hospital staff did not appear to care about the possibility that there could be a fire in the hospital.  Nor did they take the time to tell us, in the waiting room, that everything was OK -- or not.

I told my son that it was probably someone in medical distress and the hospital used the fire alarm system to request for medical assistance.  My son asked what if it is indeed a fire? To be honest, I was a little anxious myself but did not want to worry my son.  After waiting for about three minutes -- beep ... beep ... beep -- flash ... flash ... flash, I was about to get up and head over to where we registered, to get clarification on what the alarm was about.  Two personnel in scrubs came up the stairs and headed into one of the rooms.  One of them waved to a registration clerk behind the counter down the hallway and the alarm stopped immediately.

A few minutes later, my son was taken into the room for his stress test, and I headed to the bathroom on the other side of the building.  When I came out of the bathroom, the same fire alarm had gone off again.  I was worried and immediately headed back to the side of the building where my son was, afraid that he had collapsed.  The alarm was not on over there.  Good.

So why this story?  It appears that the hospital is using the fire alarm as a signal for their internal staff.  Patients have no idea what it means other than there must be a fire, but if you have been a patient who has been visiting there for a while, you have come to realize that it’s not a fire and it’s just something that the hospital is using internally -- until there actually is a fire!  There are two problems here.  For new patients, it causes anxiety. For patients who have been through it a while, they will not evacuate in the event of a real fire.

Time to call the marshal on the hospital to review their procedure and a little sensitivity and customer service training for the hospital workers.

Best wishes, Siew Pheng Tung

Should Not Healthcare Reform Include Costs?

The co-owner of Support For Home In-Home Care submitted this.  I hope it strikes a chord.  Bert

My son, who is still in college, will be turning 24 this year and our family policy was up for renewal in April.  That was before President Obama’s health care reform went through, which now allows family plans to cover their children up to the age of 26.  We went ahead and put him on an individual high deductible plan, as he has been a very healthy person and we wanted to keep the premiums low. 

Unfortunately he had a medical emergency that led us to call the paramedics, and he rode in an ambulance to the hospital.  I haven’t seen the ambulance bill yet, but anyone on a high deductible plan will know that it will not be a small amount.  This is to be followed by a series of tests that are now being conducted on him, including an MRI. 

I was in the radiology department yesterday with him to check in, and we were told it would cost $1,120.  We flinched a little and went ahead and put it on my credit card.  While still in the waiting room, a gentleman in his mid- to late 50s came in to check in and was told "That will be $1,120."  He said "What? I don’t have $1,120 to pay for it. Why is it not only a $30 co-pay?"  The clerk explained to him that he is on a deductible plan and the price will drop after he hits his maximum deductible amount.  He then asked the clerk to cancel the appointment.  The clerk asked him if she could put him in touch with someone to discuss and he said no and left.  What good was talking about $1,120 that he did not have?

This unfortunate gentleman could have a serious medical condition that now may go undiscovered.  An aneurysm or tumor or other potential issue that led his doctor to schedule the MRI in the first place may not be found before something potentially fatal happens.

This immediately triggered my thoughts on the health care reform that was just passed, which does not address the issues around cost that I had just witnessed.  Does this gentleman have health insurance?  Yes, but he does not have the money to cover the out of pocket medical expenses.  Health care reform will help many more people obtain insurance.  But what it does not address is the issue of out of pocket costs, even with an HMO policy. 

There are many, many factors that go into the high cost of healthcare.  But, what happened to the proposal to place a cap on medical malpractice?  A cap on medical malpractice will lower doctors’ liability insurance costs, which in effect will lower the doctors’ or radiologists’ costs and how much the patients will need to pay. 

What happened to allowing Americans buy prescription drugs from Canada and other countries where the prices are much lower?  Americans have been impacted by President Obama's inability to implement his promise that he would reform this during his election campaign. 

