Caregiving at the Crossroads

VOICES of the VILLAGE: Shawnee Penkacik

2011-06-30T10:46:00.000-07:00

Shawnee Penkacik

By Cara Moore, Investigative Reporter

Caregiver Village is all about caregivers. Most of us think about caregivers as older people – middle-aged, at least – caring for an aging parent. One of my airhead friends even said to me recently, “You write about caregivers? Ick! Caregivers are never very cool.”

Anyone who thinks caregivers are never very cool hasn’t met Shawnee Penkacik. Shawnee is not only cool, she’s young, vibrant and beautiful. She’s no middle-aged fuddy-duddy, I’ll tell you that! But Shawnee IS a caregiver. And she is very, very much a part of Caregiver Village. Let me tell you her story.

When you meet Shawnee, the first thing that gets your attention is the way she introduces herself. “I’m the mother of nine children,” she says.

“Whoa – stop right there!” is my instant response. I can barely handle one teenaged son – how on earth (not to mention why) would someone handle nine kids! But we’ll get there…

Shawnee starts off right away talking about her personal caregiver life as the mother of two sons with Mitochondrial disease, a disease that, frankly, I had to have her spell first, and then explain to me. It’s something I’ve never heard of, but as Shawnee talks about the disease she also shares that it’s much more common that anyone thought.

Shawnee pointed me to the United Mitochondrial Disease Foundation website where I learned a lot more about this disease. She also suggested I check out the website http://www.mitoaction.org. The diagnosis is tricky, as the disease affects so much of the body and looks different on different people. “Over 20% of moms are accused of Munchausen syndrome,” says Shawnee. I know what that means: the docs think they’re making stuff up just to get attention.

“When my first son was born, I had no idea what was wrong. He just slept all the time, and never wanted to eat,” says Shawnee. “When my second son was born showing some of the same symptoms, the doctors just thought I was projecting my experience with my first son on this baby. They were wrong – he’s also affected by the disease.”

As we talk, Shawnee shares a little bit more about herself. “I never thought I’d have kids,” she says. “The doctors told me that my spine was too affected by scoliosis to be able to get pregnant. I was OK with that, too. Guess God had other plans for me!” Shawnee talks about the challenges of getting her kids to their medical appointments, but she always says it in a positive way.

“I don’t drive (I have M.S.), but my friends, my mom and my husband drive me and the kids. I’m so lucky!” says Shawnee.

“But NINE kids,” I say. “What’s THAT about?”

“We just figured each baby was a blessing from God that we were meant to have,” she replies, and then continues to talk about how “lucky” she is.

“So many other parents of kids with this disease have it so much harder. We don’t have to worry about oxygen or other problems. I did have to learn how to put a feeding tube down my infant son without getting it into his lungs – that was scary. But otherwise, we’ve been really blessed.”

When I talked to Shawnee she was busy packing. “We’re moving to Arizona in a few days,” she tells me. “My husband got transferred, so we’ve started packing and will move there soon.”

As for connecting with health care professionals there, Shawnee has already hooked up with a mom’s support group, who is helping her find great medical support. She’s positive and looking forward to the move, excited, as well, that her husband can also find a dad’s support group there.

“My husband, who is my best friend and biggest supporter, handles it differently than I do,” she says. “I think it’s just harder for him to express his feelings, even though he’s willing to do whatever needs done to help the kids and me.”

Shawnee says her biggest caregiving challenge comes from talking with the health care providers. “I had to learn to keep a journal and to document everything. Most importantly, though, I had to learn to stand up and fight for my kids. That was hard for me to do at first, but it’s been the toughest challenge and the most important thing I’ve learned.”

Connecting with other caregivers has been the best stress-reliever for Shawnee. “Many of the moms I connect with online have it so much harder than I do. I think, in many ways, my problems are really just inconveniences, especially compared to other moms.”

Learning about the disease and educating herself about caregiving has been extremely valuable, too. “I found a scheduler through Caregiver Village that is essential to helping me keep track of all the daily medications my kids take – even though it was designed for people with Alzheimer’s disease. It’s perfect for me! I’ve also learned a lot more about taking care of myself, and am trying hard to do that,” Shawnee says.

I can only imagine how hard keeping a marriage intact would be with nine kids, not to mention two kids with very special medical challenges. When I ask Shawnee how she does it she replies, “It’s easy: we laugh a lot. We try to have a weekly date night, too.” Shawnee talks about her husband with fondness and a genuine sense of romance.

“Sharing my story is one way I can help other people,” says Shawnee. “It can feel like you’re all alone – but there are actually lots of us facing really tough caregiving situations. If we can support each other it makes the whole experience a lot easier.”

I think sharing Shawnee’s story can be more than encouraging. For me, at least, it provides some kind of perspective that maybe my own caregiving challenges aren’t all so bad. If Shawnee can feel lucky and blessed, so can I!

VOICES of the VILLAGE: Lisa Cerasoli

2011-06-08T11:48:00.000-07:00

By Cara Moore, investigative reporter

Lisa and her Gram

Editor’s note: Lisa Cerasoli is the author of “When Nora Jo Fades Away,” a book selected for the Village Chronicles caregiver game book club discussion in Episode 2. Lisa makes a guest appearance in the game; she also hosts a real Book Club in Caregiver Village called “It’s Hip to Care!”

Lisa Cerasoli is one of the funniest, most fun people I have had the privilege to meet recently. She’s full of life, energy and sass. It doesn’t surprise me in the least that she named her daughter “Jazz” – I think, for Lisa, life is a full-on riff, just setting the stage for us to get up and start dancing.

What does surprise me is how Lisa took to caregiving. She’s an actor; a Hollywood pro. But clearly, when her family called, Lisa was just as ready to dive head-first, full-steam-ahead into caregiving as she had been into acting.

And of course for Lisa, it wasn’t enough just to head to the Michigan home lands. No, Lisa also found a husband, had a baby and wrote a couple of books.

Typical Lisa style!

When I first met Lisa her Gram was living with her, providing her with not only funny stories and great life experiences, but also with real-life caregiving moments. The kind of moments that make you question your sanity, your judgment and your ability to continue the caregiving role. But Lisa was devoted. She was committed to caring for her Gram, as long as needed.

Then suddenly, not long before Christmas, Lisa’s Gram died. I was really worried about my new friend: how would she cope with such a monumental loss? Would it be devastating to Lisa and her family?

When I checked back in with Lisa recently, I wasn’t really surprised at her perspective. For Lisa, losing her Gram was not the end of something, but rather the beginning.

But I’ll let Lisa tell her own story, in her own words (warning: Lisa is colorful, as my own gram used to say!)…

Life on Hiatus

I feel like this is just a quick break from the Universe before I’m assigned another “task” -- this sudden onset of FREE time. Even the week Gram was dying in our home, we had hospice and relatives weaving in and out at all hours, and many would ask if they could be next in line. The atmosphere was (for lack of a better word) jovial, all considered. I hadn’t slept in a dozen days, and so I’d chuckle and then nod at each and every request. But that jovial vibe they were all experiencing was really more “Gram” than me. That’s what everyone was so drawn to. Even in her most labor-intensive hours of death, her lighthearted spirit permeated every room in our home.

When you incidentally become a caregiver, you discover a whole bunch of crazy shit. One thing that really blew me away was that not everybody can do it. Some of my biggest mentors and most cherished family members are not cut out for caregiving. So I’d use and abuse them for other tasks when they’d volunteer to help, like grocery shopping, detailing my car or helping me tile a floor. (I know -- I seriously abused them.) It’s funny, though -- they were grateful for it. They were glad to help in a way they felt comfortable doing. And I am no good at grocery shopping, so we all have our talents.

Gram died on December 16, 2010. And January was just plain weird. I cried in my car. I cried while reading my kid The Cat in the Hat. I cried during disco bowling (and not because I didn’t break a hundred). I cried when I watched The Dr. Oz Show. Gram and my daughter, Jazz and I used to watch it every day after Jazz came home from school. One of my last memories was an episode he did on breast care. Gram literally broke out her boobs and gave herself an exam right along with the TV, and Jazz and I were laughing so hard we couldn’t get the words out to stop her. I cried so much, I had begun feeling like a real fool crying over a nearly ninety-year-old woman.

One night during “the reading hour” tears were streaming down my face, into my ears, off my chin, etc.. and Jazz said, “Mommy, are you sad over G.G. again?” I nodded, “Yes.” I was missing her Great Grandma. Then she ran to the window and looked up into the night sky and said, “Mom, come look. See that bright star right there? I bet that’s G.G. ‘cause she was loud and she was really bright. You don’t need to cry anymore. If you’re ever sad again, just look up into the sky and you can wave to her.” We both waved away, and I stopped crying. I had to. I got hit with a gigantic dose of wisdom from a five-year-old and crying seemed pointless after that. But my grieving didn’t end there... Oh, no...

I left with Jazz for Los Angeles and Las Vegas the end of January. We had friends and family who invited us out for an extended stay. We readily accepted and ran to the airport like we were being chased by a pack of rabid wolves. And then we extended our Out West Adventure from three to ten weeks. Talk about weird ... my husband started to wonder if we were coming back! I worked like a madwoman on writing and other endeavors, like my documentary, 50 DAYS with Alzheimer’s. Jazz played with her triplet cousins and lived part-time with the grandparents in Vegas, too. She learned how to be a happy, carefree kid. And I learned how to be a real, live mom -- you know, one with rules and consequences and an inexhaustible amount of time for their kid(s). This stuff didn’t exist in our former “caregiving” lives.

June 1st was Jazzy’s sixth birthday. Pete and I invited fifteen kids over for water sports in the backyard. Okay, I invited the fifteen kids; Pete was my unwitting hostage. Thank God he’s a special education teacher! That never could have happened last year. Pete and I also went for a three hour walk along Lake Superior one day (which ended with a couple of beers at a local nano brewery, Black Rocks). It was a fresh adventure for the two of us as a married couple.

The truth is, the last six months have been an experiment in “making it” without Gram. And life is more relaxed. It’s calm. It’s easy. But, it’s not the same. There is an emptiness that stalks me. It doesn’t happen all the time. This wave of longing doesn’t frequent me like anxiety used to when I was knee-deep in caregiving, that’s for sure, but it lurks and strikes randomly. I miss the hell out of her. We all do. The house misses her. And it’s going to take a lot longer to get over than I imagined back when I was busy whining about my lack of FREE time while she was busy losing her memories and her mind.

So, now that I am six months out of caregiving, people have asked me, “Would you do it again?” Yes, yes I would. I’d do it without thinking or blinking, just like I have done for the last eight years. And I answered “yes” to this question during the most emotionally and physically draining days of my six year adventure with Gram, the amazing Miss Nora Jo. I answered “yes” while bathing her in bed and while she was screaming from being moved because her pain was so intense (but I had to change her, nonetheless). And I answered “yes” after spending several nights curled up on the tile floor bedside her because I was afraid it would be our last night together. Yes, I’d take care of another loved one because I believe caregiving chooses us. So, if I am chosen again, I am ready. In my mind, this is just a hiatus.

And, “yes,” I’d even do it for my mother-in-law, but, you know, she’d have to say, “Pretty please with sugar and a six-pack on top?”

Lisa Cerasoli
Author of, As Nora Jo Fades Away
Host of It’s HIP to Care @ Caregiver Village

VOICES of the VILLAGE: Meet Sharon Brothers

2011-06-03T12:28:00.000-07:00

By Cara Moore, Caregiver Village investigative reporter

I’m so pleased to be able to introduce you to Sharon Brothers in this “Voices of the Village” segment. Interviewing Sharon was a bit like interviewing myself as we have so much in common!

Sharon is a passionate advocate for family caregivers, so I asked her, “How did you become so involved in family caregiver issues?”

“It all started with a phone call,” says Sharon. “I know a lot of other family caregivers can relate. One minute your life is filled to the max with kids, work, friends, and just the ordinary stuff of living. The next minute – out of the blue – the phone rings.”

I’ll let Sharon take her story from here.

I was sitting in front of the neighborhood ballet studio waiting for my daughter’s class to finish. I had rushed out of the house to get there in time…I have a bit of a reputation for being the mom who keeps her daughters waiting for their ride…so this time I was going to be on time!

As usual, I was half-way through a number of projects at home – dinner on the stove, mail all over the counter, clothes fresh from the dryer - and just left everything where it was. I was only going to be gone a minute.

And then my cell phone rang. It was my mother’s cell phone number, so I answered it, expecting some news about my sister, an update from her doctor’s visit or just a general, chatty ‘hello.’

But it was not my mother’s voice. It was a stranger’s voice, who started out by identifying himself as a paramedic. He said, "I’m taking your mother to the trauma center."

"What happened? Where’s my dad?" I asked.

"Your dad was taken to the rural hospital close to the accident site," he replied. "I can’t tell you anything else but you can call the hospital directly."

I’ll bet you know that feeling of having your world shift significantly in an instant. Somehow I sensed that my own world would never be the same after that moment, but I didn’t know exactly how. My routine, my chores, my daily order of life was off-kilter. I didn’t know what to do or how to do this, so I did what I knew: I started driving.

The trauma center in my city was about 40 minutes away. During that drive, my cell phone rang twice with calls from the hospital social worker, urging me to hurry; suggesting that I not come alone. She would give me no additional details; the implications were clear: it would not be good news.

As I parked in front of the hospital I had the sensation that this was as far as I could go on auto-pilot. From here, I’d need information or help to navigate the next steps. I felt shaken to my bones, as much with the unknown as from the fear of what was to come. I sat, frozen in my car, while my young daughter asked, “What can I do, mom?” I could only look at her with a frozen look, knowing that I was failing at that very moment in my job as a mom: to shield her from the worst life had to offer. I knew that we would soon see the worst, up close and very, very personal.

Minutes passed. I decided that, rather than face what I believed I’d find inside the hospital, I should find out about my dad. He must have been only slightly injured to have been taken to a small rural hospital.

Three disconnected, badly transferred calls later, I was speaking with a physician. He began, “We did everything we could for him….” and ended with “we couldn’t save him.” I never really heard the words that came between.

My protective mom instinct left in that moment and I wailed long and loud. I had convinced myself that this would be the good news – what could possibly be worse? My daughter grabbed my cell phone out of my hands, dialed my husband, and said into the phone in a shaken, anguished voice, “Dad, you’ve got to come NOW. Mom needs you NOW.”

I sat, frozen in the car until my husband arrived. We entered the hospital together, and began a journey that continued late into the night, and for several years to come. I became, in that instant, a family caregiver.

I don’t know about you, but I get chills listening to Sharon’s story. It seems to me she captures the essence of what it means to have your life turned upside down by an event that turns you from parent, boss, employee and friend into a new life definition of being a caregiver.

I asked Sharon for a quick update on what has happened since that night.

“A lot has happened. I learned that no matter how long I’d been involved on the professional side of caregiving, when my own family was involved the needs I faced were exactly the same as every other family caregiver. I learned to navigate my way through acute care, long-term care and rehab. Sometimes, I learned to just be quiet and be patient – not in my nature!

“Sometimes, I learned to strongly advocate for my mother, who survived and, within a year was able to walk and live independently – against all predictions of everyone who cared for her in those early days following the accident.

“And one week ago, my mother, five years after the accident that took the life of my dad, married a man with whom she’s passionately in love. The only negative part of this story is that they are so in love that it feels like being around teenagers – and it’s my MOM!”

Now I know where Sharon gets the passion and the intensity she brings to the Caregiver Village development team. She’s walked in the shoes of the family caregiver – and she’s helping build a place where we can connect, learn, share and grow as we face similar challenges together.

Sharon Brothers is the Vice President and Content Specialist for Caregiver Village. She has a Master’s degree in Social Work from the University of British Columbia and has dedicated her career to helping create programs and services that meet the needs of the aging and those that care for them. Find Sharon in Caregiver Village on the web or on the Caregiver Village Facebook page.

VOICES from the VILLAGE: Jennie Shortridge

2011-05-25T14:52:00.000-07:00

Jennie Shortridge

You may have heard the advice new writers are given by the pros: “Write what you know.”

My new friend, Jennie Shortridge, the author of the book Eating Heaven, does exactly that.

I had never met Jennie or even heard about her until my own book club (the one you’ll get to eavesdrop on during the Village Chronicles game) picked Eating Heaven to read, based on recommendations and reviews from other book clubs. Once I read the book (READ it – you’ll LOVE it!), I knew I needed to meet the author.

Jennie is an amazingly accessible person. I sent her an email and arranged to meet her in her home town, Seattle, during a quick trip I was making to the West Coast to visit my brother. What a pleasure! Jennie’s a down-to-earth, warm person who clearly wrote what she knew in this book. Jennie knows caregiving.

“When my stepmother was diagnosed with pancreatic cancer, like Ellie, the only thing I really knew how to do for her was cook all her favorite foods… one last time. It was an amazing experience to share her last months with her, and through her grace I learned a lot about both living and dying,” Jennie told me.

The book isn’t just about caregiving, though. It starts on a theme that seems, to Jennie, to be universal to all women.

“As women, we learn that we’re supposed to look a certain way. We get it from the magazines, and from all the media. But all of us love to eat, love to cook, and love to nourish, and those things can be in opposition to each other. In Eating Heaven, I wanted to write a book on how this tears us up inside sometimes.”

The themes of eating, nourishing through food, and body image do, indeed, form much of the book’s broader story. At the heart of the book, though – and at the heart of Jennie’s personal experience, is the theme of caregiving.

“The book came from a deeper place, even, than the experiences I had with my step mom. I had lost other people in my life. As a middle child, it’s in my nature to care for other people. It was important to understand how to do this in a way that makes sense, without it being judgmental, overbearing or other things that aren’t really very helpful – or becoming paralyzed by fear of death. Fear of our own mortality can be paralyzing – it’s frightening.”

Jennie – and Eleanor – find that caregiving turns from being the hardest work ever to the most rewarding work ever.

“Looking at caregiving from my own experience, you start out feeling obligated – you’re the one person who should or could. You dive in: you’re going to be the best caregiver ever. Then you get burned out and it feels like just plain hard work. Then you start to realize that all the effort you’re putting into the caregiving work is resulting in a relationship that changes – blossoms, perhaps - in a new way. You may feel a gratitude for small things, and you realize that what you’ve done really does make a difference. Pretty soon, little tiny moments of recognition that your effort is worth it start appearing. Even better, you feel your heart has grown, and you’re a more rounded, loving, open person as the result. Your life is fuller for the experience.”

In Eating Heaven, Eleanor, much like many family members, is an “accidental caregiver.” It isn’t until Uncle Benny comes home from the hospital and the hospice worker asks Eleanor where she is going to sleep that she realizes she’s now his primary caregiver.

“Caregiving is the ultimate act of giving up yourself in service to someone. I do think that a big part of our life is to be in service to others, but caregiving takes this to a whole new level. Your entire life has to shift. That’s a huge change. We may resist it at first, as Eleanor does, and we may need to take breaks and do what we need to do for ourselves. We DO need to get help, often.

“The hospice worker in Eating Heaven is very much modeled after the hospice worker my step-mom had. She was funny and no-nonsense, and helped us understand what the ‘new normal’ was in our lives. Getting help is imperative. Sometimes you even need someone else to help you figure out how to cope with your own feelings and experiences.”

Jennie is a fan, as well, of finding communities to help you with caregiving emotions and tasks.

“Anytime you can embrace and engage a community around anything in your life, it makes the experience easier. It gives you a place for communication, idea sharing, resources sharing and emotional bonding. Finding someone to cry and laugh with; someone who understands things no one else can understand – that is very much a part of letting yourself or your loved one become a part of a community, whether a facility community or a support community.

Through it all, Jennie has learned that caregiving is a time of practical adjustment.

“Caregiving is like so many other times in our life: having a baby, getting a divorce. These are adjustment times, when things will never again be the way they were before. There’s a new normal now, and it’s just what we do now.”

What I love most about Jennie, though, is her perspective on being with a loved one who is dying.

“Being with someone who is actually dying and who passes can be joyous in an amazing way. Just like Eleanor realizes in the book, that experience is the termination of a life, but it’s also the completion of a cycle. The person has allowed you – wanted you – to be with them, and you’re somehow part of this incredible experience. Yes, there’s pain and loss, but there’s also a sort of release and bliss that’s hard to explain until you’ve been a part of it.

“There’s a certain peace. You’ve been through the hard parts and the sadness. You’ve worked through much of this, and now that they’re gone, you’ve dealt with much of this loss and can now feel peace.”

Eating Heaven is an incredible book, but the real story, for me, is the person behind the book, Jennie Shortridge. She’s one of the pure, strong voices from Caregiver Village.

Press Release: New Website Coming to Support the Family Caregiver

2010-11-02T14:33:00.001-07:00

Caregiver Village
An Entirely New Type of Gathering

For Immediate Release

New Website Coming to Support the Family Caregiver

New York City, NY (November 2, 2010) - This November marks the thirteenth annual celebration of National Family Caregivers month. The celebrations of these cornerstones of care began under President Clinton in attempt to recognize the millions of people providing unpaid care to their family members.

According to the National Alliance for Caregiving there are currently more than 50 million family caregivers. The typical family caregiver provides as much as 20 hours of care every week, many in addition to their careers and other family responsibilities. The need for family caregivers has increased rapidly over the past decade due to an overall increase in the average lifespan as well as the aging baby boomer generation. As a result, more and more families have a family member requiring either long or short term care.

The family caregiver is an essential piece of our society’s care for the sick, wounded and elderly; however, this additional task often adds financial and emotional stress on caregivers and their families. According to the Rosalynn Carter Institute for Caregiving the annual value of unpaid caregiving in the US is more than $375 billion. This value is higher than the funding set aside for Medicare ($342 billion), Medicaid spending on long term care ($300 billion), nursing home and home health care ($206.6 billion), and paid homecare services ($76.8 billion). Recognizing the worth of care that family members provide helps provide a frame of reference, as well, for the impact on the U.S. economy if family members can no longer continue to provide care.

Although many web-based sites exist to provide family caregivers with information and resources, caregivers continue to express a need for help and support, especially in relation to the physical and emotional stress of the work. In response to this need, a team originating in New York City is creating the Caregiver Village, expected to launch in early 2011.

“Caregiver Village is a unique place on the web, unlike anything currently available for family caregivers,” says Sharon K. Brothers, MSW, Vice President of the company. “Caregivers have told us repeatedly that they’re stressed and frequently exhausted from their caregiving work – on top of their jobs and family responsibilities. Even though they recognize the value of caregiver classes and books, the last thing they want is help that feels like more work.”

Brothers says that caregivers need relaxation and an opportunity to re-energize while gaining encouragement and support from others.

“Caregiver Village will offer an opportunity for people to connect and communicate – something caregivers clearly need today,” says Brothers. “Our experience leading family support groups and working with family caregivers over the years has demonstrated to us the value of peer support – along with the challenges of making that happen in a caregiver’s already over-filled schedule. Offering this support virtually, through the internet, opens accessibility to many, many more individuals.”

Caregiver Village is offering family caregivers and caregiving professionals the opportunity to become pre-launch Ambassadors. For details, see www.caregivervillage.com.

###

Caregiver Village is set to launch publicly in early 2011. During the pre-launch period, caregivers, authors of books written for caregivers and professionals who work with caregivers are invited to join the development team in creating this virtual community. Interested individuals are urged to join by emailing join@caregivervillage.com and become a part of this important experience.

Redefining retirement

2010-08-26T13:08:00.000-07:00

One of the pleasures of parenting is meeting other parents who have kids your age. You sit together at the sidelines of football, softball or soccer fields, cheering on your kid and theirs alike. During halftime you chat about how busy the kids are, the demands of practice, school and family, and how crazy your lives as parents have become.

