Mom and Dad, Spend It All!

I came across an interesting blog from Carolyn L. Rosenblatt, Nurse-Attorney, at AgingParents.com.  Carolyn makes some great points, at least from my perspective:

I say let elders stay at home if that’s their choice. Making them poor so Suzy Q can get a chunk of cash when Mom passes seems unfair to me. It’s not Suzy’s money, she’s the child. I hope aging parents will take another look at the future, if they are in declining health.


Make sure your estate plan doesn’t let your kids sell the house, stash the cash legally and put you in a nursing home as long as you are aware of your surroundings. You might not like a nursing home on Medicaid as much as you like your own bed. You’d have at least one roommate, maybe two in a Medicaid nursing home bed.


So, think it over. Kids counting on an inheritance can see their hopes dashed by the need to pay for mom’s care with Mom’s assets. Getting an inheritance is something adult kids are lucky to get, not something to which they are entitled.

The greatest bumper sticker I have seen was on the back of a big motor home: "Spending Our Kids' Inheritance".  That kept me smiling for days, because it said several things to me.

First, it said that this couple were "working" at having a great time in their retirement.  Secondly, it said they had raised kids that were supportive of that goal -- you don't put bumper stickers like that on without laughter from all involved.

A conversation I had with my own father a number of years ago went along similar lines.  Basically, I told him that if he and mom left us kids more than about $.25, I would be disappointed.  Spend it all, I said.  He laughed.  He and mom both passed away this year.  I have no clue what was in their wills.  I'm hoping for $.25.  :-)

Parents Driving and Other Conversations

Forbes magazine has a good article, entitled "Boomers' Burden: Aging Parents Who Shouldn't Drive".  Driving is only one issue, as our parents age, of course, but it is an emotional and important one.

The article launched a discussion on LinkedIn, with a posting from Dr. Mikol Davis:

Imagine that the phone rings, and it's the police department in the city where your 85-year-old mother lives. She's been in a car accident. She hit a pedestrian, the officer is saying, and your mom is hurt. You feel a rush of fear and guilt. You saw the warning signs, the forgetfulness, the lack of ability to concentrate. Mom really shouldn't have been on the road. You're afraid to ask what happened to the pedestrian. Could you have prevented this?

Our thoughts at Support For Home?

This is an incredibly important question, but it is, of course, part of a much broader discussion that we all have had or will need to have with our parents, as they age.


My own parents' situation was actually one of the drivers (if you'll forgive the pun) for my wife and I leaving Intel Corporation to found Support For Home, our own in-home care company.


Our preference would be that parents continue to be parents, even as we age. They should be driving this discussion, not waitiing with trepidation for "the kids" to bring the issues of driving and support for other ADLs and Instrumental ADLs. If that does not happen in a family, then yes, the offspring must step up in a timely fashion to initiate the conversation and establish some parameters that parents and children can support. Most of these are readily set, in a very objective fashion.


Our parents need to know that their value has nothing whatsoever to do with whether they have a driver's license and that our respect and love is for their lives and character and accomplishments over the course of their lives, not about their current medical state.


So, if you have to have a difficult conversation that will protect your parents and others, even if it may bring on a tear or two at the time, "just do it."

Parkinson's Disease - A Major Focus

This past Saturday was the Parkinson Association of Northern California's (PANC) Conference and Resource Fair, and Support For Home was delighted to be able to participate.  The program was great and the people were better.  :-) 

A number of our home care clients have Parkinson's or related conditions.  Not only is it a real challenge to the client, obviously, but it is one of the most common conditions in which there is likely to be a spouse who is the primary caregiver.  Our role, in those situations, is to help the client but also to ensure that the primary, family caregiver gets the respite she or he needs.

In addition to their conference and other programs, PANC has a network of support groups across Northern California.  We have linked the list of those groups in this article.  If you or a loved one has Parkinson's these support groups can be absolutely invaluable.

For folks in the Sacramento area (or who love casino nights!), there is also a "Play & Parlay 4 Parkinson's Casino Night" on September 11th, from 5 to 9 PM.  It should be great fun and will definitely benefit the cause.

The next Conference & Resource Fair is in San Jose, at the Doubletree Hotel, on August 28th.

A Family's Story

In the last two weeks, in addition to losing my own mother, two of our home care clients passed away.  The family of one client was gracious enough to share the story of their father, which we are delighted to publish, below.  I think you will see how extraordinary the client was and the family is. 

