Support For Home

Moving to WordPress

2010-08-05T13:32:00.000-07:00

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

2010-08-03T18:47:00.000-07:00

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

2010-08-01T17:08:00.000-07:00

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

2010-07-31T13:23:00.000-07:00

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

2010-07-30T09:24:00.000-07:00

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?

2010-07-29T15:43:00.000-07:00

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?

2010-07-29T14:46:00.000-07:00

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

2010-07-29T11:03:00.000-07:00

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

2010-07-28T15:14:00.000-07:00

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

2010-07-28T10:14:00.000-07:00

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:

Homemaker Services -- Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs) in the home
Companion Services -- ADLs and IADLs that involve our interfaces with others and outside the home
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

2010-07-27T16:15:00.000-07:00

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

2010-07-27T10:28:00.000-07:00

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:

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.
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.
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

2010-07-26T16:37:00.000-07:00

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?

2010-07-23T11:40:00.000-07:00

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 ...

2010-07-22T16:17:00.000-07:00

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

2010-07-22T11:09:00.000-07:00

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?

2010-07-22T09:05:00.000-07:00

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!

2010-07-20T09:53:00.000-07:00

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!?

2010-07-19T14:40:00.000-07:00

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

2010-07-16T09:23:00.000-07:00

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

Dementia and Alzheimer's Series #6: Sleep

2010-07-14T14:35:00.000-07:00

As often observed by the Home Care Aides of Support For Home, sleep disturbance is a major issue for many individuals with dementia, as well as their families.

Families of patients with dementia can often tolerate agitation, delusions, and wandering as long as nighttime sleep remains uninterrupted. However, when behavioral disturbances occur day and night, families often feel compelled to resort to institutionalization. Educating families about strategies for preventing or correcting sleep problems may help delay assisted living or skilled nursing facility placement. Helping with such placements is what Senior Care Solutions does, but if we can help folks stay at home, that is great.

Many factors can contribute to poor sleep habits in persons with dementia, including disrupted sleep patterns, alterations in circadian rhythm, concurrent medical problems that cause frequent urination, daytime use of sedating medication, and frequent napping. In our experience, the chief causes of sleep disruption are frequent napping and excessive expectation of sleep needs.

Families often report that the patient wakes and dresses for morning activities at 3 AM. On further questioning, they may reveal that the patient naps while watching television during the day and goes to bed at 8 PM. In this common scenario, the patient's early morning awakening is not abnormal. Daily sleep requirements do not increase as a person ages, and the patient is often sleeping more than the 7 to 8 hours required for most persons to feel rested. In addition, caregivers often see the patient's nap time as an opportunity to accomplish tasks around the house. This is a shortsighted view that many come to regret.

The first step in reestablishing a normal sleep pattern is to limit daytime napping. Leaving a patient with dementia in front of a television set almost always leads to napping. As an aside, the content of TV watched by a person with dementia must be monitored carefully, as violence or other content may be very disturbing to the patient, making sleep issues even worse.

To prevent the problem of napping in front of the TV, caregivers should engage patients in activities that are tailored to the degree of dementia, such as simple handicrafts, household tasks and, most important, regular physical exercise. Such activities can be carried out at home, but many patients and families benefit from the added structure of adult day care.

Once poor sleep hygiene has become established, it is much more difficult to eradicate. The first steps in correcting sleep problems are to set a more reasonable bedtime and prevent napping. The patient's activity level should be increased, and fluid intake should be decreased in the hours before bedtime. After a few difficult nights, the patient will begin to sleep for longer periods.

For families who cannot accept the possibility that the problem will worsen before improving, talk to the patient's doctor about the possibility of limited use of a hypnotic or sedating drug (e.g., trazodone, zolpidem tartrate, a short-acting benzodiazepine). However, long-term reliance on sleeping medication, especially benzodiazepines, is rarely successful. Again, a medical professional should be the decision maker concerning these approaches.

Environmental lighting may also have a role in sleep disturbance. Light is an important modulator of circadian rhythms, which may be disrupted in dementia. Increased lighting during afternoon and early evening hours may improve sleeping patterns. In one sleep study on the effect of increased daytime illumination in 22 patients with dementia, improvement in the rest-activity rhythm occurred in patients with intact vision but not in visually impaired patients. A clinical trial assessing the efficacy of melatonin in the treatment of sleep disturbance in Alzheimer's disease is under way, but results are not yet available.

The most difficult part of managing sleep problems is the need for continued adherence to a rigid schedule. Families should be taught that periodic disruption of the schedule will likely result in a return to irregular sleep patterns. A doctor's prescription for use of a hypnotic agent for periodic administration is helpful and provides families with a sense of control.

Best wishes,

Carol Kinsel, Senior Care Solutions

Bert Cave, Support For Home

Dementia and Alzheimer's Series #5: Driving

2010-07-14T08:39:00.000-07:00

There is an excellent, on-going series of in The New York Times, called The New Old Age. Written by Paula Span and Jane Gross, the blog series covers a wide variety of topics involved in aging and senior care. All of the topics are important, but one that concerns us very much, at Support For Home and Senior Care Solutions, is driving.

In an April 2010 article, titled "Driving While Demented," Paula Span points out that "several studies had shown that a considerable number of those with mild dementia — 41 percent to 76 percent, depending on the study — could pass an on-road driving test." We absolutely believe that. It does not, however, mean that folks with dementia should be driving. Rather, it means that we do not have good driving tests!

Every one of us who drives has "gotten away" with periods of inattention or bad judgment. Some one else avoided the accident we might have caused or there was no one else around. The point is, even without dementia, driving is extremely dangerous. When families look at Dad or Mom and consider whether they should be driving, they either forget that or do not want to face it.

One reason they do not want to face it is they might then have to be the "bad guys" and take the keys away from someone who has been an authority in their lives forever. They do not want to hurt their parent(s). In our view, this is simply making the wrong choice.

Paula Span includes two very important points in her article, including the standard used by the American Association for Geriatric Psychiatry, as stated by their past President, Dr. Gary Kennedy:

“Our recommendation is that you stop driving once you have a dementia diagnosis.”

Less formally, he relies on “the grandchild rule”: If a patient’s children don’t want the grandchildren in the car when the patient is driving, he or she needs to relinquish the keys before hurting someone else’s grandchildren.