When the kids leave home, those casual, informal parent-gatherings are gone – and they leave a void.

So what a treat to get an email out of the blue a couple of weeks ago from good friend of our college grad daughter, inviting us to a lunch with his parents.

We instantly connected with that bond you get with people who are going through the same transitions and changes as you are. Then we started talking about our own lives, now that the kids are grown and gone.

“You just have to redefine yourself,” said Ellen. “You’re no longer first the parent – or even the professional if you’re retired like we are.”

“How can you retire?” I blurted. “What on earth do you do? You can’t possibly travel, ski and shop all the time. We’ve got a ton of years ahead of us - healthy, productive years. What will you do?”

“You redefine yourself – and you redefine retirement,” she replied.

She reached into her pocketbook and pulled out a small book.

“Here’s one thing we’ve been doing,” she said.

The book was a beautifully written and illustrated guide to learning to ski, complete with photos of body alignment and ski positioning. Clearly, it had taken a lot of time and effort to create.

“We’re skiers,” she said, “and we thought, ‘Why not put our knowledge to use teaching other people how to ski the easiest way we can?’ So far, the book has been very positively received by ski experts all over.”

She turned the book over and showed me quotes of endorsement written by skiers whose names even I recognized.

We went on to talk about some of the other projects burning inside us, just waiting for the time to get out and get expressed – projects we didn’t have time to tackle when working and parenting on a busy, full-time schedule. As we talked, I could see that retirement – redefined – could be every bit as busy and productive as our working, parenting years have been.

I must admit, I’m thinking about the whole concept of retirement in a new way these days. I’m looking ahead to a day when I can devote the skills that I’ve honed, polished and refined over the years to making the world a better place for the coming generations – and have fun doing it.

I’ll write a book, or maybe paint a picture.

I’ll happily care for my god-children (someday, hopefully, my grandkids, too) and give the young parents in our lives a much-needed break.

No doubt I’ll be busy. With grace and luck, I’ll be productive and engaged in life – right to the very end.

Personal Care Aides working at povery levels in many states

2010-08-06T16:31:00.000-07:00

Imagine working hard every day, caring for people who depend on you to help them with the most basic physical and emotional tasks. Your daily work involves helping your clients slowly, patiently move from their bed to a chair. You bend and lift, do laundry and vacuum floors every day. Some of your clients refuse to let you help them, or yell at you when you come to work.

When you go home at the end of the day, your back is sore and your feet are just a little bit swollen. You want nothing more than to put your feet up and rest a bit.

But you can't.

You have to go to a second job, or care for your neighbor's kids, or figure out how to pay the utilities before your power is turned off. You've got to put food on the table and try to figure out how to serve your family satisfying, nutritious meals spending any money.

Your kids are always fussing at you, asking when they can get a new cell phone, a bike, or even a skateboard like all their friends have. You know you can barely afford to go back-to-school shopping for them, so you just sigh exhaustedly and say - again - "Not this month."

Welcome to the life of the caregiver today. In the majority of this country, according to a recent study by PHI, this typical Personal Care Aide earns near poverty level wages - which means less than $10.42 per hour. This caregiver, who works one of the hardest physical jobs and experiences one of the highest risks for on-the-job injury of any worker, not only lives paycheck to paycheck, she also is likely receiving some form of public assistance just to get by.

It's about time we focus on the way caregivers are treated in this country - not only by carefully examining their training and certification prior to working with vulnerable elders, but also in how we compensate them. It's no wonder that even those most dedicated find they cannot afford to stay in this line of work if they face wages that don't increase year after year, keeping them mired in poverty.

As we baby boomers age, we'll need lots of these caring, compassionate Personal Care Aides, fully trained and prepared to help us live at home, or in care communities of our choosing. We'll want the good ones to stay, and we'll want them to look forward to coming to care for us and our loved ones, without the looming worry about their economic survival.

As we're beginning to address the vast health care needs in this country, it's the perfect time to get educated about this problem - and begin taking concrete steps to fix it.

Selecting a Care Center

2010-08-04T13:08:00.000-07:00

Loved this recent New York Times article on selecting a care community, "One Way to Judge a Nursing Home."

In the article, the author talks about trying to select a nursing home for his mother over 10 years ago. He would ask the person touring him if he could talk to the nurses aides. All but one said "no" - indicating that their aides hadn't been with them very long. In the one building that said "yes," he discovered that the nurses aides had all been there for years. They loved their jobs and felt rewarded and appreciated by the organization. It was an excellent choice for this author - and great advice to others looking for a place for their loved one.

If you're faced with this challenge, don't look on the outside (beautiful place, doesn't smell) - look at the people. They're the ones who will be providing the care to your loved one. They will either become significant people in your loved one's life, caring, supporting, observing and loving them, or they'll be here today; gone tomorrow.

People who become caregivers generally have a deep compassion for the people in their care. When they leave - which most will, in today's revolving door of caregiving - they are not leaving their clients. They're leaving organizations that don't provide the training they need to continue to build caregiving skills. They're leaving supervisiors who are just interested in filling shifts and covering their tasks.

They are leaving, most often, employers who don't recognize, acknowledge and appreciate the physical hard work of a caregiver, not to mention the emotional burnout it's easy to feel when you spend your day caring for people who need you desperately.

Halting turnover is one of the most important things we can do to improve the overall quality of care we give elders in this country. It's not rocket science, either. Just good, old-fashioned attention to meeting the needs of the people doing this most vital work. Training them (a lot), supporting them (emotionally, verbally and financially); appreciating them for the work they do - every single day.

Rose Villa getting Culture Change Right

2010-07-06T12:51:00.000-07:00

Imagine my surprise when I went to meet a colleague for a tour, and walked into a room full of people. My first thought was, “Oops – wrong room!” But my colleague quickly grabbed me and showed me to a seat. Someone else placed three cups full of mystery fluids in front of me. The meeting was clearly well underway, with lots of spirited interaction. It took a good 5 minutes for a lull to occur long enough for my colleague to introduce me to the group and clue me in on what I was observing.

I had wandered into an active “Culture Change” meeting with the full team at Rose Villa, one of the first Continuing Care Retirement Communities in the Portland, Oregon area. Serena Lewis (below left), a Therapeutic Recreation Specialist was creating fruit smoothies while Erin Cornell (below right) from Human Resources was demonstrating how easy it is to make tasty juice from raw veggies. The topic of the day was food, and the group not only tasted the smoothies and juices, but also discussed ways to improve the appeal of pureed foods, ways to implement a realistic finger-food diet, and the use of “Dining Scarves” in place of the old-fashioned bibs to protect clothing during meals. Everyone in the room contributed; everyone was respectfully listened to and supported.

It was clear that this is a group that takes Culture Change seriously. They don’t just talk about it; they actively pursue it in their work with residents. They set aside time to meet, try new things, discuss problems and come up with solutions.

With so many nursing facilities still operating the same old way, it was tremendously refreshing to see that the team at Rose Villa is not just talking about culture change – they’re living it. Kudos to the entire team:

Vassar Byrd, CEO
Ellen Burns, RN, DNS
Lynn Cikara, OT
Jill Getty, PT
Janes Pagtama, CNA
Kay Girsberger, Director of Health Services
Rachel Rushing, MSW
Serena Lewis, TRS
Erin Cornell, HR
Marianna Iverson, CNA, Rehab.
Christi Morris, Housekeeping Supervisor
Brian Quinn, Director of Dining Services

Comments

2010-07-06T12:37:00.001-07:00

Thanks, Vickie Young, for sharing your comments about my last article:

Working as a in home care giver I see first hand what you are talking about. My relief came to work this morning saddened , unable to afford the cost of a car she relies on a friend for a ride to work. Because of car trouble difficult public trans and time she had to call a taxi can you imagine what that set her back. But she soon brightened up when she told me she only had 2 lessons left to finish your on line caregiver training class.Our employer has offered your class to all and is having a graduation steak BBQ for all that finish. I think this is awesome. Our clients are very lucky all of our caregivers are getting this extra training .It works great because they can do it when the time is right for them in between work family and car trouble . Thanks for making better trained caregivers your mission Vickie Young

Where do you turn when you’re all burned out?

2010-06-22T14:50:00.000-07:00

Google the term “Caregiver Burnout” and you’ll find over one million results. From articles to opinions to videos, advice on preventing burnout is all over the web.

Clearly, this is a problem. Spotting the problem is generally easy; coming up with a solution is where the going gets tough.

Do you call in help from the family?

Many family caregivers tell me that first, they assumed their siblings would see how hard they worked and offer to help. Later, they began demanding help. Finally, they had to accept that many family members simply couldn’t help. It usually boils down to the primary caregiver…burning out.

Do you turn to facility placement?

I’m an advocate for finding care communities that meet the needs of our aging loved ones. Both my mother and my father-in-law live in retirement communities. Both will tell you that the quality of their lives has increased significantly from what it would have been living alone in their former homes. Assisted living communities and memory care communities offer much in the way of person-centered, homelike care today.

But they can present both emotional and financial barriers to many family caregivers, especially those caring for spouses.

Do you get help to come into your home?

This too is a solution that literally saves the lives of family caregivers, in many situations. But cost is significant, and can quickly amount to more than moving into an assisted living residence if round-the-clock care is needed.

And then there’s the question that burns in our minds: who is providing the care?

Today in this country that’s a very serious question. Most caregivers, both in home-care and in facility care settings are entry level workers. They’ve got entry level training – if any – and they’re paid entry level wages. Many cannot afford their own health care, let alone child care, education and transportation.

This creates a caregiver group that struggles with their own burnout issues. They struggle to stay in jobs that may be emotionally gratifying, while financially marginal. They leave for jobs paying just a quarter an hour more – or just a couple bus stops closer to home.

That leaves families and the person receiving care in a position of turnover. New caregivers means new people to train. It means losing the knowledge that the old caregiver had of your loved one’s condition and needs. It means starting over to build a significant relationship with someone who is often performing intimate tasks for the client.

We have an opportunity today to shape the way we enter into the next generation of caregiving. Since so many of us – this massive, aging baby boomer generation – will one day need caregiving services ourselves, this is a task we’d better take on soon.

We cannot afford to avoid any opportunity to employ technology in our effort. We need to support online caregiver training (my own personal focus), online scheduling systems and care tracking/management programs. We need to refine currently available programs to let us communicate socially as well as health care data quickly, electronically – even automatically, in some cases.

We need to achieve economies in some areas so we can invest in other areas, like boosting the pay, training and professional regard of the paid caregiver.

It’s not to early to start – today!

Alzheimer's Disease Epidemic

2010-06-07T15:50:00.000-07:00

As the baby boomers begin to reach old age, we're likely to see an explosion in the number of individuals affected with Alzheimer's disease. What can we do about it? Even Newt Gingrich got into the act this past weekend. Read the full article - this challenge will take all of us, both sides of the aisle!

Caregiver Training – access and quality make all the difference

2010-06-02T13:12:00.000-07:00

At the first of this year we launched our newest online caregiver training course: the Personal Care Aide Certification course offered through our licensed career school, the Institute for Professional Care Education (www.IPCed.com).

This course is being used by individuals seeking to become familiar with caregiving so they can open their own home care agency. It’s being used by families so that a granddaughter can be prepared to help care for grandpa.

It’s being used by students in career schools who are studying to become nursing assistants and home health aides.

The good news is that it is being used to increase the number of trained, skilled caregivers throughout the country.

The even better news is that the students love the learning process. Just listen:

“This entire course showed me step by step how to be a good caregiver! It also provided the does and don’ts on different situations that you may experience out in the field! I give this program an A+!”

“Online learning was excellent!”

“The audio option made the online experience more personal and rewarding.”

“I have taken many online courses and this one was right up there with some of the better ones I’ve taken.”

“Every caregiver should have access to this kind of website at all times.”

It’s gratifying to hear that the students find this course valuable and interesting. I might be a little bit biased, but I certainly agree with the last student comment: every caregiver should have access to information that can help them provide the very best care possible to every person in their care.

It’s what I would want for my mother’s caregiver – and definitely what I’d want for my own caregiver!

Making a Difference every single day

2010-05-28T16:09:00.000-07:00

Listen for just a minute to this music video recorded by senior care professionals and posted on the Assisted Living Federation of America's youtube channel. It'll remind you that all of us who are caregivers make a difference - every single day.

ALFA Music Video

Culture Change in Care Today

2010-04-12T12:39:00.000-07:00

Have you ever heard of the Pioneer Network? It’s a website and a movement devoted to changing the culture in nursing homes today.

I’d heard about this movement, and certainly heard the words “culture change” associated with nursing homes for the past two decades. I thought that real culture change was happening everywhere, in every nursing home in the U.S.

And then I was faced with a personal crisis. My mother needed nursing home care following a severe car accident.

Three years later, my mother-in-law needed nursing home care following surgery for an intestinal blockage.

Both experiences left me convinced that even though Oregon is one of the leaders in culture change in the U.S., for families like mine, in the nursing homes we carefully selected, it was DOA – dead on arrival.

I was appalled to discover the look, feel and function of the two nursing homes seemed as if they were time warped – no different from my experiences in nursing homes in the mid-1980s, when I first began my career in senior care.

Today, the volunteer advocacy group I participate in talked about culture change. We had a speaker from the local coalition for culture change talk about what they’re doing, and what she sees changing. The bottom line: nowhere near enough.

What will it take to truly effect culture change in today’s nursing homes? What will it take to create an environment where caregivers are empowered to care for people in a warm, genuine way?

I have a feeling it will take a lot more than just talk. It will take more than revising schedules so that medications (or meals) can be delivered when the resident wants them, rather than on a fixed schedule.

Families who have a choice will do exactly what my family did in both situations: as soon as we possibly could, we picked up our loved one and we ran – not walked – to the nearest assisted living community.

In both cases, we ended up with our mothers in an assisted living community that provided gentle, loving, compassionate care, in apartments that felt like apartments not hospital rooms, for less than half the cost. The bottom line in both cases was significantly better care for significantly less money.

Which brings me to my own personal conclusion: families who have a choice in the matter will respond to the lack of change with action. Nursing homes that still feel dark, crowded, cold and clinical will be places where only those who have no choice end up. That will be a sad, sad day, for those individuals who have no ability to choose where they receive care.

Across the country, the number of nursing home beds is declining. The number of assisted living units is increasing. That should give us a clue about what the market wants.

In my own work as the owner of an online training company, we created a new Nursing Assistant training program online that doesn’t just have a lesson in person-centered care, but emphasizes the PERSON behind the care needs in every single lesson. We believe that maybe, just maybe, we can contribute a little to genuine culture change by training people right, from the very start.

Imagine if those people trained the right way from day one stick it out to become the leaders in care. Imagine if companies looked – with their eyes fully open – and saw how the trend to move out of nursing homes into residential models of care will ultimately affect their bottom line.

Imagine if they then decide to do it differently – to give the consumer, and their baby-boomer family, what they want today: a place to receive the care our mothers and fathers need, when they need it, in a compassionate, caring way.

Perhaps then we’ll truly see culture change in nursing home – because we demand it and won’t accept anything less.

Caregivers don’t need to go it alone.

2010-03-12T10:39:00.000-08:00

Some days you know that you should just sit down and shut up, because someone else is able to express exactly what you’re thinking, but in a much clearer way.

That’s how I felt today when I came across Jonathan Rauch’s article, Letting Go of My Father, in April’s online edition of the Atlantic magazine

Rauch shares his belief that family caregiving is much the same today as the experience of women was in the 60s and 70s. Certain expectations were placed on women to stay home and care for house and family, and to be happy doing it. Men – husbands – were free to work, come home and read the paper, waiting for that pre-dinner martini to be delivered with a smile.

The reality was that many women felt isolated in the modern single-family home. Many felt bored while their kids were at school most of the day. Many simply felt trapped.

It wasn’t until some women began daring to say, “We can do more” that other women became empowered to make choices that worked better for them and for their families.

Today, family caregiving is much the same way. Caregivers report a higher rate of depression and stress than non-caregiving adults. They report challenges staying on top of their job requirements, costing employers billions of dollars ($13.4 billion annually, at last count) each year in additional health care costs, not to mention the cost in lost productivity.

And yet we are only just now beginning to share our stories; to bring the tasks of family caregiving out of the dark and into the light of dinner parties and cocktail hours; of support networks and resource communities.

Rausch shares his frustration that the culture of caregiving in this country keeps the individual family caregiver in isolation and in the dark about resources that may be readily available.

He talks about the importance of learning more, as family caregivers, about tools, techniques and resources. In that, I can add my wholehearted support, as I see, every day, family caregivers who report that caregiver training classes [link to IPCed PCA main page] “saved my life” by providing them information they needed to keep doing what they chose to do – be a caregiver.

In the end, Raush says,

“There should be no need for anyone to go through this alone, and no glory in trying.”

To which I simply say, AMEN!

Caregiving concerns are ultimately personal concerns

2010-03-02T14:13:00.001-08:00

Every 8 seconds another baby boomer turns 50 in America.

Having completed that right of passage myself, it’s not all that painful. After all, 50 is the new 30, right? Just look at all the trends we boomers are bringing to this ripe, middle-age time in life – “cougaring” (the older woman/younger man romance); the increase in marijuana usage in older adults (directly attributed to the aging baby boomer/stoner phenomena), the growth of new businesses started by us “mature” adults, to name just a few examples.

Here’s a more sobering fact: one in three of us “over-50s” will be thrust into caregiving tasks for a parent or spouse, often with no more warning than the ringing of the phone.

We’re pretty well prepared to carry on most of our other aging baby boomer roles, but are we ready for this one?

Do we know what we would want to do, much less what our parents want us to do for them? Will we bring them home to our house if they need care, or will we insist they move to a care facility? Are we prepared to step back into daily communication and decision-making with our siblings, many of whom we no longer share much in common?

Just listen in to the conversations around you next time you’re at a gathering of people in this age group. You’ll hear snippets like these (I’m paraphrasing from a recent gathering I attended):

“My wife’s mom died last summer; we’re still reeling from all of the tasks we need to do for her estate. We never realized what a job this would be. We haven’t been able to travel at all this year.”

“My parents are driving me nuts. I worry about them every day, and they simply refuse to leave their home. Anyone know how on earth I can talk them into moving into an assisted living community?”

“My dad finally agreed to move into a retirement center a couple of months ago. I feel like I have my life back!”

“Margie’s mom is in a hospital bed in our living room. That consumes us physically, emotionally and in every other way. We explored other options, but Margie says, ‘She’s my mom – I need to care for her.’ The whole family, though, is involved; not just Margie. It’s incredibly difficult right now.”

There’s a certain awareness of this impending, life-changing dynamic within many governmental and political circles. Businesses and publications are picking up on the boomer-turning-senior phenomenon.

But, as is typically for us self-focused boomers, we are finding it difficult to prepare on a personal level.

Talking to mom and dad about the future? It’s a tough conversation; I think I’ll wait a bit longer.

Talking to the siblings about planning ahead? We can barely talk about whose turn it is to host Christmas this year, let alone about what we’d do if something happened to mom or dad.

And while we’re delaying these important discussions, the day is looming closer when the phone will ring…and it suddenly becomes personal.

Christmas Treasures

2009-12-21T14:53:00.000-08:00

It's Christmas and we're busy getting ready.

Our tree is decorated and the lights are on. But one of the most important parts of Christmas will be missing this year: family. Oh, most of our family will show up like always - full of laughter, hugs and warmth.

But this year we'll be missing my dad (his third year missing) as well as my husband's mom who died this past summer.

At a holiday party this past weekend I learned of three other friends who lost their moms this past year. We're in the generation that is facing the decline, and ultimate death, of our parents.

The other night I woke up from a sound sleep thinking of something I needed to tell my father right away. It took me a few seconds to come fully awake and realize that I would never again be able to simply pick up the phone and call my dad. His loss, like the loss of my mother-in-law, has left a hole.

Most days that hole is covered and not so raw, but there are moments, like the other morning, when the scab rips off and the pain is fresh and real again.

The new report by AARP finds about 66 million Americans today are helping care for an family member. These individuals – my peers – are facing a holiday filled with stress and worry. It may be hard for them to find the “peace on earth; good will toward men” this Christmas.

The tree may be decorated and the lights strung on the house. But inside, we’ll be facing a new kind of Christmas reality; the reality that life is short and those we have left are much to be treasured.

The true meaning of Christmas

2009-12-08T16:53:00.000-08:00

Lots of families are at a crossroads today.

I just got an email from my niece. She’s a single mom with three young boys; she got laid off from her job last week. She’s struggling to figure out how to make Christmas simply happen for her family this year, let alone make it a merry one.

A colleague is taking a month off, starting next week, to care for a family member at home.

Many people, tired of pounding the pavement looking for elusive jobs, are turning to education to try to get trained in something that offers better job potential – or just helps them keep their dignity until the job market changes.

Whether the issue is work or care – or something else entirely, a juncture into the unknown is where many of us find ourselves.

What do we do now? How do we know the right path to take?

My niece says she’s not eating well and is barely sleeping. The experience of being at a life crossroads is causing her severe stress. She’s probably not alone. Here we are, headed into the merry holiday season, and many, many individuals are sharing my niece’s feelings.

Feelings that life’s sudden uncertainness may bring worse times ahead, not better.

Feelings that you won’t be able to play your role in life – as a mom, a breadwinner, or a caregiver.

Feelings that maybe this Christmas will be a bust rather than the family’s annual highlight.

I don’t have any magical fairy dust to change those feelings of despair to feelings of hope and joy. I wish I could find just the right words to say to my niece, my friends, my colleague.

Sometimes it helps to know that, even at the toughest of life’s crossroads, you are not traveling alone. You’ve got other people cheering you on, offering you love, support and encouragement.

Maybe that’s why so many people of my generation are joining social networking websites like Facebook, reconnecting with friends and family far-removed and nearly forgotten; people who will send you hundreds of birthday wishes or random messages of friendship and support.

Maybe that friendship and support is, after all, the true meaning of Christmas.

A Fair Wage for Caregivers

2009-07-21T11:46:00.000-07:00

The New York Times recently ran an editorial advocating that home care workers be paid in accordance to federal labor laws that cover other employees, including paying at least minimum wage and overtime.

Currently in several states home care workers can be covered under a “companion” exemption and paid less than minimum wage, with no overtime requirements.

One the one hand, I completely support this change. I believe that ALL caregivers should be paid a fair wage. Far too many caregivers, in a variety of care settings, are paid so poorly that they are eligible for food stamps, Medicaid and other benefits that we all end of paying for. In addition, poor pay is a leading cause of turnover and the inability to attract the best and brightest individuals into this field. That hurts all of us.

Let me play devil’s advocate for just a moment, however. Let’s say that my mom needs someone at her home 24 hours a day. She needs assistance to the toilet, and someone available if she should fall during the night hours as well as during the day.

During the daytime while she’s awake, my mom needs a considerable amount of assistance – bathing, dressing, meal preparation and laundry, for example (in this hypothetical situation). At night, she sleeps soundly with rare exceptions, at least 8 hours each night.

With a minimum wage requirement, I’d be forced to pay at least $7.25 per hour for the nighttime person, even if they slept through almost all nights. With the companion provision, I’d might be able to pay a flat rate for nighttime that would allow me to keep my mother at home longer. I’d also be able to have a caregiver, conceivably, work evenings helping my mom get ready for bed, then sleep through the night. The caregiver might be “working” 10 – 12 hours, but actually sleeping 6-7 hours of that time. The change in the law would require overtime pay at a minimum of $10.88 per hour for those extra 2-4 hours each evening.

In the end, the round-the-clock care would cost me at least $175 per day, not including the time I need to cover meals and breaks. That’s over $5,000 per month. According to Genworth Financial, the average monthly rate of assisted living is $3,008 (2008); clearly, that would be the more financially feasible solution.

