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

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

Parkinson's Disease - A Major Focus

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

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

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

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

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

We Talk About Comprehensive Plans of Care

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

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

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

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

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

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

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

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

Best wishes, Bert

"Convergence Between Healthcare IT and Life Sciences Informatics"

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

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

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

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

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

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

Communication: Client, Family, Home Care Support

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

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

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

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

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

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

Best wishes, Bert

Best Laid Plans -- Oh, Well

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

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

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

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

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

Best wishes, Bert

Stair Lifts and Homecare

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

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

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

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

Find a Reason Not To ...

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

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

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

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

Dangers of Falling

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

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

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.

The More Things Change... The More Things Change

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.

Emergency Alert System - Don't Be Home Without It

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

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.