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

We Already Talked About This Once, But ...

Recently, we discussed the difficulty that clients and family sometimes have separating excellent home care from a particulare Home Care Aide.  When we, at Support For Home, have to make a change, sometimes family just has a hard time accepting it.

Recently, we had a case of a Home Care Aide not showing up for an assignment.  Unfortunately, it can -- and will, at some point -- happen with the best senior care agencies.  The real crux of the matter is how the home care agency handles it.

This was a client undergoing dialysis on a regular basis, and the day in question was a dialysis day -- but the employee failed to show up.  Under California penal code section 368, that is a potential criminal offense for the individual.  We covered the assignment and got our client to dialysis. 

When the employee called, the next day, we informed her that she had "self-terminated" her employment with Support For Home and that, as she already knew, it would be reported to the authorities.

That is bad enough.  The former employee behaved in an ethically reprehensible manner.  It is up to the authorities whether they deem it to be something they will prosecute.  For us, there is no alternative.  She is no longer an employee.  We cannot trust her and will not subject any client to such potential behavior.

However, the family member of another client for whom she provided services actually wanted us to rehire the former employee.  That person was unable to take an objective view and realize the potential jeopardy the client might be in with someone who already demonstrated a willingness to abandon a dialysis patient.  Our answer -- it's not going to happen.  We will happily lose a client before we will hire back someone who behaves in such a manner.

And That's Good Because ...?

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

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

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

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

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

We Have Talked About Hospice Before ...

We have talked about Hospice services before.  It is a natural and critically important service associated with what we do, providing home care for the elderly. 

As a senior care, in-home care agency, Support For Home works with many very good Hospice agencies.  Today we saw a Hospice RN that combined the best of professionalism, medical knowledge and true compassion in working with a family.  Absolutely amazing mix of education for the family, honest, straight talk, and help for the family in dealing with the emotional trauma with which they are really only starting to deal.

As stated above, we work with a number of excellent Hospice agencies, but our hats are off, today, to Yolo Hospice and their team of RNs and Social Workers.  They make both life and death easier for our clients, our families and our Home Care Aides.

Thank you for the passion and commitment to the services you provide.

Best wishes, Bert

We Wish We Could Help Every Single Person, But ...

This is a tough topic, as we wish that we could help every family that asks us to assist someone.  However, every good (read "honest") home care agency will tell you that once in a while there is someone that we just know we will not be able to satisfy. 

In our case, that happens maybe only once per year, but it hurts when it does happen.  It hurts not from a business perspective -- we have plenty of clients for whom we are doing a great job at Support For Home, and we continue to grow rapidly in the Sacramento region.

Rather, it hurts because this is a person who really does need help with ADLs (Activities of Daily Living) and IADLs, or the family would not have contacted us.  To know, from the assessment, that we will not be able to make a person happy, no matter how good the care will be, is both frustrating and sad.  Our Home Care Aides are professional.  They know it is "all about the client," not about them.  However, there is always a limit to what we ask our employees to accept.

To quote the Philosopher, "Arrrrrggghhhh!"

"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.

And Now For Something Entirely Different

So, this is something that has been brewing in my mind for quite a while.  I did not really intend to blog on the topic, but a comment by a new client actually convinced me that I should.

Just to be clear, this is not about how our senior care, in-home care agency, Support For Home, is better than others.  It is about the fact that we would love to see other agencies understand the sensitivities of seniors and decide to stop this practice.

OK, so what in the world am I talking about?  The issue is "branded" cars that scream the names of homecare agencies. 

If I'm a realtor or sell insurance, no issue with the decals or paint jobs that tell the world what I'm doing.  However, if my passion is, however -- as ours is -- to enable seniors to continue to live at home, I'm not going to do that.  Many seniors have enough issues accepting that they need help.  It is an emotionally difficult decision for them.  If they want to share the fact that they are receiving care with their neighbors, great.  We are not going to advertise that fact by the cars our administrative staff or Home Care Aides drive.

For us, it is just a matter of being a little bit more sensitive.  Do you agree or disagree?  We would love to have your comments.

Best wishes, Bert

Costs: Home Care vs. Assisted Living vs. Skilled Nursing Facility

CareScout is a Genworth (the Long-Term Care Insurance company -- see earlier blog on LTCI) company that serves seniors and their families in a variety of ways, including free referrals to facilities and home care companies.  They just published their latest study of costs, with very interesting results, including the following:

This year's survey once again shows the cost of home ... care to be rising much slower than the cost of staying in a nursing home or assisted living facility... The historical compound annual growth rate for this type of care service has been only 1.7% over a five-year period. A one-bedroom assisted living residence has increased 6.7% percent annually over the same five year period. A private room in a nursing home has increased 4.5%.