It’s a challenging dilemma for all of us to consider. I think it’s possible that business interests may well create their own solution. Agencies employing home care workers that treat those workers fairly and pay them well will retain their workers. Their reputation will grow and they’ll experience success.

Conversely, those agencies that choose to cut corners on pay and benefits will see the results in high turnover, resulting in poor services and an even poorer reputation.

Today, home care agencies are expanding at an exponential rate. Communities – and families – typically have more than one choice. If we do our own due diligence as consumers and check out the reputation and turnover rate of an agency before we sign up for services, we may be able to directly affect this process and support those that treat their workers well and fairly.

For those who have no choice – typically those receiving publicly funded services - we may well need to change the law to support those who provide the most basic care for our loved ones in their homes.

Of caregiving and budgets

2009-06-30T15:31:00.000-07:00

It’s a very sorry state of affairs when California needs to cut essential services to seniors and their families to help balance the budget.

Earlier this month the Los Angeles Times ran a news story about governor Schwarzenegger’s proposal to shut down state supported day health programs, many designed especially for elderly or individuals with Alzheimer’s disease.

Anyone who has cared for an individual with Alzheimer’s knows what a daunting task this is. Not only is there a constant need to anticipate the desires of the person in your care, but there is a constant need for safety supervision.

Usually, quality of life is only a phrase in someone else’s vocabulary – not even a consideration when you’re just trying to get through the day. There are behavioral challenges and wandering issues; nighttime awakenings and daytime confusion. All in all, families who provide this care deserve every bit of support that we, as a society, can give them.

One of the program directors involved estimates that families facing the loss of day programs will have little choice but to seek nursing home care for their loved one, usually at the state’s expense.

What seems like a savings of $385.8 million could, estimates Debra Cherry, end up costing the state many times more if nursing home care is needed for these individuals.

That’s the economic reality. The personal reality is much more heartbreaking and, well, personal.

Join the healthcare debate

2009-06-23T15:04:00.000-07:00

According to the recent New York Times/CBS poll, the majority of Americans wants a government run healthcare system and would be willing to pay extra taxes for it. Of the people participating in the poll, 85% reportedly believe the healthcare system needs to be “fundamentally changed or completely rebuilt.”

Google the words “healthcare poll” and you’ll find articles from the Wall Street Journal to bloggers on the street debating this subject – usually in no gentle terms.

I’ve been reading the letters to the editor in my own local paper, though, and repeatedly I see the support that the New York Times' poll expressed. People are tired – exhausted, actually – with the constant fear of bankruptcy and ruin because of the high cost of health care.

Oh sure, most of us have insurance. But most of us also know friends or family members, if we haven’t experienced it ourselves, who had insurance but who still experienced the nightmare of our healthcare system’s dysfunction.

Like my friend, Melanie, who has been clean of her dual-sited cancer now for more than two years. The medication she takes to keep her that way costs nearly $1,000 per month. That’s the co-pay after her insurance kicks in its share.

Or my oldest daughter who, at age 23 is still on our family health insurance plan. In the current job market, she is unable to find a job that includes health insurance, or pays enough to allow her to purchase her own private coverage. She’s a college grad and a willing worker, but she’s stuck.

One person writing in to our local paper notes, “I’ve been driving on ‘socialized’ streets all my life, and sending my kids to ‘socialized’ schools. It works reasonably well in those areas – what’s so awful about the idea of ‘socialized’ medicine?” Used in this way, the term “socialized” simply means “publicly funded.” Seriously, what IS so wrong about that?

My favorite line from the entire last season of the TV show, Desperate Housewives, occurred when Teri Hatcher’s character, Susan Mayer, was arguing with her old boyfriend who now wanted to marry her to avoid being deported back to Canada. Frustrated with his demands, she resists, saying, “It’s Canada – it’s not Iran. It’s like American, but with free health insurance.”

People from this country often point to Canada as an example of healthcare gone wrong. Maybe it’s different now, but as a graduate student many years ago, living in Canada and paying for student coverage in the national health insurance program, I loved it. Despite a series of minor health problems, one of which required outpatient surgery, worries about cost or access never once took my mind off my studies or my future. I was covered, for whatever I needed. I was free to choose my own provider, and I recall no long waits for appointments, either. What I remember was a series of health care professionals who treated me with respect, educating me about my condition and my needs and inviting me to participate in the decisions about my care.

As the population of the United States ages, we’ll all experience more health care needs. We’ll all pay for it, too, one way or another.

From my daughter, who would likely require publicly supported health care with one major illness or accident, were she not on our policy, to my grandmother, who is on the waiting list for a Medicaid-funded nursing home bed in her small town; we all pay the price of healthcare.

Let’s find a system that, like our schools and roads, offers access to everyone, no matter what their income level. Let’s include long term care in the conversation, as well. Our roads may not be perfect and our schools may have challenges of their own, but in these areas at least we can boast some level of world leadership. In healthcare? Not so much.

Managing the Growth of Home Care Companies

2009-06-18T16:06:00.000-07:00

I’m always interested in listening to what people are saying about care for our nation’s elderly. We know that, if it were left up to most of us, we’d prefer to stay in our own homes right to the end of our lives.

Home care is the fastest growing sector of care in this country today. A couple of days ago I was listening to a recorded interview of a woman by the name of Shelly Sun who, with her husband, founded a home care franchise company. Their company, BrightStar Healthcare, is only a few years old, but already they have over 45 locations. They’re planning to grow to 400 locations by the end of next year. I’m betting they do it.

Their story is featured in Entrepreneur Magazine, July 2008, as a successful start-up story. Like most people who are successful in the field of elder care, they got started because of a personal need. The Suns needed care for his grandmother, according to their story, and when quality care was not readily available, they saw a need.

Filling a personal need is how many of us got started in senior care. It’s where most of us get the passion to continue to explore best practices, no matter what our particular niche might be.

And when it becomes personal – when we need help for ourselves or a member of our own family – we look for others who share the passion. We look for someone who will be dependable and trustworthy, but most of all we look for someone who will know what to do and how – and when – to do it.

Today, home care has a reputation of helping people stay where they want to stay – in their homes. Keeping a positive reputation, however, will mean that home care agencies manage their rapid growth with skill.

They’ll need to find a way to provide compassionate, dependable caregivers to families in need, often on an ever-fluctuating schedule.

They’ll need to ensure that their staff are not only trustworthy but well trained to provide exactly the care their clients need. Working alone in a client’s home presents unique challenges, particularly to new caregivers.

One of the first skills we teach new caregivers, especially those working with people with memory loss, is to get help when they feel overwhelmed. When a client resists bathing or personal care, for example, forcing the person will result in someone getting hurt – usually the caregiver.

In home care, no one is around to hand the ball to when the caregiver has tried everything she knows. No one is there to say, “Give it a rest for a few minutes – why not take a short break?” when the caregiver is clearly frustrated and at her wits’ end.

Will home care agencies end up with the same negative reputation that has plagued nursing homes over the years? Will they become the focus of front page newspaper and TV investigations, with stories and images that cause us all to shudder?

Clearly, it depends on keeping the passion for providing quality care. It depends on focusing on staff training with a laser eye. It depends, in short, on managing the high rate of growth so that ever more people can choose to receive care in their own homes, right to the end.

Caregiver training essential

2009-06-09T12:33:00.000-07:00

Training is essential for good caregiving. Yes, you can love the person in your care. You can be compassionate and caring by nature. You can be dedicated to providing the best care possible.

But you still need training.

Google the term “caregiver training” and you’ll find tons of options. Many community centers, hospitals and senior centers provide free or low-cost training courses. Many community colleges offer training as well.

You can order video tapes or training books. You can even take a full Caregiver Certification course online.

What’s the payoff? If you’re a family caregiver, studies show that you’ll be able to reduce your own caregiving stress and continue to provide care for 1 ½ years longer that you could without training.

If you’re a professional, paid caregiver, you’ll find better jobs and more options with training. You’ll also be able to earn more and feel more confident in your work.

It’s a no-brainer – get the training!

Long term health care personal and political: A book review of “Caring for our Parents” by Howard Gleckman

2009-06-02T14:03:00.000-07:00

Story telling is one of the oldest forms of communicating ideas and information. It’s an approach that Howard Gleckman, journalist and researcher, uses to good effect in his new book, “Caring for our Parents: Inspiring stories of families seeking new solutions to American’s most urgent health crisis” (St. Martin’s Press, 2009).

Like most of our personal experiences, Gleckman’s starts with a phone call. “With just a few words, my family was sent plummeting into a painful, mysterious, and all-consuming world for which we were completely unprepared,” says Gleckman. “It would be, at once, the most difficult and the most rewarding thing I have done in my life.”

Gleckman tells how first his mother-in-law suffered a fatal stroke, revealing his father-in-law’s fragile health condition. Following a stress-filled, long-distance caring experience that lasted three months and spanned several attempts at caregiving solutions, he died. Shortly before he died, however, Gleckman received another phone call, this time from his mother. His father was dying. Gleckman and his wife balanced their own jobs, travel to help family members and all of the emotional drain of losing a loved one – at the same time running into endless challenges finding and paying for the services their loved ones needed.

“Caring for our Parents” is filled with stories similar to these – stories that many of us recognize only too well as we struggle to balance our own roles simultaneously raising our children, holding down a career and supporting our parents.

Running through these stories is a theme of frustration at the disjointed, challenging nature of health and long term care for Americans today. Gleckman points out that not only do most people want to stay home through the end of their lives, most Americans do, in fact, receive care at home by a family member. Not that this is easy, cheap or without personal cost: caregivers have significantly higher rates of illness and accidents than non-caregivers, often dying before the persons in their care.

Support and training for family caregivers helps, of course, but that is frequently difficult to access or to fit into an already over-crowded schedule.

Gleckman proposes a variety of creative solutions to these challenges, including neighborhoods that join together to become NORCs – naturally occurring retirement communities.

As Americans age, however, the cost of long term care will become more and more of a social issue, not just a personal one. In his recent opinion piece in USA Today, Gleckman points out that while 80% of Americans have some form of health care coverage (that’s more than 250 million of us) only 7 million Americans have long term care insurance.

“What will we do when the Baby Boomers start needing this care over the next few decades?” Gleckman asks. “As 77 million Boomers reach old age, today’s challenges will become a full-blown crisis.” (USA Today).

“Caring for our Parents” is a book that accurately and poignantly portrays a real need that is personal and political. Care for our aged parents - and soon, for ourselves - is something we need to take action on now if we are going to have any hope of averting this "full-blown crisis."

The high cost of caregiving

2009-05-19T16:26:00.000-07:00

An article in the Orange County Register last week caught my attention. The headline blared, “Caregiving costs Americans millions.”

This isn’t ground-breaking news; we know that caregiving has a significant cost to businesses, and anyone who has left a job to become a family caregiver knows the high personal cost, too.

The issue today is that more and more of us are facing the need to become caregivers. As we baby boomers begin aging we face the challenge on a scale larger than anything seen in history: a caregiving need that will cost us, personally and socially, millions of dollars.

Of course, the tough economy isn’t helping matters. Where we might have, at one time, simply contributed to the cost of hiring more caregiving help, today we’re giving a job to a nephew (untrained and inexperienced) because he needs the work. We’re taking on the task of caregiving ourselves, after becoming down-sized or RIFed.

According to the story, “43 percent of caregivers have taken a pay cut or have been forced to work fewer hours as a result of the recession.” The story goes on to point out that as we live longer, nearly all of us can expect to spend at least a few years as caregiver to a parent or spouse.

And as we start to face these situations personally, we may, as a society, start to take steps to improve the awareness of the very real cost, both measurable and not.

Boomers and technology

2009-05-13T09:40:00.000-07:00

Baby boomers love their technology. Even seniors today are getting hooked on technology. My 76 year old mom uses email almost every day, and my 90 year old mother-in-law’s best friend (in her late 80s) is so computer connected she won’t move into the retirement community where my in-laws live until they build three bedroom apartments: one for her, one for her spouse and one for her computer equipment.

We’ll need all the technology assist we can get as we boomers head into the coming years. More of us will be living longer, more productive lives, but many of us will need help, too.

We may be the ones to install motion sensors throughout our homes, monitored by a company that tracks our usual level of activity and alerts someone when that usual activity changes.

We might be the ones to use health monitors that send data directly to our health care providers.

We’ll certainly be the ones to turn to the internet with each new ache and pain; each new prescriptions; each new diagnosis. We’ll turn to our friends on Facebook and other social networking sites to discuss how we deal with the problems we’ll all face as we age – relationships, needs, challenges.

Many are beginning to look today to technology to help bridge the gap between needed knowledge and available time. Internet based training courses abound – both free and for a fee. There’s less and less of a shyster reputation attached, too, as prominent universities are offering courses and degrees, fully online.

Teaching through a virtual classroom helps bridge another gap in our society: too few teachers and classrooms for the number of interested learners. Virtual classrooms allow individuals in Fiji to learn alongside those in Calgary, Alberta, who are studying classes offered by a small company situated in Oregon City, Oregon.

It’s a great thing that we boomers are so enamored of our technology. In the coming years, we’re going to need the advantages it offers us to live the kinds of lives we’re determined to live, well into our good old age.

May focus on older Americans

2009-05-06T11:04:00.000-07:00

May is Older Americans Month, declared so by President Obama in recognition of the contributions of older citizens to our country.

“Older Americans have carried our Nation through great challenges and triumphs. They have enriched our national character and strengthened the Republic for those who have followed. During the month of May, we pay tribute to the wisest among us.

“Throughout the land, older Americans are strengthening our communities and the American way of life. Many senior citizens remain in the workforce to support themselves and their families. Others are embarking on second careers and exploring new interests and fields of knowledge. Inspiring citizens of all ages, many serve as advocates and volunteers in community service roles. In this important work, they make a real difference in the daily lives of fellow citizens of all ages, while promoting and strengthening the American spirit of civic participation.” (read more)

In one community, Marietta, Ohio, the local Area Agency on Aging is offering a variety of resource to help caregivers and their employers. Focusing on caregivers and employers makes good sense, since current estimates place the cost to businesses nationally in the billions of dollars.

Many of these costs to businesses related to absenteeism and work interruptions due to emergencies – not a surprise to any family caregiver. Caregiving is emotionally draining and time-consuming during working and non-working hours.

Employers can reduce some of their costs by helping caregiving employees work flexible hours, take leaves when needed, and by supporting caregiver’s education and training. As more and more family members face the need to step into caregiving roles employers will, by necessity, need to become even more creative to help their employees continuing caregiving, and continue working, too.

Older Americans Month gives us a moment to pause and think about the contributions of elders in our society, and commit, as a nation, to supporting those who care for them.

Need for qualified eldercare outpacing trained, available caregivers

2009-04-29T15:16:00.000-07:00

The story, told in the Foster Daily Democrat newspaper (Dover, NH) is one familiar to most family caregivers.

“…Between the constant worry that her mother, Aletha Mitchell, may fall again, and the hours spent bringing her to the doctor, running errands and paying bills, the physical and mental exhaustion of this second full-time job has set in for the 56-year-old Dover reading tutor.”

Family members are assuming more and more of their parent’s caregiving responsibilities. They want to keep their loved one at home, if at all possible. And they need help to make that happen.

“By 2030, one in five Americans will be 65 or older, and by 2050, there will be 88.5 million citizens in that age group, more than doubling the current 65-and-over population. Meanwhile, the number of working-age people between ages 18 and 64 is projected to decline from 63 percent now to 57 percent in 2050, according to the U.S. Census Bureau.”

The challenge is that, as our population ages, we won’t have enough younger, willing people to care for the aged in their homes. We certainly, even today, have a gap in the number of trained, qualified in-home caregivers.

As one of the experts in the article points out, the care that previously required a hospital or nursing home stay is today being provided at home. Individuals are being discharged to home with more complex medical problems, caregiving needs and fragile health states.

As caregivers frequently say, caregiving for these individuals isn’t for sissies. It requires knowledge, skills and training.

“Along with pay, there needs to be more training programs and a broader volunteer base for those caring for loved ones in order to offset the occupation's dwindling ‘population base.’”

Now is the time to begin exploring this problem in depth, and finding solutions for our own loved ones’ care and for the future needs of the aged nationwide.

Certified Personal Care Aides offer advantages to consumer and providers

2009-04-21T16:53:00.000-07:00

It’s not a job requirement. But – wow – are employers jumping on board.

For caregivers working in community based care settings (home care, assisted living or residential care, typically), few pre-employment requirements exist. The federal government has just recently agreed on a job title – Personal Care Aide – for caregivers in these settings. Training? Certification? Not so much.

But for employers hiring caregivers in these settings, pre-employment certification means two things: an individual who has taken the time and initiative to build their skills, and a crucial time-and-money savings in the need for post-employment training.

For the consumer, it’s a win-win, too. Knowing that the person providing care to your loved one is a Certified Personal Care Aide (PCA) can provide greater peace of mind and confidence. Finding an agency that saves money on new hires can possibly result in savings for the consumer, too, or at the very least a stronger, more viable business model for the agency.

We’ve been introducing this idea to employers in our home state of Oregon. So far, employers are very excited about the prospect of hiring pre-certified PCAs. Many of them know the quality of our online training programs through courses they currently use in training their staff. They can see the advantages to them and to their clients very clearly.

Watch closely for further developments on this program as we prepare to launch it first here in Oregon, and later throughout the entire country.

We just may be able to change the face of caregiving in the U.S. today.

Wherever you go, whatever you do, say you’re a Professional

2009-04-15T11:20:00.000-07:00

When I was in school getting a degree in social work people would ask me, “So what exactly does a social worker do?”

My mom thought social workers only worked in public assistance offices. My dad thought maybe social workers just took kids out of bad homes. No one really knew that social workers then – and now – work in hospitals, work as counselors, create and manage programs for special populations, and perform a whole range of tasks, in a wide variety of settings.

Titles mean something, especially job titles. That’s why nurses often say they’re “RNs” instead of just nurses – it reflects the level of training, skill and knowledge that they’ve achieved.

But when your job title isn’t one that people recognize it has less meaning. That’s why, when I was just finishing graduate school, the National Association of Social Workers began a campaign of saying, “Wherever you go, whatever you do, say you’re a social worker.”

They wanted the general public to start getting a better idea of the broad range of jobs that social workers do, and how they contribute to the fabric of our society in many different ways. They also wanted to help people working as social workers gain a more professional status at the same time.

Today, one of the growth fields in an era of massive unemployment is the field of caregiving. Open any newspaper’s want ads or look at any online job board and you’ll see this immediately: caregiving is a field that has openings.

But it’s also a field where workers are frequently undervalued and underpaid. Many caregivers work for minimum wage or just a little above, with no health care benefits, paid vacation or sick leave.

It’s not really surprising that the national turnover rate in caregiver positions approaches 200% today.

In some states caregivers are organizing with the help of labor unions, demanding respect and professional recognition. That’s one approach, but not the only approach.

There’s another way that’s even more effective because it’s even more grass-roots. That’s when every single caregiver says, “I’m a professional caregiver,” and begins to ask for respect and benefits.

PHI advocates for the term Personal Care Aide. This term has been accepted by the federal Office of Management and Budget, too.

Our company is preparing to launch a comprehensive certification course for Personal Care Aides, allowing them to complete 40 hours of foundational training completely online. We’re instructing graduates to identify themselves as Certified Personal Care Aides.

We’re telling them: “Wherever you go, whatever you do, say you’re a Certified PCA.”

Together, we’ll begin to raise the bar for caregiver professionalism.

THAT’S my caregiver?

2009-04-08T12:31:00.000-07:00

I had the pleasure of catching up with one of the first people I ever hired to be a caregiver. She was not only one of my first, she was, hands’ down, one of my best. She ended up working for me until we sold our business 13 years after I hired her.

Today she works as a private caregiver for a gentleman who requires total care. It’s physically and emotionally challenging. While she’s not “old”, she’s no longer a spring chicken, either, and is feeling every one of her years.

In the course of this caregiving, she has supported the family numerous days during brief hospitalizations. She has witnessed the full gamut of caregivers: Some great, some awful.

She has become a passionate spokesperson for improved training, compensation, and treatment of caregivers as a result.

“If we don’t pay attention to how we’re treating caregivers, we’re going to get, as caregivers, those people who can’t get any other job,” she says. “I don’t know about you, but that’s not the person that I want to take care of me when I’m old and frail!”

Vickie’s got a good point. As our generation ages, and we face the need to find caregiving solutions for our mothers and fathers – and someday, ourselves – we need to give some very serious thought to who we want providing that care.

Who do we want to help us bathe?

Who do we want to prepare our meals?

Who do we want in our homes, helping with the most intimate and personal of tasks?

I’m not being critical of any individual or group of people, but I do think this is worthy of our consideration. We, as a society, seem to have little regard for caregivers when our own life or our loved ones’ aren’t impacted. We pay them minimum wage, offer few or no benefits, and generally regard them as lower-tier workers. How are we going to attract anyone other than those individuals who don’t have a passion for the job but can’t work anyplace else?

Without a change in perception by society as a whole, we will miss the opportunity to attract those people who have a caring, compassionate, dedicated heart – but need to pay their rent.

We’ll miss the opportunity to change the face of caregiving, until it’s too late and we’re desperately trying to find someone who will care for us or our loved ones.

It’s time to set the bar a little higher. It’s time to create a professional caregiver – a Personal Care Aide – that is trained, certified, and respected: A person who can earn a living wage, and who can be proud to say, “I’m a professional caregiver.”

Careers in caring: investing in ourselves builds human capital

2009-04-02T09:50:00.000-07:00

The last few months have been all about loss of capital. Nearly 12 years of gains in savings, investments, 401ks, and assets vanished almost overnight for most people.

But what about the toll on the human capital? In my state, the front page of the daily newspaper reports an average loss of 775 jobs each day over the past several months. That level of loss boggles my mind. The human toll is staggering: On individuals, families, and companies.

My entire career has been focused on caring for people. I started in mental health counseling, helping people cope with fractured relationships, emotions, and families. Twice during my career I have worked for crisis lines, once building one from the ground up in a remote rural community.

While I’m in favor of spending money on highways and bridges, I’m even more supportive of investing in human capital. It’s people, after all, that make the difference when you’re sick or emotionally anguished – not the beautiful, new medical center with all the latest diagnostic tools.

It’s people that matter most when your mom is ill; when your dad is injured; when your loved one can no longer take care of basic personal needs without assistance. In healthcare, the people providing the care are the most valuable assets of all.

Many of us, world-wide, are slowing down just a little right now. We’re stopping before we shop, instead of shopping ‘til we drop. We’re waiting to see what will happen, before we rush out to take the trip of a lifetime or make that big purchase.

We’re examining what’s important in life and what new plan we should consider. Many of us are at a career crossroads, where we must choose a new employment direction, like it or not.

I believe it is an ideal time to invest in ourselves. It’s an ideal time to look at our hearts and think about our true values – what really brings us satisfaction and joy.

With a little extra time, we can invest in our own personal growth. Online education makes that easier, more convenient, and more accessible than ever before.

Studying online for a career in caring may be the perfect way for many to reinvest in our personal, human capital. Health and caregiving industries are among the few that are still hiring, and caring for others is a perfect way for us to find value in our lives.

I’m a “glass half full” kind of person. This crisis? It’s really just an opportunity to learn, grow, and build the sort of human capital that will benefit us all.

Jobs that have meaning: Career switching to rewarding work important to today’s worker

2009-03-24T09:46:00.000-07:00

“I’ve spent the last decade doing a job that paid well, but was completely unrewarding to me. Now, I want a different kind of job. I want to feel like my work has meaning.”

A small group of us were out to dinner, and Jennifer was answering my query, “What kind of work do you do?”