It has been a true privilege being part of the team helping their father stay at home.  Mark and Andria, we thank you so much:

Afer my mother died in January 2009, we realized Dad was no longer able to care for himself on a long term basis. He was already in the late stages of emphysema, and although he did everything he could in terms of exercise and medicine, he lacked the energy to prepare the hot and nutritious meals that his wife had fixed for him right up until her last few days, when pain from her lung cancer sent her to bed.
She died within two days of that time, as if she had no longer any reason to live when she couldn't care for him any longer.  The day of her death, we took Dad to the hospital with pneumonia, an event that happened with increasing frequency as his disease progressed. He spent the first night after her death in a hospital room, less than a kilometer from his house, the same hospital where he died in June of 2010.


We decided we would do all we could to make him comfortable at home. He didn't have many surviving friends and enjoyed staying in the house, reading and watching television. Life in a facility would have been a trial for him, and he was already too weak to take advantage of collective outings and other amenities of those living situations.


We practiced with my mother's recipes and cooked him much the same dishes she had prepared whenever we were there. We went out to local destinations at first, when his strength still permitted, since already driving more than a few minutes was too taxing.


Dad was able to prepare himself a simple breakfast, and walk out in the cool Davis mornings to collect the newspaper and do limited yard maintenance, until close to the end. He was not a gregarious man and enjoyed reading and reflecting by himself. He would never have been able to adapt to a collective living facility.


Initially my wife and I came to the house nearly every weekend to do shopping and prepare food that he could reheat during the week. Dad resisted having any in home care for several months, but as he continued to weaken we had people come to the home at first on an ad hoc, informal, basis, and then,for the last six months or so, on a regularly scheduled basis, twice a week. At first he was not comfortable with strangers in the home, but his opinion changed with time.


Dad enjoyed the periodic visits from neighbors, who often brought him cooked meals, and watched over him to make sure he would get to the hospital promptly if he again developed pneumonia.


As his oxygen needs increased, it became more and more difficult for him to drive or leave the house for any length of time. Trips to the library more and more had to wait until we could be there on weekends


He enjoyed the company of the people from Support For HOme In-Home Care and the volunteers that came just to socialize: a student from the University doing her service hours for graduation, and local retired people.  But the fact that he could set his own schedule, even for inreasingly limited activities, was important to him.


Dad also enjoyed talking with people he hired to work on landscaping as he became increasingly unable to do it himself. As long as he could, he watered and weeded the small garden he had maintained in the back yard for many years. This spring he had reached the point where he couldn't even walk out to be in the garden, but contented himself with watching out his small bathroon window, which overlooked it.


Dad was very adaptable and didn't seem frustrated with the narrowing scope of his life and his increasing dependence on others. He very much wanted to be in the home he lived in since 1971, and the familiar surroundings of neighbors and local venues such as the bird sanctuary.


He outlined and managed small projects around the house and chatted at length with the younger people, graduate students at UCD for the most part, about their lives. He liked to compare their situations with episodes in his own life from his student days in Berkeley.


It was interesting to him, since this was the first time in many years that he had contact outside his family with people of younger generations.  Many of their life experiences were new to him, involving non-English speaking communities, but he had a gift of empathy that enabled him to understand their feelings, and they seemed to appreciate the opportunity to get his opinion on their difficulties.  But, again, the fact that he was able to decide on when and how long to carry on these contacts was very important to him.


Most of his friends and all the family members of his generation had pre-deceased him, and the younger family lived far away, so during the work week, when we family members couldn't often come to Davis, he was often lonely, although he was careful never to complain about this.  He accepted it as normal for the stage of life he was in.  He read several newspapers and all the books he could carry home from the libarary, did crossword puzzles, and welcomed visits from caregivers during the work week.


With time he came to consider the people who came to the house as friends, rather than just hired help, and looked forward to their arrival.  He tried not to burden them with too many tasks and spent as much time as possible playing cards or chatting with them.  It made staying in his own home much more enjoyable for him during the 18 months he lived after his wife's death.


Even at the end, when he only could sit and watch the squirrels and birds outside on his patio, and read before falling asleep, he was still pretty content.  He had the peace of a quiet, familiar neighborhood.  He was surrounded by all the memories of his 39 years there, and a house whose every corner had a history for him.


If he had lived longer, he would have had to share nearly all his time with caregivers in the house, but it would have been far better for him and for us than placing him in a noisy facility with complete strangers for the last few months of his life.


Fortunately, really, he was spared having to live in a hospital type of setting in the home since he died in the hospital.  His last memories of his home were of a place little changed from when he lived there with his wife and family.


I think he was totally content with his situation right up until the end.