Health care reform does not address actual costs of health care for Americans.  Health care reform is just passing around who pays for the costs.  It’s making small businesses, corporations and middle and higher income tax payers pay for them -- but the gentleman who could not afford an MRI still will not be able to pay for it.  Small business and corporations may cut jobs and reduce pay to their workers in order to pay for the health care costs. 

The pharmaceutical companies apparently are going to get richer.  The few who sue at every opportunity may get richer.  Is the rest of the country really going to benefit, if we do not get healthcare costs under control?  What do you think about these issues?

Best wishes, Siew Pheng Tung

Effectiveness of Hands-Only CPR Good News

An article on MSNBC reports,

two new studies conclude that "hands-only" chest compression is enough to save a life. They are the largest and most rigorous yet to suggest that breathing into a victim's mouth isn't needed in most cases.

This is really good news for a number of reasons.  The first is that it is easier to perform, requiring less skill and training.  A second major factor is that most folks who are not medical or healthcare professionals are far more willing to perform chest compressions than the mouth-to-mouth procedure.

At Support For Home In-Home Care, we require that our Home Care Aides are CPR certified, at the health professional level.  That is very unusual, however, even in the industry, much less in the general population.  The studies appear to indicate that 911 Dispatcher directed, hands-only CPR was most effective.  Bystanders operating under the Dispatcher's guidance were highly successful, even if they had not been trained in CPR techniques.  The simplicity of the hands-only approach contributes a lot to that.

The results confirm the American Heart Association's own recommendations, which have been hands-only for the last two years.  We still will require CPR training for our Home Care Aides, but this is still really good news.

Best wishes, Bert

Sun City Roseville Foundation

At Support For Home, we have the privilege of delivering in-home care as an invited provider to a truly wonderful community program.  The program is the Sun City Roseville Caregiver Relief Program.  It is funded by the Sun City Roseville Foundation and administered by the The Sunshine Services and Resources group.

The gist of the program is that families who live in that community, if they meet a few criteria, receive respite care from a few approved in-home care companies, with the Foundation paying about 75% of the cost.  The Foundation (Director, Helen Bisenius) also sponsors and organizes many other programs that are meaningful to residents.

Frankly, we would love to see the Caregiver Relief Program replicated in every retirement / senior community.  Being able to provide relief caregiving once a week, to enable the family caregiver to take a breather or attend to personal business is a very rewarding opportunity for us.  It is not that the program is really a revenue source for us, as a business.  We probably donate as much as we make!  Rather, this is a program that just fits so well with the passion that led us to start our home care company in the first place and that keeps us going.

So, to all the professionals and volunteers that make Sun City Roseville work and the Foundation possible, Thank You, from all of us at Support For Home.  May every other community look to your model and imitate it.  If you live in Sun City Roseville and are unfamiliar with the program -- or need help -- contact Sunshine Coordinators Clare Handcock at 786-7857 or Betty Meers at 771-2637.

Best Wishes, Bert

Social Engagement Critical in Senior Care

Thanks to Marc Onigman in National Senior Living Providers Network for bringing a medical study to my attention.  The information is not really "news" to those of us in the senior home care industry, but it is always good to spotlight it.

When we do an assessment (free, of course) of a new client at Support For Home, we cover three areas:

1. Homemaker Services -- Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs) in the home
2. Companion Services -- ADLs and IADLs that involve our interfaces with others and outside the home
3. Personal Services -- ADLs and IADLs such as bathing, dressing, toileting

As we discuss the second category, we frequently observe a much smaller social calendar and circle of friends and acquaintances than is "healthy."  Of course, that is not surprising, since, as we age, we tend to lose family members and friends.  The challenge is for our clients, hopefully with our help, to renew and rebuild that circle.  If my friend Joe and I never get together any more, because neither one of us drives, that can easily be and must be "fixed."  A truly Comprehensive Plan of Care must be as focused on number 2, above, as on 1 and 3.

The study is as cautious as all of them are, in terms of cause and effect, but reports,

In a pooled analysis of 148 studies, having strong social relationships was associated with a 50% greater likelihood of surviving through follow-up (OR 1.50, 95% CI 1.42 to 1.59), according to Julianne Holt-Lunstad, PhD, of Brigham Young University in Provo, Utah, and colleagues.

