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

Judging Senior Care Agencies Through Employees

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

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

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

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

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

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

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

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

Best wishes, Bert

Pain Management in Senior Care

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

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

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

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

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

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


Best wishes, Bert

More Dangers of "Under the Table" Caregivers

We have talked with so many families and prospective home care clients about the dangers of "independent contractors" who really are not and referral agencies that offer no protection to senior clients and families.

The issues include no liability insurance, dishonesty bonds, background checks, unemployment insurance and on and so forth.  Partially because of the economy the last couple of years, we are now seeing government, both state and federal, get a lot more interested in the issue.

Several months ago, The New York Times published an article, "U.S. Cracks Down on ‘Contractors’ as a Tax Dodge".  It indicates that:

Federal and state officials, many facing record budget deficits, are starting to aggressively pursue companies that try to pass off regular employees as independent contractors.
President Obama’s 2010 budget assumes that the federal crackdown will yield at least $7 billion over 10 years. More than two dozen states also have stepped up enforcement, often by enacting stricter penalties for misclassifying workers.

Interestingly, this emphasis is being supported by organized labor, one of the Obama administration's major supporters.

Another article was published in March by The Wall Street Journal, titled, "Cash & Career: The Perils of 'Off the Book' Jobs". 

The bottom line is that "referral agencies" that do not operate honestly and caregivers who claim to be "independent contractors" but are not doing the right things are increasingly the focus of the IRS and state tax and employment agencies.  it does not stop there, however, because the people who hire -- and that is the right word, because the seniors and their families will be seen as the employers of record in many cases -- are going to be on the hook for Social Security, Workers Comp claims and insurance and a whole lot more.

That is just not right, and we wish all businesses -- and individuals -- would operate ethically and legally.  The home care industry would be so much better.
Your thoughts?  Best wishes, Bert

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!"

Honest Disagreements, But Crucial

Stephen and Jason Tweed are very well-known figures in the home care industry, and rightly so.  They are bright, witty and very smart folks.  So, when we discovered a fundamental area of disagreement this week, we were very surprised.  But it is such an important area that we had a serious dialogue with them on the topic.  Some of that dialogue is reproduced, below, from our email exchanges.  We still think they are great and, even more, inspiring, but it is such an important topic that we want folks to see both perspectives.

So, what is this big question?  It is whether families who need in-home care should hire privately or hire an agency which employs Home Care Aides.  As you will see, we are in about 90% agreement.  The Tweeds believe that "most of the time families are much better served by hiring a home care company rather than trying to hire privately."  Our own position is that "most of the time" is about 99%.

From our own family and professional experience, we feel so strongly about this that we have devoted a whole section of our Web site to the issue.  So, why do we have this basic disagreement?

Jason Tweed has actually hired caregivers privately, as his own employees.  He and his family have the experience in the industry to understand all of the issues specific to the home care industry, including workers compensation insurance codes, liability insurance, and so forth.

Our own experience, however, is that, unless a family has that level of knowledge, hiring privately or using an "independent contractor" is a disaster waiting to happen.

As we explained to Stephen and Jason Tweed,

[We] know of one case where caregivers were hired privately, through a family’s business. They paid workers comp, unemployment insurance, etc. Everything is good, right?  Not so much.  The family / business did not know to use the right workers comp code, so a claim blew up in their faces.  Not pretty.  A carrier may even choose to not cover employees if home care is outside the scope of the normal “business of the business.”

Other families have thought their home owners insurance would protect them, in terms of liability, only to have the insurance companies say, “Nope, that’s a domestic employee. You need business liability.  Home owners insurance does not cover.” 

The bottom line is that very few families – and even fewer senior clients without family resources – have the knowledge and resources to do everything right to protect themselves.

So, our wish for Jason and Stephen is, keep pushing the industry for higher quality and integrity.  We are with you 100%.  But when it comes to advising about hiring an agency versus a private caregiver, please make sure you are not counting on the family having your level of experience and knowledge of what needs to go right and what can go wrong.

Best wishes, Bert

Mom and Dad, Spend It All!

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

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


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


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

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

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

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

Parents Driving and Other Conversations

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

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

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

Our thoughts at Support For Home?

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


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


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


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


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

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.

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.

Every Day is an Interview

At Support For Home In-Home Care, all of our Home Care Aides are our employees.  We are not a referral agency for some very simple reasons.  As the employer of record, we perform the background checks, determine who is worthy of being a member of our extended family, cover them with liability insurance, our dishonesty bond, workers comp, etc.  That means our home care clients and their families are protected from unemployment claims, injury claims, and so forth.