We think that is a good approach. Assume that there are children who are at risk -- because they always are when we drive -- and let that guide you.

Too often, we talk to seniors with dementia and family members who think that driving is OK, as long as it is just in the local area. Our response to that is to ask where most non-driving accidents happen: answer, at home, with the bathroom the most dangerous location. So, being close to home does not improve our safety. Why would it do so while we are driving?

Another reason that some families want Dad or Mom to keep driving is that they see it as therapy. "It keeps him stimulated and sharper," we actually heard from one daughter. With all due respect, NO! This is part of a larger problem we will talk about in another article, which is that some families are unable to absorb that dementia is truly a disease; that their parent(s) cannot help their behavior; and that it is not going to get better simply by expecting the parent(s) to work at it.

Best wishes,

Carol Kinsel, Senior Care Solutions

Bert Cave, Support For Home

Dementia and Alzheimer's Series #4: Hospital Stays

2010-07-13T10:51:00.000-07:00

The following great set of guidelines comes from the Alzheimer's Aid Society of Northern California. We thank them sincerely for all of the support they provide to Alzheimer's patients and their families and friends.

Almost everyone who has ever had the experience of being a patient in a hospital knows that it can be frightening. It is even scarier for persons with dementia. Unfamiliar surroundings, food, and caretakers can be devastating
when one is confused and disoriented. Confusion and disorientation affect how quickly and how well a patient recovers. Providing useful techniques for staff and family visitors can mitigate resulting problems such as anxiety and wandering. Some suggestions include:

Have a caregiver advocate on behalf of the patient. If possible, a family member should remain with the patient at all times. This person can help distract and soothe the patient during medical procedures.

Use non-verbal techniques and simple language to communicate. Gestures, facial expressions, pictures, and signs are all examples of non-verbal communication. These can be used when cuing the patient to eat or bathe.

Have a list of patient’s likes and dislikes. Favorite items can provide comfort and distraction. Knowledge of dislikes can help the staff avoid negative reactions and minimize anxiety.

Studies have shown that the use of restraints tends to increase injuries and causes distress for the patient. Other methods that can keep the patient safe are distraction, soothing touch, music, or prayer.

Be sure the patient is not over or under-stimulated. Patients with dementia have more difficulty communicating when over-stimulated by television or multiple conversations. Conversely, insufficient stimulation may increase anxiety.

Be aware of changes that may be occurring in the patient. Some patients won’t express pain or other feelings. Note any physical or mood changes which may indicate a complication or new illness.

Allow the patient to make as many decisions as he or she can. Guided choices providing some control can limit distress.

Best wishes,

Carol Kinsel, Senior Care Solutions

Bert Cave, Support For Home

Recognizing and Treating Caregiver Stress

2010-07-13T10:22:00.000-07:00

Senior Care Solutions and Support For Home work with many seniors and their family members -- many of whom are caregivers in their own right. We see and learn about issues that caregivers face all the time, and it is very important that they be able to recognize those issues and that they have resources to help.

Below are some of the signs to watch for and some resources that might help. The first and most important thing we want caregivers -- family or professional -- to do, however, is to be willing to admit they are human and that they cannot do everything and be everything to their loved one or their client.

Physical signs of Care giving Stress:

Disturbed sleep
Back, shoulder, neck pain, muscle tension
Headaches
Stomach, digestive problems
Unusual loss of hair
Fatigue
High blood pressure
Chest pain
Excessive perspiration
Skin disorders
Weakened immune system

Emotional signs of Care Giving Stress:

Anxiety/depression
Moodiness/mood swings
Irritability, easily frustrated
Memory problems/lack of concentration
Feeling out of control
Phobias
Argumentative
Feeling of isolation
Job dissatisfaction

Tips for avoiding and managing Care Giver Stress:

Work out
Meditate
Ask for help
Set realistic goals
Prioritize: Establish a daily routine
Take a break: family, friends, volunteers or professional care givers can help
Eat well: eat plenty of fruits, vegetables and protein
Take care of yourself: get your annual checkup
Indulge: treat yourself to something nice
Support: find a local care giver support group

Some places to go to for support: Helpful Resources

Support For Home
1333 Howe Ave., Suite 206
Sacramento, CA 95825
http://www.supportforhome.com/
916.482.8484
530.792.8484
Senior Care Solutions
916.965.5565
http://www.seniorcs.com/
Leeza’s Place
888.ok.leeza
http://www.leezasplace.org/
National Family Caregiver Association (NFCA)
800.869.3650
http://www.nfcacares.org/
Family Caregiver Alliance (FCA)
415.434.3388
http://www.caregiver.org/
Administration on Aging (AOA)
800.677.1116
http://www.aoa.dhhs.gov/
Well Spouse Foundation
800.838.0879
http://www.wellspouse.org/
National Alzheimer’s Association
800.272.3900
http://www.alz.org/
National Council on Aging
http://www.benefitscheckup.org/

The best way to provide excellent care for your loved one or client is to take excellent care of yourself!

Best wishes,

Carol Kinsel, Senior Care Solutions

Bert Cave, Support For Home

Helping Caregivers Be All That They Can Be

2010-07-12T16:42:00.000-07:00

From Carlotta Sanchez, Care Services Manager

At Support For Home one of my responsibilities is to make sure that our Home Care Aides receive the proper training and knowledge necessary to give the best care to our clients. That covers a very broad range of issues, from continuing education credits for our Certified Nurse Assistants and Certified Home Health Aides to the glycemic index for blood sugar impact in diets for our clients.

Today, a caregiver had a question concerning support hosiery (compression stockings) and how to properly put them on a client. Support Hose are used to reduce stress on the blood vessels in the legs. They are essentially very tight fitting socks that come in different brands and varieties, which can go to the mid-calf, knees, and upper thighs.

For something this basic, there are no classes offered to teach a Home Care Aide how to do this, so they must find a willing healthcare professional to ask about it or go to the Internet, which is what I did. I found an excellent video on YouTube that describes how to easily put Support Hose on a client. I do not endorse the Internet as the best source for how to be a great family or professional caregiver, but it does have some great insights to help Home Care Aides gain better understanding of the various tasks required.

So, check out the YouTube video on putting on compression stockings. A great hint is that the gloves in the video can be switched out for dishwashing gloves, which can definitely make it easier to put the hose on.