The magnitude of the association puts social relationships on a par with quitting smoking and beyond obesity and physical inactivity in terms of relationship with mortality, the researchers reported in the July issue of PLoS Medicine.

In the senior care industry, we must all put even more emphasis on this issue and look for creative ways to increase social interaction and relationships for our clients and patients.  It is not just a matter of quality of life.  It looks pretty clear it is about quantity of life.
Best wishes, Bert

We Prefer Integrity, Dignity and Values

So, I am not a huge fan of sales people who could just as easily be pushing cars or insurance or washing machines or -- the Better Business Bureau.  That is just my own personal feeling and does not represent the views of the employees or (other) owners of Support For Home In-Home Care.  People who love cars and have a passion for selling them (or insurance, or ...), well that is another story.  I am fine with those folks.  But when I encounter someone who is genetically engineered to just plain sell -- anything and everything -- I tend to back away.

So, why am I off on this tangential tirade?  One of our office staff got a call from a representative of the Better Business Bureau here in northern California.  He wants to talk about our company joining and becoming "accredited" by BBB.  So, what does that actually mean?  Here is what their Web site says:

If a business has been accredited by the BBB, it means BBB has determined that the business meets accreditation standards which include a commitment to make a good faith effort to resolve any consumer complaints. BBB accredited businesses pay a fee for accreditation review/monitoring and for support of BBB services to the public.

BBB Code of Business Practices represents standards for business accreditation by BBB. Businesses based in the United States and Canada that meet these standards and complete all application procedures will be accredited by BBB. The Code is built on the BBB Standards for Trust, eight principles that summarize important elements of creating and maintaining trust in business.

BBB accreditation does not mean that the business’ products or services have been evaluated or endorsed by BBB, or that BBB has made a determination as to the business’ product quality or competency in performing services.

Businesses are under no obligation to seek BBB accreditation, and some businesses are not accredited because they have not sought BBB accreditation.

I have put in red italics the part that irks me.  First of all, accreditation, in virtually every field, means examination, evaluation, audit, verification, certification.  It means real work by the accreditation body to determine compliance with standards.  What does it mean to BBB?  It means that there has been no evaluation or determination of compliance to standards of quality or competence.  In other words, what it really means is that you have paid that business a fee so that you have something you can put on your Web site.

So, about this call from the salesman.  He said that we should really join the BBB and get "accredited," because he has had 18 inquiries about our company, so far.  Now that is really curious to me, because since starting Support For Home in 2007, I have had one client ask me if we belonged to the Better Business Bureau.  I said no, because my own personal experience had been that they were not particularly helpful.  The client's response?  "You got that right!"

Now, do we believe in standards?  You better believe it.  That's why we belong to and are certified by the California Association for Health Services at Home.  That's why we are members of the National Private Duty Association.  That's why we are certified by the Caregiver Quality Assurance program:

So, to those 18 people who asked the salesman at the BBB if we are "accredited," if you are really out there somewhere, feel free to give me a call, if you think I am wrong.  In the meantime,

Best wishes, Bert

Judging Senior Care Agencies Through Employees

When we started our in-home care agency, Support For Home, we knew that we, the two owners, were never going to BE Support For Home.  The heart and soul of the company would always be our Home Care Aides.

As a result of that, we made several commitments -- to ourselves and to our employees:

1. Our Home Care Aides would always be as important as our clients.  We would not tolerate abuse of our employees any more than we would put up with abuse of our clients.  This has actually led us to "fire" several clients because of their treatment of our Home Care Aides.
2. Our employees would be paid as much as the company could afford, even though that means a significantly smaller margin than other agencies have.  At this point, our Home Care Aides are paid 20% to 30% more than caregivers at other agencies in our region.  We know this, because our employees tell us so and we see employment ads.  For 24-hour assignments, we actually pay 35% to 50% more than other agencies, because those agencies are not complying with California's Wage Order 15 -- and we do not know how they are getting away with it, frankly.  We continue to make the choice to treat our employees the way we believe they should be.
3. We are still growing rapidly, so we continue to add new Home Care Aides.  That brings down our "average" length of employment.  However, we measure ourselves by our ability to retain great employees.  When we lose an employee, it is almost always because they moved to a different state or have finished their LVN program or Social Work degree.  We love that, even though we miss them.