We Screwed Up

Yesterday, I wrote a couple of pieces about customer services and how we must excel every single day.  Our clients and their families deserve that.

What they do not deserve is for us to screw up.  Not in a big thing and not in small things.  Last night I talked to the family of a client about something we did wrong.  We mailed some care worksheets to the client's home, and whoever at the office addressed the envelope misspelled the client's name. 

That is not respectful.  That is not treating our client with the dignity that person deserves.  That is not customer service.  That is not excelling. 

As the owners of Support For Home, my wife and I take full responsibility, and I made that very clear to the family.  It does not matter who addressed the envelope incorrectly.  We are responsible.  We take it seriously.  We will, in fact, be talking about it in staff meeting tomorrow, to create a process that prevents this from occurring in the future.  If that means two people look at material that goes out, even if it is just an envelope, then that is what we will do.

We want to excel.  Our clients expect us to excel.  Every single day is an interview.  Every client is the center of the universe, for us.

Quiche and Customer Service!

Okay, so this blog is not about our usual subjects, involving senior care or home care, but it does involve two other topics that my wife, the co-owner of Support For Home, and I love.  Normally, we would not talk much about quiche in this blog, but it is the wonderful combination of great quiche and great customer service that we have encountered that leads me to do so, today.

I cannot even remember the first time we ordered quiche at a Coco's restaurant near our office, but I remember it was good.  :-)  So, when it disappeared from the breakfast menu a while later, we were not amused!  Normally, that would be the end of the story.

In this case, it was not.  We talked to the manager, Denise.  She explained that they are driven by the menu set at the corporate level for the chain.  We understand that, but it does not solve our problem, which is that there is no more Quiche Lorraine for breakfast!

Denise's response was consummate customer service.  She produced a list of over half-a-dozen quiches that her baker could prepare, if we ordered them.  So, once a week we order a couple of quiches to take home.  Problem solved (the Santa Fe last night was terrific, by the way).  She even took the time to instruct her staff that, when we call to order, the day before, we have her OK.

So, you see why I am writing about this.  That is the attitude and creativity that we strive for in every Support For Home employee, whether it is in the office or a Home Care Aide in our clients' homes.  To do less would be to disappoint not only our clients and their families, but Denise!

Every Day is an Interview

At Support For Home In-Home Care, all of our Home Care Aides are our employees.  We are not a referral agency for some very simple reasons.  As the employer of record, we perform the background checks, determine who is worthy of being a member of our extended family, cover them with liability insurance, our dishonesty bond, workers comp, etc.  That means our home care clients and their families are protected from unemployment claims, injury claims, and so forth.

To be the employer of record, we actually have to assign our Home Care Aides to our clients.  Every once in a while, a client or his / her family will ask to interview the Home Care Aide, first.  When this happens, we explain two things:

• If the client or family "interviews" the potential caregiver, they are indicating to the State that they may be the actual employer, not Support For Home.  That is dangerous for the client or family, because it can result in government burdens and expectations that the client is not prepared for, at all.  We are the employer of record to protect against that.  The client hires and / or fires us, Support For Home, not an individual employee.
• Every day that a Support For Home employee works for a client is an interview, in reality.  We tell our clients several things.  One is that we never want the client to "try to make it work" with a Home Care Aide.  The client and the caregiver are either a good match or they are not.  If they are not, we put a new Home Care Aide in place.  The second message is that things change.  A caregiver who is great for you right now may not be in six months, for whatever reason.  Every day is an interview, at which Support For Home and our employees must excel.

If you or a loved one needs home care, make sure you work with an agency that is the employer or record.  You may pay a bit more per hour, but you avoid a ton of potential liability.

It’s Senior Care – Do The Right Thing

Some folks in the industry feel that there is a fight for customers between Assisted Living (with a variety of levels of support) and Home Care. Some of know that is not what it is about at all. For those of us with a passion for senior care, it is about the living solution that is the best fit for the elder client and her or his family.

That is the situation for Support For Home In-Home Care and Senior Care Solutions, for example, in the Sacramento region. We and others who are committed to our clients’ well-being work together to look for what is best for them. As Carol Kinsel, owner of Senior Care Solutions puts it, “if you always do what’s right, good things will follow.” Our individual businesses will continue to grow and prosper, because we focus on what is right for the client and the family.

Over time, that best living situation may well change. For some seniors, the best option is to live at home until they pass. For others, a time is reached when, economically or medically or for other reasons, an alternative is needed. It may be that a memory care unit is appropriate, for example.