This is not a new trend.  The cost of home care for the elderly has consistently been less expensive "pound for pound" than within a facility.  We certainly expect that to continue.  When you measure home care versus facilities care in terms of cost-benefit (where constant skilled nursing is not a requirement for the individual), the difference is even greater.  The quality of life benefits, for most seniors, makes it a no brainer.

Agree, disagree, questions?  Give us your comments, please.

Best wishes, Bert, Support For Home

Should a Family Member Be a Parent's Caregiver

We are a member of several industry groups that include discussion topics meant to stimulate thought and improvement in the are of in-home care for seniors.  One of them is the National Senior Living Providers Network, which is the Internet "location" for a discusion about "Should I become my parent's caregiver?"

I think the answer should not be a "yes" or a "no," actually. At our in-home care agency (Support For Home, in the Sacramento, CA region), we believe that client homecare is family care and that, ideally, homecare is a team effort -- the homecare agency, including administrative staff and Home Care Aides, the family members (whether local or remote) and the client.

The statistic that we in the homecare industry know all too well is that about 63% of family caregivers actually die before the person for whom they are caring.  That says it all about the stresses -- physical, emotional, psychological -- of being a family caregiver.

In addition, good in-home care means a certain amount -- actually, a lot -- of care management, beyond the direct support of ADLs and IADLs delivered by the home care agency. Being able to identify and locate resources for home safety, fall prevention, emergency alert systems, mobility support, etc., reuires a lot of time and knowledge.

So, for the good of the client and the good of the family members, adding a non-medical in-home care agency to the team is really important.  Whether you agree or disagree, please let us know.

Best wishes, Bert

Elder Abuse: On-Going Problem for Seniors, Families, Caregivers

In California, all homecare agencies, whether medical (home health) or non-medical are mandated reporters of elder abuse.  Abuse can take many forms, however, from "simple" neglect (benign or otherwise) to physical or financial.

We will be talking about some of these issues in several upcoming blogs.  Today's focus is on financial abuse of seniors.  There are many good Internet resources on this topic.  A few of them:

• Crimes of Persuasion - this site talks about many of the signs to watch for that might indicate abuse.
• Article by Karen Stephenson - sums up a good bit of research.
• National Committe for the Prevention of Elder Abuse -  this is an excellent site for more than the financial issues

For us at Support For Home, this is a very personal issue.  Many of us have seen episodes of attempted -- or worse, successful -- financial abuse of seniors.  Our Director of Client Services even wrote her Master's thesis on this topic.

It is one we make sure our Home Care Aides are sensitive to, not just in terms of avoiding anything that could be interpreted as abuse, but also awareness of the signs that it may be occurring.  One of the dangers is that when an elderly citizen reports issues -- items missing, not as much money as they used to have, ... -- some people might simply dismiss as "forgetfulness" or "senior moments".  This must not happen.  If there are signs of possible abuse, they must not be ignored and must be looked into by the appropriate people.

There are far too many stories of financial abuse by the caregiver population, whether family, "friends" or employed.  We are dedicated to ensuring it does not happen on our watch.

If you have stories to share, lessons we can all learn from, please let us know.

Best wishes, Bert

Communication: Client, Family, Home Care Support

At Support For Home, our ideal situation is when the client and his or her family are "on the same page" about homecare and the significant issues being faced as the senior(s) strive to continue to live safely and securely at home.  Sometimes, though, those folks are on very different pages, in spite of deeply caring for each other.

Occasionally, the daughters or sons are very reluctant to have the serious dialogue necessary with their parents on the topic of aging in place / senior care.  The "children" may have played that role for so long that it is tough to initiate that adult-to-adult conversation.

Equally likely is that the parent(s) may resist having the conversation, because they feel it diminishes their status as parents and independent, self-sufficient adults.  In reality, of course, the conversation does not diminish the parent(s) in any way, but it can "feel" very uncomfortable.

In either case, whether the reluctance comes from the children or the parents, we are often able to play a "facilitator" role in that critical dialogue.  We do not have the emotional history of the family members.  We approach the need for care as professionals -- in our case, led by our MSW (Masters in Social Work) Director of Client Services -- with experience in gerontology and a passion for helping folks live at home, even if they need help with Activities of Daily Living (ADLs).

For on-going communication between clients and family members at a distance (e.g., "Mom lives here, but I live in New Jersey"), our Home Care Aides often serve as an important information link, either directly or through the administrative team in the Support For Home office.