To be the employer of record, we actually have to assign our Home Care Aides to our clients.  Every once in a while, a client or his / her family will ask to interview the Home Care Aide, first.  When this happens, we explain two things:

• If the client or family "interviews" the potential caregiver, they are indicating to the State that they may be the actual employer, not Support For Home.  That is dangerous for the client or family, because it can result in government burdens and expectations that the client is not prepared for, at all.  We are the employer of record to protect against that.  The client hires and / or fires us, Support For Home, not an individual employee.
• Every day that a Support For Home employee works for a client is an interview, in reality.  We tell our clients several things.  One is that we never want the client to "try to make it work" with a Home Care Aide.  The client and the caregiver are either a good match or they are not.  If they are not, we put a new Home Care Aide in place.  The second message is that things change.  A caregiver who is great for you right now may not be in six months, for whatever reason.  Every day is an interview, at which Support For Home and our employees must excel.

If you or a loved one needs home care, make sure you work with an agency that is the employer or record.  You may pay a bit more per hour, but you avoid a ton of potential liability.

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

"Five Wishes"

If you are not familiar with the "Five Wishes" document, you want to find out about it.  There is an excellent discussion of it in Wikipedia.  Basically, Five Wishes is a living will that allows you to address not just your medical wishes for care if you are seriously ill, but also your emotional and spiritual needs.

The Five Wishes involve:

• The Person You Want to Make Care Decisions for Me When You Can't
• The Kind of Medical Treatment You Want or Don't Want
• How Comfortable You Want to Be
• How You Want People to Treat Me
• What You Want Your Loved Ones to Know

Five Wishes is accepted in 42 states, including California, as well as the District of Columbia.  We are starting to see more Five Wishes documents with our home care clients at Support For Home.  Your financial wishes are not covered, of course, so you will probably still want a good trust attorney.

Five Wishes is also not a substitute for a Do Not Resuscitate (DNR) order, for those folks who do not wish to received CPR. 

Check it out.  It's simple, clear and can save a lot of anguish later.

Best wishes.  Bert

I Hope This Is Not True

Yesterday, I was told that what is probably the largest home care agency in Sacramento has a policy that really shocked me.  If what I have been told is true, I found out that my wife and co-owner of Support For Home would be considered ineligible to work at that agency!

Now, luckily, she has no desire to do that, as we intend to continue managing our own home care agency for a long time, but the news was still a bit of a shock.

It turns out, at least so I have been informed, that this large franchise agency has a policy that only citizens of the United States are eligible to be hired.  My wife, on the other hand, was born in and is still a citizen of Singapore.  That was okay with Fortune 100 companies like Texas Instruments, Phillips and Intel Corporation, where she was a senior manager before we started Support For Home.  Evidently it is not good enough for a local franchise owner.

At Support For Home In-Home Care, we are very careful only to hire folks who have the legal right to work in the United States.  We complete what is called the I-9 process, including use of the Department of Homeland Security's E-Verify process.  Both ethically and legally, we will not discriminate against anyone who has the legal right to work in my country.

As the title of this piece says, I hope what I have been told is not true.  It would be un-American.

And That's Good Because ...?

So, it is Saturday afternoon, and we answer the phone at Support For Home, as always, 24x7.  But today we get three very interesting phone calls in a row, from the same person.

A Home Care Aide Applicant calls.  She wants to talk to our HR Manager.  Well, the HR Manager is not in the office today (neither are we -- we're answering from home).  "No, we don't use voice mail, since we always answer the phone.  But we'll take a message or you can call back Monday."  No message.  She'll call back Monday.  Two minutes later, she calls again, thinking she'll "sneak" past us and leave a voice mail for Carlotta, our HR Manager.  "No, we answer the phone 24x7, so you won't get to voice mail for her."  OK.  Two minutes later, the same person calls, but hangs up when we answer the phone.  So, I call her back and tell her that she is not making a great first impression.

Well, it turns out, she is not trying to make a good impression.  It turns out that she has a criminal record, and our HR Manager said, "No, we won't hire you."  So, what she REALLY wanted to do was tell our HR Manager that she had found a job, anyway -- with IHSS, the County agency that provides caregivers to low income recipients.  She wants to gloat about that.

To us, this is a very sad thing.  In-Home Supportive Services (IHSS), a government agency, has hired her to provide home care.  We would not hire her ever, based on her background.

Now, we are fans of the program IHSS, in the Sacramento area.  Low income seniors need home care.  What they do not need is caregivers that cannot pass the background screening of Support For Home.  We hope this woman's clients through IHSS receive great care.

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!"

Bonding with Your Caregiver is a Good Thing, But ...

This is something that every really good home care agency experiences -- the client falls in love with the caregiver.  In some ways, that's great, but it is a double edged sword. 

First, we stress to our Home Care Aides -- and to our clients -- that the relationship between the two of them is and must remain a professional one.  That does not mean that they should not care personally, but, for the Home Care Aide, there is a job to be done, every shift.  They are not family members or guests in their clients home.  The are providing critical support for Activities of Daily Living (ADLs) and Instrumental ADLs, such as cleaning, cooking, bathing, dressing and so forth.  That service role is primary.