So, when I read an article in The New York Times, called "One Way to Judge a Nursing Home," it absolutely resonated with me.  The essence of the story is that the author was evaluating nursing homes for his mother.  With each visit, he asked the tour guides if he could talk with the nurses' aides.  In almost every case, the answer was, "No."  His comment was,

I soon realized why. In casual conversations in hallways and dining rooms at more than a dozen facilities, I found only one nurses’ aide who had been on the job more than six months. I was witnessing in real life one of the most dismal statistics in long-term care: More than 70 percent of nurses’ aides, or certified nursing assistants, change jobs in a given year.

When he finally found a facility that said it was fine to sit down with the nurses' aides that worked there, he was amazed to find that of three aides, the shortest tenure was four years.  That pretty much made up his mind, right there.

We absolutely endorse this approach.  Are employees happy working for their home care agency (or assisted living or skilled nursing facility or other senior care company)?  Do they feel like it is a "we" situation?  -- Quick anecdote on that ... A Home Care Aide came in for a briefing on a new client this morning.  We recently moved from one office suite to a larger one.  The Home Care Aide's comment was, "I really like our new office!"  She has probably been in our office four times in the last year, as she works in our clients' homes, but she clearly felt that the office is hers, not just the administrative team's.  I love it.

Another significant point about our employee base is the extremely high percentage of Home Care Aides who have worked in nursing homes, who say, "Never again!"  They are asked to take care of so many residents that they cannot take care of any.  They come to us, even though home care is less predictable, in terms of schedule, because they long to be able to express their passion to provide care in a 1:1 setting, in their client's home.  That makes us and our clients feel very lucky.

Best wishes, Bert

Pain Management in Senior Care

At Support For Home, we provide non-medical in-home care.  That does not mean, however, that our clients are not receiving medical treatment for a variety of chronic conditions.  One of the more frequent issues is arthritis and other causes of on-going and intense pain.

Where the client's doctor has stipulated a clear and specific course of treatment and medication, caregivers, family members and the client have an easier time with managing that pain.  All too often, however, the doctor has prescribed pain medication to be taken PRN (pro re nata), meaning as needed by the client.

As long as the client does not suffer from dementia, that is still manageable for caregivers, family and the client her- or himself.  But what happens if the client does have dementia.  The doctor often recommends that the pain medication be given when the pain level is above X (provided the maximum dosage has not been reached). 

The other day, however, our Director of Client Services was meeting with a client and asked her what pain level she was at, on a scale of 1-10.  The client, however, was unable to grasp that scale.  She could not really manage to put a number on her pain.

Knowing where the client is, in terms of pain level, is critical to complying with doctor's orders.  In these situations, a tool our Director of Client Services often uses is the Wong-Baker Pain Rating Scale(c).  That scale goes from a big smile on the left to tears on the right, in a total of six faces.  This tool was developed for use in pediatrics, but works well with some seniors with dementia.

Check it out.  It might help someone you care for and love.


Best wishes, Bert

Robot Care for Seniors at Home?

OK, so I am a self-confessed techno-geek.  I did Information Technology work for 25+ years, including 18 years at Intel Corporation, retiring as an IT Director.  I love video games and computers and technology in general.

And then, there is "Elder Care Robot," from Gecko Systems.  I believe that this kind of technology can play a significant future role in senior care, but at this stage, frankly it is just plain creepy. 

Most forms of technology start out looking as sad as this does, so I am not saying it is or will be a failure.  For some of our clients, automated medication containers pop open and tell the client it is time to take some pills.  The co-owner of Support For Home and I both supported Intel's Digital Health business when we were in IT at that corporation.  We remain huge fans of the effort of our former colleagues.