At Support For Home, we have had clients who needed to move from their home of 30 years to assisted living. We look to Senior Care Solutions to help them, and we do so with confidence. If the family calls Senior Care Solutions, but the “right” situation is staying at home, with excellent home care, Carol and her team turn to Support For Home or one or two other top quality home care agencies.

We will be continuing the dialogue about “doing what’s right” in these pages, covering a variety of elder care topics. We would love to see your comments and suggestions.

Best wishes,

Carol Kinsel

Bert Cave

"Five Wishes"

If you are not familiar with the "Five Wishes" document, you want to find out about it.  There is an excellent discussion of it in Wikipedia.  Basically, Five Wishes is a living will that allows you to address not just your medical wishes for care if you are seriously ill, but also your emotional and spiritual needs.

The Five Wishes involve:

• The Person You Want to Make Care Decisions for Me When You Can't
• The Kind of Medical Treatment You Want or Don't Want
• How Comfortable You Want to Be
• How You Want People to Treat Me
• What You Want Your Loved Ones to Know

Five Wishes is accepted in 42 states, including California, as well as the District of Columbia.  We are starting to see more Five Wishes documents with our home care clients at Support For Home.  Your financial wishes are not covered, of course, so you will probably still want a good trust attorney.

Five Wishes is also not a substitute for a Do Not Resuscitate (DNR) order, for those folks who do not wish to received CPR. 

Check it out.  It's simple, clear and can save a lot of anguish later.

Best wishes.  Bert

Discovering a Great Service, Sadly

Early this year, my father passed away.  Late last week, my mother also died.  Yes, both of those events hurt a lot.  The silver lining was discovering (actually my wife, the Chief Operating Officer of Support For Home, discovered) Dignity Memorial.

Dignity Memorial is an amazing service available to loved ones who are left behind.  To see just what I mean, below are the links to the memorials for my mother (Margaret Cave) and my father (Hardy Cave). 

Aside from being happy that others might see what grand people they were, I am amazingly proud of my sisters, in Oregon, where my folks lived, for making this happen.  Being the primary caregivers for my folks and making these memorials happen is amazing.

Being able to add some thoughts to the guest books, read what others have written, and at any time, maybe years from now, go back and look through the pictures -- this is an incredible service.

With love, Bert

I Hope This Is Not True

Yesterday, I was told that what is probably the largest home care agency in Sacramento has a policy that really shocked me.  If what I have been told is true, I found out that my wife and co-owner of Support For Home would be considered ineligible to work at that agency!

Now, luckily, she has no desire to do that, as we intend to continue managing our own home care agency for a long time, but the news was still a bit of a shock.

It turns out, at least so I have been informed, that this large franchise agency has a policy that only citizens of the United States are eligible to be hired.  My wife, on the other hand, was born in and is still a citizen of Singapore.  That was okay with Fortune 100 companies like Texas Instruments, Phillips and Intel Corporation, where she was a senior manager before we started Support For Home.  Evidently it is not good enough for a local franchise owner.

At Support For Home In-Home Care, we are very careful only to hire folks who have the legal right to work in the United States.  We complete what is called the I-9 process, including use of the Department of Homeland Security's E-Verify process.  Both ethically and legally, we will not discriminate against anyone who has the legal right to work in my country.

As the title of this piece says, I hope what I have been told is not true.  It would be un-American.

We Talk About Comprehensive Plans of Care

One of the most important concerns for us at Support For Home is that when we do a (free) assessment of new clients that we do a comprehensive assessment, looking at all areas of need, not just non-medical home care.

It is because of this focus, knowing that we can only provide a slice of the services pie that most of our clients need, that our Director of Client Services is an MSW (Masters in Social Work).  Providing great service starts with understanding need.

Over the years, we have managed to identify great allies who can provide services that address other slices of the pie within a comprehensive plan of care.  Some are local; some are national.  Some we know personally; some we know by reputation.

From time to time, we will list a few providers of services or products that folks who need assistance with ADLs (Activities of Daily Living) might find useful.  We would be delighted to hear your comments and suggestions on this topic.

Assistive Technology Services - These folks have a great variety of products in the areas of Mobility, Vision, Hearing, Security Home Automation, and Communicating.

Rebuilding Together - This is a national non-profit organization.  Their message is that they create "affordable, safe and efficient housing. Our vision is that all homeowners, particularly low-income seniors, live independently in comfort and safety in their own home. We accomplish our mission through home repairs and modifications on existing homes."  The Sacramento office is fantastic in terms of home safety for our clients.