At Support For Home, we even make employees sign waivers forfeiting any chance of inheritance, and gifts are very closely monitored.  We do not want our clients or their families negatively impacted in any way.  That is the case regardless of whether the client has any level of dementia.

The second concern about emotional bonding with the Home Care Aide is what sometimes happens when the caregiver is ill or needs time off from an assignment.  Ideally, the client will remember that we, the agency, are the ones who assigned the wonderful Home Care Aide, in the first place.  They will say, yes, I still need the services, and I have confidence that you will give me someone equally good as a backup.  Thankfully, that is the norm.

Unfortunately, some clients sacrifice the care they actually need, feeling that no one else could possibly provide that care.  "If Mary is not available, then I don't want anyone."  That puts the client in jeopardy, since, if they did not need the care, the shift would not have been scheduled in the first place.

We actually had one extreme case of this recently.  When an employee did not show up for an assignment until an hour after they were supposed to and gave no indication of recognizing this as a problem, we terminated the employee.  When a different client was told that the Home Care Aide was being replaced, because that person no longer worked for us, the client's response was not, "Thank you for watching out for the best interests of Support For Home clients."  Instead, the client felt that we were making life "miserable."  Even though after two days with the new caregiver the client said the new person was "great," the bond with the prior Home Care Aide simply could not be overcome.

We want to make it very clear that this is not a complaint.  As mentioned earlier, a bond is a very good thing in some ways.  Our clients need to trust our employees.  Rather, it is a recognition of the importance of emotion in senior homecare.  It is not just about services X, Y and Z.  The really good homecare agencies keep that in mind, all the time.

When the Family Home Just Doesn't Work Anymore

At Support For Home, our goal - our passion - is to help our clients live safely in their homes, with a high quality of life.  That will never change.  There are many services that can help folks stay at home, including Durable Medical Equipment suppliers (e.g., hospital beds) and mobility specialists (stairlifts for example, in two-story homes - see an earlier blog on that topic).

However, for some folks, a time comes when the familiar (interesting word, yes?) home simply is no longer the right place to live.  Sometimes that means moving from a larger, two-story home to a smaller house or a condo.  Sometimes it means an assisted living facility.  For the latter, a referral service may be very helpful, but make sure you are working with the best people.  In the Sacramento region, Carol Kinsel's Senior Care Solutions is one of the very best. 

For all of us, moving is very hard work, and probably not the favorite way to spend time.  For seniors, it can be even more frustrating, emotional and physically challenging.  In the Sacramento area, there is a company called Compassionate Relocations that can help with the move and the logistics.  They also provide assisted living referrals.

So, we will do everything in our power to help you or your loved one stay at home as long as desired.  If a decision is made that moving is the only option, make sure you choose the agencies that will help you find and move to your new residence as carefully as you chose the agency that provides homecare.  And yes, of course Support For Home provides care to residents of assisted living facilities, as well.  :-)

Best wishes, Bert

How Does Your Homecare Agency Respond to Challenges?

Even excellent homecare agencies encounter challenges and problems.  Believe me, we know.  :-)  The question is, how does the agency respond to those challenges?

The family and homecare client can count on one or more of the following scenarios occurring.  The quality of the private duty (homecare) agency will determine how transparent those issues are to the client and family.  Ideally, these challenges will all be handled behind the scenes, with the family not even aware of them.  Still, it is good for the family to be aware, so they can have high, yet reasonable expectations.

So, here are some of the possible scenarios:

1. Everyone gets sick from time to time, even the very best Home Care Aides.  The family and client have a right to expect that:
• No caregiver will go to work with a communicable disease -- cold, flu, whatever.  The caregiver has a responsibility to let the agency know, as soon as possible, when they are beginning to feel ill.
• The agency has the responsibility to have a backup plan for care.  Talk to your agency about how many hours it will take, in such a circumstance, to have a backup Home Care Aide in place.  For some clients, the answer should be zero, as the care needs to be continuous.
2. Every agency makes hiring mistakes.  The two owners of Support For Home have about 50 years of experience hiring and managing people.  We can still make mistakes.  That's why we use the Caregiver Quality Assurance testing program, one of the most extensive background checks, reference checks and multiple interviews.  Even for us, that does not mean 100% foolproof hiring.
• The client and family, however, should not be impacted by an agencies hiring mistakes.  Any mistakes should be ones that make life harder for the agency, not the client!  Additionally, those mistakes should be fixed in very short order.  When you are interviewing agencies, ask them to tell you about someone they hired and should not have.  :-)

In general, homecare agencies are like most other businesses, in terms of the challenges they face.  The difference is that noone is really hurt if a shoe store's cash registers stop working.  Providing support to a senior's ADLs (Activities of Daily Living) is a very different situation.  Talk to your agency about what can "go wrong" and how they deal with challenges.

Best wishes, Bert