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

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

What Does Information Technology Have To Do With Senior Care?

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

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

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

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

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

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

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

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

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

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

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

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

Dementia and Alzheimer's Series #4: Hospital Stays

The following great set of guidelines comes from the Alzheimer's Aid Society of Northern California.  We thank them sincerely for all of the support they provide to Alzheimer's patients and their families and friends.

Almost everyone who has ever had the experience of being a patient in a hospital knows that it can be frightening. It is even scarier for persons with dementia.  Unfamiliar surroundings, food, and caretakers can be devastating
when one is confused and disoriented. Confusion and disorientation affect how quickly and how well a patient recovers.  Providing useful techniques for staff and family visitors can mitigate resulting problems such as anxiety and wandering.  Some suggestions include: 

• Have a caregiver advocate on behalf of the patient. If possible, a family member should remain with the patient at all times. This person can help distract and soothe the patient during medical procedures.

• Use non-verbal techniques and simple language to communicate. Gestures, facial expressions, pictures, and signs are all examples of non-verbal communication. These can be used when cuing the patient to eat or bathe.

• Have a list of patient’s likes and dislikes. Favorite items can provide comfort and distraction. Knowledge of dislikes can help the staff avoid negative reactions and minimize anxiety.

• Studies have shown that the use of restraints tends to increase injuries and causes distress for the patient.  Other methods that can keep the patient safe are distraction, soothing touch, music, or prayer.

• Be sure the patient is not over or under-stimulated.  Patients with dementia have more difficulty communicating when over-stimulated by television or multiple conversations. Conversely, insufficient stimulation may increase anxiety. 

• Be aware of changes that may be occurring in the patient. Some patients won’t express pain or other feelings. Note any physical or mood changes which may indicate a complication or new illness.

• Allow the patient to make as many decisions as he or she can. Guided choices providing some control can limit distress.

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

Helping Caregivers Be All That They Can Be

From Carlotta Sanchez, Care Services Manager

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

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

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

Rewards Do Not Always Mean Revenue

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

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

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

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

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

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

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

Say What You Will Do ...

Say What You Will Do, Then Do What You Said

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

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

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

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

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

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

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

We Screwed Up

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

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

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

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

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

Quiche and Customer Service!

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

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

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

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

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