We are always here to support our caregivers, to help them do their job and realize the talent and potential they have to continually give the optimal care our clients deserve.

More Dangers of "Under the Table" Caregivers

2010-07-12T13:37:00.000-07:00

We have talked with so many families and prospective home care clients about the dangers of "independent contractors" who really are not and referral agencies that offer no protection to senior clients and families.

The issues include no liability insurance, dishonesty bonds, background checks, unemployment insurance and on and so forth. Partially because of the economy the last couple of years, we are now seeing government, both state and federal, get a lot more interested in the issue.

Several months ago, The New York Times published an article, "U.S. Cracks Down on ‘Contractors’ as a Tax Dodge". It indicates that:

Federal and state officials, many facing record budget deficits, are starting to aggressively pursue companies that try to pass off regular employees as independent contractors.
President Obama’s 2010 budget assumes that the federal crackdown will yield at least $7 billion over 10 years. More than two dozen states also have stepped up enforcement, often by enacting stricter penalties for misclassifying workers.

Interestingly, this emphasis is being supported by organized labor, one of the Obama administration's major supporters.

Another article was published in March by The Wall Street Journal, titled, "Cash & Career: The Perils of 'Off the Book' Jobs".

The bottom line is that "referral agencies" that do not operate honestly and caregivers who claim to be "independent contractors" but are not doing the right things are increasingly the focus of the IRS and state tax and employment agencies. it does not stop there, however, because the people who hire -- and that is the right word, because the seniors and their families will be seen as the employers of record in many cases -- are going to be on the hook for Social Security, Workers Comp claims and insurance and a whole lot more.

That is just not right, and we wish all businesses -- and individuals -- would operate ethically and legally. The home care industry would be so much better.
Your thoughts? Best wishes, Bert

Dementia & Alzheimer's Series: #3

2010-07-10T09:17:00.000-07:00

Perhaps the most meaningful and moving resources for individuals with dementia or Alzheimer's and for the families that love them are from people who are already suffering. Their blogs, articles, books and interviews provide insights that we really need to continue to drive us to a cure. They also are excellent reminders of the dignity of the individual and the respect they deserve.

One such resource is Mike Donohue's blog, plus his book, From AA to AD, a Wistful Travelogue. Started in 2007, his blog began after he was diagnosed with Alzheimer's. One of the critical points he makes -- there are a great many, in a blog with over 250 articles -- is that we tend to focus so much on the cure (the future) that we forgot the needs of now:

AD needs more attention, in so many different ways, than it is getting. There is so much concentration on raising money to find a cure, little more than lip service to the universe of needs of those suffering the disease.

Take a long look at what Mr. Donohue has done for us. It is worth it.

Just one other suggestion for today, which is actually a novel named STiLL ALiCE, by Lisa Genova. Dr. Genova is a Neuroscientist who has written about a professor who develops early onset Alzheimer's. It is a story we should all know and feel.

Best wishes, Bert

Rewards Do Not Always Mean Revenue

2010-07-09T09:34:00.000-07:00

A few days ago, our Director of Client Services, Tonja, received a call from a nurse on a case management team who was at a loss as to how to help a client. The gentleman in question lives in a rural area, and is at a rehabilitation facility quite some distance away, recovering from surgery.

The nurse reported that the man was becoming increasingly anxious, thinking of his mail not being picked up and wanting to manage his household business while in the facility. Support For Home had helped quite a few patients from the rehab facility by providing home care after the patients were discharged. The nurse did not know what we could do, but she -- and the patient -- needed help.

This was not about home care, so whatever we did was not going to generate an invoice. There was not going to be any revenue. To us, that did not matter.

The Social Worker inside our Director of Client Services took over, and she made a number of phone calls and reached the local senior center, whose representative stated that with written permission, their volunteers who deliver homebound meals in that area could pick up his mail. The senior center even offered to priority mail his correspondence for free!

Tonja phoned back the nurse from the case management team, and after providing her with the information she needed to assist her client, she stated, “I always call Support For Home when I don’t know what to do – you always help!” We just got our reward -- smiles in the office for the rest of the day!

Working together to assist older adults, no matter what their issue: that’s what this industry should always be about, whether that is a nurse who is smart enough to know that not every issue involved in recovery is medical and caring enough to do something about it, or a home care agency that knows not every reward has a $ in front of it or a senior center dedicated to their mission. We love it! Nobody told the patient to just get over it or not worry about it. We all worked together to help, treating the senior with dignity and respect.

Dementia & Alzheimer's Series: #2

2010-07-08T10:14:00.000-07:00

One of the on-going goals of this blog is to point to other sites and resources that we at Support For Home believe are useful for both professional and family caregivers. One of those sites is SeniorsList.

Not every article they publish is great, but a number of them are. while you will find our business listed on the site, we do not necessarily think Internet sites are the best way to find home care agencies. A local human whose business is to know the agencies in an area is a much better approach.

However, as I say, some of the articles are very good. One that has just been published is "Caring for Someone with Alzheimer's," by Murphy Ortiz. The author begins by saying something that, from our experience, we all need to let "sink in," and that is -

It's very easy to say "I'll never put Mom in a nursing home" when she's healthy. But if you're one of the many family caregivers of someone with Alzheimer's, that promise may not be easy to keep.

There are still many folks who hold to that promise, but it can be very tough, and there are some critical points we believe family caregivers need to remember. One of the most important principles, in our experience, is that the family caregiver must be able to be selfish.

Sounds strange, right? What we mean by that is that we see too many families where the primary caregiver (and secondary ones, too, sometimes) is absolutely physically, emotionally and psychologically exhausted, because she or he is not getting the respite that is vital to being able to go on.

When that respite is missing, provided either by other family or professional home care agencies, the chances of being able to keep that promise are significantly diminished. It will be more expensive to bring in a home care agency to help than going it alone, but the chances of success, in keeping that promise, are tremendously higher.

As Murphy Ortiz writes,

Learn how to ask for help. You might be trying to do too much yourself. Caring for a loved one with Alzheimer's requires a great deal of patience and sacrifice, and one person can't do it alone. Don't feel guilty asking for help. You'll be doing your Mom more good having help on your side... Maybe you can ask a friend or family member to sit with your Mom to give you a much needed break. You can also contact a home care agency that can provide someone to assist your Mom with her care. These caregivers can also engage your Mom and participate in enjoyable activities with her.

