Moving to WordPress

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

http://supportforhome.wordpress.com/

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

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

Best wishes, Bert

So They're Not Accredited, But They Are

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

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

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

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

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

Best wishes, Bert

The Second Hardest Job: Professional Caregiver

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

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

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

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

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

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

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

Best wishes, Bert

These Aren't Scams, They're Comedy Bloggers

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

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

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

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

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

Some People Understand It's About Passion

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

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

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

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

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

Best wishes, Bert

Isn't There Enough Stress at a Hospital?

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

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

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

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

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

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

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

Best wishes, Siew Pheng Tung

Should Not Healthcare Reform Include Costs?

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

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

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

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

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

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

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

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

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

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

Best wishes, Siew Pheng Tung

Effectiveness of Hands-Only CPR Good News

An article on MSNBC reports,

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

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

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

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

Best wishes, Bert

Sun City Roseville Foundation

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

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

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

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

Best Wishes, Bert

Social Engagement Critical in Senior Care

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

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

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

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

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

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

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

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

We Prefer Integrity, Dignity and Values

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

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

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

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

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

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

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

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

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

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

Best wishes, Bert

Judging Senior Care Agencies Through Employees

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

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

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

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

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

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

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

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

Best wishes, Bert

Pain Management in Senior Care

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

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

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

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

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

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


Best wishes, Bert

Robot Care for Seniors at Home?

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

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

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

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

Best wishes (including to caregiver robots), Bert

Federal Study on Aging Good, But ...

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

As most of us are aware,

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

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

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

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

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

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

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

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

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

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

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

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

Best wishes, Bert

OK, I'm Ordering a MEDCottage Today

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

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

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

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

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

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

Best wishes, Bert

What Does Information Technology Have To Do With Senior Care?

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

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

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

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

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

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

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

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

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

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

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

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

OK, This Aging Issue Is Personal!

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

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

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

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

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

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

Best wishes, Bert

Could We Get a Little Attention!?

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

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

So, what are those categories?

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

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

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

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

Best wishes, Bert

Adjusting to Death of Parents Is Hard

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

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

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

Thanks, Mom and Dad.

With love, Bert and Siew Pheng

Dementia and Alzheimer's Series #6: Sleep

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

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

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

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

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

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

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

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

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 ...

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

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:

1. 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.
2. 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.
3. 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

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!

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

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


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


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

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

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

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

Parents Driving and Other Conversations

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

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

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

Our thoughts at Support For Home?

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


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


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


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


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