All that having been said, I might have kept this metal beast under wraps for a bit longer, if I were Gecko Systems.  When they can build in a bit more "human touch" into their technology, they might just have something.  We will be happy to welcome them to our home care team.

Best wishes (including to caregiver robots), Bert

Federal Study on Aging Good, But ...

There are some very interesting data points in the recently published study, "Older Americans 2010: Key Indicators of Well-Being."  The study was put out by
The Federal Interagency Forum on Aging-Related Statistics.

As most of us are aware,

Americans are living longer than ever before. Life expectancies at both age 65 and age 85 have increased. Under current mortality conditions, people who survive to age 65 can expect to live an average of 18.5 more years, about 4 years longer than people age 65 in 1960. The life expectancy of people who survive to age 85 today is 6.8 years for women and 5.7 years for men.

That is, on its face, a wonderful thing.  However, there are many implications that are a bit more complicated.  When one begins to look at the size of the senior population (including me), one's eyebrows begin to rise:

In 2008, 39 million people age 65 and over lived in the United States, accounting for 13 percent of the total population. The older population grew from 3 million in 1900 to 39 million in 2008. The oldest-old population (those age 85 and over) grew from just over 100,000 in 1900 to 5.7 million in 2008.

The implication for Social Security is old news, but still a valid concern.  Less intuitively obvious, however, are some of the other issues.  For example, 42% of women 65 years of age or older are widowed (much smaller number for men).  76% of women over the age of 85 are widowed and 38% of men that age are widowers.  This has very significant meaning, socially.

Another set of issues involves the chronic medical conditions which face us as we age.  The chart below, from the study, has a great deal to say about that:

The number of seniors with multiple chronic conditions is clearly evident when one looks at the percentages for each.

One of the areas that the study clearly fails in, at least in my judgment, is dementia, including Alzheimer's.  Statistics are really not reported and analysis is missing.  As the study itself says,

While there are several studies which report estimates of the prevalence of Alzheimer’s, one of the major barriers to reliable national estimates of prevalence is the lack of uniform diagnostic criteria among the national surveys that attempt to measure dementia or Alzheimer’s. A meeting convened by the NIA in 2009 to describe the prevalence of Alzheimer’s concluded that most of the variation in prevalence estimates is not driven primarily by the reliability of the measures or instruments per se but by systematic differences in the definition of dementia.

This is very, very disappointing to all of us involved in senior care.  Until we really gain an understanding of what it means and what the impact is, we will not do the best job of addressing the problems of dementia and Alzheimer's.

An area that the study better addresses is the need for assistance with Activities of Daily Living (ADLs).  That need is the real basis for non-medical home care existing in the first place:

It is interesting that the largest growth in meeting ADL needs is in the area of equipment.  That is one reason we work so closely with mobility and durable medical equipment suppliers for our own home care clients.  We have to understand and be able to address the total universe of need.

All in all, it is a very good and interesting study.  Check it out.

Best wishes, Bert

OK, I'm Ordering a MEDCottage Today

At Support For Home, we provide in-home care to seniors and others who need help with Activities of Daily Living (ADLs).  We do a lot of work with home health agencies, who support the same clients as medical patients, with skilled nursing and physical or other forms of therapy. 

All of those services are provided within the confines of the client's home.  The clients are passionate about continuing to age in place, in those homes.  They resist moving to some level of assisted living or a skilled nursing facility. 

Sometimes, though, we wish there was a middle ground that was available to our clients.  The home they have lived in for the last 30 years is too big, perhaps too expensive, perhaps too far from loved ones.

That middle ground may have become literal with what is called the MEDCottage.  "Invented" by a Methodist minister in Virginia, the MedCottage is a modular home, 288 square feet in size (12' x 24'), that is designed to meet the medical and non-medical caregiving needs of the client.  It is small enough to actually fit into the backyard of a family home, but provides privacy for the client and for her or his family.