It is a noble promise, and it is possible to keep it, but it means being willing to ask for help.

Best wishes, Bert

Say What You Will Do ...

2010-07-07T15:38:00.000-07:00

Say What You Will Do, Then Do What You Said

That was the favorite motto of one of my old bosses at Intel. When you really analyze it, it is a pretty solid axiom by which to live and run a business. It is absolutely the way we try to run our in-home care company, Support For Home.

It relates to the way we manage our employees and the way we relate to our clients and their families. One example is that when we started this agency, we encountered what is called Wage Order 15, which governs California employers and employees providing personal attendant care in the home.

The first point to note is that California regulations are stricter than at the Federal level. The US Department of Labor provides meal time and sleep time exemptions from wage and overtime provisions for 24-hour assignments for personal care attendants. In California, there are no such exemptions for employers. They are required, by a literal reading of Wage Order 15, to pay for all 24 hours that the employee is on the assignment.

When we started Support For Home in 2007, we were told no agencies in California were actually complying with Wage Order 15. CAHSAH (California Association for Health Services at Home) confirmed that the Order required employees to be paid for each hour, but that they did not know of any other agency actually doing so, as they try to rely on the Federal regulations.

So, why is Support For Home following Wage Order 15? When we started the company, we promised that we would make our employees the heart and soul of the agency. We told them that and we told them we were going to pay more than any other agency for 24-hour assignments.

Now, even the labor lawyers are saying the State of California will not prosecute; that agencies can get away with it. That means we could too. We could pay what other agencies are paying -- $100-$140 or so. Not to put too fine a spin on it -- it is not going to happen.

We said we will conform to Wage Order 15, and pay $192 to our 24-hour assignment Home Care Aides. We are doing what we said. Do we have to? Maybe not. But, it is the right thing to do. There is that other old saw about "You get what you pay for!"

Dementia and Alzheimer's: A Series

2010-07-06T14:13:00.000-07:00

In senior care, one of the most frequent conditions we encounter is dementia, in one of its 1000+ forms. The most "famous" is Alzheimer's, but in any form it is very serious, for the individual and his or her family.

Over the next few weeks, we will be talking about this issue from a number of perspectives: the client / patient, family members, including family caregivers, professional caregivers at home and the facilities who serve people with dementia, including those that provide memory care. We will talk about the dignity of those suffering and the immense respect we have for them, as well as for those helping.

One of the topics we will be spending time on is the many resources that are available to us on the topic of dementia. Thankfully, this is a condition that we take very seriously as a society, and there is a great deal of study going on and helpful material that has been published. We will just mention a few of the "biggest" in this first article:

One of the most significant sources is the National Institutes of Health's National Institute on Aging. This site has many helpful sections. One of the most important is their Alzheimer's Disease Education and Referral (ADEAR) Center. The Center has many publications and links to tools and services that can be very helpful to everyone affected by or supporting someone with Alzheimer's. The site is updated frequently and well maintained.
Also part of the National Institutes of Health is the National Institute of Neurological Disorders and Stroke. They have an excellent section called Dementia: Hope Through Research. That Institute has a separate "page" called Dementia Information that is also very useful.
The third resource we will mention today, as we get started, is one all of us concerned about this topic should be aware of and with which we should be involved. That is the Alzheimer's Association. They have great information, but, even more than that, they are at the heart of the fight.

In future articles, we will include other resources, including some you might tell us about. We will also have some stories from our own collective experience. If you have a story to share, let us know. Thank you.

Carol Kinsel, Senior Care Solutions

Bert Cave, Support For Home

Honest Disagreements, But Crucial

2010-07-02T13:39:00.000-07:00

Stephen and Jason Tweed are very well-known figures in the home care industry, and rightly so. They are bright, witty and very smart folks. So, when we discovered a fundamental area of disagreement this week, we were very surprised. But it is such an important area that we had a serious dialogue with them on the topic. Some of that dialogue is reproduced, below, from our email exchanges. We still think they are great and, even more, inspiring, but it is such an important topic that we want folks to see both perspectives.

So, what is this big question? It is whether families who need in-home care should hire privately or hire an agency which employs Home Care Aides. As you will see, we are in about 90% agreement. The Tweeds believe that "most of the time families are much better served by hiring a home care company rather than trying to hire privately." Our own position is that "most of the time" is about 99%.

From our own family and professional experience, we feel so strongly about this that we have devoted a whole section of our Web site to the issue. So, why do we have this basic disagreement?

Jason Tweed has actually hired caregivers privately, as his own employees. He and his family have the experience in the industry to understand all of the issues specific to the home care industry, including workers compensation insurance codes, liability insurance, and so forth.

Our own experience, however, is that, unless a family has that level of knowledge, hiring privately or using an "independent contractor" is a disaster waiting to happen.

As we explained to Stephen and Jason Tweed,

[We] know of one case where caregivers were hired privately, through a family’s business. They paid workers comp, unemployment insurance, etc. Everything is good, right? Not so much. The family / business did not know to use the right workers comp code, so a claim blew up in their faces. Not pretty. A carrier may even choose to not cover employees if home care is outside the scope of the normal “business of the business.”

Other families have thought their home owners insurance would protect them, in terms of liability, only to have the insurance companies say, “Nope, that’s a domestic employee. You need business liability. Home owners insurance does not cover.”

The bottom line is that very few families – and even fewer senior clients without family resources – have the knowledge and resources to do everything right to protect themselves.

So, our wish for Jason and Stephen is, keep pushing the industry for higher quality and integrity. We are with you 100%. But when it comes to advising about hiring an agency versus a private caregiver, please make sure you are not counting on the family having your level of experience and knowledge of what needs to go right and what can go wrong.

Best wishes, Bert

Mom and Dad, Spend It All!

2010-06-29T09:25:00.000-07:00

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

2010-06-28T19:47:00.000-07:00

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

2010-06-28T16:04:00.000-07:00

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

2010-06-28T14:28:00.000-07:00

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

2010-06-27T10:20:00.000-07:00

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!