Jennifer continued, “I’m at the point in my life where I feel like my days are too valuable to waste doing a job that doesn’t matter to me. I honestly don’t care what I earn; I just want to feel like my life – and my work – makes a difference in the world.”

The Boston Globe ran a story this week about the number of people who are choosing to leave their jobs to become teachers. One man ran an internet start-up, but loved reading at his kid’s school. According to the article, “He loved the feeling he was making a difference” – and he got hooked. Today, he teaches middle school in the suburbs of Washington D.C.

My friend Jennifer is contemplating entering the career of nursing. She wants to work with children; possibly infants and newborn.

As economic turmoil reshapes our world, many people find themselves at a career crossroads. Some view this as an opportunity to switch to a career that offers more personal satisfaction, even if the paycheck is lighter. In industries such as education and health care, pathways are opening up to help people get there quickly.

For people who wish to convert their skills to teaching, the New Teacher Project helps people quickly switch careers. The program has seen an increase in 44% from the previous year.

In healthcare, more and more opportunities to gain at least entry level skills through distance education are emerging. These programs allow individuals who don’t have the time or money for a full-time traditional education to gain the knowledge and skills – and often, important certification – needed to enter these high-demand careers.

For the career-switchers mentioned in the Boston Globe story, the personal pay-off has been huge and long-lasting. Getting a paycheck while doing a job that offers personal satisfaction is worth it, they all agree. For anyone contemplating the change to a more satisfying career, new online training and resources can make the change easier and more accessible.

The journey that ends in a fulfilling career in health or senior care

2009-03-17T15:01:00.000-07:00

Have you ever asked someone “How did you get started in THAT job?”

Many of us have following long, winding career paths, ending up at a place we didn’t even know existed.

Many of us are still looking for that place – the place where our talents and skills are used every single day in our work; where we go home each day feeling like what we did today mattered; where we earn a decent, respectable income, doing work that we love.

The journey to that magical place is often one filled with twists and turns. We may not know exactly where we’re going but we have the sense that we’ll know it when we arrive.

Often the starting point is something as simple as taking a course in a subject that sounds like it might be interesting. That course might lead to a specialty certification, which might lead to a job that – voila’ – becomes that perfect fit.

Many of these jobs aren’t licensed. Some don’t require any specific training at all. These jobs are the ones that are open to everyone; getting started in them is often mostly a matter of knowing the right person.

Until now. With the specialized training programs available you can jump to the head of the line. You can demonstrate that you’re motivated, willing to learn – and able to learn in a self-directed way, using today’s technology – and you’ll have a Certificate to prove it.

We talked to many, many employers about these training programs. We know that they aren’t required to hire someone with this training – but every single one we talked to said, “YES – we’ll give someone hiring preference with this kind of evidence of training!”

Life is a journey. Finding the work you love is the place where the journey ends and the career begins. We’re here to help.

Need for national caregiver training standards crucial for quality care for our nation's elderly

2009-03-10T17:17:00.000-07:00

PHInational recently announced that their efforts to begin defining the terms for direct care workers have begun to have effect. The Office of Management and Budget (OMB)has accepted the term “Personal Care Aide” as the consistent term it will use to define work provided by caregivers in a variety of settings, including home and community based care. (Full story)

Having a standard language – or at least job title– is a good starting place. We can begin to talk about the role of direct care workers, caregiver, attendants and others in the same way we talk about CNAs and home health aides – in words we all understand.

The next step – an important step – is to begin defining what this term means.

What prepares someone to become a Personal Care Aide? What training, at a minimum is required?

The Caregiving Project for Older Americans, a collaboration of the International Longevity Center-USA and the Schmieding Center for Senior Health and Education co-produced a white paper last year titled “The Need for National Training Standards/Guidelines for Privately Paid Geriatric Home Caregivers.”

The paper starts out with these two stories:

Margaret, a 78-year-old widow who lives alone, is normally up and ready for breakfast by 7 A.M. Today, however, she was still asleep when the in-home private duty caregiver arrived at the house. When the caregiver checked on her, Margaret said she wanted to sleep. The caregiver, who has cared for older adults for many years, but who has had no formal caregiver training, assumed Margaret must be more tired than usual this morning and left her alone. She cleaned the house and the kitchen as usual and left without taking further action. The next day, Margaret’s daughter came by to find her mother still in bed. Margaret was admitted to the hospital with a urinary tract infection.

Fred, an 83-year-old retired businessman, relies on in-home private duty home care several hours each day. Today, however, when his caregiver arrived he was uncharacteristically disheveled, acted as if she were a stranger, and gruffly told her he didn’t want her there. The untrained caregiver documented that services were refused and went on to her next client, while Fred was left alone until the next morning. Fred was later hospitalized, with dehydration and delirium.

In both of these situations the outcome would very likely have been different if the caregiver had been professionally trained. Margaret’s caregiver would have been trained to observe changes in behavior and report these behaviors immediately to Margaret’s daughter and health care provider.

Fred’s caregiver would have known that changes in behavior and awareness are signs of potentially serious health issues. She would have known to immediately get help for Fred.

The report goes on to note that caregivers, working in individuals' homes, are generally alone and unsupervised. Often they are the only ones to see an isolated frail elderly person in the course of a day, a week or even longer. Without professional supervision or support, these caregivers are often the deciding factor between an individual living a healthy life filled with meaning and quality, and just barely getting by.

The organizations sponsoring this report are among those who are actively working to educate families about the importance of hiring only professionally trained caregivers. They are working hard to build awareness in families that training offers a qualitative difference in the outcome of the care.

They are also advocating for a national standard of training certification, with training content similar to that required by nursing assistants and home health aides.

We support all of these efforts. We believe, in fact, that quality, professional training is now within reach of every individual who wishes to enter the field of caregiving through the use of online training courses like our Caregiver Certification course (soon to be renamed the Personal Care Aide Certification).

It’s time for families to be educated and to understand the value of having a professionally trained caregiver. And to demand it for anyone providing care to their loved one.

Certification offers hiring advantage to unemployed

2009-02-24T16:32:00.000-08:00

Would you give preferential consideration to an applicant that had completed a course targeted to your specific product or service?

For example, if your shop sold shoes, and you needed a new store clerk, wouldn’t you consider someone who produced a Certificate in Selling and Fitting Shoes above another applicant, equal in other ways, without the training?

With the number of unemployed Americans increasing daily, many are looking to re-training to enter the field of health care – one field that continues to hire, despite the economic downturn.

It couldn’t come at a better time, either. The shortage of workers, especially in nursing and in direct care, is approaching the crisis stage in many areas.

At the same time, many workers are looking for a career that will give them something more than a paycheck; a sense of purpose and of making a genuine difference in peoples’ lives.

The challenges with traditional approaches to education are two-fold: first, admission to the majority of health care training programs is restricted by a limited supply of classrooms and qualified classroom educators. Second, the path to completion is long and costly, both in terms of real out-of-pocket dollars and time.

One solution: online certifications, provided by qualified educational sources, designed to give individuals the tools to become “job-ready.”

In healthcare, this can mean certification in the entry level field of caregiving, or in more advanced areas of study. Today, a flood of professionally skilled workers - newly unemployed - are seeking ways to transition their skills from other industries into the health care industry. While these certifications may not be an entry ticket directly to a job, or a job guarantee, they can significantly boost the individual’s chances of scoring a much-needed job, perhaps in a field new to the applicant.

After all, if you’re hiring, wouldn’t you consider someone with certified training in the area of your work above someone without it?

Caregiving hits sandwich generation hard

2009-02-18T14:02:00.000-08:00

Everyone I know is a member of the sandwich generation today. My friend, Melanie, spent the week at her father's bedside in the hospital, juggling her work, husband, friends and kids with her handy (and prohibited in the hospital) cell phone.

My friends Ken and Elaine cornered me at a dinner party Saturday night with questions about how to help his parents move out of their home into an assisted living community. And then how to keep his siblings from freaking out and throwing a fit when he achieves it.

It's not easy being a member of the generation whose parents are living longer than any before in history. My own aging mother, living happily and busily in a retirement community, takes the train at least twice a year to stay with her mother, who, at 98, is queen of her retirement community in northern Minnesota.

She called me during her last visit saying, "Grandma keeps falling and I don't know what to do. Can you talk to her and tell her to be a good girl and stop trying to get out of bed at night?"

My mother knows that it isn't helpful to talk down to older people - she taught me that when I was just a child.

But dealing with her own mother turns her into any other frustrated family member. She forgets to objectively look at what is causing my grandmother to fall, and to work on solutions. She reacts emotionally - as we all do when dealing with our family.

I'm just far enough away that I could talk through the situation with my mom and help her find some workable solutions. Turning my grandma's bed so that there was more room on the side she likes to use to get in and out means that she can fit her walker there (she couldn't before, leading to fall after fall). We talked about solutions like a smaller bed, half-rails for her to use to pull herself up and steady herself when she first gets up, maybe even a bed-side commode for night needs. There are logical ways to start addressing the problems of falling, at least in my grandma's case.

But at the moment, my mom was shaken up. She was upset, scared and frustrated. She acted like we all act when we feel helpless to solve the problems of our aging parents.

There is one thing we members of the sandwich generation are learning, though. Simply this: when we turn to other people for ideas, advice and support we can get through some of the toughest spots we face on this journey through life.

Training for the healthcare future needs today

2009-02-11T12:14:00.000-08:00

The economic and job loss news seems to get worse by the day. While the statistics are awful the personal stories are even worse. The ones that brought instant tears to my eyes were the stories of individuals in their 70s who thought their retirement funds were wisely and safely invested, only to have lost them all in the past few months. Now they, too, are looking for jobs.

During times of high unemployment another phenomenon occurs: the enrollment in colleges and training programs increases. Many people choose to use this as an opportunity for personal advancement, maybe entering into a new career entirely.

What an opportunity for building our healthcare profession, especially nursing and caregiving! What an incredible time for us to use all the technological solutions we can find to enroll more people into these training programs, instead of limiting them to classroom availability.

One of the local colleges recently advertised for a director of distance learning– I have to admit, the idea was tempting to me.

If someone made me in charge of the healthcare education universe today I know exactly what I’d do: I’d blow the walls off.

I’d create powerful, moving, engaging online courses that taught facts, skills, concepts and compassion.

I’d include, in every single healthcare course, emotion-grabbing content to help the learner understand the human element of care.

I’d make sure that all students really got the message of person-centered care, or they didn’t go on.

I’d create learning experiences to allow the person to move through learning at his own pace – not mine. If he already knew material, I’d let him advance quickly to new material. I wouldn’t hold one student back just because others didn’t yet know something – each person would advance at his or her own pace.

I’d incorporate social learning, too, encouraging students to share their stories, their life experiences and their thoughts what they were learning.

I’d challenge them to grow as people, at the same time they were growing as professionals.

I’d build a system that could train unlimited numbers of individuals, learning together in classroom made of the web, interacting with each other and with instructors through virtual class discussions and knowledge checkpoints.

And then I’d turn my well-trained students out to the world, to practice – and perfect - their new skills in clinical settings – where nurses and caregivers and compassionate, involved individuals are so desperately needed.

I may not get the chance to be in charge of this particular universe, but even in my own little world opportunities exist to change the world.

Or at least to change the way we train – and the way we care.

To get just a small taste check out the Caregiver Certification course our team has recently developed. It’s a fully online way to step well-prepared into a whole new helping profession.

The risk of wandering in Alzheimer's

2009-01-27T14:53:00.000-08:00

In today’s newspaper I saw two reports of seniors freezing to death in the cold spell that has trapped much of the country.

Yesterday I was editing a caregiver course on the topic of wandering, so maybe I was especially aware of this topic.

In one report in the Chicago Tribune, the two people in the story actually died right outside their residences. One was a younger woman who slipped and fell, and, with a broken leg, was unable to make it to the door of the house where her ex-husband and sons were sitting, warm, cozy and unaware, just inside. The other was an elderly person who died on the sidewalk outside the assisted living community where he lived.

Researching the topic of seniors with Alzheimer’s or memory loss wandering away and becoming lost, it was clear to me that this is an event that happens all too often in our country.

It is an opportunity for inventors and makers of tracking devices and alarms. Sensors, monitors and all sorts of tools exist to help us keep these vulnerable people safe.

Sometimes, though, it’s like all the guards, sensors and razor-topped fences at the maximum security prison. Pretty effective for most of the residents, but never, ever, 100% guaranteed safe.

Stories like those I read today make my stomach knot up. I can’t imagine how the families must feel, or the staff who didn’t know the person was outside and missing for too long.

What is do know is that good training, for families, caregivers and managers, is one of the best wandering tools available. Knowing how to keep the person busy and engaged so he doesn’t try to get out; offering frequent walks with a companion; having a regular check-in system to keep track of people throughout the day; knowing what to do the minute you identify someone as missing – no amount of razor wire can protect you as well.

I believe in training because I’ve seen the difference it can make in outcomes of care. And I believe that, in this country, in this century, the least we can do is everything we can possibly do to prevent the tragedy of a missing loved one for just one more family.

Senior care providers contributing to the change

2009-01-21T11:44:00.000-08:00

More than just caregiving is at a crossroad today.

We’ve got a new President. We have unlimited potential, and new leaders throughout government.

It’s a breath-taking moment of possibilities; an exciting time to be alive as we witness history being made.

As my friend Patrick commented yesterday during the inauguration, “The hope is palpable and we believe a change can take place. WE WILL make sure to contribute to that change!”

Change is in the very air today. Change in how we view one another; how we care for each other.

There are many aspects of our society that need changed. We need to change the way we as a society care for our elders, and even more importantly the way we care for those who directly provide the care.

We need to honor and respect those who choose caregiving as a profession.

We need to recognize that as our society ages it is ourselves – our mother, fathers and our husbands and wives – who will need care.

We need to commit to train enough people to become caregivers – nurses, doctors and aides – so that we don’t have a shortage of providers.

We need to express our appreciation for these skills, by raising geriatric physicians below the lowest paid specialty, for example. By opening our eyes to new approaches to train the many people wanting to become nurses but who cannot get into any current programs because of severely limited instructional capacity, at the same time we have a nursing shortage that approaches a crisis in some parts of our country. By raising the wages and benefits of nurses aides and direct care workers in homes and care settings.

We are at a crossroad in our country. We have a choice to continue business as usual, or to join my friend Patrick in saying, “WE WILL contribute to that change!”

Caring for a senior parent is simpler with a medical alert system.

2009-01-16T13:46:00.000-08:00

Guest posting by Igor Mordkovich, LifeStation, Inc.
The role of a primary caregiver to an elderly parent is not an easy job, especially when you can’t be with them all the time. Constantly worrying about their safety and wellbeing can take a toll on a caregiver so any bit of help counts.

“More than 90% of hip fractures among adults ages 65 and older are caused by falls”… reported by CDC

SeniorCarePharmacist.com reports

“More than 11 million seniors - one of every three - will fall this year (Sattin 1992; Tinetti, Speechley, and Ginter 1988), and approximately one in 10 of those falls will result in a serious injury such as a hip fracture or head injury (Tinnetti 2003). More than 500,000 seniors will suffer hip fractures annually by 2040 (Cummings, Rubin, and Black 1990).”

For many years, medical alert systems have helped caregivers gain valuable peace of mind knowing that their parents can get assistance 24 hours a day by simply pushing their medical alert emergency button. This works well for situations when they simply can’t reach their phone to call for help.

The operation of a medical alert system is incredibly simple. The user can wear a portable help button around their neck, wrist or on a belt clip. The button is waterproof, allowing a senior to be protected even when taking a shower. In case of a fall, heart attack or any emergency situation, the user can simply press their emergency button and within moments an operator from the medical alert company will come on the line via the console’s hands free speakerphone. After assessing the situation, the operator will contact neighbors, relatives or local EMS personnel if needed.

This service has saved thousands of lives and given caregivers the comfort they desire. With the rapid pace of daily living, we cannot be with our parents all of the time. Having a medical alert system provides safety for the user and peace of mind for the caregiver.

There are a number of companies that provide medical alert monitoring services. An excellent article to read is the one published by LifeStation medical alert company on how to choose the best medical alert provider.

Aging and healthcare: an impending crisis

2009-01-12T15:54:00.000-08:00

A news article titled “Here come the seniors” caught my eye today. It describes the challenges for the health care industry as all of us boomers age and need more medical care.

More importantly, however, it outlined solutions. Here’s how it starts:

The silver tsunami. The age wave. The graying of America. Whatever cliché you want to use, the strain that the aging baby boomer population will place on the healthcare system in the near future has been well-documented and thoroughly discussed. Yet the industry as a whole remains surprisingly unprepared to care for a wave of new elderly patients who may fill as many as two-thirds of hospital beds in the next 30 years.

So that’s the problem, in a nutshell. Here are some of the recommended solutions:

Success Key No. 1: Look downstream
Tie in acute hospital care with other services like long-term care, hospice care, outpatient care and fitness programs.

Success Key No. 2: New models of care
The ACE program in Cleveland, OH, is a model for senior care that not only treats the whole person using an interdisciplinary approach, and incorporates principles of patient-centered care. It’s a program that is effective in reducing hospital and long term care stays – both things that seniors would applaud.

Success Key No. 3: Coordinate in the community

"One of the biggest challenges with the geriatric population is the handoff; the transition of care," says Barbara Looby, administrative director of senior health services at Crozer-Keystone Health System, a five-hospital system based in Drexel Hill, PA, covering 774 inpatient beds. "What happens when patients leave the inpatient hospital setting to go to an outpatient level of care, whether that's home care or another level of care such as nursing home or assisted living?"

Communication is vital, but so is training. The caregiver providing the care to the patient needs very specific training to ensure that the patient doesn’t end up right back in the hospital. Too often the elderly are discharged out of the hospital to untrained, inexperienced family members who are very willing, but not appropriately trained to provide quality follow-up care.

Success Key No. 4: Train physicians

Currently the US has a little over 7,000 geriatricians (specialists in geriatric medicine). It seems that med students see little reward in this field of practice and they’re right – it is one of the lowest paid specializations. The projected need for geriatric physicians to meet increasing demand is estimated at 36,000 by 2030. Making this more attractive to new, young physicians – and compensating appropriately – must begin happening soon for this need to be met.

Changing Nursing Homes and culture of care, one person at a time

2009-01-07T14:38:00.000-08:00

December is a very busy month in my office. Many administrators of nursing homes and assisted living communities have a December 31 deadline for renewing their licenses. Many of those get to the end of the year only to find that they're lacking just a few continuing education courses they need for license renewal.

And we get really, really busy meeting those last-minute needs for training.

It's a fun time for us, as we get to talk to one person after another, calling us for help in solving their urgent need. Most of the conversations start off something like this,

"This is really embarrassing, but I need to take an online course that I can finish within the next 2 days. Can you help me?"

The typical caller goes on to explain why he or she left it to the last minute, and why the rush is on to finish so they can keep their license.

This December, I got to personally field more of these calls than usual. An extraordinary amount of snow virtually shut down all traffic to our office. Fortunately, I live close enough so that I could put on 6 layers of ski clothes, boots, hat and goggles, grab my ski poles and walk in to work.

That meant that I also answered the phones.

Here's what I heard:

"Thank you so much for helping me. I was afraid that I wouldn't be able to renew my license this year. It's been such a rough year - my husband died, completely unexpectedly, just 3 weeks ago. My job - my residents and staff - are the only things that keeps me going right now."

This caller and I ended up talking for nearly 20 minutes about life's challenges, and how she was handling them with grace and courage. I was humbled by her story, and proud to be able to help.

Then Sherry called:

"I had never been a nursing home administrator before this year. I have no nursing background either, and even though I had worked in a drug store pharmacy and had been involved in placing several families members in nursing homes, the staff didn't think I knew anything about the job. That was hard."

Sherry went on to share some of the changes she had made in the past year in her job:

"Staff were feeding residents in the living room. They had put sheets over all the chairs and had turned the chairs away from the windows. After a meal, staff were busy helping residents and food didn't get cleaned up quickly enough, resulting in flies and ants on the floor. In general, it was horrible, but it was 'the way things were done.'"

Sherry instructed staff to take all the sheets off the chairs, deep-clean the living room and turn the chairs to the windows. No residents were allowed to be fed in the living room; they had to be fed in their rooms or in the dining room only. After a little resistance, but careful monitoring on Sherry's part, here's what happened:

"Staff say that is is easier to feed residents in the dining area. Extra food is available, clean up is faster and the residents have begun to eat more.

"Residents are using the living room more as a living room, too. Families visit longer; residents are calmer and happier."

Sherry makes me proud to be a part of training administrators to manage person-centered care environments. But she also makes me aware of how much farther we still need to go.

"It's an uphill battle working in a nursing home trying to care for residents on the minimal amount of money available."

Sherry's right about that. As we head into a new year and a new economic reality the money is not going to flow any more freely.

But we'll have one person here and another person there, working their hardest to ensure that care is provided to our nation's most vulnerable citizens in a way that is caring, compassionate and dignified.

A Caregiver’s Christmas

2008-12-24T11:46:00.000-08:00

Thelma needs her medicine. George is crabby again; he wants to walk on his own so badly. Families are calling; neighbors are visiting. Everyone seems to be in a great, holiday mood. And you’re working.

Caregivers don’t get a holiday break. The tasks of caregiving go around the clock, every day of the year.

And yet, the compassion of a good caregiver continues to be replenished by the smallest rewards – and the rewards are often very, very small.

Today, a great portion of Americans depend on the compassion of caregivers to provide care to a family member or to give them relief in their own work of caregiving. And yet we continue, as a society, to neglect to show our appreciation for their work.

In the year ahead we will have the opportunity to discuss ways to strengthen the workforce and rebuild the economy. Vital to this effort:

Increased education and training for all caregivers – mandated and funded.
Increased awareness of caregiving as a career track through programs that not only train but adequately recognize and compensate caregivers for their work.
Increased training and support for family caregivers who provide care for the majority of dependent elders in our country – often without recognition, support or encouragement.

It’s a work that is not only important to our society, but it is important to me and my family; someday – if not today – to yours as well.

The senior citizen un-retired - are we all destined to become Wal-Mart greeters?

2008-12-17T11:55:00.000-08:00

This past weekend I played catch-up with my back-log of magazines. In the middle of gloomy and even gloomier economic news and forecasts was a story about the growing population of seniors who have had to un-retire – come out of their retirement to go back to work, simply to pay their daily bills.

My first reaction was, “Well, if they had planned better they’d be fine.”

But I kept reading.

There were stories about retired engineers and accountants who had planned carefully, putting away significant savings and paying off homes.

In every case, something unforeseen occurred, leaving the individual (or couple) scrambling to pay their bills.

In one story, cancer not only took the life of the woman involved just following her husband’s retirement, but it also wiped out their nest egg and put their financial stability in serious jeopardy.

In other stories the combined one-two punch of falling home values and the plummeting stock market left people who retired at the top of their profession looking for jobs at Wal-Mart and Home Depot. And of course, with retail sales being off, even those jobs are tough to get.

For seniors the main issues go deeper than simply not being able to pay the house payments and insurance. Health care and long-term care costs can begin to eat into savings quickly.

The ripple effect hits all generations. A recent NPR interview of college students discussing how to pay their school bills included a brief clip from a young person saying, “My parents are having to help my grandparents pay their bills now too, so I don’t know how long I’ll be able to afford to go to school here.”

The American Association of Homes and Services for the Aging (AAHSA) has a website called The Long Term Care Solution that has as the tag line this sentence: “Left unchecked, America’s long term care financing crisis will devastate millions of American families.” Here’s the lead story:

Walt is 82 years old. He's your father, brother, uncle. Someday, he might be you. Like so many others, he's experienced a physical setback - car wreck, stroke, diabetes, heart disease - and now he needs help. Perhaps bathing, or dressing, or going to the bathroom - just doing some of the things we all take for granted. He needs this help every day, for the rest of his life, and the cost for his long-term care will become overwhelming to him and his family. This financial crisis should never happen to anyone. But it does . . . every day.

