How Does Your Homecare Agency Respond to Challenges?

Even excellent homecare agencies encounter challenges and problems.  Believe me, we know.  :-)  The question is, how does the agency respond to those challenges?

The family and homecare client can count on one or more of the following scenarios occurring.  The quality of the private duty (homecare) agency will determine how transparent those issues are to the client and family.  Ideally, these challenges will all be handled behind the scenes, with the family not even aware of them.  Still, it is good for the family to be aware, so they can have high, yet reasonable expectations.

So, here are some of the possible scenarios:

1. Everyone gets sick from time to time, even the very best Home Care Aides.  The family and client have a right to expect that:
• No caregiver will go to work with a communicable disease -- cold, flu, whatever.  The caregiver has a responsibility to let the agency know, as soon as possible, when they are beginning to feel ill.
• The agency has the responsibility to have a backup plan for care.  Talk to your agency about how many hours it will take, in such a circumstance, to have a backup Home Care Aide in place.  For some clients, the answer should be zero, as the care needs to be continuous.
2. Every agency makes hiring mistakes.  The two owners of Support For Home have about 50 years of experience hiring and managing people.  We can still make mistakes.  That's why we use the Caregiver Quality Assurance testing program, one of the most extensive background checks, reference checks and multiple interviews.  Even for us, that does not mean 100% foolproof hiring.
• The client and family, however, should not be impacted by an agencies hiring mistakes.  Any mistakes should be ones that make life harder for the agency, not the client!  Additionally, those mistakes should be fixed in very short order.  When you are interviewing agencies, ask them to tell you about someone they hired and should not have.  :-)

In general, homecare agencies are like most other businesses, in terms of the challenges they face.  The difference is that noone is really hurt if a shoe store's cash registers stop working.  Providing support to a senior's ADLs (Activities of Daily Living) is a very different situation.  Talk to your agency about what can "go wrong" and how they deal with challenges.

Best wishes, Bert

Best Laid Plans -- Oh, Well

At Support For Home, we urge families -- whether they will be working with us or some other agency -- to plan ahead, in terms of homecare for loved ones.  That planning involves a number of factors, including:

1. What is the budget? 
• What will homecare cost, at several levels of care, from perhaps 4 hours a few days per week to 24 hours, 7 days per week?  That is a wide range of care, and it corresponds to very different costs.
• How will homecare costs be paid?  Is there Long-Term Care Insurance?  Is the loved one eligible for Veteran's Aid & Attendance benefits to subsidize homecare costs?
2. What is the "tolerance" for homecare?
• While it may be clear that assistance with ADLs (Activities of Daily Living) and Instrumental ADLs is critical to success in aging in place, we all have different levels of tolerance for that assistance.  We have each been independent for a long time.  There are issues of pride and privacy that need long and sensitive discussions.  Often it is better to start with a smaller schedule, to allow adjustments, if #3 allows it.
3. What is the goal of implementing homecare?
• This is actually a big deal.  In our view, homecare support should be started before there is a major crisis, such as a fall and a broken hip or a stroke.  Our goal is to begin supporting our clients early enough that we are able to help maintain a safe environment and high quality of life for them, avoiding crises to the extent possible.  If we are already in a crisis, the immediate well-being of the senior is the key, always.

One of the reasons it is so important to have these discussions and make plans early enough is that we do not know when the crisis will arise.  A family called us in last Tuesday, to begin a schedule of 4.5 hours per day, Monday through Friday.  By Thursday, when we met with the senior and her family, the need had changed to seven days per week, starting the following Monday.  By Sunday morning, the need had changed to 24-hour shifts, seven days per week, starting that day.  The crisis was here.

Neither the family nor the client have had time to adjust to homecare or the costs of it.  That means more stress than they need, but ...

So, plan ahead, but be ready to move quickly, as the situation changes.  Need for homecare goes up, down and sideways.  We can help you deal with it.

Best wishes, Bert

Stair Lifts and Homecare

I saw a tweet this morning about how stairlifts reduce the need for homecare.  At Support For Home, we think stairlifts can be extremely helpful, but, frankly, I think that is the wrong point, entirely. 

If seniors need to utilize a stairlift to stay in their multi-story home, they almost certainly need other help, as well.  Stairlifts can absolutely make it possible for seniors to stay in the home they love, providing they have support for ADLs (Activities of Daily Living) and Instrumental ADLs.