2010-06-26T16:28:00.000-07:00

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

2010-06-26T15:56:00.000-07:00

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

2010-06-25T15:35:00.000-07:00

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"

2010-06-24T11:00:00.000-07:00

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

2010-06-23T15:05:00.000-07:00

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

2010-06-23T11:09:00.000-07:00

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

2010-06-21T12:34:00.000-07:00

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 ...

2010-06-19T19:05:00.000-07:00

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 ...?

2010-06-19T18:45:00.000-07:00

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 ...

2010-06-12T21:06:00.000-07:00

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 ...

2010-06-11T09:36:00.000-07:00

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"

2010-06-10T15:10:00.000-07:00

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

2010-06-10T11:37:00.000-07:00

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

2010-06-09T15:24:00.000-07:00

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

2010-06-09T10:53:00.000-07:00

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

2010-06-08T10:57:00.000-07:00

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

2010-06-07T15:55:00.000-07:00

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

2010-06-03T09:29:00.000-07:00

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 ...

2010-06-02T09:34:00.000-07:00

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

2010-06-01T10:13:00.000-07:00

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

How Does Your Homecare Agency Respond to Challenges?

2010-05-25T10:24:00.000-07:00

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:

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.

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

2010-05-24T10:55:00.000-07:00

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:

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?

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.

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

2010-05-22T08:26:00.000-07:00

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 ...

2010-05-20T14:47:00.000-07:00

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

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.
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?

2010-05-14T15:12:00.000-07:00

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

2010-05-06T11:09:00.000-07:00

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

Dangers of Falling

2009-11-12T09:33:00.000-08:00

We received an email from the folks at Bay Alarm Medical that has some interesting, if scary, facts:

• 1 out of 3 seniors will fall every year.

• 1 out of 7 women will break their hip; 50% of them will end up in a nursing home.

• 90% of fall victims responded to in the “Golden Hour” (the first hour) will return home to independent living.

• 97% of those that do not receive care for 12 or more hours will lose their independence.

• The average response time for a senior incapacitated in their home is 17.5 hours.

The message is one that we endorse at Support For Home. If you are a senior living at home -- especially if you are living alone -- an emergency alarm system, with a pendant or bracelet button you can push for help, is a very important investment.

For that matter, such a system is a great idea, we feel, for anyone who is living alone, regardless of age. Someone thirty years of age who falls down some stairs and breaks a leg needs help too! If the phone is two rooms away, dragging yourself there is not the best plan. I don't want to challenge anyone's sense of macho independence, but think about it.

:-)

Maximizing Long-Term Care Insurance Benefits

2009-11-02T11:13:00.000-08:00

We have talked about long-term care insurance (LTCI) before. It is a very good thing, in our view. We strongly recommend everyone take a serious look at purchasing it, before something happens that would keep them from qualifying. And, no, we do not sell insurance or get commissions!

Below are some questions that we think folks who are making a choice of which LTCI provider to buy from. The questions are equally important for people who have already purchased long-term care insurance, as the answers will help them manage their use of the benefits, to maximize them.

The first question is -- Is there a waiting period before benefits can be used?

This question has some definite twists and turns, depending on the insurance company involved. Waiting periods can range from zero days (very rare) to 100 days, in our experience. You want to find out from the insurance company what event starts the clock running. Is it a doctor's order? Is it such an order plus the actual start of privately paid care? Within the waiting period is any agency-provided care required? If so, is there a minimum number of days? For example, if the waiting period is 30 days, does the insurance company mean 30 calendar days or does it mean 30 days of actual care? Obviously, that makes a very big difference.

The second question is -- Does payment of the premium end when benefits begin?

This sounds elementary, but you really need to confirm it with the company. Premiums may end when the claim is made or when payment of benefits begin. Continuing to collect premiums after benefits begin is non-standard. If you are looking to buy, make sure your company does not do that.

Third question -- Is the benefit a purely daily amount, or is there really a monthly budget that you have the ability to manage?

Most policies will state that there is a daily benefit. For illustration, we will use $150 per day. For some companies, they will pay up to $150 per day, maximum. If you are authorized for care every day, you will receive up to that amount on any day you have care. However, some of the better companies actually consider the benefit as a monthly budget. In other words, if the daily benefit is $150 per day, that would create a pool of $4500 for use in a 30-day month. In these cases, some days might use less than $150 and some days might cost more, but be managed on a monthly, rather than a daily basis.

Next question -- Whether it is a daily or monthly benefit budget, are unspent benefit dollars available for the future, or do they "disappear?"

If the daily benefit is $150 and I only use $100, does the extra $50 go into the "bank" to be used in a future period? Same question applies for a monthly pool -- if I only use $3000 of the $4500 available for the month, does the extra $1500 go back in my "bank" of benefits?

The inflation factor -- Does the benefit keep pace with inflation?

Is there a guaranteed increase in benefits (either a specified percentage, say 5%, or tied to the Consumer Price Index) over time, or is the benefit fixed forever? This is definitely something you want to consider. $100 per day now, while you are healthy and 45, may not be nearly enough after 35 years of inflation.

Keeping the benefit coming -- Is there a recurring validation process required by the insurance company?

Some companies will send out an RN periodically (every 6-12 months) to do an assessment of on-going need for care. Others may want an updated doctor's order. Find out how intrusive this process is going to be. We have sat through some nasty ones with our clients.

If you have other questions, comments or suggestions about LTCI, we would love to hear from you. Drop me a line at bertcave@supportforhome.com.

Great Expectations

2009-10-12T10:52:00.000-07:00

If you are serious about being in the homecare industry, rather than simply doing it instead of selling insurance, you learn a lot about the issues facing your clients and their families. There is a wide range of such issues, from falls that lead to hip replacements to heart conditions to Parkinsons and many others.

Two major conditions facing too many of our clients are dementia (including Alzheimer's) and MS. We were delighted to have the opportunity to sponsor and participate in major events this year with the National Multiple Sclerosis Society (the Home Smart Home Expo) and the Alzheimer's Association Memory Walk. Both events were huge successes in terms of raising the awareness of the community and even serviced providers. These associations and others focused on different issues face huge challenges, but also raise great expectations.

With every client that we support, we are always looking at the total plan of care, the "pie" of needs, of which our homecare is one slice. Without the proper plan of care partners, whether that's the Alzheimer's Association or emergency alert systems or fiduciaries or living space designers, our homecare will not succeed.