This is real life for many seniors and their families today. Most of these individuals do not have the option to un-retire.

Like so much that affects one segment of our population, it doesn’t just stop there. Yes, it’s a societal problem.

But for millions of Americans today, it’s also personal. It’s time for action – and action always starts with the individual.

Nursing shortages in the US – creating jobs that have long term positive effects

2008-12-10T14:24:00.000-08:00

I’m in the education business – but I’m also in the business of improving the quality of care we provide seniors and others in our society.

Today, I found myself arguing on the side of less training – maybe for the first time ever. A proposal came to my attention to increase the hours of nursing assistant training before certification. On the surface, I can say, “Yeah; more work for me!”

Inside I know that more hours of training isn’t what we need right now. What we truly need now is a clear, barrier free path to help individuals who want to enter caregiving and health care do so. Our training programs are already strong and robust. It’s getting people into the programs that’s the problem.

While we’re in the middle of a nursing shortage that is fast becoming a crisis, we’re discussing barriers to getting individuals trained.

One area college has a 7 year waiting list for individuals to get into their nursing assistant training program.

One group of individuals – all straight “A” students – applied to every nursing school in the area, only to be rejected by all.

As most problems go, this one has neither a simple explanation nor a simple answer. Getting more students into the front door requires getting more people out the top end of the career ladder; in short, more individuals trained and qualify to teach those wanting to get started.

We can effectively train more people using the instructors we currently have if we’ll start tapping into technology. Even using minimal online course components can reduce the hours of instructor time needed overall, freeing up those individuals to teach hands’ on elements of care. Many students today prefer to look up information they need on the internet, and have gained great proficiency at learning what they want, when they want it using technology.

There’s a fabulous video on youtube.com that spells out, in stunning clarity, the changes we have faced in the world of technology and learning in the past 10 years. It’s called Shift Happened: Educational (Technology) Reform. If you haven’t watched it, take a minute to do so today.

Albert Einstein is quoted in the video as saying, “We can’t solve problems by using the same kind of thinking we used when we created them.” It’s time for health care education and training to catch up; to use technology wisely and well to build the workforce for the future.

A Thanksgiving Story

2008-11-25T15:35:00.000-08:00

Three Thanksgivings ago we sat down at the extended table with our extended family and felt so incredibly blessed we could barely speak. My father had survived a small stroke; my husband’s father had survived a heart attack and bypass surgery. We didn’t expect to all be together that year, but we were.

A year later, my father was dead and my mother in the hospital, unable to join us for Thanksgiving dinner. We rushed, somewhat numbly, through dinner, avoiding the traditional recitation of blessings.

This year feels a little like that particular Thanksgiving, on a global scale. It’s hard to find things to be thankful for (if you actually open your investment reports). It can be frightening, as companies and individuals we have long looked up to for leadership are faltering – maybe even failing.

And yet. Today the sun shone through the piles of golden leaves. I walked to work the long way, savoring perhaps the last nice morning of the month, feeling healthy, alive and filled with thanks.

Today, we had a chance to help a whole group of individuals begin their journey to become caregivers and nursing assistants. We connected with business associates who are challenged but persevering; and several who are thriving.

My children are spread out all over the globe; one in India and one in Israel. They’re studying, volunteering, and traveling. They’re excited about their adventures and fully engaged in their work of growing into global citizens.

Our table will be a little lighter this year for Thanksgiving dinner. Our bank accounts and investment portfolios are certainly a lot lighter. But when I count my blessings this year – out loud – the list will be long.

Happy Thanksgiving.

Caregiver Stress study confirms daily family experience

2008-11-20T16:05:00.000-08:00

Today's Washington Post article titled "When the caregiver becomes the patient" put numbers to what caregivers - both professional and family caregivers - experience every day: caregiving is stressful.

In fact, caregiving is so stressful that, according to the article, 25% of caregivers of people with Alzheimer's disease end up in the emergency room or hospital every 6 months - at least once. The study doesn't compare this rate to the rate for non-caregivers, but my gut tells me its many, many times higher.

One of the researchers went so far as to suggest that we start thinking of both the person with the AD diagnosis and their family caregiver both as "patients." Clearly, caregivers end up as literal patients far too frequently.

What this means to us as a society is significant, too. With the number of individuals with Alzheimer's disease expected to grow from the current estimate of 4 million to 18.5 million in the coming 40 years, perhaps we should be thinking in terms of double that number of individuals who need to be considered in future health care planning.

And with the state of our health care system, how we can provide compassionate, appropriate care to those individuals - both with Alzheimer's and those who care for them?

Clearly, we need to find as many ways as possible to support family caregivers today, right now. And we need to plan for - and budget for - ongoing support for these individuals so that they, too, do not become victims of a devastating disease.

Give a caregiver in your life a gift of training and support.

Caregivers get increased training requirements but may also gain in status with Washington’s new Initiative 1029

2008-11-12T12:16:00.000-08:00

This month’s election has produced results that will change the face of our nation – and I don’t mean that as literally as a lot of political pundits do when they talk about the groundbreaking nature of having the first African American president.

In my mind, we crossed that barrier about 3 seasons ago on “24”…but that’s another story!

The changes I’m thinking about relate to caregiver training. In Washington, an initiative mandating increased training for caregivers passed by a wide margin. The initiative’s backers (full disclosure – it was backed to the tune of millions of dollars by the SEIU) got the public’s attention by pointing out that caregivers in Washington require less training that hair dresser or dog groomers.

Many providers are concerned with this new mandate for training. They know, with the turnover of caregiving staff, that the cost will be high to gain compliance. It will add an extra layer of overhead to a home care agency that will, inevitably, get passed on somewhere (any guesses?).

But at the same time I can’t help but wonder if increasing the training requirements of caregivers may help them gain status and respect. Perhaps, if we require something akin to licensing, we will recognize the value of these workers. We may even – gasp – increase pay and benefits for this group of chronically undervalued workers.

As my mother grows older, and my own years seem to rapidly move toward the “senior” classification, I know that I find much more compelling the need to respect caregivers who may someday – soon – be caring for my mom or me.

Baby steps…

Holiday Gift Ideas for Caregivers

Caregiver Certification Course provides comprehensive online training for in-home, assisted living staff

2008-11-06T14:59:00.000-08:00

This month has been proclaimed National Family Caregiver Month. It's also the month that our team at aQuire Training has completed and launched the new Caregiver Certification Course.

Caregiver training is a nationwide issue as the number of seniors needing some sort of assistance balloons in the coming years. Just a few days ago, in fact, Washington State voters approved a new bill which would more than double current caregiver training requirements.

PHI, the direct care worker's advocacy and support organization led this week's newsletter with this bold headline: "PHI Project finds less turnover with more training." Turnover is one of the biggest challenges in providing uninterrupted quality care to the most vulnerable citizens.

These issues reflect the growing awareness that caregivers must have more than just minimal training to provide the quality of care we all want for our aging loved ones.

aQuire Training's Caregiver Certification Course, designed for in-home and assisted living caregivers, includes training in ethics, client’s rights, and elder abuse as well as training in emergency first aid, personal care and assistance with daily living tasks like mobility, bathing, and toileting. Throughout the course students are taught to respect the individual’s rights to privacy and dignity and provide care in such a way that the person’s independence is enhanced and supported rather than removed. The entire course provides a comprehensive program of more than 40 hours of caregiver training.

What a perfect gift to give a family caregiver. I know that if someone was caring for my mother in her home, I'd feel much more confident if I knew that the caregiver had extra training and skills.

This course has been endorsed by Casualty and Surety of New York, a company providing liability insurance to senior care providers, as a course that “is comprehensive and yet provided in an easy-to-understand presentation,” says David G. Condon, President of the company. Caregiver training is a known approach to reducing liability risks for senior care communities like nursing homes and assisted living facilities, Condon notes.

The course will also be used in parts of Canada as a tool to train respite caregivers. Respite caregivers provide much-needed relief for family caregivers through a government supported program there.

It's a privilege to join in the celebration during National Family Caregiver Month of some of the hardest working individuals, whose labor is too often unnoticed and unappreciated.

Aging and Death - a new reality for us all

2008-10-30T09:48:00.000-07:00

Last night my husband and I had the pleasure of taking my mom to dinner. My mother, widowed now for two years, lives in a nearby retirement village. It's a small village and a close-knit community of individuals, all of whom waited several years to join and now value their membership. The minimum move-in age is 62, but the average resident age is probably mid-80s.

Last night I was shocked to hear my mom say she doesn't know if she still likes living there.

"There are too many people who die," she said. "I'm not used to losing so many friends, especially close friends."

She went on to tell of a memorial service that was held in the village chapel the day before for a gentleman who lived just across the grassy "quad" from her; a man she counted as a good friend.

"I had to leave after just a few minutes," she said. "The chapel was full, with chairs lining the hallway outside. It reminded me too much of dad's funeral, and I just couldn't take it."

For my mother, this was the second significant loss of a good friend in the last several months. It is, she says, one of the hardest parts of living in a close-knit village of senior adults.

I thought about this conversation long into the night. Here was a solution we'd worked hard at achieving, for both my mom and my husband's parents. Living in a community of senior adults, with special activities, outings and services designed for them, seems ideal.

And then my mom pointed out the one thing I hadn't really given much thought to: death.

It brings to my mind not only questions about how to help my loved ones cope with even more losses in their lives, but also questions about how I'll handle that phase of life.

On an even larger scale, what about the way our society deals with death and dying?

We boomers have had a way of changing a lot of society's standard approaches to living, from our teens through this aging process.

Perhaps it's time to give some thought to the dying process, and how we handle loss and grief. Maybe we can, together, find our way to a place where we better accept death as a part of life, and together learn to celebrate lives passed, rather than suffer grief-filled lives.

I have a feeling that life - and death - won't give us the luxury of spending too much time thinking about it. It certainly hasn't waited for my mom to prepare - and it won't wait for us, either.

The View from the Street: It Matters Which Way You're Looking

2008-10-21T10:13:00.000-07:00

The other day my husband and I were taking our morning walk. It was a beautiful fall morning. The sun was shining and the sky was a pure, translucent blue - on the right. On the left, the sky was angry and black and looked ready to dump buckets on us any second.

On my daily walk to my office I cross over an old bridge that separates two communities. The Willamette river underneath is broad and swift. On the right side of the bridge is the waterfall; a crashing, thundering, powerful display of water. I always walk on the right sidewalk because I love watching how the waterfall changes with the seasons. I also love the power of the pounding water.

The other day, I decided to cross over to the other side of the bridge. To my surprise, the water view there is calm and peaceful. Fishermen relax in their boats. Ducks gently bob along.

It's the same river, but the views from different sides of the bridge are dramatically different.

It was the same sky that morning, too, but the view to one side was sunny and beautiful. To the other, the sky was frightening.

It's a pretty good metaphor for today's social and economic outlook, I think.

If we look in one direction, we see deep recession and worrisome prospects for our future, both personally and as a society. That direction looks powerful and frightening.

But when we turn our heads just a little we can see the other side of the picture: the side that is filled with great human compassion, creativity and ingenuity. We can see hope for a future for ourselves, our families and our children that is brighter than today; that is calm and peaceful, too.

I think particularly about the view of today's typical family. The middle (sandwich) generation worries about their own eventual retirement. They worry about how to provide and pay for care for their aging parents (and maybe even grandparents). They worry about paying for their children's college education. The view, especially considering the changing demographics and the economic outlook can be very frightening.

And yet when we consider the other view, we see a society that has progressed in a few short years from one in which the average person never lived to see 60, to today's increasingly common centennial birthday. In the past century, in fact, the life expectancy for most Americans has increased 30 years.

During this time, we've developed options for supporting our seniors, too. No longer is it only family care or nursing home care. Now, we not only have assisted living options that are designed to sustain quality of life as well as provide essential support, we have a growing army of in-home care providers, the fastest growing segment of senior care providers.

We have creativity and good old fashioned neighborliness to consider, too. When was the last time you needed help, only to have a "good Samaritan" stranger or neighbor happily step up? It happens every day in our country, and it is only a small indicator of the abilities we possess to share the burdens as well as the joys.

It can be easy to give in to Wall Street's panic and the social prognosticator's predictions of unmet needs. I believe, however, if we just turn our heads we can see the other side of the picture and use our energy to help make that view - the one that is filled with hope and quality of life - a reality.

Nurses and the Bottom Line

2008-10-13T14:42:00.000-07:00

An interesting article popped into my email today. It's titled The New Rainmakers, and discusses the role of nurses in hospital budgets.

Nurses cost money. In fact, their salaries are perhaps the biggest staffing cost a hospital must absorb. Over the past few decades, though few chief executive officers like to admit it, those costs have caused many hospitals to encourage their nursing managers to try to do more with less--less nurses per patient, that is.

Staffing is the biggest cost center for all providers of care to seniors, whether hospital, nursing home or assisted living communities. When financial times are tough - and even when they're not - cutting these costs directly affects the bottom line. When revenue slips, usually related to a lower census or occupancy, the biggest area to cut is staff wages - and that means staff hours.

With increasing emphasis being placed on quality and patient satisfaction by health plans and consumers alike, hospitals are realizing that reimbursement increasingly depends on how well nurses do their jobs, making nurses, as a new PricewaterhouseCoopers report says, the "rainmakers" of the hospital.

In my own local newspaper, printed tables display the patient satisfaction scores at all of our local hospitals side by side. Many of us have a choice in medical providers, and viewing these scores will undoubtedly help us choose a provider.

And yet, says Janet Hinchcliff, author of What Works: Healing the Healthcare Staffing Shortage,

"I'm not sure they [hospital administrators] realize the interconnections. This is going to be a big deal for them," she says. "Quality and patient satisfaction scores will show that a great deal of how a hospital is perceived has to do with the nursing staff. So they're a revenue contributor from a payment side, but also in terms of the fact that people are going to those hospitals because the nurses are really good."

What happens when a hospital chooses to spend just a little more in staff wages?

What about training expenditures, especially in the areas of leadership, customer relations and communication?

Repeated studies have shown that adequate levels of staffing and above average training investments DO have a significant return in the longevity of staff and, consequently in customer satisfaction.

Says Lilee Gelinas, another hospital executive (vice-president and chief nursing officer with VHA Inc.)

Nurse turnover among those with three years or less experience at some hospitals is 45 percent to 55 percent. "We can't hold on to the new kids coming out of school. Retention is tied to stability in the patient care environment, it's tied to nursing excellence, and it's tied to patient care excellence."

Excellence in care is apparently a language that the top management level didn't understand. But when the excellence of care and the happiness of patients reflects directly on the bottom line dollars, that's starting to speak their language.

It's a Baby Boomer Theme - Caring for Aging Parents

2008-10-08T10:12:00.001-07:00

We were at an end-of-summer garden party last weekend. The day was unexpectedly warm and sunny, and we arrived to the beautiful creek-side yard of our friends Lane and Maureen. Many of the people there were friends we had known for decades.

As we mingled and caught up with old friends, we shared what had occupied our time this past summer.

"We didn't go anywhere this summer. We were busy all summer selling my mom's house and helping her move into a small house just a mile away from our home," said Bridgett. "I go over to her house every day just to visit, and most evenings we'll either cook dinner or barbecue at her house so we can eat together. It's been a challenge, but it's rewarding seeing my mom so much happier, and closer to us so we can help more."

"We had to move my mom into a new care home this summer," said Linda. "Her Alzheimer's has been getting worse and worse, and then we were told we had to move her. It took all summer to find a place, get her settled in and hope for the best."

As we worked our way around the party, we noted that every one of us were dealing with similar problems: aging parents who needed our help, work and careers - or making the transition to retirement, which is also a challenge for many, and our own children.

We're not alone. 13 million baby boomers throughout the US - just like us - are all facing the need to care for their elderly parents. Some are worrying long distance, feeling the need to travel as often as possible to arrange care. Some move parents into their own homes, resulting in caregiving close at hand, but often increasing family tensions at the same time.

Health care and financial challenges (how will we pay for all the services we need) are increasingly common topics of dinner tables and garden parties.

For us and our friends, it was eye-opening to hear how many of us are experiencing a different life-style than we planned for this stage of our lives. How many of us are finding that time is our most valuable asset, just when we thought maybe life would slow down a bit, and we could enjoy it a little more.

We're just starting down the path of challenges, too. We'll need all the mutual support, all the resources and all the ingenuity we can dig up to support our own families - and each other - as we face coming caregiving crises.

In the meantime, we'll enjoy these last days of summer, and we'll value knowing that we're not alone in this drama. And maybe that will make it a little bit easier to keep moving on, searching for solutions that fit just right for our families.

Compassion Fatigue for a Reason - and why it hurts you

2008-10-01T15:42:00.000-07:00

You may never heard of a condition that you might have. It's called by some Compassion Fatigue, and it refers to that point in time when stress, fatigue and tension start overtaking compassion and caring.

It's a feeling common to caregivers of individuals with Alzheimer's disease, many of whom suffer more physical and emotional ailments than the people in their care.

It's becoming increasingly common with professional caregivers, too. These are the home care workers, the nursing assistants and the assisted living caregivers who work for the love of the job and their clients - not the money.

In times of economic downturn, these are the folks who get hurt the most.

Many of them have no company-paid health insurance. Their real wages, in terms of buying power has actually decreased, according to PHI.

This decline in wages is even more distressing when you compare caregivers' wages to wages earned in other occupations.

It's no wonder that many of these hardworking individuals are being stretched even tighter in these challenging economic times.

PHI lists the 9 Elements of a Quality Job. It's their mission to advocate for direct care workers to achieve these elements:

1. Family sustaining wages (we're not moving in the right direction on this one yet).

2. Affordable health insurance (in my state - Oregon, there are 612,000 people without insurance. In tough economic times, this number increases dramatically).

3. Full-time hours (many caregivers work irregular, part time shifts. It's tough for many, especially home care workers, to cobble together the equivalent of full time work).

4. Excellent training (my area of passion; a pivotal area of determining the quality of care that will be delivered).

5. Participation in decisions (empowering employees means greater job satisfaction. It means the good ones might just stay).

6. Career advancement (an opportunity through training to advance through a "career ladder" to increased opportunity and pay).

7. Linkages to services (removing barriers to work for some who would be great caregivers but need support to get started).

8. Supervisors who set clear expectation and encourage and support as well (leadership is one of the greatest needs in health care today).

9. Owners and managers who are willing to truly implement a system of quality improvement.

These 9 element break down into three main areas: Compensation, Opportunity and Support.

Without these elements, those individuals who provide care to my mom and yours will suffer enough compassion fatigue to possibly lose them from the caregiving workforce.

And that will hurt me. And you. And our elderly loved ones.

It's time for all of us to better understand this challenge and continue to advocate for relief for these very valuable, very caring individuals.

Depression a Financial State or a Mental State?

2008-09-30T09:02:00.000-07:00

We're hearing the word "depression" bandied about a lot these days. Wall Street and the President are trying hard to convince us that a financial calamity worse than the Great Depression is on our doorstep - just minutes away.

Investors are bouncing from panic to opportunistic buying sprees, keeping the stock market so volatile that many of us simply choose not to watch our own investments leap and then plummet. It's too easy to buy into the panic mentality and feel the fear that, perhaps, our political leaders are hoping we feel.

It may, in fact, be real. We may be facing a financial breakdown like we've never seen before.

But my money is on us. I believe that we can weather this storm, and that, while we may feel some pain, we'll find ways collectively and individually to assure that our parents continue to receive good quality care in the retirement or care communities where they live, and that, as we eek our way toward our own retirement, we have plans and support networks to get where we need to go.

In a recent article from Newsday.com, seniors shared their memories of living through the Depression. They recalled living very frugally, and simply accepting that everyone couldn't have everything. "If you didn't have the money, you did without," commented one person interviewed for the story.

That's so dramatically different from today's "no payment for 12 months" approach to purchasing. There's no reason why anyone needs to go without anything, including new furniture, new cars, new TVs and more. Don't have the money today? No problem - get it anyway.

Maybe it's a good thing to take a look at how we live. Maybe, like those who lived through the Depression, it's time to only purchase what we can afford. To save up for the future. To pay off our homes. To learn to value life because of the friendships we have, not the possessions we lug around.

If times get tough, I'm betting on the fact that we have a resilience and a creativity that will get us through. We'll look to each other, and find ways to contribute toward a greater common good. Maybe my role will be to train people to provide care for your parent, while you supply the food from your garden to feed both our loved ones.

It may become a time of financial depression, but it will not, in my view, demand a mental depression in response. We have too much strength; too many talents; too much promise.

We've got what everyone in the world envies: the American spirit.

Vote with your Heart and Mind

2008-09-24T12:28:00.000-07:00

It's election season. Bills, measures and initiative for improving the quality of care abound. Some propose additional staff training, others increase the regulations of senior care in a variety of settings.

As a senior care professional and a member of the sandwich generation (that's the place where you're smushed in the middle of two generations: your kids and your aging folks, spread liberally, as one person put it, not with mayo but with Ben-Gay), improving the quality of care of our nations elderly is a personal and professional priority.

While we're at it, we have to look down the road to make sure our own retirement savings and investments, not to mention Social Security, are managed as well as possible.

How do you know how to vote in a way that will actually result in real benefit?

Look at who is sponsoring the bill. Read the fine print. Listen to your local politicians, and ask them questions about their positions on social security, senior care and other vital issues.

Bottom line: get involved.

My daughters and I have been regular participants in the Race for the Cure event in our home town. The turn-out, until recently limited to women only, is third largest in the country.

When we participate in this event we look around us and see how strong we can be - what a difference we can make - when we all come together for one focused purpose.

I think on election day we might get a better perspective of our power if we all turned up at a voting center within the same 2 hour period. OK, I agree - it would be a logistical nightmare. But we'd get a different - and clearer - understanding of how powerful we are when we put our minds and our voices together for a cause.

Don't miss out on our own personal power trip this year. Get involved. Vote!

Crossroads in History, not Just in Caregiving

2008-09-17T11:15:00.000-07:00

I titled this blog "Caregiving at the Crossroads" because I believe passionately that the choices we make and the actions we take TODAY will have long term effects on caregiving in our families, our communities and within our nation.

But we face more than just a crossroads in caregiving; we face a crossroads in our country on a much bigger scale today.

When I was a new social work grad there was a theme among social workers, designed to get people to understand what social workers are really about (this, in an age where my mom freaked out about my going to social work school, thinking all social workers were bra-less, Birkenstock-wearing liberal "nut-jobs" - oh wait, people still think that today...):

"Wherever you go, whatever you do, say you're a social worker."

I've proudly worn my social work creds throughout my work as a business developer, manager, consultant and entrepreneur. It's important to who I am, and to what I value, no matter what I'm doing professionally.

And at a time when I see caregiving - and many, many other issues - at a crossroads in our country, it's time to stand up and say what I believe. It's not a time to be politically correct, or overly sensitive to our differing opinions.

That doesn't mean I don't believe in agreeing to disagree, or discussing things civilly. It does mean, though, that I can't stay silent on topics that mean so very much to me. Topics like:

Health care. It's embarrassing to live in a country where basic health care is not affordable even to many hard-working wage-earning individuals. I truly believe that we not only CAN figure out a solution to universal health care, but that we MUST come up with a solution. We're not getting any younger, you know - we baby-boomers will tax this system beyond its ability to bear if we don't come up with a solution. If other developed countries in the world can do this, certainly WE can do it.