The bottom line is, communication between the client, the family and Support For Home (or any very good home care agency) is absolutely critical to successful senior care.  It's not good enough to just focus on the ADLs and IADLs and think everything else will take care of itself.  We know that, which is why, in our philosophy, client care is family care.

Best wishes, Bert

Follow-Up on Bonding with Home Care Aides

Yesterday, we talked about challenges for providing services to homecare clients when the regular Home Care Aide is out for some reason, and the client feels that no one else could possibly be as good. 

As we said, this happens even -- perhaps more so -- with very good agencies.  Part of what will make an agency great, in our opinion, is eliminating this issue, so that clients never hesitate to accept a substitute caregiver.  Support For Home is committed to moving from "very good" to "great," by this and other measures.

So, what are we -- and what should other very good non-medical homecare agencies be doing to move up the quality ladder?  Some folks will disagree with us, but that has not stopped us yet!  :-)

The first thing we are doing is in fact emphasizing the fact that we are providing Non-Medical Homecare, supporting our clients Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs).  Home Health agencies are tasked with providing skilled nursing and other forms of therapy (e.g., physical or speech therapy).  These agencies, in California, are licensed and the employees are, as well.  Unfortunately, not every state licenses Home Health agencies.  That is a bad thing, as far as we are concerned.

However, our major point is that we are focused on the non-medical needs of the client, including home safety, emergency alert systems, memory care, and all of the ADLs and IADLs.  So, now comes the controversial part.  :-)

Many non-medical homecare agencies are headed by RNs.  For many of them, they consider this a strength.  For home health agencies, we think it definitely is, as well.  For non-medical homecare agencies, however, we think a social work focus is far more appropriate.  Because of that, our Director of Client Services holds a Masters in Social Work (MSW), rather than an RN status.  Don't get us wrong, some of our best friends are RNs, and a close friend who is an RN runs excellent agencies in the Palm Springs and San Francisco areas.

However, our social work emphasis recognizes that there is a totality of need to be understood and addressed, from mental health to shopping to toileting and everything in between.  For medical needs, we work with clients' doctors and home health agencies, who address their slice of the universe of need.  In our view, the better we become at the social work focus, the faster we will move from "very good" to "great."

Best wishes.  Bert

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

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

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

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

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

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

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

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

When the Family Home Just Doesn't Work Anymore

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

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

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

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

Best wishes, Bert

How Does Your Homecare Agency Respond to Challenges?

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

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

So, here are some of the possible scenarios:

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

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

Best wishes, Bert

Best Laid Plans -- Oh, Well

At Support For Home, we urge families -- whether they will be working with us or some other agency -- to plan ahead, in terms of homecare for loved ones.  That planning involves a number of factors, including:

1. What is the budget? 
• What will homecare cost, at several levels of care, from perhaps 4 hours a few days per week to 24 hours, 7 days per week?  That is a wide range of care, and it corresponds to very different costs.
• How will homecare costs be paid?  Is there Long-Term Care Insurance?  Is the loved one eligible for Veteran's Aid & Attendance benefits to subsidize homecare costs?
2. What is the "tolerance" for homecare?
• While it may be clear that assistance with ADLs (Activities of Daily Living) and Instrumental ADLs is critical to success in aging in place, we all have different levels of tolerance for that assistance.  We have each been independent for a long time.  There are issues of pride and privacy that need long and sensitive discussions.  Often it is better to start with a smaller schedule, to allow adjustments, if #3 allows it.
3. What is the goal of implementing homecare?
• This is actually a big deal.  In our view, homecare support should be started before there is a major crisis, such as a fall and a broken hip or a stroke.  Our goal is to begin supporting our clients early enough that we are able to help maintain a safe environment and high quality of life for them, avoiding crises to the extent possible.  If we are already in a crisis, the immediate well-being of the senior is the key, always.

One of the reasons it is so important to have these discussions and make plans early enough is that we do not know when the crisis will arise.  A family called us in last Tuesday, to begin a schedule of 4.5 hours per day, Monday through Friday.  By Thursday, when we met with the senior and her family, the need had changed to seven days per week, starting the following Monday.  By Sunday morning, the need had changed to 24-hour shifts, seven days per week, starting that day.  The crisis was here.

Neither the family nor the client have had time to adjust to homecare or the costs of it.  That means more stress than they need, but ...

So, plan ahead, but be ready to move quickly, as the situation changes.  Need for homecare goes up, down and sideways.  We can help you deal with it.

Best wishes, Bert

Stair Lifts and Homecare

I saw a tweet this morning about how stairlifts reduce the need for homecare.  At Support For Home, we think stairlifts can be extremely helpful, but, frankly, I think that is the wrong point, entirely. 