We salute the more than 70 members of our Bright Lights team for the Memory Walk, and every other volunteer and association helping to create great expectations for the future.

I Hope Congress Actually Read It!

2009-10-02T09:05:00.000-07:00

On September 14, 2009, a concurrent resolution was passed by Congress, on the topic of homecare. We have posted the text and document on our Web site. There are a number of excellent data points in the resolution, as well as a very positive recognition of "caregiving as a profession."

I don't usually care much for quoting dictionary definitions, but this one calls for it, in my view. Dictionary.com says that a profession is "a vocation requiring knowledge of some department of learning or science".

At Support For Home, we believe that our Home Care Aides are, indeed professionals. Over 75% of our employees are certified -- Certified Nurse Assistants, Certified Home Health Aides or Licensed Vocational Nurses. Others are certified as Direct Support Professionals. These are not agency designations -- although some agencies will try to fake it, with similar titles. These are actual State of California certifications. Even our folks who have nto yet achieved certification are truly professional, in terms of knowledge and attitude, or we would not hire them.

The bottom line is that a professional caregiver is a person with character, dignity, passion and knowledge, all of which are applied within a structured, disciplined plan of care, to ensure the highest possible quality of life for the clients they serve. These caregivers deserve respect and support, from us and from our clients. They are the heart and soul of Support For Home. Any homecare agency that does not feel that way and treat their Home Care Aides that way needs to find another business to pursue.

Bert and Siew Pheng, Support For Home

A Focus on IADLs

2009-09-15T15:45:00.000-07:00

For most of us, if there is an issue with Activities of Daily Living (ADLs), such as bathing or dressing or eating, the need for support is very obvious. We will return to this topic (ADLs) in a future blog, but today we want to talk about Instrumental ADLs (IADLs) as a basis for determining need for homecare support. We have adapted an IADL discussion from an early gerontology article, because we think it is still one of the most useful. We have provided just three examples, below, of the seven IADLs included in an Excel spreadsheet we have created that is posted on our Web site.

IADL Status

Ability to Use Telephone (4 points - highest - to 1 point)
Operates telephone on own initiative; looks up and dials numbers, etc.
Dials a few well-known numbers
Answers telephone but does not dial
Does not use telephone at all.

Shopping (4 points to 1 point)
Takes care of all shopping needs independently
Shops independently for small purchases
Needs to be accompanied on any shopping trip
Completely unable to shop.

Food Preparation (4 points to 1 point)
Plans, prepares and serves adequate meals independently
Prepares adequate meals if supplied with ingredients
Heats, serves and prepares meals or prepares meals but does not maintain adequate diet
Needs to have meals prepared and served

The idea, for each IADL, is that the more functionality I have, the higher my score will be. In this particular scale, as we have implemented it, there is a maximum of 31 points, total, for all seven IADLs. However, each IADL needs to be looked at by itself, as well as being part of an overall pattern.

In my current baseline (as discussed in a prior blog), I'm doing okay and do not need home care. However, for each IADL, I have set a lowest acceptable status before taking a very serious look at getting home care for myself.

We would be delighted to have your feedback and suggestions. Thanks for listening.

They Have It Backwards

2009-09-10T09:45:00.000-07:00

I just got a call from a daughter who had convinced her father to talk to us about home care, saying that he has changed his mind "again" and is not ready. We have seen this before and we will see it again. One of the big franchise companies in home care thinks they have the answer, with what they call the "40/70" rule: "The idea is that if you're 40, or your parents are 70, it's time to start talking - at least about certain senior topics."

We do not intend to take children of seniors "off the hook," but, frankly, we think this is a little bit backwards. It puts the onus on the children of seniors, rather than where it belongs -- with the parents. We see children of seniors, every day, willing and able to talk with their parents about aging and home care and other issues.

Too often, the parents' response is along the lines of "I know I will need help, eventually, but not now." The real problem is that the parents have too often not established the parameters of what "eventually" will look like.

So, here is some "Tough Love" for all of us seniors (yes, me too, I'm an AARP member!):

1. First of all, we need to remember that we are the parents, and act like it. When we are raising children, we would never think of putting them through the stress that they endure worrying about us when we do need home care, as we age. It is our responsibility to deal with our own aging, not make our children carry it around as a burden.
2. That means we must define what the boundaries of "eventually" are, in determining when we do need -- and will accept -- home care. That means learning about the Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs) and establishing clear lines for when we need support. Please see the Gilbert Guide or Wikipedia for more information on this and other topics.

ADLs:
• Hygiene (bathing, grooming, shaving and oral care)
• Continence (bladder and bowel control)
• Dressing
• Eating (the ability to feed oneself)
• Toileting (the ability to use a restroom)
• Transferring (actions such as going from a seated to standing position and getting in and out of bed)

IADLs:

• Finding and utilizing resources (looking up phone numbers, using a telephone, making and keeping doctors appointments)
• Driving or arranging travel (either by public transportation, such as Paratransit, or private car)
• Preparing meals (opening containers, using kitchen equipment)
• Shopping (getting to stores and purchasing necessities like food or clothing)
• Doing housework (doing laundry, cleaning up spills and maintaining a clean living space)
• Managing medication (taking prescribed dosages at correct times and keeping track of medications)
• Managing finances (basic budgeting, paying bills and writing checks)

For each of these areas, we should take the time to establish a baseline (what can I do now) and an acceptable limit of competence that will tell me I need help in that area. If I need to assign someone that I truly trust as an advisor in this, who can bring a second set of (independent) eyes, great. Ideally, that should be someone other than my children, to help minimize their stress.

In a future blog, we will go into more discussion of how we might set those baselines and limits, with regard to our ADLs and IADLs. Thanks for listening.

Long-Term Care Insurance - Don't Stay Home Without It!

2009-09-09T10:35:00.000-07:00

Obviously, that title is an overstatement, as some families have the resources to self-fund home care - and the willingness to spend money to get the care they need to be able to safely live at home, when the time comes.

For the rest of us, building Long-Term Care Insurance (LTCI) premiums into our budgets -- and getting qualified while we're still healthy enough -- is something to very seriously consider. That last point is an important one. Siew Pheng and I recently applied for LTCI. She got it. I did not, because of my Diabetes. Even though it is well controlled, the insurance company said, "No thanks," when it came to covering me. I should have bought it five or six years ago.

