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

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

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

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, 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

 
 
 

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."

A Family's Story

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

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

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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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

It’s Senior Care – Do The Right Thing

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

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

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

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

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

Best wishes,

Carol Kinsel

Bert Cave

We Talk About Comprehensive Plans of Care

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

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

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

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

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

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

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

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

Best wishes, Bert

We Have Talked About Hospice Before ...

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

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

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

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

Best wishes, Bert

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

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

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

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

To quote the Philosopher, "Arrrrrggghhhh!"

"Convergence Between Healthcare IT and Life Sciences Informatics"

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

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

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

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

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

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