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

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

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 #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

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

Find a Reason Not To ...

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

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

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

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

Licensing Homecare Providers?

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

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

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

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

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

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

Caring for Spouses with Dementia

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

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

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

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


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

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

Best wishes, Bert

The Hardest Job in the World

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

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

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

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

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

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