Bay Alarm Medical - Most of the technology of various companies providing emergency alert products, including bracelets and pendants, is pretty standard.  The responsiveness to and cost for our clients is what separates one provider from another.

We will have more "useful resources" in future blogs.  Again, we would be delighted to have your opinions and suggestions.

Best wishes, Bert

We Already Talked About This Once, But ...

Recently, we discussed the difficulty that clients and family sometimes have separating excellent home care from a particulare Home Care Aide.  When we, at Support For Home, have to make a change, sometimes family just has a hard time accepting it.

Recently, we had a case of a Home Care Aide not showing up for an assignment.  Unfortunately, it can -- and will, at some point -- happen with the best senior care agencies.  The real crux of the matter is how the home care agency handles it.

This was a client undergoing dialysis on a regular basis, and the day in question was a dialysis day -- but the employee failed to show up.  Under California penal code section 368, that is a potential criminal offense for the individual.  We covered the assignment and got our client to dialysis. 

When the employee called, the next day, we informed her that she had "self-terminated" her employment with Support For Home and that, as she already knew, it would be reported to the authorities.

That is bad enough.  The former employee behaved in an ethically reprehensible manner.  It is up to the authorities whether they deem it to be something they will prosecute.  For us, there is no alternative.  She is no longer an employee.  We cannot trust her and will not subject any client to such potential behavior.

However, the family member of another client for whom she provided services actually wanted us to rehire the former employee.  That person was unable to take an objective view and realize the potential jeopardy the client might be in with someone who already demonstrated a willingness to abandon a dialysis patient.  Our answer -- it's not going to happen.  We will happily lose a client before we will hire back someone who behaves in such a manner.

And That's Good Because ...?

So, it is Saturday afternoon, and we answer the phone at Support For Home, as always, 24x7.  But today we get three very interesting phone calls in a row, from the same person.

A Home Care Aide Applicant calls.  She wants to talk to our HR Manager.  Well, the HR Manager is not in the office today (neither are we -- we're answering from home).  "No, we don't use voice mail, since we always answer the phone.  But we'll take a message or you can call back Monday."  No message.  She'll call back Monday.  Two minutes later, she calls again, thinking she'll "sneak" past us and leave a voice mail for Carlotta, our HR Manager.  "No, we answer the phone 24x7, so you won't get to voice mail for her."  OK.  Two minutes later, the same person calls, but hangs up when we answer the phone.  So, I call her back and tell her that she is not making a great first impression.

Well, it turns out, she is not trying to make a good impression.  It turns out that she has a criminal record, and our HR Manager said, "No, we won't hire you."  So, what she REALLY wanted to do was tell our HR Manager that she had found a job, anyway -- with IHSS, the County agency that provides caregivers to low income recipients.  She wants to gloat about that.

To us, this is a very sad thing.  In-Home Supportive Services (IHSS), a government agency, has hired her to provide home care.  We would not hire her ever, based on her background.

Now, we are fans of the program IHSS, in the Sacramento area.  Low income seniors need home care.  What they do not need is caregivers that cannot pass the background screening of Support For Home.  We hope this woman's clients through IHSS receive great care.

We Have Talked About Hospice Before ...

We have talked about Hospice services before.  It is a natural and critically important service associated with what we do, providing home care for the elderly. 

As a senior care, in-home care agency, Support For Home works with many very good Hospice agencies.  Today we saw a Hospice RN that combined the best of professionalism, medical knowledge and true compassion in working with a family.  Absolutely amazing mix of education for the family, honest, straight talk, and help for the family in dealing with the emotional trauma with which they are really only starting to deal.

As stated above, we work with a number of excellent Hospice agencies, but our hats are off, today, to Yolo Hospice and their team of RNs and Social Workers.  They make both life and death easier for our clients, our families and our Home Care Aides.

Thank you for the passion and commitment to the services you provide.

Best wishes, Bert

We Wish We Could Help Every Single Person, But ...

This is a tough topic, as we wish that we could help every family that asks us to assist someone.  However, every good (read "honest") home care agency will tell you that once in a while there is someone that we just know we will not be able to satisfy. 

In our case, that happens maybe only once per year, but it hurts when it does happen.  It hurts not from a business perspective -- we have plenty of clients for whom we are doing a great job at Support For Home, and we continue to grow rapidly in the Sacramento region.

Rather, it hurts because this is a person who really does need help with ADLs (Activities of Daily Living) and IADLs, or the family would not have contacted us.  To know, from the assessment, that we will not be able to make a person happy, no matter how good the care will be, is both frustrating and sad.  Our Home Care Aides are professional.  They know it is "all about the client," not about them.  However, there is always a limit to what we ask our employees to accept.