If seniors need to utilize a stairlift to stay in their multi-story home, they almost certainly need other help, as well.  Stairlifts can absolutely make it possible for seniors to stay in the home they love, providing they have support for ADLs (Activities of Daily Living) and Instrumental ADLs.

When we bought our current two-story home, we knew that visits from my mother were going to be very difficult for her, without a stairlift, because her mobility would not be sufficient to climb the stairs.  So, we had one installed.  It made it possible for her to enjoy our home any time she wished.  It did not remove the need for support with other ADLs / IADLs.

Stairlifts are not cheap, but they can still be less expensive -- and traumatic -- than disrupting our clients' lives and homes and forcing a move.  It is something we always look at as we do homecare client assessments, putting together a comprehensive plan of care.  We do not sell or install stairlifts, or make a penny from them, but we make sure we know great resources for our clients, to help them stay at home.

Find a Reason Not To ...

In our homecare agency, our HR / Care Services Manager has to deal with the tension between two very clear expectations that we have.  

1. The first is to find all of the Home Care Aides that want to become employees of Support For Home.  To do this, she visits all of the schools in the area that have Certified Nurse Assistant and Certified Home Health Aide programs, sanctioned by the State of California.  She also participates in employment fairs.  And, of course, she gets lots of referrals from our own employees.
2. The second expectation is that for every job applicant, our Care Services Manager will work very hard to find a reason not to hire them.  We want only the very best Home Care Aides working at Support For Home.  Our employees are the heart and soul of our homecare agency, so hiring and retaining great people is our mission.

Our advice to all families looking for homecare for a loved one is to do the very same thing.  Find only the best agencies, grill them in the interview process (using the questions and standards we talk about on our Web site, at http://www.supportforhome.com/), and work hard to find a reason not to hire each one.  You do not want an agency that is "good enough."  When you make the hardest decision that a family can make, about who will provide care to a loved one, you want only the best.

We strive to be the best, one employee at a time.

Licensing Homecare Providers?

In virtually all states, skilled nursing homecare or "home health" agencies are licensed by that state's government.  When it comes to non-medical homecare, however, the situation is much more mixed.  Slightly more than half of the states do license non-medical homecare companies, but exactly what that means varies greatly.  There is a fairly current reference page at Private Duty Today of what licensing requirements exist, state by state.

In Oklahoma, for example, the agency sends a letter and a form and $1 to the Department of Health.  That's about it.  Like every business, you need state and federal employer ID numbers and you have payroll responsibilities, but there is not much substance to the requirements in terms of quality or safety for the clients and their families.  The fee for the license, to me, indicates the seriousness with which it should be taken.

In Oregon, on the other hand, applications cost $1500 and renewals cost $750.  Right there you have an indication of a rather more serious approach, in that state.  From colleagues operating there, Oregon does, indeed, take homecare seriously.

In California, on the other hand, there is no licensing involved for non-medical homecare, at all!

So, what's the big deal?  Well, in our view, it does not make any sense at all that home furnishings business are licensed (Bureau of Electronic Appliance Repair, Home Furnishings and Thermal Insulation), but the people who take care of folks in those furnished homes are not!

As owners of a homecare agency in California, we would welcome a change to that situation.  Seniors need as much protection as anyone having landscaping done or a car repaired.  Will it cost our business money to implement the needed licensing overview?  Yes.  Is it an important investment in the safety and quality of care of our clients.

Caring for Spouses with Dementia

There is a very serious article on MSNBC (http://www.msnbc.msn.com/id/36975938/ns/health-aging/) concerning a strong correlation between caring for a spouse with dementia and developing dementia oneself.  The first paragraph raises grave concerns:

"Being married to someone with dementia may sharply increase your own risk of developing the condition, a new study shows."

There is no causal link established yet, but one very significant point is made by Dr. Gary Small of UCLA:

"'Caregiving is very stressful,' said Dr. Gary W. Small, director of the University of California-Los Angeles, Center on Aging and director of the Geriatric Psychiatry Division at the Semel Institute for Neuroscience and Human Behavior at the David Geffen School of Medicine at UCLA. 'Studies have shown that caregivers for dementia patients have a high risk for major clinical depression. And there has been a study that showed that people who are prone to stress are at higher risk for Alzheimer’s.'"


To those of us in the home care industry -- or family caregivers -- the stress level is not news.  However, the issue of stress related to Alzheimer's risks is something on which we all really need to focus.  It reinforces how important it is for the family caregiver -- whom we already know has the hardest job in the world -- to receive adequate respite and support.

If you or a family member face this situation, talk to a social worker with knowledge of gerontology about options, or give a solid, certified home care agency a call, just to talk about your situation.  There is help!

Best wishes, Bert