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

These Aren't Scams, They're Comedy Bloggers

So, after reading my 9,427th email sent from everywhere from Algeria to Zimbabwe, telling me that a very small investment -- just a show of good faith, really, will secure my share of an unclaimed treasure worth $7,832,451.09, I have decided that these are really not scams at all.

I am now quite certain that these folks are simply fellows looking to become comedy writers for Conan's new show -- or maybe Leno's old, new show.  That part is not clear to me.  What is clear is that these are not simple scammers from Russia or Africa or North Dakota (well, I suppose some of them could be from North Dakota).  A few of them may be from Goldman Sachs.  The grammatical ability seems to match.

But clearly, they are not seriously inviting me to send over $50,000 to secure my good fortune.  I mean, for goodness sake, they must know I run a home care company, so there is no way I've got $50,000!  There is an old joke, about a New England dairy farmer who won the lottery.  He was asked what he was going to do now that he was rich.  "Well," he said, "I guess I'll just keep on dairyin' until it's all gone!"  He might as well have been in the senior home care industry.  :-)  If you are not doing what you are doing for passion, you are doing the wrong thing!  At Support For Home, it's all about passion -- for our client's and their desire to age in place -- in their own homes.

So, keep those emails coming guys.  When you are working 24x7, a little laughter goes a long way.

For the rest of you, if you don't agree with my theory, I've learned about $4,000,000 in Confederate money that we can split, if you just send me $50,000.  I need the money up front to send to this guy in Ukraine from whom I just heard who has a sweet deal for me.

Effectiveness of Hands-Only CPR Good News

An article on MSNBC reports,

two new studies conclude that "hands-only" chest compression is enough to save a life. They are the largest and most rigorous yet to suggest that breathing into a victim's mouth isn't needed in most cases.

This is really good news for a number of reasons.  The first is that it is easier to perform, requiring less skill and training.  A second major factor is that most folks who are not medical or healthcare professionals are far more willing to perform chest compressions than the mouth-to-mouth procedure.

At Support For Home In-Home Care, we require that our Home Care Aides are CPR certified, at the health professional level.  That is very unusual, however, even in the industry, much less in the general population.  The studies appear to indicate that 911 Dispatcher directed, hands-only CPR was most effective.  Bystanders operating under the Dispatcher's guidance were highly successful, even if they had not been trained in CPR techniques.  The simplicity of the hands-only approach contributes a lot to that.

The results confirm the American Heart Association's own recommendations, which have been hands-only for the last two years.  We still will require CPR training for our Home Care Aides, but this is still really good news.

Best wishes, Bert

Sun City Roseville Foundation

At Support For Home, we have the privilege of delivering in-home care as an invited provider to a truly wonderful community program.  The program is the Sun City Roseville Caregiver Relief Program.  It is funded by the Sun City Roseville Foundation and administered by the The Sunshine Services and Resources group.

The gist of the program is that families who live in that community, if they meet a few criteria, receive respite care from a few approved in-home care companies, with the Foundation paying about 75% of the cost.  The Foundation (Director, Helen Bisenius) also sponsors and organizes many other programs that are meaningful to residents.

Frankly, we would love to see the Caregiver Relief Program replicated in every retirement / senior community.  Being able to provide relief caregiving once a week, to enable the family caregiver to take a breather or attend to personal business is a very rewarding opportunity for us.  It is not that the program is really a revenue source for us, as a business.  We probably donate as much as we make!  Rather, this is a program that just fits so well with the passion that led us to start our home care company in the first place and that keeps us going.

So, to all the professionals and volunteers that make Sun City Roseville work and the Foundation possible, Thank You, from all of us at Support For Home.  May every other community look to your model and imitate it.  If you live in Sun City Roseville and are unfamiliar with the program -- or need help -- contact Sunshine Coordinators Clare Handcock at 786-7857 or Betty Meers at 771-2637.

Best Wishes, Bert

Social Engagement Critical in Senior Care

Thanks to Marc Onigman in National Senior Living Providers Network for bringing a medical study to my attention.  The information is not really "news" to those of us in the senior home care industry, but it is always good to spotlight it.

When we do an assessment (free, of course) of a new client at Support For Home, we cover three areas:

1. Homemaker Services -- Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs) in the home
2. Companion Services -- ADLs and IADLs that involve our interfaces with others and outside the home
3. Personal Services -- ADLs and IADLs such as bathing, dressing, toileting

As we discuss the second category, we frequently observe a much smaller social calendar and circle of friends and acquaintances than is "healthy."  Of course, that is not surprising, since, as we age, we tend to lose family members and friends.  The challenge is for our clients, hopefully with our help, to renew and rebuild that circle.  If my friend Joe and I never get together any more, because neither one of us drives, that can easily be and must be "fixed."  A truly Comprehensive Plan of Care must be as focused on number 2, above, as on 1 and 3.

The study is as cautious as all of them are, in terms of cause and effect, but reports,

In a pooled analysis of 148 studies, having strong social relationships was associated with a 50% greater likelihood of surviving through follow-up (OR 1.50, 95% CI 1.42 to 1.59), according to Julianne Holt-Lunstad, PhD, of Brigham Young University in Provo, Utah, and colleagues.

The magnitude of the association puts social relationships on a par with quitting smoking and beyond obesity and physical inactivity in terms of relationship with mortality, the researchers reported in the July issue of PLoS Medicine.

In the senior care industry, we must all put even more emphasis on this issue and look for creative ways to increase social interaction and relationships for our clients and patients.  It is not just a matter of quality of life.  It looks pretty clear it is about quantity of life.
Best wishes, Bert

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

Robot Care for Seniors at Home?