To quote the Philosopher, "Arrrrrggghhhh!"

"Convergence Between Healthcare IT and Life Sciences Informatics"

The reason for the quotes around the title is that there is a conference coming up on the subject, and below are some comments I added to the discussion thread in preparation for the conference.

As an old IT geek, myself -- my wife and business partner is an IT pro, as well, but I'd get hit if I called her an old IT geek :-) -- now managing a non-medical in-home care agency, we are always thinking about ways that information technology can help our clients.

This is obviously an incredibly important topic, one which we feel is still not fully appreciated by the Healthcare IT, vendor or medical provider communities.

As a former IT Director at Intel, supporting Digital Health and other business groups, the importance of IT for healthcare was easily seen, if more difficult to implement. What was not included in most of the usage models at Intel's Digital Health and other suppliers in the field, however, was the non-medical home care needs of seniors, folks recovering at home from hospitalization or skilled nursing facilities. These usage models became very clear to us as we founded Support For Home, which provides non-medical in-home care.

For our clients, many of whom have either family caregivers or professional Home Care Aides, the issues are Activities of Daily Living (ADLs) and Instrumental ADLs, in addition to the interface between the caregiver / Home Care Aide and a Home Health agency (e.g., skilled nursing, PT, OT, ST) and/or other healthcare providers.

Given that few Home Health agencies do shift nursing -- and few clients can afford it -- having the Healthcare IT products that a non-medical caregiver can assist a client / patient to use is very important. From medication reminders and automated dispensers to cognitive testing, remotely, for dementia, the opportunities for non-medical -- but critical to health and healthcare -- IT products and services are enormous.

And Now For Something Entirely Different

So, this is something that has been brewing in my mind for quite a while.  I did not really intend to blog on the topic, but a comment by a new client actually convinced me that I should.

Just to be clear, this is not about how our senior care, in-home care agency, Support For Home, is better than others.  It is about the fact that we would love to see other agencies understand the sensitivities of seniors and decide to stop this practice.

OK, so what in the world am I talking about?  The issue is "branded" cars that scream the names of homecare agencies. 

If I'm a realtor or sell insurance, no issue with the decals or paint jobs that tell the world what I'm doing.  However, if my passion is, however -- as ours is -- to enable seniors to continue to live at home, I'm not going to do that.  Many seniors have enough issues accepting that they need help.  It is an emotionally difficult decision for them.  If they want to share the fact that they are receiving care with their neighbors, great.  We are not going to advertise that fact by the cars our administrative staff or Home Care Aides drive.

For us, it is just a matter of being a little bit more sensitive.  Do you agree or disagree?  We would love to have your comments.

Best wishes, Bert

Costs: Home Care vs. Assisted Living vs. Skilled Nursing Facility

CareScout is a Genworth (the Long-Term Care Insurance company -- see earlier blog on LTCI) company that serves seniors and their families in a variety of ways, including free referrals to facilities and home care companies.  They just published their latest study of costs, with very interesting results, including the following:

This year's survey once again shows the cost of home ... care to be rising much slower than the cost of staying in a nursing home or assisted living facility... The historical compound annual growth rate for this type of care service has been only 1.7% over a five-year period. A one-bedroom assisted living residence has increased 6.7% percent annually over the same five year period. A private room in a nursing home has increased 4.5%.

This is not a new trend.  The cost of home care for the elderly has consistently been less expensive "pound for pound" than within a facility.  We certainly expect that to continue.  When you measure home care versus facilities care in terms of cost-benefit (where constant skilled nursing is not a requirement for the individual), the difference is even greater.  The quality of life benefits, for most seniors, makes it a no brainer.

Agree, disagree, questions?  Give us your comments, please.

Best wishes, Bert, Support For Home

Should a Family Member Be a Parent's Caregiver

We are a member of several industry groups that include discussion topics meant to stimulate thought and improvement in the are of in-home care for seniors.  One of them is the National Senior Living Providers Network, which is the Internet "location" for a discusion about "Should I become my parent's caregiver?"

I think the answer should not be a "yes" or a "no," actually. At our in-home care agency (Support For Home, in the Sacramento, CA region), we believe that client homecare is family care and that, ideally, homecare is a team effort -- the homecare agency, including administrative staff and Home Care Aides, the family members (whether local or remote) and the client.

The statistic that we in the homecare industry know all too well is that about 63% of family caregivers actually die before the person for whom they are caring.  That says it all about the stresses -- physical, emotional, psychological -- of being a family caregiver.