Women's Issues. I'm a professional woman with three daughters. I know something of what it takes to run a business, work long, hard hours, and raise daughters who make responsible choices. I believe that some of the most important work we do as women is in the raising of our children; children who choose to make a difference in the world, who make responsible choices in every aspect of their lives, and who we trust to make the tough choices personally as they grow and develop. As a mom, I have always parented from the perspective of teaching my children the right way to live, and doing my best to model that in my own life. And then giving them the freedom to make their own choices, knowing that I've given them tools to make good choices. (The proof is always in the pudding, as my mom would say!)

For my country, all I ask is that legislators respect me and my fellow women enough to let us make our own choices about some of the most personal - and life-changing - events in our lives. Legislating this choice says that we don't respect our fellow women enough to let them make choices for their own lives - and I profoundly disagree with that.

Money. Ah, the hard part. Many people in the suburb where I live plan to vote from their pocketbook alone. I admit, higher taxes will pinch, if it affects me personally. At the same time, I'm so proud to live in a community that is safe to walk in, day and night, that provides a public education to rival most private schools, and that has good roads, parks and libraries. I'm willing to pay my fair share to ensure that we continue to have these assets. And I'm also willing to contribute to the work of caring for those who don't have the advantages I have. I remember the words from that good book, "To whom much has been given, much is expected." I know that my family has been richly blessed. I believe it is my responsibility to share these blessings, and so I will pay my taxes and work hard to make sure that the money is well spent.

Today I wear heals and a suit most days (and a bra, mom), but I'm still a social worker. I'm still committed to making a difference in my own small world, and maybe, if I'm lucky, in the larger scheme of things as well.

In the weeks ahead we all have a choice to make. Consider carefully your values when you make that choice. We're at a crossroads. Your choice - and your vote - is vital for ensuring that we take the road that leads to a better future.

Celebrating Assisted Living Week

2008-09-12T10:06:00.000-07:00

This week ends National Assisted Living Week. You probably were completely unaware of this week of honoring assisted living, especially since we also honored and remembered events that changed our world with the 9/11 tragedies.

But while most of us missed the party, for millions of seniors and their families throughout the U.S. the celebration took place quietly and in an everyday sort of way. It is a celebration nonetheless of a kind of care that wasn't even available just a few years ago.

Less than a generation ago, seniors who needed care had fewer options. Most either went straight into a nursing home or remained at home with family caregivers.

The family caregiver pool diminished dramatically with the growth of women in the workforce, and nursing homes were clearly not the best environment for many seniors who didn't really have medical needs.

And so a new level of care developed that offered support for daily living tasks but minimal nursing care. It was developed on a model, too, that specifically and intentionally feels and looks more like home (or, in many cases, a nice hotel) than like an institution - another aspect that set it apart from nursing homes.

Today families have options for care that range from in-home care (one of the fastest growing segments of elder care today) to assisted living communities to nursing homes that now incorporate many of the values of person-centered care that assisted living has made the norm.

As a society facing an aging population and a potential crisis in care options, we have many reasons to celebrate assisted living this week. Here's my personal word of thanks for all the folks who provide this care, from the investor and developer to the care staff who give so many families a good night sleep knowing their loved one is in good, caring, compassionate hands.

Michael Jackson Had It Right

2008-09-11T09:35:00.000-07:00

Michael Jackson turned 50 this year - a milestone many of us have already passed. I admit, I've tended to think of Jackson more as "Wacko Jacko" recently than as someone who changed the world, albeit in his own small sphere.

Maybe because of the milestone birthday, or simply the youngsters' desire to revitalize some of my generation's "oldies," but Michael Jackson's music has become popular again.

Twice this summer I saw dance performances set to his song, "Man in the Mirror," and it's gotten stuck in my head. The message in this Michael Jackson song got it exactly right:

If you want to make the world a better place, take a look at yourself and make a change.

In my small corner of the world, I'm working hard to make the world a better place for frail, dependent elders. I remind myself often that making the world a better place starts with what I do, every single day.

As a colleague and I were discussing yesterday, if we want to change the world of senior care, we've got to change the way we train the folks who actually deliver the hands' on care.

So today, join me in looking at the person in the mirror and making a decision to change the world.

Moving Day - Getting the Folks into Retirement Housing

2008-09-03T10:03:00.000-07:00

Last weekend, over the Labor Day holiday, we moved my husband's parents out of their home of 55 years and into a retirement apartment.

We all worried about them that last night in their home. Would they feel remorse over the sale and decision to move? Would they be grief-stricken at the thought of actually moving out?

As the family converged early Saturday morning - kids, grandkids, aunts and uncles - we were met by two busy, scurrying people, laughing and working hard to pack the last few things in the house. Both were clearly eager to move on with their lives; neither showed any sign of sadness.

I usually get elected to have the heart-to-heart with the folks to make sure they're really coping OK. As I took my mother-in-law aside to check in with her, she was beaming. "I can't wait to be as happy as all of those other people living there," she said. Clearly, she was ready to make the move.

Later, I asked my dad-in-law how he was doing. He started reciting a list of repairs needed to the house - roof, electrical, plumbing - ending with a big sigh. "I don't have to worry about any of those things now - I couldn't be more relieved."

The move went smoothly. The stuff they couldn't part with was pretty much crammed into their new 1 bedroom apartment, but they were smiling and happy. As the entire family sat down for lunch together in the retirement community's dining room, we all felt a sense of accomplishment and a hope of the promise: tomorrow will be better. We won't have to worry about them being alone and isolated in their house. They don't have to navigate stairs, mow the lawn and climb up on ladders anymore.

A couple of years ago when this whole process began I had a conversation with my mom-in-law about moving. What I said then, and believe today, is that where you live is much less important than how you live. I believe that this move will make a qualitative difference in the HOW of my loved ones' lives.

Nursing Shortage Has Solutions

2008-08-19T11:02:00.000-07:00

Over the weekend the University of Louisville and Owensboro Medical health System in Kentucky announced a collaborative effort to train an additional 40 nurses a year, utilizing distance education.

Last week, we got a phone call in our office from a guy who wants to become a nurse - badly. He says he was one of over 600 people applying to a local nursing school that had 24 openings. And the nursing shortage is near crisis level.

There's simply no rational reason for such a dramatic restriction in the admission to nursing programs, especially today with elearning options.

In the online nursing assistant program we launched July 1, we've had over 150 applicants with minimal publicity. Many of these individuals are anxious to take the first step in their nursing career with this program - and many of them need the flexibility and accessibility that elearning offers.

It's time to blow the doors off the classroom and begin training enough individuals to become nurses that we make a significant difference in the shortage of trained professionals - from the nursing assistant and caregiver level all the way through to the graduate nurse level.

We have the skills. We have the technology. We simply need the focus and the dedication of resources and we can solve this problem today and for the future needs in our country.

Moving Home - the continuing journey

2008-08-06T10:43:00.000-07:00

Many of you have been following my family's journey with our two sets of elderly parents. My mom's squared away in a perfect retirement village, happy and traveling with new companions following the loss of my father.

It's my in-laws that have been challenging the family lately. They have been reluctant to give up the home where they have lived for the past 55+ years. However, with their mobility diminishing (neither drive much anymore), loss of friends, neighbors and their social circle, and home repairs and maintenance that are simply too tough for them to handle any longer, the time has come for them to make a change.

Fortunately, my sister-in-law determined to make it her mission to convince them to move. She toured retirement communities with them until they located one very close to their home that they really like.

Three weeks ago, we all met at the retirement community for lunch and a tour. Walking through, we all commented on how much they will be gaining by this move - not giving up. They finally agreed, too.

The following weekend they put their home on the market. My mother-in-law threw a fit when the "for sale" sign went up on the lawn (she didn't want a sign), but a few days later a young couple, renting in the neighborhood, walked by and saw the sign. The papers have been signed and, even in this very slow market, the house sold in a matter of days.

Last week the in-laws went to a Hawaiian luau at their new community. They came home happy about the decision they've made, and really looking forward to the move.

Whew! It's been quite a journey for us all. Our one goal: to see the folks more active and more involved with others. In short, to see them happy again. They are both very social people by nature. My mother-in-law had at least 3 social groups she belonged to for more than 60 years - one composed of the other mothers whom she met in the hospital giving birth to my husband! One by one, her group members have died or moved away. My father-in-law loved to golf, go to the beach, and play cards. Over the past few years, their circle has gradually shrunk to their living room, with only each other for companionship.

They, as so many others today, have been blessed with a long life. My father-in-law is 96; my mother-in-law close behind. Living fully, right to the end of life, can mean tough choices and tough decisions.

But in the end, living fully, all the way to the end, is the difference between just existing, and truly gaining the richness and joy that life has to offer.

Giving Gifts

2008-07-31T10:05:00.000-07:00

I walk to work every day. It’s nothing righteous or even green, but it’s my time to get the blood flowing to my brain, think through the day’s projects and hopefully work off enough calories so that I can eat a real dinner. Besides, one advantage of being the owner of the company is the privilege of choosing the office location - just down the hill and across the bridge from our home. So my walk takes all of 15 minutes every morning. They are 15 minutes that I treasure, too. I count my many blessings, take deep breaths of clean, pure air, and plot new challenges for my team.

Yesterday, I was given a gift on my way to work. Totally out of the blue, a man ran up to me and handed me a card. It happened so quickly and so unexpectedly (not to mention the fact that I was in my own little world of thinking, planning and probably talking out loud) that I didn’t even get a good look at the man.

The card contained a hand-written note. In the note were some very nice comments made from someone who had, unbeknown to me, watched me walk to work every day for the past several weeks.

Weird, a little, but nonetheless, it was a nice gift.

I remember when I first started running for exercise. I started late in life – actually, the week before my 40th birthday. I was determined not to let myself age into a heavy, sedentary person, so I joined a running team and began preparing to run in the Hood-to-Coast, a local event that is very challenging and fun.

Those first runs were tortuously difficult. Within a mile or so, I was feeling ragged and exhausted. But then, out of nowhere, another runner would pass by me. If that person slowed down a little to smile and say, “You’re doing great,” or some other encouraging word, I found a new reserve of energy. It completely changed how I felt at that moment.

After my own little “aha” moment I determined to smile and say something positive to people I met every day. I realized that this is one of those rare and precious things: a gift, unexpected, from a stranger. And it can change the way the entire day proceeds.

I like to apply this concept in my work, too. As a boss, I sometimes have to remember that my own smile changes the work environment completely. A little joke, a small compliment – these are gifts I can give every single day.

I think of this, too, in terms of the people who provide direct care to seniors, either in a facility setting or in the home. Their work probably feels like my 6 mile run some days: exhausting, difficult and pretty unrewarding.

Taking just a minute to smile, say “Thanks” and make a comment: “You’ve got such a gentle touch,” for example, is an easy, free gift we can give that might just make a world of difference.

Sleeping Well at Night

2008-07-21T17:32:00.000-07:00

I was touched by the entry written yesterday by a family member who had just moved his loved one into a care center.

He talked of the pain of leaving his wife, but the joy when he came to visit a few days later to see his wife happy - dancing, even.

His closing comment was the most poignant:

This good news has lifted a huge burden from me. I now sleep through the night for the first time in eight years.

This is a comment I've heard countless times over the years. Families agonize about finding care for a loved one. They feel deep angst about moving a mom, dad or spouse out of the family home. Of course there's a little guilt. Of course there's grieving what once was, and is now lost.

After it's all said and done, however, the dominant feeling is relief.

It's all about balance. What works for one family is not the same as what will work for another. In this era, we need to be open, accepting and supportive of the solution that each individual family chooses. Not everyone should move into a care community. Not everyone should stay in his or her own home.

The true beauty of living in the age we do is that we have the choice. It's no longer home or nursing home - many options exist in between.

Here's to finding what works for you, and what lets you sleep well at night.

Medicaid is NOT the solution

2008-07-18T09:22:00.000-07:00

Today's promising headline read, "Solutions for elder-care issues." in the LoHud.com, the Journal News of the Lower Hudson's news site.

Among the solutions? Transfer all mom and dad's assets to your own bank account, so that Medicaid will pick up the cost of their care. Takes all the stress off the sandwich generation kids, and - hey, the government can pick up the tab!

Here's my response:

It's a solution for one individual family to transfer assets and make mom or dad eligible for Medicaid - but it's a societal nightmare. Imagine the implications if all 18.2 million individuals over 85 paid no portion of their own care, but left it all up to the government in the form of subsidies and Medicaid. No longer would the individual family benefit - we'd all be paying the cost through tax rates through the roof.

I believe it is time to look for more creative solutions that benefit not just the heirs but the greater society as well. Perhaps if we start by recognizing those who provide care in this country and honoring, training and valuing these individuals, more people will be willing to take on this work. We need honest discussions about best ways - and places - to provide care to individuals, whether they need just a little support or are fully dependent.

Being a tightly squeezed member of the sandwich generation myself, I know that this is not a battle for me alone. We're facing these issues with both sets of parents, at the same time we're having discussions among ourselves, our siblings and children about how we want to handle our own aging needs when they arise. While we don't have unlimited assets, we all have some ability to plan, to pay and to creatively address these challenges - not to leave the solutions to "the government."

As we boomers age, we may rediscover the commune - now for mutual caring purposes. We may find that we can afford the services we need (and want) best by joining together with others. We may find other creative options that work for many, and are affordable in cost.

We WILL need individuals from the younger generation who find personal meaning and societal value in providing care. We WILL need to invest in their training as well, if we want quality care for our parents today, and ourselves tomorrow.

For my part, I've dedicated my time and resources to developing training programs, accessible via the internet, to train not only the minds but also the hearts of the next generation of caregivers. It's a professional focus, but it's also very, very personal.

Join me for creative solutions to this challenge,

Sharon K. Brothers, MSW
aQuire Training Solutions
Sharon@aquiretraining.com

A Lesson from Joe Louis's Sister

2008-07-17T14:31:00.000-07:00

In the news today is a story about the great boxer, Joe Louis’s sister, who died in February after wandering away from her care center and freezing to death.

It’s a tragic story; one that encapsulates every family member's fear when mom or dad loses the ability to remember and reason, and is moved into a care setting.

Will she be safe? Will anyone pay attention to him? Will she feel lost, alone and worried?

For many folks with memory loss the feelings of confusion, loss and anxiety are present all the time. No place seems familiar anymore. No one is recognizable. Every place – and everyone – seems strange, uncomfortable and foreign.

What we call wandering is usually just an attempt on the part of that person to return to a place where things make sense again – and it clearly isn’t the place they currently reside.

For Joe Louis’s family, this story ends tragically. According to the allegations in the lawsuit, the facility had neither monitoring nor alarms on the door; truly, an lapse that is hard to explain or excuse if true.

For families everywhere, familiar with this scenario, the truth is often more challenging. Doors with alarms can feel safe, but what happens when the attendant (or family member) is vacuuming or in the restroom and doesn’t hear the alarm? What happens when the person slides out with someone else, like another visiting family member?

It’s happened to me in my own alarmed, secured memory care communities. A resident walked freely out on the tails of a visiting family group who was so absorbed in conversation no one noticed the tag-along.

An experienced nurse told me the story just the other day of an incident when she actually let the person out of the secured facility – held the door for her. She looked so “normal” and had asked nicely if the new nurse would please hold the door – so she did.

Security in the best of situations is not foolproof (witness prison breakouts); far better to focus on helping the person feel comfortable, safe and at home – no matter where you are.

And set the door alarms.

In the Game

2008-07-16T13:46:00.001-07:00

Send a JibJab Sendables® eCard Today!

Caregiver Shortage to Affect Everyone

2008-07-16T10:21:00.000-07:00

Here’s the headline that hit my inbox today: “One Million New Direct-Care Workers Needed by 2016.”

This fact was taken from a recent report by PHI, an advocacy group for direct care workers, that also noted that home care and home health aides are among the fastest growing occupations projected for the coming decade.
That number is an incredibly large number, especially when it is accompanied by the miniscule growth in the pool from which these workers are typically drawn – women ages 25-54.

This level of shortage will likely affect nearly every community – and many, many families.

What can we do? Here are some ideas that we all can participate in implementing:

1. Start a small movement in your work, home, and community to improve the respect caregivers experience. If you work with caregivers, go out of your way to thank them. Tell others what a great job they do for all of us. If the job begins to have more social rewards, perhaps it will begin to attract more individuals, male and female.

2. Support caregiver training. If you employ caregivers (whether on a family level or a corporate level), invest in their training. This not only helps the individual caregiver build skills and knowledge, it also supports training efforts that are available in the community. Free training opportunities are out there (here’s a sample that came into my inbox today); many caregivers, however, need support in the form of payment for their time or other compensation to be able to take advantage of these opportunities. Find a way to help this process. Our company is supporting caregiving training by posting “How-To” videos on the internet on a website called Howcast. Check out a few samples: Blood Pressure, Wash Hands, and more. We're also actively involved in developing and providing more online training for CNAs and caregivers, increasing the access which will, in turn, increase the supply of qualified caregivers.

3. Support bills, regulations and initiatives to improve the pay and benefits of caregivers in your state.

Small steps, but the payoff will be huge – and personal – some day.

It Takes a Village, Part 2

2008-07-14T17:07:00.000-07:00

Thanks to Bruce Craig for his comment:

Clearly your parents have options. Many older adults do not have the option of selling their home and moving to another location. That is why we see a growing movement towards neighborhood and community programs for older adults which retain the intergenerational mix with an emphasis on socialization, wellness and access to services. The baby boomer trend to move to segregated communities when nearing retirement can increase societal tension when they ask for the polities they have separated themselves from for the new services they will need to remain independent.

You're correct, Bruce. My in-laws DO have options that others don't have. It's not because they're wealthy, however. They are a solidly middle class family. My mother-in-law stayed home and never worked once the children arrived; my father-in-law worked at a print shop his entire career. He saved every month, paid off their 2 bedroom 1 bath bungalow, and, in general, were frugal. Now, they have a home with no mortgage, that, even in this housing market, will give them the cash they need to pay for their retirement center apartment likely for the rest of their lives (barring any other unforseen cash needs).

I like the concept of neighborhood based programs that offer socialization and support in a variety of ways. It's pretty hard, though, if your neighborhood hasn't been organized. In my family's case, their neighbors - several of whom had lived in the neighborhood as long as the in-laws - have all died or moved out. New neighbors are busy with their own jobs and families.

I love the idea of options. I love the idea of community. I truly believe that the village is needed to support our elders as they age. The village can be neighborhood based, or it can be in a community of individuals who have pooled their resources to hire a full staff of support people - oh wait, that's exactly what a retirement community is!

I'm very interested to learn if anyone else has had success with a neighborhood-based community support network for seniors - anyone out there want to share?

New Features from Wellsphere

2008-07-10T17:41:00.000-07:00

Look over to the right...down a little..see the two new features we've just added to this blog? They're called "widgets" and they provide a message that changes every day.

The first one, called Wellevation, has a daily motivational quote. If you're like me, sometimes they'll seem a little cliche' or, as the kids' say, "lame" - but other times they're right on target. I'm a firm believer in focusing my mind on things that reflect my goals and my values. Motivational sayings sometimes help with that process. It is a process...a journey.

The second new block is one called WellTip of the Day. It is, likewise, a daily changing idea to give you motivation and encouragement. I've selected the topic of stress management. I think, maybe, it's more appropriate than the rock-climbing topic, at least for people like us!

Here's another reason I'm adding these features: I've been invited to join the Wellsphere family of bloggers, sharing with their larger audience my perspectives on caregiving issues, training and how we, together, face the challenges of today's aging society.

Thanks for traveling through this part of the journey with me. Get motivated, get relaxed, get involved!

It Takes a Village

2008-07-10T14:51:00.000-07:00

You know the saying, “It takes a village to raise a child.” It’s a saying that recognizes the importance of many different individuals in providing the care, training and nurturing that a child needs to grow and to thrive.

I’d like to purpose a slightly different version of this saying: “It takes a village to support a senior.”

Despite all of the work being done – good, important work – to help individuals prepare their homes for aging in place, I believe that this is only one part of the important set of tasks involved in supporting an aging population.

One of the biggest health and wellness – not to mention quality of life – indicators is social connectedness. Even with a fully accessible home, social isolation, loneliness and lack of mental stimulation are real concerns.

According to a study recently published in the Personality and Social Psychology Bulletin, social interaction was “just as effective as more traditional kinds of mental exercise in boosting memory and intellectual performance,” according to lead author Oscar Ybarra (as reported in Medical News Today).

We know, both from our own experience working with seniors and from more recent research that the keys to a longer, healthier life can be found in simple things: physical exercise, good nutrition and social interaction.

All three of these things can be compromised when a person (or couple) is living alone in increasingly isolated surrounding.

Physical exercise? Does walking from bedroom to bathroom to the La-Z-Boy count?

Good Nutrition? Cooking for one (or two very light appetites)? Ha – try eating out of the can, standing over the sink.

Social Interaction? If you count talking back to the TV announcers.

In my in-laws case, all of these areas have been so significantly compromised that their decline became readily evident. This couple, both active, gregarious individuals throughout life, now have no surviving neighbors or friends, find the public golf course too difficult to navigate most days, and don’t drive much anymore anyway.

For them, the social isolation has dramatically reduced their quality of life. Hence, our push to encourage them to join a community of other older people – a retirement living community.

They’ve made the decision to move now. All that’s left is to sell the house. Their faces are already brighter; their moods cheerier.

The rest of the story remains to be written, but for now, we’re voting with the village as the solution to the challenges of this stage of life.

It's Called Moving Up, NOT Giving Up

2008-07-07T17:29:00.000-07:00

Last week we met my in-laws for lunch at a new retirement community in town. This time, they're really interested...they think.

As you may recall, my in-laws (90 and 95 years old) have been fighting the idea of leaving their home, despite becoming more and more bored, lonely, depressed, overwhelmed by home maintenance - all those things that signal the rest of us that it's time to do something different. They would, we all believe (all the kids, that is) love all of the social activities and new friends at a retirement community.

So we've been gently, and not so gently, encouraging this step.

Now the plumbing is going in the house, and it just might be the final straw.

As we were touring the building, I kept telling my mother-in-law, "This is a step UP, not a step down. Think about what you're gaining, not what you're giving up."

She looked around at the beautiful new building, complete with a dining room, maid service, maintenance and names they recognized on the doors of neighboring apartments and sighed, "You're right. If I can just get my brain to think that way - I know you're right, but old ways of thinking are hard to change."

She's right, of course. Old ways of thinking ARE hard to change. We're so programmed in our culture to focus on trying to keep older people in their own homes that sometimes we don't see when it would be a step UP for them to leave their homes.

All I want, as a family member, is to see them actively enjoy whatever years they have left. And they're not likely to do that feeling like their home is an anchor and an isolation chamber.

Sandwiched but Strong - sort of

2008-07-03T15:27:00.000-07:00

Last night I had a dream. I was all alone in the house, fixing myself dinner and picking up after the kids. No big deal, just relaxing and enjoying an evening alone.

All of a sudden, a mass of bad guys began breaking in – coming in through windows and doors, on both floors, all at the same time. The bad guys were breaking apart handrails and furniture, pulling out any metal pieces (thanks, media folks, for those story on druggies stealing metals for drug money…).

I’m tackling the bad guys right and left and then – the phone rings.

I stop what I’m doing, pick up the phone, and it’s my mom.

“Hi mom,” I say.

“Hi.” She replies. “I just wanted to talk with you about some things,” she says with a quiver in her voice.

“I’ll call you back a little later, Mom, OK?” I say, and hang up the phone to go back to fighting the bad guys.

About then I woke up and thought, “Wow, if that doesn’t exactly express how the person stuck in that ‘sandwich generation’ feels!”

It’s not like the visual of nice comfort food between two yummy slices of bread.