When we bought our current two-story home, we knew that visits from my mother were going to be very difficult for her, without a stairlift, because her mobility would not be sufficient to climb the stairs.  So, we had one installed.  It made it possible for her to enjoy our home any time she wished.  It did not remove the need for support with other ADLs / IADLs.

Stairlifts are not cheap, but they can still be less expensive -- and traumatic -- than disrupting our clients' lives and homes and forcing a move.  It is something we always look at as we do homecare client assessments, putting together a comprehensive plan of care.  We do not sell or install stairlifts, or make a penny from them, but we make sure we know great resources for our clients, to help them stay at home.

Find a Reason Not To ...

In our homecare agency, our HR / Care Services Manager has to deal with the tension between two very clear expectations that we have.  

1. The first is to find all of the Home Care Aides that want to become employees of Support For Home.  To do this, she visits all of the schools in the area that have Certified Nurse Assistant and Certified Home Health Aide programs, sanctioned by the State of California.  She also participates in employment fairs.  And, of course, she gets lots of referrals from our own employees.
2. The second expectation is that for every job applicant, our Care Services Manager will work very hard to find a reason not to hire them.  We want only the very best Home Care Aides working at Support For Home.  Our employees are the heart and soul of our homecare agency, so hiring and retaining great people is our mission.

Our advice to all families looking for homecare for a loved one is to do the very same thing.  Find only the best agencies, grill them in the interview process (using the questions and standards we talk about on our Web site, at http://www.supportforhome.com/), and work hard to find a reason not to hire each one.  You do not want an agency that is "good enough."  When you make the hardest decision that a family can make, about who will provide care to a loved one, you want only the best.

We strive to be the best, one employee at a time.

Licensing Homecare Providers?

In virtually all states, skilled nursing homecare or "home health" agencies are licensed by that state's government.  When it comes to non-medical homecare, however, the situation is much more mixed.  Slightly more than half of the states do license non-medical homecare companies, but exactly what that means varies greatly.  There is a fairly current reference page at Private Duty Today of what licensing requirements exist, state by state.

In Oklahoma, for example, the agency sends a letter and a form and $1 to the Department of Health.  That's about it.  Like every business, you need state and federal employer ID numbers and you have payroll responsibilities, but there is not much substance to the requirements in terms of quality or safety for the clients and their families.  The fee for the license, to me, indicates the seriousness with which it should be taken.

In Oregon, on the other hand, applications cost $1500 and renewals cost $750.  Right there you have an indication of a rather more serious approach, in that state.  From colleagues operating there, Oregon does, indeed, take homecare seriously.

In California, on the other hand, there is no licensing involved for non-medical homecare, at all!

So, what's the big deal?  Well, in our view, it does not make any sense at all that home furnishings business are licensed (Bureau of Electronic Appliance Repair, Home Furnishings and Thermal Insulation), but the people who take care of folks in those furnished homes are not!

As owners of a homecare agency in California, we would welcome a change to that situation.  Seniors need as much protection as anyone having landscaping done or a car repaired.  Will it cost our business money to implement the needed licensing overview?  Yes.  Is it an important investment in the safety and quality of care of our clients.

Caring for Spouses with Dementia

There is a very serious article on MSNBC (http://www.msnbc.msn.com/id/36975938/ns/health-aging/) concerning a strong correlation between caring for a spouse with dementia and developing dementia oneself.  The first paragraph raises grave concerns:

"Being married to someone with dementia may sharply increase your own risk of developing the condition, a new study shows."

There is no causal link established yet, but one very significant point is made by Dr. Gary Small of UCLA:

"'Caregiving is very stressful,' said Dr. Gary W. Small, director of the University of California-Los Angeles, Center on Aging and director of the Geriatric Psychiatry Division at the Semel Institute for Neuroscience and Human Behavior at the David Geffen School of Medicine at UCLA. 'Studies have shown that caregivers for dementia patients have a high risk for major clinical depression. And there has been a study that showed that people who are prone to stress are at higher risk for Alzheimer’s.'"


To those of us in the home care industry -- or family caregivers -- the stress level is not news.  However, the issue of stress related to Alzheimer's risks is something on which we all really need to focus.  It reinforces how important it is for the family caregiver -- whom we already know has the hardest job in the world -- to receive adequate respite and support.

If you or a family member face this situation, talk to a social worker with knowledge of gerontology about options, or give a solid, certified home care agency a call, just to talk about your situation.  There is help!

Best wishes, Bert