In addition, good in-home care means a certain amount -- actually, a lot -- of care management, beyond the direct support of ADLs and IADLs delivered by the home care agency. Being able to identify and locate resources for home safety, fall prevention, emergency alert systems, mobility support, etc., reuires a lot of time and knowledge.

So, for the good of the client and the good of the family members, adding a non-medical in-home care agency to the team is really important.  Whether you agree or disagree, please let us know.

Best wishes, Bert

Elder Abuse: On-Going Problem for Seniors, Families, Caregivers

In California, all homecare agencies, whether medical (home health) or non-medical are mandated reporters of elder abuse.  Abuse can take many forms, however, from "simple" neglect (benign or otherwise) to physical or financial.

We will be talking about some of these issues in several upcoming blogs.  Today's focus is on financial abuse of seniors.  There are many good Internet resources on this topic.  A few of them:

• Crimes of Persuasion - this site talks about many of the signs to watch for that might indicate abuse.
• Article by Karen Stephenson - sums up a good bit of research.
• National Committe for the Prevention of Elder Abuse -  this is an excellent site for more than the financial issues

For us at Support For Home, this is a very personal issue.  Many of us have seen episodes of attempted -- or worse, successful -- financial abuse of seniors.  Our Director of Client Services even wrote her Master's thesis on this topic.

It is one we make sure our Home Care Aides are sensitive to, not just in terms of avoiding anything that could be interpreted as abuse, but also awareness of the signs that it may be occurring.  One of the dangers is that when an elderly citizen reports issues -- items missing, not as much money as they used to have, ... -- some people might simply dismiss as "forgetfulness" or "senior moments".  This must not happen.  If there are signs of possible abuse, they must not be ignored and must be looked into by the appropriate people.

There are far too many stories of financial abuse by the caregiver population, whether family, "friends" or employed.  We are dedicated to ensuring it does not happen on our watch.

If you have stories to share, lessons we can all learn from, please let us know.

Best wishes, Bert

Communication: Client, Family, Home Care Support

At Support For Home, our ideal situation is when the client and his or her family are "on the same page" about homecare and the significant issues being faced as the senior(s) strive to continue to live safely and securely at home.  Sometimes, though, those folks are on very different pages, in spite of deeply caring for each other.

Occasionally, the daughters or sons are very reluctant to have the serious dialogue necessary with their parents on the topic of aging in place / senior care.  The "children" may have played that role for so long that it is tough to initiate that adult-to-adult conversation.

Equally likely is that the parent(s) may resist having the conversation, because they feel it diminishes their status as parents and independent, self-sufficient adults.  In reality, of course, the conversation does not diminish the parent(s) in any way, but it can "feel" very uncomfortable.

In either case, whether the reluctance comes from the children or the parents, we are often able to play a "facilitator" role in that critical dialogue.  We do not have the emotional history of the family members.  We approach the need for care as professionals -- in our case, led by our MSW (Masters in Social Work) Director of Client Services -- with experience in gerontology and a passion for helping folks live at home, even if they need help with Activities of Daily Living (ADLs).

For on-going communication between clients and family members at a distance (e.g., "Mom lives here, but I live in New Jersey"), our Home Care Aides often serve as an important information link, either directly or through the administrative team in the Support For Home office.

The bottom line is, communication between the client, the family and Support For Home (or any very good home care agency) is absolutely critical to successful senior care.  It's not good enough to just focus on the ADLs and IADLs and think everything else will take care of itself.  We know that, which is why, in our philosophy, client care is family care.

Best wishes, Bert

Follow-Up on Bonding with Home Care Aides

Yesterday, we talked about challenges for providing services to homecare clients when the regular Home Care Aide is out for some reason, and the client feels that no one else could possibly be as good. 

As we said, this happens even -- perhaps more so -- with very good agencies.  Part of what will make an agency great, in our opinion, is eliminating this issue, so that clients never hesitate to accept a substitute caregiver.  Support For Home is committed to moving from "very good" to "great," by this and other measures.

So, what are we -- and what should other very good non-medical homecare agencies be doing to move up the quality ladder?  Some folks will disagree with us, but that has not stopped us yet!  :-)

The first thing we are doing is in fact emphasizing the fact that we are providing Non-Medical Homecare, supporting our clients Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs).  Home Health agencies are tasked with providing skilled nursing and other forms of therapy (e.g., physical or speech therapy).  These agencies, in California, are licensed and the employees are, as well.  Unfortunately, not every state licenses Home Health agencies.  That is a bad thing, as far as we are concerned.

