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

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

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

 
 
 

Recognizing and Treating Caregiver Stress

Senior Care Solutions and Support For Home work with many seniors and their family members -- many of whom are caregivers in their own right.  We see and learn about issues that caregivers face all the time, and it is very important that they be able to recognize those issues and that they have resources to help.

Below are some of the signs to watch for and some resources that might help.  The first and most important thing we want caregivers -- family or professional -- to do, however, is to be willing to admit they are human and that they cannot do everything and be everything to their loved one or their client.

Physical signs of Care giving Stress:

• Disturbed sleep
• Back, shoulder, neck pain, muscle tension
• Headaches
• Stomach, digestive problems
• Unusual loss of hair
• Fatigue
• High blood pressure
• Chest pain
• Excessive perspiration
• Skin disorders
• Weakened immune system

Emotional signs of Care Giving Stress:

• Anxiety/depression
• Moodiness/mood swings
• Irritability, easily frustrated
• Memory problems/lack of concentration
• Feeling out of control
• Phobias
• Argumentative
• Feeling of isolation
• Job dissatisfaction

Tips for avoiding and managing Care Giver Stress:

• Work out
• Meditate
• Ask for help
• Set realistic goals
• Prioritize: Establish a daily routine
• Take a break: family, friends, volunteers or professional care givers can help
• Eat well: eat plenty of fruits, vegetables and protein
• Take care of yourself: get your annual checkup
• Indulge: treat yourself to something nice
• Support: find a local care giver support group

Some places to go to for support: Helpful Resources

• Support For Home
  1333 Howe Ave., Suite 206
  Sacramento, CA 95825
  http://www.supportforhome.com/
  916.482.8484
  530.792.8484
• Senior Care Solutions
  916.965.5565
  http://www.seniorcs.com/
• Leeza’s Place
  888.ok.leeza
  http://www.leezasplace.org/
• National Family Caregiver Association (NFCA)
  800.869.3650
  http://www.nfcacares.org/
• Family Caregiver Alliance (FCA)
  415.434.3388
  http://www.caregiver.org/
• Administration on Aging (AOA)
  800.677.1116
  http://www.aoa.dhhs.gov/
• Well Spouse Foundation
  800.838.0879
  http://www.wellspouse.org/
• National Alzheimer’s Association
  800.272.3900
  http://www.alz.org/
• National Council on Aging
  http://www.benefitscheckup.org/

The best way to provide excellent care for your loved one or client is to take excellent care of yourself!

Best wishes,

Carol Kinsel, Senior Care Solutions










Bert Cave, Support For Home

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

Dementia & Alzheimer's Series: #2

One of the on-going goals of this blog is to point to other sites and resources that we at Support For Home believe are useful for both professional and family caregivers.  One of those sites is SeniorsList. 

Not every article they publish is great, but a number of them are.  while you will find our business listed on the site, we do not necessarily think Internet sites are the best way to find home care agencies.  A local human whose business is to know the agencies in an area is a much better approach.

However, as I say, some of the articles are very good.  One that has just been published is "Caring for Someone with Alzheimer's," by Murphy Ortiz.  The author begins by saying something that, from our experience, we all need to let "sink in," and that is -

It's very easy to say "I'll never put Mom in a nursing home" when she's healthy. But if you're one of the many family caregivers of someone with Alzheimer's, that promise may not be easy to keep.

There are still many folks who hold to that promise, but it can be very tough, and there are some critical points we believe family caregivers need to remember.  One of the most important principles, in our experience, is that the family caregiver must be able to be selfish.

Sounds strange, right?  What we mean by that is that we see too many families where the primary caregiver (and secondary ones, too, sometimes) is absolutely physically, emotionally and psychologically exhausted, because she or he is not getting the respite that is vital to being able to go on.

When that respite is missing, provided either by other family or professional home care agencies, the chances of being able to keep that promise are significantly diminished.  It will be more expensive to bring in a home care agency to help than going it alone, but the chances of success, in keeping that promise, are tremendously higher.

As Murphy Ortiz writes,

Learn how to ask for help. You might be trying to do too much yourself. Caring for a loved one with Alzheimer's requires a great deal of patience and sacrifice, and one person can't do it alone. Don't feel guilty asking for help. You'll be doing your Mom more good having help on your side...  Maybe you can ask a friend or family member to sit with your Mom to give you a much needed break. You can also contact a home care agency that can provide someone to assist your Mom with her care. These caregivers can also engage your Mom and participate in enjoyable activities with her.

It is a noble promise, and it is possible to keep it, but it means being willing to ask for help.

Best wishes, Bert

Dementia and Alzheimer's: A Series

In senior care, one of the most frequent conditions we encounter is dementia, in one of its 1000+ forms.  The most "famous" is Alzheimer's, but in any form it is very serious, for the individual and his or her family.

Over the next few weeks, we will be talking about this issue from a number of perspectives: the client / patient, family members, including family caregivers, professional caregivers at home and the facilities who serve people with dementia, including those that provide memory care.  We will talk about the dignity of those suffering and the immense respect we have for them, as well as for those helping.

One of the topics we will be spending time on is the many resources that are available to us on the topic of dementia.  Thankfully, this is a condition that we take very seriously as a society, and there is a great deal of study going on and helpful material that has been published.  We will just mention a few of the "biggest" in this first article:

1. One of the most significant sources is the National Institutes of Health's  National Institute on Aging.  This site has many helpful sections.  One of the most important is their Alzheimer's Disease Education and Referral (ADEAR) Center.  The Center has many publications and links to tools and services that can be very helpful to everyone affected by or supporting someone with Alzheimer's.  The site is updated frequently and well maintained.
2. Also part of the National Institutes of Health is the National Institute of Neurological Disorders and Stroke.  They have an excellent section called Dementia: Hope Through Research.  That Institute has a separate "page" called Dementia Information that is also very useful.
3. The third resource we will mention today, as we get started, is one all of us concerned about this topic should be aware of and with which we should be involved.  That is the Alzheimer's Association.  They have great information, but, even more than that, they are at the heart of the fight.

In future articles, we will include other resources, including some you might tell us about.  We will also have some stories from our own collective experience.  If you have a story to share, let us know.  Thank you.

Carol Kinsel, Senior Care Solutions

Bert Cave, Support For Home

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.

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.

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

Discovering a Great Service, Sadly

Early this year, my father passed away.  Late last week, my mother also died.  Yes, both of those events hurt a lot.  The silver lining was discovering (actually my wife, the Chief Operating Officer of Support For Home, discovered) Dignity Memorial.

Dignity Memorial is an amazing service available to loved ones who are left behind.  To see just what I mean, below are the links to the memorials for my mother (Margaret Cave) and my father (Hardy Cave). 

Aside from being happy that others might see what grand people they were, I am amazingly proud of my sisters, in Oregon, where my folks lived, for making this happen.  Being the primary caregivers for my folks and making these memorials happen is amazing.

Being able to add some thoughts to the guest books, read what others have written, and at any time, maybe years from now, go back and look through the pictures -- this is an incredible service.

With love, Bert

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