OK, so I am a self-confessed techno-geek.  I did Information Technology work for 25+ years, including 18 years at Intel Corporation, retiring as an IT Director.  I love video games and computers and technology in general.

And then, there is "Elder Care Robot," from Gecko Systems.  I believe that this kind of technology can play a significant future role in senior care, but at this stage, frankly it is just plain creepy. 

Most forms of technology start out looking as sad as this does, so I am not saying it is or will be a failure.  For some of our clients, automated medication containers pop open and tell the client it is time to take some pills.  The co-owner of Support For Home and I both supported Intel's Digital Health business when we were in IT at that corporation.  We remain huge fans of the effort of our former colleagues.

All that having been said, I might have kept this metal beast under wraps for a bit longer, if I were Gecko Systems.  When they can build in a bit more "human touch" into their technology, they might just have something.  We will be happy to welcome them to our home care team.

Best wishes (including to caregiver robots), Bert

Federal Study on Aging Good, But ...

There are some very interesting data points in the recently published study, "Older Americans 2010: Key Indicators of Well-Being."  The study was put out by
The Federal Interagency Forum on Aging-Related Statistics.

As most of us are aware,

Americans are living longer than ever before. Life expectancies at both age 65 and age 85 have increased. Under current mortality conditions, people who survive to age 65 can expect to live an average of 18.5 more years, about 4 years longer than people age 65 in 1960. The life expectancy of people who survive to age 85 today is 6.8 years for women and 5.7 years for men.

That is, on its face, a wonderful thing.  However, there are many implications that are a bit more complicated.  When one begins to look at the size of the senior population (including me), one's eyebrows begin to rise:

In 2008, 39 million people age 65 and over lived in the United States, accounting for 13 percent of the total population. The older population grew from 3 million in 1900 to 39 million in 2008. The oldest-old population (those age 85 and over) grew from just over 100,000 in 1900 to 5.7 million in 2008.

The implication for Social Security is old news, but still a valid concern.  Less intuitively obvious, however, are some of the other issues.  For example, 42% of women 65 years of age or older are widowed (much smaller number for men).  76% of women over the age of 85 are widowed and 38% of men that age are widowers.  This has very significant meaning, socially.

Another set of issues involves the chronic medical conditions which face us as we age.  The chart below, from the study, has a great deal to say about that:

The number of seniors with multiple chronic conditions is clearly evident when one looks at the percentages for each.

One of the areas that the study clearly fails in, at least in my judgment, is dementia, including Alzheimer's.  Statistics are really not reported and analysis is missing.  As the study itself says,

While there are several studies which report estimates of the prevalence of Alzheimer’s, one of the major barriers to reliable national estimates of prevalence is the lack of uniform diagnostic criteria among the national surveys that attempt to measure dementia or Alzheimer’s. A meeting convened by the NIA in 2009 to describe the prevalence of Alzheimer’s concluded that most of the variation in prevalence estimates is not driven primarily by the reliability of the measures or instruments per se but by systematic differences in the definition of dementia.

This is very, very disappointing to all of us involved in senior care.  Until we really gain an understanding of what it means and what the impact is, we will not do the best job of addressing the problems of dementia and Alzheimer's.

An area that the study better addresses is the need for assistance with Activities of Daily Living (ADLs).  That need is the real basis for non-medical home care existing in the first place:

It is interesting that the largest growth in meeting ADL needs is in the area of equipment.  That is one reason we work so closely with mobility and durable medical equipment suppliers for our own home care clients.  We have to understand and be able to address the total universe of need.

All in all, it is a very good and interesting study.  Check it out.

Best wishes, Bert

OK, This Aging Issue Is Personal!

As I have gotten older, so have my eyes.  Yes, that is a truism, but that does not make it unimportant for seniors -- and those soon to be seniors.

I have more trouble than many folks, because I am naturally (pre-cataract surgery days) very nearsighted.  That means that my eyes are naturally longer than normal.  That puts me at much greater risk for things like detached retinas.  It also makes me much more susceptible to macular degeneration caused by bleeding into the retina.  As one retina specialist told me, you only get so many cells to "wallpaper" the back of the eye, and if they get stretched to much, there can be bleeding.

In my case, there has been bleeding, in both eyes, over the past six or seven years.  The first time it happened, in my right eye, I was pumped full of an expensive chemical and got to stare into a laser.  Fun.  That had to be done several times.  This year it happened in my left eye.  Advances in medicine meant I got to have a needle poked into my eye once a month for three months.  Also really fun.  At this point, I do not see straight lines anymore, but at least I see.  I am a firm believer that the earth is curved, if not round.

Now, aside from fascinating you with my life story, what is the significance of all this?  Really, it is two-fold.  The first is that these issues happened after I turned 50.  The older I get, the more likely they are to recur and get worse.  That fact is another reason why we founded Support For Home In-Home Care.  The problems I am having now and will have as I get older are not news to some of our clients.  Their desire to live at home is threatened by declining eyesight.  Our support of their Activities of Daily Living (ADLs) is critical to their success. 

There are many excellent sources about macular degeneration on the Web.  One such source is Wikipedia.  The National Eye Institute of the National Institutes of Health has excellent information and links.

In my case, I have had good medical insurance and been able to pay for great treatment for my eye problems.  For many seniors, that is not the case.  One program seniors and family members should check out is EyeCare America.  Aside from excellent information, many seniors may qualify for a free eye exam or even up to a year of free care from volunteer ophthalmologists.  It is a great program.  Check it out and keep an eye on this blog for more information on issues of aging.  Sorry for the pun -- could not help myself.

Best wishes, Bert

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.

"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

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

"Convergence Between Healthcare IT and Life Sciences Informatics"

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

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

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

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

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

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