Isn't There Enough Stress at a Hospital?

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

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

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

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

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

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

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

Best wishes, Siew Pheng Tung

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

We Prefer Integrity, Dignity and Values

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

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

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

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

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

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

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

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

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

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

Best wishes, Bert

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

What Does Information Technology Have To Do With Senior Care?

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

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

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

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

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

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

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

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

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

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

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

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

Helping Caregivers Be All That They Can Be

From Carlotta Sanchez, Care Services Manager

At Support For Home one of my responsibilities is to make sure that our Home Care Aides receive the proper training and knowledge necessary to give the best care to our clients.  That covers a very broad range of issues, from continuing education credits for our Certified Nurse Assistants and Certified Home Health Aides to the glycemic index for blood sugar impact in diets for our clients.
 
Today, a caregiver had a question concerning support hosiery (compression stockings) and how to properly put them on a client. Support Hose are used to reduce stress on the blood vessels in the legs. They are essentially very tight fitting socks that come in different brands and varieties, which can go to the mid-calf, knees, and upper thighs.
 
For something this basic, there are no classes offered to teach a Home Care Aide how to do this, so they must find a willing healthcare professional to ask about it or go to the Internet, which is what I did. I found an excellent video on YouTube that describes how to easily put Support Hose on a client.  I do not endorse the Internet as the best source for how to be a great family or professional caregiver, but it does have some great insights to help Home Care Aides gain better understanding of the various tasks required.

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

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

Rewards Do Not Always Mean Revenue

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

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

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

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

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

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

Say What You Will Do ...

Say What You Will Do, Then Do What You Said

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

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

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

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

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

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

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

We Screwed Up

Yesterday, I wrote a couple of pieces about customer services and how we must excel every single day.  Our clients and their families deserve that.

What they do not deserve is for us to screw up.  Not in a big thing and not in small things.  Last night I talked to the family of a client about something we did wrong.  We mailed some care worksheets to the client's home, and whoever at the office addressed the envelope misspelled the client's name. 

That is not respectful.  That is not treating our client with the dignity that person deserves.  That is not customer service.  That is not excelling. 

As the owners of Support For Home, my wife and I take full responsibility, and I made that very clear to the family.  It does not matter who addressed the envelope incorrectly.  We are responsible.  We take it seriously.  We will, in fact, be talking about it in staff meeting tomorrow, to create a process that prevents this from occurring in the future.  If that means two people look at material that goes out, even if it is just an envelope, then that is what we will do.

We want to excel.  Our clients expect us to excel.  Every single day is an interview.  Every client is the center of the universe, for us.

Quiche and Customer Service!

Okay, so this blog is not about our usual subjects, involving senior care or home care, but it does involve two other topics that my wife, the co-owner of Support For Home, and I love.  Normally, we would not talk much about quiche in this blog, but it is the wonderful combination of great quiche and great customer service that we have encountered that leads me to do so, today.

I cannot even remember the first time we ordered quiche at a Coco's restaurant near our office, but I remember it was good.  :-)  So, when it disappeared from the breakfast menu a while later, we were not amused!  Normally, that would be the end of the story.

In this case, it was not.  We talked to the manager, Denise.  She explained that they are driven by the menu set at the corporate level for the chain.  We understand that, but it does not solve our problem, which is that there is no more Quiche Lorraine for breakfast!

Denise's response was consummate customer service.  She produced a list of over half-a-dozen quiches that her baker could prepare, if we ordered them.  So, once a week we order a couple of quiches to take home.  Problem solved (the Santa Fe last night was terrific, by the way).  She even took the time to instruct her staff that, when we call to order, the day before, we have her OK.

So, you see why I am writing about this.  That is the attitude and creativity that we strive for in every Support For Home employee, whether it is in the office or a Home Care Aide in our clients' homes.  To do less would be to disappoint not only our clients and their families, but Denise!