Even for clients who can afford to self-fund home care, we at Support For Home have seen many instances where they are reluctant to do so. They know they need care, but the idea of spending money on themselves (or having their families do so) just goes against the grain of a life time of independence and self-reliance. If they have already paid for LTCI, the clients are much more likely to get the care they need, as they feel they have already paid for it, through premiums -- and they are right.

So, the bottom line is, if you can self-fund your future long-term care needs, great, but create a special account that you build up over time to provide that funding. Set the money aside, invest it and let it grow. If you cannot reasonably expect to self-fund, explore Long-Term Care Insurance, early, and do some research as to what real costs are going to be, when you will need home care. Get enough coverage. Get peace of mind for the future. I wish I had!

The More Things Change... The More Things Change

2009-09-08T10:38:00.000-07:00

As with every good homecare company, we take the process of client assessment very seriously. Ensuring that we understand client needs is critical to developing the right plan of care, which includes assigning the right Home Care Aide from our staff. In many ways, though, that is the easiest part of our job.

Once we have the right Home Care Aide in place, delivering the right services, the real work of being a great homecare company begins.

Each client's need is dynamic. Not only does need increase and decrease over time, but the details also change. We provide care in three different areas, associated with clients' activities of daily living (ADLs):

Homemaker Care:

This involves light housekeeping, such as changing bed and bath linens, laundry, meal planning and preparation. Basically, it involves the activities of daily living (including what are called instrumental ADLs) that occur in the home.

Companion Care:

This area involves our interfaces with society, including health professionals (e.g., reminders and monitoring for medications), errands, shopping, appointments, and so forth.

Personal Care:

Our most intimate activities of daily living include dressing, bathing and toileting (including incontinence care).

Some times our job is to help our client recover from an injury, surgery, stroke or other crisis. The client may need a high level of care in one or more areas, right now, with the expectation that need will decrease, over time. That may mean that Home Care Aide #1 is the perfect answer, right now, but Home Care Aide #2 may be more appropriate in three months, as needs change.

Unfortunately, need can go the other way as well, with a client who requires more care over time. If we do not catch those changes in need, we will fail to optimize our care. If we are not constantly working to optimize our care for our clients, we will no longer be great at what we do. In a future blog, we'll talk about what we do to stay on top of changing needs.

Homecare Employers - Who's on First?

2009-09-02T09:18:00.000-07:00

Who is the employer of the caregiver supporting your mother's, father's or your activities of daily living (ADLs)?

This is a subject that just keeps coming up, because it continues to cause so many issues for families. In the State of California, the law is actually quite simple about who is the employer of a caregiver or other household employee, but unscrupulous referral agencies try to avoid providing clients with information about the issue. Some even intentionally -- well, I cannot find a polite word, but ...

First, let's make our position clear. The employer of Home Care Aides / caregivers should be the agency that is sending them to the home. For us, at Support For Home, that is the case. We are the employer. We provide liability insurance and bonding, pay payroll taxes, Workers Comp insurance, background screening, and so forth. There are a number of other reputable agencies who are doing the same (we talk about certification by the California Association for Health Services at Home on our Web site). Unfortunately, many referral agencies (sometimes called DRAs) operate very, very differently.

These folks simply will not raise the issue of who is the employer -- too often, it is going to be the client and / or the client's family or trustee. Then, if something happens (the caregiver trips over an ottoman or is let go or commits a dishonest act, ...) the client is left holding the bag -- with the State of California wanting the bag to be filled up with taxes and fines and handed over.

One very good document on this subject from the Employment Development Department (EDD) is called "Household Employment." This talks about the client's / family's responsibilities when hiring an "independent contractor" from a DRA. Basically, the referral agency is off the hook, if they follow a simple set of rules, and the client is on that same hook.

The discussion starts with some definitions:

So, becoming the employer of your -- or your family member's -- caregiver is pretty easy. Operating in that role, following all the rules of an employer, understanding the financial implications ... That's not nearly as easy. That does not mean that being the employer is always the wrong answer. It just means when you are making that hardest decision -- about who is going to provide home care -- it needs to be an important factor.

If you have any questions, please feel free to contact us, by email at info@supportforhome.com or by phone at 916 482-8484 or 530 792-8484.
Good luck, Bert and Siew Pheng

Who is a Household Employer?

A household employer is someone who has paid $750 in cash wages to one or more individuals in a calendar quarter to household workers. You must register with EDD within 15 days after you pay $750 in total cash wages.

What Are Wages?

Wages are all payments made to employees for personal services, whether paid by check, cash, or the reasonable cash value of noncash payments, such as meals and lodging.

Home Care Sometimes Means Mourning

2009-08-31T10:25:00.000-07:00

Support For Home provides in-home care for our clients and emotional and respite support for their families. In fact, our clients and their families are really part of our own extended family.

There is very little that can surpass the emotional gratification of being successful in extending our clients' ability to live at home, safely and with good quality of life.

When, as occasionally happens, a client moves to another area or needs to move to a skilled nursing facility, we are saddened, but we understand such choices are sometimes the right answer (see our recent blog on making such decisions).

However, when a client passes away, the pain is intense and the mourning is very real. Losing a member of our extended family isn't just a phrase, it's very personal. We run a professional operation, exercise professional judgment and so forth, but we are with our client sometimes every day of the week. The connection is not simply a business relationship. It's a personal bond.

Do we continue to provide in-home care, in spite of losing extended family members, on occasion? Of course we do. The rewards are immediate and the memories are forever. Seeing the smile on a man's face, on his 87th birthday, because we took him some of his favorite custard tarts, is worth every bit of worry -- and potential eventual pain -- associated with developing that emotional bond.

So, to our clients and to their families, thank you for being part of our lives and letting us be part of your extended families. Bert and Siew Pheng

Is Home Still the Right Place?

2009-08-26T11:20:00.000-07:00

At Support For Home, our mission is to help people live at home just as long as they want to and safely can. We, along with the courts and gerontologists, believe that home is normally the place where quality of life is the highest. However, we believe that every individual and every family should, in advance, determine the criteria which establishes home as a viable living space.