The technology and utilization of space are impressive, already, but I am sure there will be many advancements, over time.  The cost is, according to AARP, $65,000 to $75,000.  That is quite a bit of money, but if one considers a skilled nursing facility at $7,000++ per month, the return on investment can be significant.  Combining the ROI with the ability to continue to "live at home," the MEDCottage is a pretty impressive "product" for elder care.

We will let you know when we have our first client living in a MEDCottage.

Best wishes, Bert

What Does Information Technology Have To Do With Senior Care?

I owe this article to my co-owner of Support For Home In-Home Care and spouse.  She started vibrating at a dangerous frequency recently when we encountered a problem with a vendor.

The topic is not one which may be intuitively obvious.  It is about IT (Information Technology) and how it relates to customer service, but even more importantly to safety of our senior and other clients in the home care industry.

As IT professionals for 25 years, ourselves, we have seen Information Technology evolve to be a utility that is expected to work all the time.  We tend to think of reliability similar to the phone system in our homes or the gas / electricity supplier.

That having been said, what does IT have to do with senior home care?  Actually, it has a lot to do with being able to deliver high quality, trusted care.  Our computerized scheduling system (from vendor "A") is integrated with another program called Telephony (from vendor "B").  Our caregivers call the computer (via our toll-free number) using client’s home phone when they arrive to "clock-in".  When a shift is over, they call (using Telephony) again to "clock-out".

If the Home Care Aide does not clock-in using the computer system, those of us in the office receive an email telling us that the caregiver may not be with the client.  The Support For Home administrative team then calls the client's home to find out if the caregiver has forgotten to clock in or was delayed in getting to a client’s home. 

Since we are providing critical support to our clients' Activities of Daily Living (ADLs) , enabling them to safely live at home, being there on time when we say we will and working the stipulated shift hours are vital components of home care.

This past Sunday to Tuesday, we encountered an issue with the Telephony computer system, with caregivers encountering frequent but intermittent busy signals. Our scheduling system vendor only provided technical support on the phone Monday through Friday, 8:00 am to 2:00 pm. Of course, we have Home Care Aides scheduled with clients 24 hours per day, 7 days per week.

We contacted our scheduling system vendor about the issue on Monday morning and were told at 1:00 pm that the problem was resolved.  The technical support said "We have no control over the situation, as Telephony is provided by a separate information technology vendor."  When we inquired about service level agreements and support between this scheduling vendor and Telephony, the person said you have to talk to our sales person.

As a customer, we are never going to be satisfied with this answer. We realized by 2:00pm that the problem was still not resolved and we had to wait yet another day and contacted them on Tuesday. The problem was only finally resolved on Wednesday.  The email response we received was that it was some other company's issue and "we have no control over it."  This is called not accepting responsibility.

In the eyes of the customer, when he/she buys service from a company, that company is responsible for the service delivered, period, no excuses.  When the company further contracts and sub-contracts services, the customer does not care about everything that goes on behind the scenes.  The company is responsible for managing its vendors and performance.  If the vendors do not perform, the company looks bad.  Worse than that, the client's security and quality of life may be negatively impacted.

A mistake may be made by a caregiver or an office staff, but as the owners of Support For Home, we are responsible.  If our scheduling software with Telephony does not alert us of a problem, we can miss our commitments, so we are making too many phone calls to clients, all of them are saying, "Yes, the caregiver is here."  But we have to add a minor disruption to their lives to ensure all is OK.

To our client, Support For Home is responsible for their care, and they are right!  At our agency, we will never pass the buck.  We just wish other companies, including those in information technology, would behave the same way, with the same level of passion, customer service and sense of responsibility.

OK, This Aging Issue Is Personal!

As I have gotten older, so have my eyes.  Yes, that is a truism, but that does not make it unimportant for seniors -- and those soon to be seniors.