It’s more like beating off the “bad guys” (work, kid worries, money – you probably have your own list) on the one hand, and pausing – just for a second – to be there for the parent, knowing that you’ve got to get back to those pressing issues – NOW – but your parent still needs you…and so it goes.

My favorite part of the dream was the fact that I, single-handedly, fought off all the bad guys.

It was probably because of the one little thing I forgot to mention – the red “Supermom” cape I happened to be wearing that evening.

Know where I can order one in real life?

E-learning Addresses Healthcare Workforce Crisis

2008-07-02T14:20:00.000-07:00

We've officially launched our new OHCA/aQuire online nursing assistant course. Even before launch, with no publicity and no way for people to find the online application website (OregonCNAonline.com) we were attracting 3-4 new applicants daily. It'll be fun to watch what happens in the coming weeks and months.

Why is this course so important?

It's important because, at the same time the senior population in our country is poised for the fastest growth ever, the workforce who typically provides care is shrinking.

Nurses and caregivers occupy 4 of the top 10 occupations with the largest job growth projected over the next 10 years. according to PHInational. The labor supply isn't growing fast enough to meet this demand - not even close.

Nursing schools are turning away applicants for lack of adequate instructors.

So how can e-learning help?

With e-learning, not only can more students enter the training pipeline but they can also receive consistent training throughout the system, regardless of where they choose to access the course.

E-learning can be a powerful tool, as well, to train individuals to meet the changing needs of the senior population. Specific approaches can be used to help the student better understand the human needs of the population, for example, and to train them on emerging challenges and approaches.

Finally, e-learning is the perfect tool for training a workforce that is diverse and includes immigrant workers who don't understand spoken English well. E-learning allows the student to learn at his or her own pace, and lets the student hear and see the words as well as the visual illustrations, representations or video examples. Students can use immediately accessible online translation programs, too, to help them better grasp concepts in their own language.

Online nursing assistant courses are only the first step to increasing the availability of healthcare workers to meet the coming demands. Our creativity, imagination and ability to employ effective e-learning approaches are tools that will help us solve this crisis, starting with this first small step.

Wings on the Web

2008-06-27T10:47:00.001-07:00

It's a fun experience seeing how far this electronic age reaches. It is truly a new age of information technology, as individuals all over the world can communicate - or listen in - to our electronic conversations.

Yesterday, one of our key staff members picked up the phone at our office, answering with her name, as we always do. The caller said, "Is this THE Wendy Finch?"

Wendy says, "Wow, did I feel like a rock star right at that moment!"

The caller went on to say that she reads Wendy's e-newsletter called Friday Funnies every week (subscribe) and feels like she knows Wendy. Wendy frequently shares stories that end up being the "joke was on me" type of stories, and readers love her.

I had a similar experience a few years ago, walking into a senior living community in northern California. The community representative handed me a packet of information. Included in that packet was an essay, printed on bright pink paper, that I had written some months ago. This community was distributing my essay to every visitor. It was exciting and humbling at the same time.

The essay is one that I think back on often, because I believe so strongly in this concept. I'll reprint it below, but, in essence, the message is this: we need to stop thinking of moving into a care community - or even a senior living community - as a step down. It's not "losing our home" - it's just changing our home address. It can be a positive, meaningful experience for so many people. It would certainly help if our society didn't label it so negatively.

Finally, this week I was invited to participate as a featured blogger for a site called Wellsphere. Once again, the power of the internet is demonstrated, as well as the power of community. As a community of resources, we can join together to make a profound difference in the lives of people all over the world.

It is truly a new age for communication, for support, and for community.

Here's a reprint of my essay titled Changing Home:

A few weeks ago I shared with you our family's story of helping BOTH sets of parents choose to move into a retirement community.

We spent weeks scheduling the first retirement community visit - weeks during which the negotiation went like this, "Mom, Dad, I know YOU aren't ready for a retirement center, but you know how much it would help the other set of parents."

And the reply invariably went like this, "You're right, we're not ready yet, but the other set of parents sure is!"

Finally, we got to the retirement center and spend hours - literally - getting through both sets of parents' anxieties and resistances.

When we left, all four parents were talking about how nice this would be - "4 or 5 years in the future" (that's a 92- year-old speaking)!

Now, two months later, MY parents have their name on two waiting lists, and are actively cleaning out their very formidable collection of stuff; my husband's parents are still talking about the "where" and the "when."

My mother-in-law keeps bringing up this refrain, "I never thought I'd have to give up my home."

And I've been thinking, we've been missing the mark here, both in our conversations with the folks, and in the marketing within our profession.

We're not asking people to "give up their home" - we're simply asking them to change their address.

Because ANYWHERE can be home - whether you own, rent, or stay free.

HOME is that place where you feel comfortable being just "you."

Where, if you're lucky (Mom, Dad, are you listening?) you're surrounded by people who make you laugh, who give you something to talk about, and who share meals, good times and bad times with you - and who are there to help you when you need help.

Because a house is just a house...but a home is absolutely wherever your heart happens to land.

Just a footnote: my parents were in a severe auto accident a little over a year ago, leaving my father dead at the scene. My mother, injured severely and, of course, devastated with her loss, never returned to their home. She went straight from the path from hospital-rehab-assisted living into her new home in the retirement community she and my father had already selected. She absolutely loves it there. The only shadow is a frequent feeling we both have that my dad would have loved living there, too - only he missed the opportunity.

My in-laws are still not budging from their house...stay tuned!

New Doors Opening Through e-learning

2008-06-24T14:46:00.000-07:00

Our company is on the verge of the formal launch of our online nursing assistant course, in partnership with Oregon Health Care Association. The nursing assistant course is required to become a CNA in Oregon - and, for the first time ever in this state, the OHCA/aQuire course allows the classroom portion of it to be done online. Following the online portion of the course the student completes lab and clinical training at one of 45 participating nursing facilities state-wide. This is by far the largest, most comprehensive nursing assistant course in the state.

We're excited about the potential to train many individuals for this incredibly important work. Already, without any publicity at all, we've gotten dozens of interested individuals who are ready to start today.

Many of them are people who haven't been able to go to a classroom based program because of time or other restrictions. With this new online course, avenues open for them to advance, personally and professionally.

Offering this course online may be one small way we can help with the current nursing shortage. Listen to the comments of some of the individuals who worked hard to find out about this course:

"I am working towards becoming a RN and becoming a CNA is required for most nursing schools."

"I am committed to helping people and also committed to finding a career in the health care field."

"I enjoy working in the medical field. Working hands on offers new experiences daily and a great opportunity to learn. I also get a great personal satisfaction from helping others."

"I am interested in becoming a CNA because I would like to work as an Emergency Room Technician. I believe that the position would give me valuable experience in working as a team with doctors. Eventually, I intend to go to medical school and become a physician."

What an impressive group of individuals, all looking to take the first step in their careers in this field.

What a privilege and an honor to help them achieve their goals, in any way we can.

aQuire Training Prepares to Launch Online CNA course

2008-06-19T16:20:00.000-07:00

After a lot of hard work on the part of all the aQuire Training Solutions' team, along with many of the folks at the Oregon Health Care Association, we are finally preparing to launch the first ever online nursing assistant course in the state of Oregon.

Might not sound like a big deal to you, but it IS a big deal to people in this state. Last year the state legislature passed a new law increasing the ratio of CNAs to residents in nursing facilities here; that ratio increases yet again two more times. The bottom line for residents is better care. For facility managers, however, it could present a nightmare scenario when they can't find enough CNAs to fill the jobs they must fund to meet the new staffing ratio.

At the same time, the number of individuals being certified as nursing assistants in the state has been in a steady decline.

At the intersection of increased demand and reduced supply is a crisis.

With this course, we not only utilized every tool at our disposal to create a course that showcases what online learning can be, but we also, in our partnership with OHCA and over 40 member facilities (where students will complete the lab and clinical aspects of training), are breaking some exciting new ground in creating the ideal blended learning environment.

We've got people clamoring to begin the course as quickly as possible - people who simply couldn't access training without the online portion of this course.

It's pretty exciting for us. We'll keep you posted on the results in the weeks and months to come.

Read the whole press release.

Does Staff Training REALLY Matter? Ask the Sheraton.

2008-06-03T10:50:00.000-07:00

We just returned from the annual ALFA conference in Orlando, full of great contacts and new ideas.

One of the themes that carried through the entire session was the customer service theme - providing consist, "four-star" customer service. The "how-to" was essential: all three key note speakers presented something on this topic, ranging from the Starbucks Way of "Creating the Total Customer Experience" (Joseph Michelli) to Chip Bell's southern humor sharing how to get your customers so excited about your product or service that it consistently impacts your bottom line in a positive way.

The site for the conference, the Gaylord Palms, presented their customer service approach during one of the sessions. For them, it's all about their tag line: Consider it Done. In fact, when you call for assistance with just about anything, that's what you hear: "Consider it done." And it gets done.

During the session that the Gaylord Palms staff presented they emphasized one thing in making this happen: training. They train their "stars" consistently and thoroughly. They consider training, in fact, to be the most important step in everything they do. Trained staff make sure that the service is delivered consistently to every guest, every day.

Industry standards in hospitality run somewhat similar to those in senior care: about a 73% annual overall staff turnover.

Because of the Gaylord Palms' emphasis on training, which trickles down to everything else they do, they've completely reversed the turnover. Their experience is over 70% RETENTION - not turnover.

That's a powerful, bottom-line testimony to the benefits that come when you commit to training. Committing to training is, after all, just one way that you show your ultimate commitment - to the people who labor hard, 24 hours a day, 7 days a week, to deliver your product or service to your clients.

Still a skeptic? Let me tell you a story: my husband, who attended the Palms' presentation, decided to test it. The microscopic screw that holds the arm onto his prescription sunglasses had fallen out that morning. He saved the screw, but had no tiny screwdriver to put it back together. After the presentation, he cornered the speaker to ask her if they had any tool that could help him. The answer? "Consider it done." Within a matter of minutes, the speaker returned to the room with a small travel toolkit, complete with a miniature screwdriver and magnifying glass. (Roger's favorite part of the story is that while the speaker was gone she left her associate there to keep him engaged in conversation, making the wait time seem to vanish.)

Of course, no story is complete without the other perspective. In the hotel where we stayed, the neighboring Sheraton Vistana Resort, our king size bed was made up with a bottom sheet that tucked in only on one side. This just happens to be one of my travel pet peeves - sheets that don't adequately cover the mattress, and stay there, the entire night.

We contacted the customer service staff who said they'd take care of it. I thought, "Well that was simple - it'll be taken care of when we return for the night."

Unfortunately, that night we returned to an undisturbed room - the bed was identical to how we'd left it.

So I picked up the phone. I didn't really think this was a big thing - it should be fixed quickly. Not too worried about it. Three phone calls later I was thinking differently. No one was willing to address the problem. Each person - going three levels up the employee ladder - said the same thing: "We don't have fitted sheets here, I'm sorry. What is on your bed is the best we have."

No one offered to come see the problem, or to fix it in any way. At each stage I patiently explained that I was sure that the hotel had king size sheets; we simply needed one put on our bed.

After doing this three times, I decided that there was only one solution. I asked if someone could simply deliver to our room one flat king size sheet.

Within minutes, I had THREE sheets delivered (they really went the full mile there). I stripped the sheet off my bed, and remade it with the correct size sheet. (The one on the bed was, in fact, marked "Queen.")

This is the first time I've had to make my own bed in a big name hotel - and guess how many people I've already shared this experience with?

My husband has told just as many people about his Gaylord Palms experience, too - and frankly, for my money, I'd rather people were telling the Palms' story if it were my business!

So does training matter? You tell me...but let me tell you another story, if you're still not convinced!

Is Wal-Mart gonna care for YOUR mom?

2008-06-02T15:22:00.000-07:00

Maybe caring for our parents won't be so difficult, but when the time comes that we need help - even a small amount of assistance with cleaning or keeping track of our meds, who will be able to help us?

It's not just the numbers game, either, although that's significant. That's the problem where so many more of us in the baby boomer age group need a little help that there are not enough younger people in the "helper" age group to go around - not by a long, long way.

The other problem is a simple one - it's a matter of money. Last week I heard more than one senior care professional remark about their own communities, "Our buildings are really high-end - I could never afford to live there!"

People all over the US drive cars and live in houses that I couldn't afford, but when it comes to care, will I be able to afford it? Will it be like gasoline and basic health insurance now...rapidly approaching the point of pain? Or will it be even worse - completely out of the financial reach of many of us?

About 47 million Americans now lack health insurance. Health care costs are
rising far faster than general inflation. And health care is on track to consume
25% of U.S. gross domestic product by 2025. That would be up from 16% today and
5% in 1960. Jim Jubak, Health Leaders Media.

Jubak proceeds, a little tongue in cheek perhaps, to suggest that we leave it to Wal-Mart to come up with a solution. Our politicians haven't done such a good job so far, and, sadly, even the current candidates have few genuine solutions in mind. Wal-Mart has not only stepped directly into sales of generic medication, often undercutting a person's co-pay (why pay more in co-pay than you can directly to Wal-Mart?) but Wal-Mart has also led the way in store-based urgent care clinics, charging, again, less than many insured individual's co-pay amount. Read more...

Do you think that when the time comes that senior care is the #1 health care crisis in America, companies like Wal-Mart will be standing around waiting to see what the government proposes to do?

I doubt it. I wonder if we'll start seeing Wal-Mart (or Costco or Target) branded senior living communities - no frills, but basic, good affordable services on a national scale?

They might not be around in time to care for your mom or mine, but who knows what will happen by the time the tail end of the baby-boomers start needing help. Without many strong, persistant voices advocating for affordable care, it will be interesting, indeed.

E-learning at its Very Best

2008-05-13T10:37:00.000-07:00

My staff and I are thoroughly enjoying this journey of learning what makes for the best e-learning experience. We read books, journals, blogs and just about anything else we can get our hands on to help us.

What we’re aiming for is a learning experience, using the technology easily available to us today, that is effective (people remember what they studied and apply it in their work and lives) and enjoyable (people find the e-learning courses engaging, interesting and user-friendly).

What particularly drew me to this was a claim I heard the other day from a local education provider about a course being completely online today. My initial thought was that the provider was doing an excellent job of making this course more widely available – one of the primary advantages of e-learning.

Then I happened to run into one of the instructors, who told me that the e-learning course was simply textbook chapters posted online. The students went to the website, read the chapters, took the test, and – voila’ – learned online!

My first response was that this isn’t e-learning. It’s disseminating text over the web, and testing on it. Students might be learning, but it's not the very best we can do in e-learning.

What if, in the early days of movies, this scenario occurred: People crowding into a theatre to see the latest movie, only to see book pages, projected on the big screen. Wow – what an experience! The book was very entertaining, after all, and the big screen offered a way for people to be entertained using the latest and greatest technology.

Sort of like what we’ve been doing with e-learning.

Even for voracious readers, going to the movies presents a different kind of entertainment experience. A well-done movie impacts our minds and our emotions in such a way that we think about the message over and over – sometimes for years.

It’s the power of images, sounds, stories. It’s a power that can’t be replicated in the printed book – although books can be very powerful tools.

E-learning has the same potential – to touch the mind, the emotions and the beliefs of the learner in a way that is much more profound than simply reading a book. It’s much more than just putting facts on the web and testing over them.

It’s learning to use stories, to use visuals, to create videos – all with the purpose of teaching more effective.

That’s e-learning at its best.

e-Training Making a Difference in Senior Care

2008-05-02T10:26:00.000-07:00

Last week we had a visit from a person who works in a state office on education. He's got a PhD, and specializes in distance education.

I admit it - I was nervous when I began showing him samples of our online courses, both on our website EasyCEU (for licensed nursing home and assisted living administrators, nurses, social workers and other licensed senior care professionals) and on our aQuire Training Solutions website. We showed him samples of all the ways we've built and designed courses to be delivered online.

Our newest course - the one we're most proud of - is the online nursing assistant course. We've just submitted it for approval, and hope to launch it in the state of Oregon within a month or so.

At the end of the presentation we sat back and waited to hear this expert's opinion. We're not distance learning experts, after all (at least we certainly weren't when we began this journey). We're just passionate about training the next generation of individuals who will care for seniors.

We're passionate in a professional way, meaning we've invested millions of hours and dollars into trying to discover the most effective, efficient ways to train new caregivers.

We're passionate in a personal way, too, since we realize that the people receiving the care are our parents, grandparents - one day (in the rapidly approaching future) ourselves.

We believe we're making a difference. We think, maybe a bit too boldly, that our newest nursing assistant course can contribute to a genuine culture change in the way care is provided in the state of Oregon.

There was a moment of silence, and then the expert commented, "I'm tremendously impressed. Your courses are visually interesting, highly interactive and rich in content. You're doing something that absolutely no one else is doing in this area right now. It will make a difference."

It's an incredibly gratifying way to end the week, believing that what you are doing DOES make a difference in senior care today, and will make a difference in the future, too.

It's exciting, too, because we've only just started out on this journey!

Use Your Brain and Your Heart

2008-04-10T10:59:00.000-07:00

Our IT Director wandered into my office the other day and made the general announcement that I send – and receive – the most emails of anyone in the company. While I was feeling a bit smug, my husband reminded everyone that only a few years ago (time goes by fast – it was at least 8 years ago) I refused to use email, telling all my friends and colleagues that if they wanted to talk to me, pick up the @#$%$& phone!

But I digress from the topic I intended to write about, and that’s an April Fool’s email I picked up today - ahhh, that’s how I got to the bit about too many emails – some don’t get read until a week or more has gone by.

It was a post from my very favorite e-learning blogger, Tom Kuhlmann at the Rapid E-Learning Blog. Here’s the link – it’s worth 5 minutes of your time: April Fool’s E-Learning Example.

While it’s a spoof on e-learning tips, one message stuck with me, because I believe this one message alone would change the face of training, especially for senior care staff in assisted living communities, nursing homes and home care settings:

“Use your brains and your heart to make your training smart.” (It’s actually part of a rap that’s on the demo.)

Although in my company we often refer to the flash-card approach to e-learning; that is, the repetition of key concepts through stories, games, quizzes and illustrations, we aren’t really teaching multiplication tables.

We’re teaching people to be compassionate, caring, observant individuals – to notice something that is unusual before it becomes a crisis.

We’re teaching people to be on the lookout for ways to brighten the days of the seniors they work with; to add smiles, hugs, laughter and playfulness to the daily dose of doctor-prescribed medication.

We’re teaching staff to understanding how to create an environment of caring and to avoid anything that might harm a resident, no matter how unintentional.

We’ve got to teach the heart and the mind to truly train people to be the kind of caregivers that we want caring for our mothers – our fathers – someday, ourselves.

Risk Management in Senior Care: the Case for e-Training

2008-04-09T14:40:00.000-07:00

I was talking with a client of ours the other day and she shared a story that I can relate to all too well. She was asking staff for their feedback on the new e-training system that they have been using – just happened to be our system, aQuire Training Solutions.
“Believe it or not,” she said, “I kept hearing comments like this: ‘I learned so many new things’ from my staff. The most eye-opening thing for me was that this is content I’ve been teaching in inservices for years – it’s not really new!”

What Debbie was commenting on – and what I’ve experienced first hand – is that staff don’t remember. They don’t remember what you said during an inservice – or a dozen inservices. Maybe it’s because we tend to schedule inservices on pay-day, and staff could be just a little tiny bit preoccupied with how badly they need that check.

Maybe it’s because staff are either on their way out the door for the day (mentally clocked out), not really checked in yet - or not quite awake (quality training for night staff probably doesn’t happen during their regular sleeping hours).

Whatever the case, it seems like a lot of the time staff just aren’t listening. And in my experience, that’s troubling.

Troubling because training topics are things that staff really need to know. It’s not “hey – here’s a fun idea to do with your family this weekend” kind of stuff. It’s the kind of information and skill development that means the difference between quality care and just eeking by.

It is also the training that makes the difference during survey or when litigation is threatened.

Did you train staff on this? When? Where’s the documentation?

And then when someone asks the employee, “Have you had training on this specific topic?” and the employee says “No – I don’t remember ever being trained on that!”

Your sign-in for the inservice training isn’t going to carry much weight. You can say, “I know we covered that information,” but if your staff doesn’t remember it, and say they have never been trained on it, guess what – you’re in trouble.

And that’s where e-training can save the day. Not only do you have documentation of training, you have the EXACT content that the training included, a test that the employee had to pass to earn a certificate, and validation that the person was tuned in and trained on the topic.

And if you, like most companies, have a blended approach to training – some stuff you still have to cover in inservices or seminars – our newest module, the Training Tracker will let you document that training on the same page as the e-training. One click of the “Print” key and you’ll be able to document full training compliance for every employee.

And if you’re like me, one of the things that keeps you up at night is managing the balancing act of meeting increasingly rigorous licensing requirements and avoiding threatened lawsuits. Lose your balance on either one, and you’ll pay in time, money, and reputation.

Sort of makes implementing an e-training system a no-brainer.

The Ethics of Truth

2008-03-22T12:16:00.000-07:00

The past couple of weeks have been ones in which truth-telling has taken a bath. One of my personal “good guys,” Eliot Spitzer, was found – well, you know where.

And while my local newspaper endorsed Barak Obama in large black editorial typeface, my periodical of choice, Time Magazine, ran its own editorial about why newspapers should never write an endorsement of a candidate (makes them look less objective, was the reasoning).

Then in this week’s Time, a columnist shared his day’s tasks: run, eat, drop off kids, vote for Barak.

It makes me think about an issue of ethics that I’ve believed in for some time: transparency.

I remember precious little else from my undergraduate education, but this one bit of extemporaneous advice from a professor stuck with me and rang true: as people setting ourselves up to help and guide other people, the most honest thing we should do is post, for everyone to see, our own personal guiding beliefs. Then, people who chose to accept our help would know what they were getting into.

It rang true to me then, and it rings true to me today. What guides me, as a person, will deeply affect the advice and assistance I give you.

As an educator, dedicating this phase of my career to training the next generation of senior care providers, my personal beliefs profoundly affect how I craft the learning experience.

My staff has been immersed in the creation of the first online course to train Certified Nursing Assistants in the state of Oregon, a project jointly sponsored by my company, aQuire Training Solutions, and the Oregon Health Care Association.

Part of what every nursing assistant must know to pass the state exam is a set of procedures for providing specific care tasks to individuals; things like transferring from bed to wheelchair, and assisting with a shower.

The state posts these procedures, step by 101-step, on their website. Instructors must teach the steps exactly as the state sets out.

As we were creating learning activities to help students learn these steps easier I felt myself getting more and more agitated – couldn’t figure out why, until I realized – and shouted, “These steps sound like we’re moving pieces of furniture!”

We’re teaching students the steps, but we’re adding in, for every step, a sample quote of what the student might say to the individual as the step is being taken.

We’re not caring for pieces of furniture. We’re caring for individuals – with losses, with needs, with real human lives.

My own beliefs show through in every aspect of this course. I think that the course will be better for it – but that’s for you to judge. My beliefs are pretty much out there for everyone to see…

Watch the movie…you’ll get it!

Life-Saving Support Systems - it's our time to act

2008-02-20T10:11:00.000-08:00

In among all the political news today was a story that caught my eye: the suicide rate of people in my age group – between ages 45 and 54 – has soared in the past five years.

Overall in that age group the suicide rate increased nearly 20%; for women, the increase was 31%. This is in sharp contract to the suicide rates in other age groups, which either increased only slightly (teenagers) or actually decreased (senior adults).

Of course, no one can do a factual study to find out why, but many theories are being discussed. I have my own theory: we’re feeling increasingly more stressed with pressures of being sandwiched between our responsibilities as parents (many of us still have young children, having waited to start our families until our 30s or even our 40s) and our parents, most of whom are living longer – not necessarily independent – lives.