In this blog and future ones, we will talk about what we consider some of those criteria. There are very few solid lines ("if I'm on this side of the line, all is OK; on that side, I need assisted living or ..."). However, there are a number of factors we feel individuals and their families need to bake into a fairly formal plan.

Many of us have or are developing living wills or Advance Health Care Directives (AHCDs) -- whatever we may call them. These AHCDs specify when we want treatment and when we don't, to prolong life, for example. They don't usually cover, however, the decisions about where we should live, under what circumstances.

What we're talking about, then, is a sort of "Advance Living Directive" -- under these circumstances, I should / must be allowed to live at home; under other circumstances, I should / must be placed in (a) assisted living or in (b) a skilled nursing facility. Identifying the "circumstances" as clearly and precisely as possible is the key to making sure the right decisions will be made (by me, a trustee, or the courts), when the time comes.

What we want to do is to eliminate as much "gray area" or "overlap" of conditions as possible, to reduce ambiguity or confusion for whomever is making the actual decision about where we live. The cleaner the lines, the happier we are all going to be -- and that includes our families.

What are the factors that need to be considered in making that Advance Living Directive real? Some are obvious -- state of health, finances, etc. Others are less so. We'll talk about these more in future blogs.

Please give us feedback. This is not about our ideas -- it's about solutions. Help us share those. Thanks. Bert and Siew Pheng, Support For Home

Help With Homecare Costs

2009-07-23T10:16:00.000-07:00

Paying for homecare for our family members is not always an easy task. Since medical insurance and Medicare do not pay for non-medical in-home care, recipients of care are in a "private pay" situation. Our family is doing this, right now, in fact.

When the economy dips and people's income is impacted, it gets harder. We even had a client or two have to stop receiving professional care when a family member is laid off and returns home. They know, and we do, that the level of care -- not love, but care -- is going to be reduced, but reality is reality.

To try to help with this issue of affordability of homecare, we've posted some information and documents on our Web site, concerning two major sources of financial support -- Long-Term Care Insurance (LTCI) and Veteran's Aid and Attendance benefits.

If either the client or the spouse is a veteran, it is important to check out Aid and Attendance, from the VA. There are income and asset criteria, but there are good sources of help to determine eligibility (again, you can check our Web site).

Long-Term Care Insurance is something that most people are just learning about. We think it is a critical piece of planning for the future. We purchased LTCI for ourselves -- and no, we don't sell it :-). There are good sources of information (there is an AARP link in the page on our site) and a number of good companies. Like all insurance, you have to buy it before you need it.

The bottom line, whether a family turns to VA Aid and Attendance or LTCI or other forms of budgeting for future care needs, making a plan is critical -- as earlier as families can do so. Good luck from Support For Home. Bert and Siew Pheng

Emergency Alert System - Don't Be Home Without It

2009-07-09T09:42:00.000-07:00

One of the simplest things that we can all do, to protect ourselves at home -- especially if we live alone, is to wear a bracelet or necklace with a button we can push if we fall or have some other medical emergency. There are many such personal alarm products / services on the market, just as there are many alarm systems for our houses.

For our own clients, believe in this service so strongly that, if we provide at least 20 hours of care per week, we actually pay for the installation and monthly fee for the personal alarm. When we are not with our clients, we want to know -- and their families to know -- that help is a simple button push away. If anything happens, after emergency services are notified, so are we. We can then provide fast help, ourselves.

You can find a link to a company we work with on our Useful Resources page, on our Web site. In addition to the alarm bracelet or pendant, most companies have a lockbox service, where you can put a key to the home. Emergency services gets the lockbox code from the alarm company, so nobody has to break down a door! :-)

If you have any questions about these services or other areas of living at home as a senior, give us a call (916) 482-8484 or send an email to info@supportforhome.com.

Comprehensive Plan of Care

2009-06-29T09:04:00.000-07:00

We were talking with some folks on Saturday, about all of the questions involved in hiring an in-home care provider. We'll talk about this list soon, although you can look at our recommendations on what questions to ask on our Web site. However, one of the most over-looked issue is making sure that whomever you are talking to can help the family build a comprehensive plan of care. As we tell families, unless all of the needs of someone requiring home care are addressed, the in-home care "slice" of the plan of care "pie" is likely to be less than adequate.

When we talk about a comprehensive plan of care, we mean a wide variety of potential needs, inclusing things like home safety (grab bars, ramps, transfer poles, ...), medical emergency alerts (a necklace or bracelet), a private fiduciary or conservator, home health (for skilled nursing), and there are many more possible needs that should be discussed with the family and client.
For each of these needs, we make sure we have a great resource who can help the family, if they do have those requirements. Obviously (well, with some agencies, not so obviously), we do NOT have any financial ties to those resources. Either they are the best, most ethical resouce or we do not work with them. Agencies providing in-home care that take commissions, are completely out of line, as far as we are concerned.

Bottom line, make sure that the agency you select can help you identify all needs and can help satisfy them with top-notch resources.

The Hardest Job in the World

2009-03-31T16:41:00.000-07:00

Some people think the hardest job in the world might be serving as President of the United States. Well, we admit we haven't worked closely with him, but we're sure it's a tough assignment. However, we are truly convinced that the hardest job in the world is actually that of being a family caregiver. It is so hard, in fact, that the statistic that reinforced our own desire to start an in-home care agency (http://www.supportforhome.com/) is that 65% of family caregivers die before the person they are taking care of at home.

That statistic is frightening. Family caregivers need help -- not just from agencies such as ours, but from friends, other family members and, strange as it may sound, from themselves.

What we mean by that last comment is that family caregivers must first take care of themselves, if they are going to be successful in caring for others. That means rest and respite. It means fun and relaxation. It means support groups, for sharing, when the person being cared for is suffering from dementia or a chronic physical condition.

More than anything else, it means that the family caregiver must act with a bit of what might feel like selfishness, once in a while, in order to be the best caregiver he or she can be.

Making sure that you get adequate respite care is the starting point. If there is someone else in the family who is competent and able to provide that respite care, great. If not, look for a very good in-home care agency, whose employees can provide you with the breaks you need. That will allow you to come back to that hardest job in the world refreshed and ready to go.

If you are ready to look for help, check out a list of questions you want to ask, before you decide who is going to provide care to your family.