I have more trouble than many folks, because I am naturally (pre-cataract surgery days) very nearsighted.  That means that my eyes are naturally longer than normal.  That puts me at much greater risk for things like detached retinas.  It also makes me much more susceptible to macular degeneration caused by bleeding into the retina.  As one retina specialist told me, you only get so many cells to "wallpaper" the back of the eye, and if they get stretched to much, there can be bleeding.

In my case, there has been bleeding, in both eyes, over the past six or seven years.  The first time it happened, in my right eye, I was pumped full of an expensive chemical and got to stare into a laser.  Fun.  That had to be done several times.  This year it happened in my left eye.  Advances in medicine meant I got to have a needle poked into my eye once a month for three months.  Also really fun.  At this point, I do not see straight lines anymore, but at least I see.  I am a firm believer that the earth is curved, if not round.

Now, aside from fascinating you with my life story, what is the significance of all this?  Really, it is two-fold.  The first is that these issues happened after I turned 50.  The older I get, the more likely they are to recur and get worse.  That fact is another reason why we founded Support For Home In-Home Care.  The problems I am having now and will have as I get older are not news to some of our clients.  Their desire to live at home is threatened by declining eyesight.  Our support of their Activities of Daily Living (ADLs) is critical to their success. 

There are many excellent sources about macular degeneration on the Web.  One such source is Wikipedia.  The National Eye Institute of the National Institutes of Health has excellent information and links.

In my case, I have had good medical insurance and been able to pay for great treatment for my eye problems.  For many seniors, that is not the case.  One program seniors and family members should check out is EyeCare America.  Aside from excellent information, many seniors may qualify for a free eye exam or even up to a year of free care from volunteer ophthalmologists.  It is a great program.  Check it out and keep an eye on this blog for more information on issues of aging.  Sorry for the pun -- could not help myself.

Best wishes, Bert

Could We Get a Little Attention!?

So, this is a fairly minor irritation, but it is a real one.  I do not intend to hire a lawyer or start a petition, but I am complaining, publicly (since it is in this blog) about MSNBC's categories for the Health section of their Internet site.
Actually, it is not just MSNBC, but that is a site I go to frequently, so I feel the proprietary right to criticize!

Our company, Support For Home, is dedicated to providing high quality in-home care to seniors who need help with Activities of Daily Living.  That is our passion.  The challenges of aging are many.  The focus on those challenges is inadequate, in terms of "news" coverage, beyond an occasionally "sexy" story about Alzheimer's and dementia.

So, what are those categories?

• Health Care
• Diet and Nutrition
• Women's Health
• Kids and Parenting
• Men's Health
• Sexual Health
• Mental Health
• Pet Health
• Fitness
• Cancer
• Skin and Beauty

So, pet health and skin and beauty are more important, according to MSNBC, than Geriatrics and Gerontology.

If I turn to The New York Times, on the other hand, right smack in the middle of the Health page I find "The New Old Age: Caring and Coping," a great, virtually daily series of articles on the issues we face as we get older. 

In the interest of full disclosure, I do not own any stock in The NY Times, nor am I selling MSNBC stock short.  ;-)  I just want to see more focus in the mainstream, general news outlets, on the issues of aging.

Best wishes, Bert

Adjusting to Death of Parents Is Hard

Today I finally got around to editing the Web site for Support For Home to reflect a rather significant change.  It was hard and I was very slow in doing so.  The change to the Web site was required because both of my parents died this year.

When my wife and I started Support For Home, our family's stories were significant drivers.  We left Intel Corporation to start a home care business partially because of the stroke my wife's father had and her observations of the impact on her mother's health from being the primary caregiver.  Likewise, my folks reaching their 80s and beginning to need some help, especially my mother.  Their experiences and their needs went a long way toward educating us to the need for high quality, client-centric home care.

Those stories will never stop driving us to improve our own company and to maintain the standards we established.  I have finally updated the Web site to reflect the fact that my wife and I lost both of my parents over the last six months, but their inspiration and our memories will go on, as will our passion to provide the very best possible home care for seniors.

Thanks, Mom and Dad.

With love, Bert and Siew Pheng