However, our major point is that we are focused on the non-medical needs of the client, including home safety, emergency alert systems, memory care, and all of the ADLs and IADLs.  So, now comes the controversial part.  :-)

Many non-medical homecare agencies are headed by RNs.  For many of them, they consider this a strength.  For home health agencies, we think it definitely is, as well.  For non-medical homecare agencies, however, we think a social work focus is far more appropriate.  Because of that, our Director of Client Services holds a Masters in Social Work (MSW), rather than an RN status.  Don't get us wrong, some of our best friends are RNs, and a close friend who is an RN runs excellent agencies in the Palm Springs and San Francisco areas.

However, our social work emphasis recognizes that there is a totality of need to be understood and addressed, from mental health to shopping to toileting and everything in between.  For medical needs, we work with clients' doctors and home health agencies, who address their slice of the universe of need.  In our view, the better we become at the social work focus, the faster we will move from "very good" to "great."

Best wishes.  Bert

Bonding with Your Caregiver is a Good Thing, But ...

This is something that every really good home care agency experiences -- the client falls in love with the caregiver.  In some ways, that's great, but it is a double edged sword. 

First, we stress to our Home Care Aides -- and to our clients -- that the relationship between the two of them is and must remain a professional one.  That does not mean that they should not care personally, but, for the Home Care Aide, there is a job to be done, every shift.  They are not family members or guests in their clients home.  The are providing critical support for Activities of Daily Living (ADLs) and Instrumental ADLs, such as cleaning, cooking, bathing, dressing and so forth.  That service role is primary.

At Support For Home, we even make employees sign waivers forfeiting any chance of inheritance, and gifts are very closely monitored.  We do not want our clients or their families negatively impacted in any way.  That is the case regardless of whether the client has any level of dementia.

The second concern about emotional bonding with the Home Care Aide is what sometimes happens when the caregiver is ill or needs time off from an assignment.  Ideally, the client will remember that we, the agency, are the ones who assigned the wonderful Home Care Aide, in the first place.  They will say, yes, I still need the services, and I have confidence that you will give me someone equally good as a backup.  Thankfully, that is the norm.

Unfortunately, some clients sacrifice the care they actually need, feeling that no one else could possibly provide that care.  "If Mary is not available, then I don't want anyone."  That puts the client in jeopardy, since, if they did not need the care, the shift would not have been scheduled in the first place.

We actually had one extreme case of this recently.  When an employee did not show up for an assignment until an hour after they were supposed to and gave no indication of recognizing this as a problem, we terminated the employee.  When a different client was told that the Home Care Aide was being replaced, because that person no longer worked for us, the client's response was not, "Thank you for watching out for the best interests of Support For Home clients."  Instead, the client felt that we were making life "miserable."  Even though after two days with the new caregiver the client said the new person was "great," the bond with the prior Home Care Aide simply could not be overcome.

We want to make it very clear that this is not a complaint.  As mentioned earlier, a bond is a very good thing in some ways.  Our clients need to trust our employees.  Rather, it is a recognition of the importance of emotion in senior homecare.  It is not just about services X, Y and Z.  The really good homecare agencies keep that in mind, all the time.

When the Family Home Just Doesn't Work Anymore

At Support For Home, our goal - our passion - is to help our clients live safely in their homes, with a high quality of life.  That will never change.  There are many services that can help folks stay at home, including Durable Medical Equipment suppliers (e.g., hospital beds) and mobility specialists (stairlifts for example, in two-story homes - see an earlier blog on that topic).

However, for some folks, a time comes when the familiar (interesting word, yes?) home simply is no longer the right place to live.  Sometimes that means moving from a larger, two-story home to a smaller house or a condo.  Sometimes it means an assisted living facility.  For the latter, a referral service may be very helpful, but make sure you are working with the best people.  In the Sacramento region, Carol Kinsel's Senior Care Solutions is one of the very best. 

For all of us, moving is very hard work, and probably not the favorite way to spend time.  For seniors, it can be even more frustrating, emotional and physically challenging.  In the Sacramento area, there is a company called Compassionate Relocations that can help with the move and the logistics.  They also provide assisted living referrals.

So, we will do everything in our power to help you or your loved one stay at home as long as desired.  If a decision is made that moving is the only option, make sure you choose the agencies that will help you find and move to your new residence as carefully as you chose the agency that provides homecare.  And yes, of course Support For Home provides care to residents of assisted living facilities, as well.  :-)

Best wishes, Bert