If you google the term “Sandwich Generation” you’ll see with page after page of stories, web sites and blog discussions. This is not an isolated experience – it is nearly universal within this age group.

Of our own personal friends, the vast majority are feeling the pressure. In the past 12 months, three of our closest friends lost a parent. All had increased their visiting, their work load (to help pay for needed services) and their own involvement in their parents’ lives. All had children at home or in college. One was even fighting her own battle with breast cancer at the same time.

Is it any wonder that some people simply say, “Enough!”?

As professionals involved in providing services to seniors, what are we doing to support the people in the middle? What more CAN we do? Support groups often aren’t the answer for people who are already running every day and evening of the week. Virtual support, email support and simply being available to listen may be one of the most significant things we can offer.

Certainly, taking some of the caregiving responsibilities off of the shoulders of maxed out kids can make a tremendous difference.

Silverado Senior Living has been taking this assistance on the road, so to speak, by offering services in the homes of individuals who are not yet ready – may never be ready – to move into a community living environment.

The Assisted Living Federation of America (ALFA) calls this approach “assisted living without walls”.

I can only imagine the relief that the families of those being served must feel.

Another option is the Quiet Care system – one which, when we previewed it in my office a couple of weeks ago, one of my team members immediately said, “I need one of those today!” For individuals trying to focus on work tasks, all the while worrying about a frail parent at home alone, the relief can be immeasurable.

There’s no doubt that the increase in suicides among the “sandwich generation” is a combination of many factors; perhaps we, as a profession of senior care providers, can step up with even more tools to provide solutions.

Elder Abuse 101

2008-01-28T13:06:00.000-08:00

We’ve been working hard in our office on new caregiver online training programs, and one of the focus topics we’re in the middle of is training on abuse and neglect – how to identify it and prevent it, and what to do if you see it happening to someone in your care.

One of the themes that comes out again and again in stories about elder abuse is caregiver exhaustion. The source for this exhaustion is typically short staffing and lack of training. Over and over we read stories of abuse happening in facilities that don’t have enough staff, haven’t screened their new staff enough, or don’t give their employees the training they need to feel confident about their work – leading to more and more job stress.

The job of caring for a vulnerable senior is a stressful job. We can’t afford NOT to screen more carefully, staff workforces fully and train above and beyond the minimum requirements. With the easy, affordability of online training resources, we have no excuses for not solving at least one of these areas that contribute to elder abuse.

If we don’t make these efforts the persons who will be abused may be you loved one or mine. For my part, I’ll do everything I can to make sure that ALL caregivers everywhere have the tools to know what constitutes abuse and neglect, and know what to do if they feel stress or overworked or see a co-worker in that position.

Thanks to a couple of YouTubers for posting videos that help spread the word about elder abuse prevention, and who have given us permission to use their material to help train new caregivers. It does indeed take a village working together to make changes!

E-Learning One Solution to Nursing Shortage

2008-01-16T11:23:00.000-08:00

T & D blog linked to my most recent press release about the adaptability of e-learning to the health care field - an adaptation that seems to me to be long past due. Here's my original comment:

When Parade Magazine highlights the nursing shortage, you know the issue has reached popular concern.

Parade Magazine is the supplement that comes in more than 400 Sunday newspapers and contains celebrity news and interviews as well as popular features.

Recently Parade ran an article titled “What’s Behind the Nurse Shortage?” In the one paragraph article Parade quotes Cheryl Peterson of the American Nurses Association citing the trend toward hiring foreign nurses as a poor solution to the problem.

But why is there a nursing shortage in the first place? Nurses make good pay, have their choice of many types of work environments including hours and shifts, and often receive large pay differentials for working the less desirable hours like evenings, nights and weekends. It seems like a good profession, with a fairly quick timeline between starting nursing school and entering a well-paying, high-prestige medical profession.

Here’s the problem, as identified in Parade: not enough schools, instructors, classrooms and training openings. Applicants are being turned away by the thousands (over 42,000 just last year, according to Parade); meanwhile foreign nationals are being hired to fill critical positions in hospitals, nursing homes and home health agencies, often with less than optimal results.

aQuire Training Solutions (www.aQuireTraining.com ) has begun developing new programs to address this problem, beginning at the most basic level, the Certified Nursing Assistant.

“So much of education is currently defined by hours in a classroom rather than by knowledge and skills developed,” comments Sharon K. Brothers, MSW, President and CEO of aQuire Training Solutions. “As the shortage of nursing staff increases across the country we will need to be much clearer about the real goals of training, and how to be more efficient – and effective – in training more individuals to be skilled nursing professionals,” says Brothers.

Brothers and her staff at aQuire Training Solutions have begun offering online courses to Certified Nursing Assistants and other caregiver staff and are working hard on developing new courses designed to train more nursing professionals.

“We can train an unlimited number of individuals with the reach of the Internet and the technology for training and testing currently available,” asserts Brothers. “There is absolutely no reason that individuals who have a heart for nursing should be turned down because of a lack of classroom space or instructors.”

Brothers believes that learner-led e-learning can be just as effective as classes taught in the traditional setting. E-learning courses are available over the Internet, and don’t need a classroom, set schedule or physical instructors.

“E-learning today involves the student in a participatory, learner-directed style,” says Brothers. “With e-learning, not only is the student unable to sit passively in the back of a classroom, but the student is also controlling his or her learning completely: the pace of learning, the environment, and the flow of the content.”

New approaches to e-learning include the use of games, real-life scenarios and content designed to grab the emotions of the learner.

“Quickly engaging the emotions of the student is especially important in training people in the field of nursing,” says Brothers. “The best nursing assistants and nurses are those who have made the ‘ah-ha’ leap between nursing knowledge and skills, and the feeling that their work makes a real difference in the lives of the people they care for.”

Brothers predicts that e-learning will rapidly grow as a viable alternative to traditional classroom training, especially for nursing professionals who are becoming increasingly in demand in the U.S.’s aging society.

About aQuire Training Solutions is an e-learning solution to the challenges of providing meaningful training – both initial and ongoing – to senior care providers, particularly those with hands on, direct care responsibilities. aQuire Training staff are senior care and education professionals who have developed online training that incorporates games, scenarios and emotional learning to help build a workforce prepared to meet today’s senior care needs and poised for tomorrow’s avalanche of needs. aQuire Training currently offers a variety of courses including compliance courses, skills training for caring for individuals with memory loss and dementia, and general direct care courses. aQuire Training also develops custom courses to meet the needs of senior care professions or provider companies. aQuire Training staff can be reached toll free at 877-843-8374. Sharon K. Brothers can be reached via email at Sharon@aQuireTraining.com.

Learning for Life

2008-01-02T14:55:00.000-08:00

One of the joys of the holidays is having the kids home from college – my own, plus their friends from colleges all over the country who drop by and are good for lengthy philosophical discussions.

Over dinner last night we talked politics and the up-coming primary, and eventually morphed into the college learning experience from three different perspectives.

One daughter was thrilled that none of her classes have more than 12 students. She craves the small group environment and the individualized attention.

Another daughter talked about her joy of learning from classmates and others besides the professor.

A friend shared his experience learning in an auditorium setting with hundreds of other students.

We all agreed, however, that the initial college education, no matter how valuable is only the first step in a process of learning that will last our whole lives.

I shared my own frustration with people who refuse to support college education for youngsters who “don’t even know what they want to do when they finish.”

Coulda been talking about me. Not that I didn’t know what I wanted to do; just that what I’m doing now wasn’t even invented when I graduated from college.

The internet may have existed, but it certainly didn’t exist in my realm. Online learning wasn’t an option, let alone a method to teach people effectively using the power of computers and the internet.

Today, I have the distinct privilege of helping people get their continuing education credits online with our website for senior care administrators, EasyCEU.com. Over and over I hear from our learners that they had no idea online learning could be so interesting, engaging and effective. It’s not unusual for a course evaluation on EasyCEU to end with this comment,

“I learned more from this one online course than from several classroom courses I’ve taken on this subject over the years.”

Music to my ears!

This past year we embarked on a journey to create meaningful, effective learning opportunities for the most important member of the senior care team: the direct care worker. Our aQuire Training Solutions’ e-learning product is specifically designed for these important people.

The caregiver, CNA, housekeeper, food service worker, activity assistant, and all of those other individuals who are our hands, eyes, and hearts “on the floor.”

The ones who provide the daily compassionate attention for the most vulnerable seniors in this country – caring that makes the difference between a good community and the proverbial warehousing.

The ones who, with the right training, tools and support will be a workforce to be proud of. A workforce to make a difference that will affect your family and mine.

A tall order, indeed.

But one that my own drive for life-long learning has equipped me to tackle with a passion and an energy that makes each day at my job an exciting, interesting time.

Can’t wish anything more for my college children and their friends today!

Training for Passion

2007-12-21T11:19:00.000-08:00

In my work I have the privilege of talking with senior care providers all over the country. One theme is constant: there are not, today, enough trained and skilled workers to meet the caregiving needs in senior care.

We all know that today is the easy stuff; it’s tomorrow and the coming years when we enter into the nightmare scenario for staffing. As one Administrator commented at a work group the other day, “Today’s newspaper has statistics about how many of us will live to 100 – what are we going to do, people?”

As I’m listening to people talk, one thing I hear that surprises me just a little is how many new hires don’t complete their initial training or drop out of the workforce very soon after beginning.

I think what’s been missing in some of our early approaches to training is instilling a “spark” – a seed of the passion that the very best senior care workers have. They may not have it during the first weeks or months of their work, but they may develop it over time if they give themselves that opportunity by staying in the field, and learning to love the people in their care.

I know I didn’t have that spark of passion when I first entered the field. In fact, as my parents were both in senior care, I’d been exposed to nursing homes and residential care as a child. I was determined to do anything BUT work with seniors.

I graduated with a social work degree and began working in the Community Mental Health Center in my town, enjoying my work with a variety of individuals and age groups. When our center was awarded a grant to develop mental health outreach programs in the local nursing homes, no one else wanted to do it.

I said, “I’m comfortable in nursing homes – I’ll take the job!” And I found myself, at the age of 22, developing an entirely new program with staff, policies and procedures, and organizational needs with a large group of individuals.

It was a blast. I loved not only the work but also the people. I discovered that I truly loved the residents, and found that I could make a difference in their lives, every single day.

When I headed off to graduate school a year later my career path was fixed: I was working with seniors, focusing on developing quality programs and services to meet their unique needs.

And here I am, 20+ years later, struggling with how to instill that passion in a whole new workforce of young – and not so young – individuals.

My own daughter, newly graduated from college with a passion and skill in creative photography and communication, has been helping us add “ahhaa” moments into each of our courses – moments that are filled with music, visual images, and inspirational messages, designed not to educate the brain, but to touch the heart of the learner.

Because if we don’t touch the hearts of our newest, freshest employees and help them get a glimpse of the emotional rewards that come from caring for seniors, we may be missing out on the perfect opportunity to build a passionate, capable workforce to meet the needs of the coming years, not to mention the very real needs we have today.

It’s About Your Team

2007-11-26T13:58:00.000-08:00

We have a motto at our company, aQuire Training Solutions. We say, repeatedly, that “In senior care, your most valuable asset is not your building, it’s your team.”

We say this based not only on our passionate belief that people make the difference in care, but also on our experience as owners and operators that you can have the most beautiful building in the world but if it is not staffed with people who love their work – and love their residents – it will not be a successful business venture, let alone a valuable contributing force for excellence in senior care.

Not too surprising then, that a company called My InnerView’s recent survey of employees in senior care found that what matters most to senior care employees is having management who cares and listens to them.

This 2006 survey found that, among the 100,000 employees of about 2,000 nursing homes, 45% felt their satisfaction level was “Good” with only 16% feeling it was "Excellent". This appears to be a win, since over 60% of employees apparently are reasonably happy.

If, however, you follow the Disney approach to customer satisfaction, you’re running a pretty dismal show. Disney, according to Fred Lee (If Disney Ran Your Hospital), considers anything less than "Excellent" to be missing the mark.

We’re about to embark on a time in history when our needs for caregivers vastly outnumber our supply of trained and capable individuals. Perhaps this is a time when we, as a profession and as a society, need to be investing far more in building the teams than in building the buildings.

Just a thought.

A Time for Reflection and Gratitude

2007-11-21T17:01:00.000-08:00

Carrie Ermshar, the President of the Tennesee Association of Homes and Services for the Aging graciously allowed me to share her Thanksgiving message with you today. After reading Carrie's message this morning I realized that I could not have said it one bit better, and so in a spirit of true thanksgiving I am honored to share this with you:

The Thanksgiving season has an uncanny way of always sneaking up on us. As we enter into the holiday season, I am inspired to remind us of the significance of our works and spirit.

Call me a traditionalist, but I am one of those souls who refuse to put out a Christmas decoration until Thanksgiving has passed. The reason being, there is a certain peace from taking this time to reflect with gratitude the blessings life has given, but also realize what opportunities lie ahead. Many of these thanks revolve around the work we do every day. The work of improving aging services for those that walked before us. I challenge us each to ask ourselves not what are we thankful, but why are we thankful?

Perhaps it could be that not only are we thankful for the residents that we serve every day, but we are thankful for the joy they bring as they reflect on their lessons of life. Or, perhaps it is the reminder of the power of human touch when we simply give a hand for them to hold. Or, better yet, it could be the complete sense of fulfillment we experience when we see our children interacting with our elders, and together they have laughter and smiles from a simple experience together.

It is also our workforce who provide the inner strength to do life's hardest work. Instead of simply being thankful for them, let us reflect on what they bring us to provide that gratefulness. The stamina it must take for them to do their work day in and day out. The sense of legacy they must possess to continue to care for our most frail while passing stories to future generations. The struggle they must face every day to maintain their own life and family on minimum wages, while continually persevering with a zest for life many have lost. Yes, the workforce we are privileged to work with exemplify the spirit and pride our forefathers gave us so many years ago.

And, then, let us not forget the work that as leaders in this field we are challenged to provide. Personally, I need to thank you for the leadership and inspiration you provide for us to continue to make a difference for our futures. The land of opportunity is ripe for success. The past years have been filled with perseverance on the message to provide options and dollars for the precious care we provide. We are seeing doors open to this message. For that we are thankful. We will carry that opportunity to continue impact for those that come before us. What a privilege we have been given!

Take this time of year to reflect, be still, find inspiration to move forward; and yes, be thankful. We are blessed to be called to serve our field. We are blessed to share a laugh, a tear, a successful message of change. Let us join together in continuing to make a difference.

Tech times at the Senior Citizen Home

2007-11-20T15:46:00.000-08:00

One of the things I’ve enjoyed most in my own personal transition from a senior care provider (through the assisted living communities we owned and operated) to an online senior care skills trainer is getting first hand look at the range of technologies that can help us all live fuller, more independent lives as we grow older.

I was fascinated by a news alert that popped into my mailbox today about a new link to a weather satellite that the Hong Kong Observatory is making available to seniors to help them prepare for “extreme weather”. The news report indicated that 10% more seniors experienced health-related problems when the weather dropped below 12 C (that’s a frigid 54 degrees F) than at usual, balmy temperatures. The story indicated that this data was derived from the number of seniors who first used the Personal Emergency Link before going to the hospital.

With just a few minutes of research I discovered that this Link is an emergency call system available throughout the country designed to contact help in case of a physical or emotional crisis. I was hoping to read that it was state-sponsored, at no charge to elderly residents, but that appears not to be the case.

What is cool about this program is the fact that technology is being widely used, monitored, and responded to (by the government, apparently, as indicated in the news story about the weather information) in an effort to keep seniors healthy and independent.

How else can we apply emerging technologies to senior care, both in home and in care settings? Only our imagination – and our determination to live out long, healthy, independent lives – will answer that question.

50 is the new 30 - of course!

2007-11-19T15:08:00.000-08:00

I loved watching the Today show staff celebrate Ann Curry's 51st birthday this morning - but I loved even more knowing that Ann and I are only a month apart in age.

Ann makes 51 look fabulous - she's healthy, fit and beautiful. She is all the things that make people think that 51 isn't all that old - heck, it isn't really "old" at all, just ask any of us 51-year-olds!

As a part of Ann's birthday tribute other women who had done remarkable things in their 50s were featured.

What a wonderful time in our world's history to be 51! Thanks, Ann, for showing us how to do it in style!

Online Training is Coming of Age

2007-11-16T10:21:00.000-08:00

One of the most interesting professional journeys I’ve been traveling has been learning how to create online courses – my small contribution to the overwhelming need of more well-trained senior care providers – in a way that makes them not just equal to, but much better than classroom education.

I started this journey by studying about teaching in general. It is fascinating to me to learn how educators in past centuries thought that teaching must be done in a one-to-one setting to be truly effective; certainly tutors could only handle just a few pupils at a time. Classrooms were considered a pathetic method to conduct true education.

Of course down the road a pace we know that classrooms are challenging. The brightest students are often bored – and disruptive – while the slower learners can become frustrated – and disruptive.

Translate that to adult learning and you get a room full of people at different skill and knowledge levels, with an instructor doing his or her best to provide each person with something of value. Or maybe just shoving in a video, and leaving the room…

Online training provides an exciting new twist to the journey; one that can utilize the best of technology (a constantly evolving definition) to, in a sense, return to training people one by one, letting the more experienced learners progress quickly, while the slower learner can move at his or her own speed.

But online training must be so much more than producing PowerPoint presentations that have 2 sentences per screen.

It must be more than loading PDFs onto a website, followed by a quiz.

Online training need to show people the “what”, the “why” and the “how”; and then it needs to give people opportunities to learn their own way, using interactive coaching activities.

We can do this quickly and easily with current technology – we simply need to have the focus and the will.

Aging Tsunami Coming

2007-11-15T13:27:00.000-08:00

In September a group of individuals came together for an “Aging Revolution Summit” – a look at how aging services providers will begin to address the coming changes in needs that the aging baby boomers will bring.

According to a story in the FutureAge magazine, the summit was kicked off by Wesley Enhanced Living’s president and CEO Jeff Petty, who said, “As ‘revolutionaries,’ we need not answer traditional questions, but begin questioning traditional answers.”

Keynote speaker David Walker, comptroller general of the US, shared a detailed analysis of coming costs and trends that the seismic demographic shift will bring. (See report.)

Walker notes that just the government liability for Social Security and Medicare benefits alone increased 197% between 2000 and 2006. In his presentation he notes that “GAO’s simulations show that balancing the budget in 2040 could require actions as large as 1) Cutting total federal spending by 60 percent or 2) Raising federal taxes to 2 times today's level.”

Clearly, we have not only a clue, but solid facts about what the future of this country will be with the dramatic increase in the aging population.

As senior care and services providers, our responses will need to be not just “more of the same,” but we will truly need to “question traditional answers” and explore ways to move beyond the current service and delivery method.

One traditional answer that we’ve been working hard to turn on its head is the traditional approach to training. More and more individuals will need to be trained to provide services to seniors in their homes, in assisted living and residential care settings and in skilled care settings.

Fewer and fewer resources will be available to train them. Introducing quality online training can not only increase the number of individuals that can be simultaneously trained, but it can also increase our output of trained individuals.

Once they’re trained, we need to figure out how to keep the goods ones in senior care. We know that ongoing training is a key element, but what other sorts of questions of traditional answers do we need to be asking?

Walker closes his presentation with a statement about the “Five Leadership Attributes that are needed for these Changing and Challenging Times: Courage, Creativity, Integrity, Stewardship and Partnership.”

It is time for real leadership. And that leadership will come through partnership as we work together, creatively, to solve these challenges.

Sandra Day O’Connor’s Love Story

2007-11-14T10:58:00.000-08:00

The O’Connor family shared a unique love story with the world this week.

The story begins as so many heartbreaking family stories start: with a diagnosis of Alzheimer’s disease, and the family’s decision to find an appropriate care setting.

The O’Connor family chose to have John, Supreme Court Justice Sandra Day O’Connor’s husband of more than 50 years, cared for in an assisted living community that specializes in memory care. Justice O’Connor could not provide the care her husband needed herself (although she apparently did bring him to work with her several times before her retirement in 2005). So she chose the best alternative possible – an experience thousands of families face each day.

The beauty of this love story is that the decision, while challenging, has worked for this family – but certainly in a way none of them could have anticipated.

Mr. O’Connor fell in love. He fell for another resident, and, in the words of the family, “became like a teenager in love.”

Here’s the dilemma I find in this story: both the family and the assisted living community have chosen to place increased public awareness over the confidentiality rights of the individual (John and his new friend, in this case) to shine light on a very little known or accepted part of the process of memory loss.

Both John and his new sweetheart are identified and shown on network television. The camera follows them around the building and grounds, holding hands and sitting close to each other.

The family is not only fully aware, but supports the comfort and joy that this new relationship has brought Mr. O’Connor.

I have somewhat mixed feelings about this story. One the one hand, I remember too well incidents in our own communities where a married resident would form an attachment to another resident, and would suddenly “bloom” (like a teenager in love) as he sat next to his new friend, holding hands or with arms entwined.

And the spouse would be stopped at the door while staff members quickly ran back to separate the resident from his new love.

Most of the time this happened because the spouse would demand that her husband (it was invariably a wife who was still functional and independent) be kept away from “that woman.”

Staff nonetheless realized that the resident had a right to companionship of his choosing, too, setting up a very uncomfortable situation for everyone involved.

Then there was the situation of the female resident who was an early onset Alzheimer's patient, physically healthy and robust but mentally very impaired. This woman would literally go bed to bed, varying partners as the whim seemed to strike her. Staff would try desperately to intervene and divert her, but she succeeded in making many male residents very happy before we finally stumbled on a solution: help her bond with just one male resident who was available and eager to have a partner, too.

Throughout this process we had many red-faced conversations with the resident’s daughters, with the families of the participating male residents, and with staff, some of whom were determined to prevent what they considered to be immoral and unacceptable behavior. We had to provide many training sessions for staff, and help them understand that they simply could not force their own moral standards on anyone, especially on residents in their care.

Throughout it all, however, we fiercely protected the privacy of everyone involved. Even for the education of the public, I don’t believe we would have shared this resident’s story.

And that leaves me somewhat ambivalent about the O’Connor family’s decision to share their own story.

While I applaud the openness and acceptance of the family and staff, I’m concerned for the individuals who are on display. Many people with memory loss have moments of clarity – will those moments cause these individuals to become anxious, concerned or fearful about their behavior, perhaps without understanding why?

It is my hope that the love, compassion and understanding of the family and the staff will compensate for the loss of privacy that the individuals are experiencing by making their story a public event. But I can’t help but wonder if this were my husband – or my father – what choice would I make?

Focusing on ALL our Caregivers

2007-11-07T09:57:00.000-08:00

This month - November - is National Family Caregiver Month, according to the Family Caregiver Alliance.

The FCA estimates about 44 million family members are caregivers in the US; over 80% of all caregivers are family members, as opposed to paid caregivers.

That 80% mark is something to pay attention to, however, I think we need to recognize those who have devoted their careers to being paid caregivers. They are the nurses aids, the in-home caregivers and the other people, men and women, who support families in providing hands' on care to those who need it most. Without them many families could not continue to provide care, or would become so exhausted with their caregiving tasks that they themselves would be at risk.

The paid caregivers - the professionals - are the ones who come to work every day at low paying jobs, with little societal respect, to perform the most intimate tasks on people who often hit at them, yell at them, or verbally wish they weren't there.

These are the people that, in the structure of senior care, are at the lowest point on the staff payroll. That often, unfortunately, translates into the lowest position of respect as well.

Let's take this month to celebrate all of these individuals, too. Let's thank those who do this work for their efforts and dedication, and maybe provide them with some support in their own lives (do I hear a rallying call for MORE TRAINING?!).

If you're a family caregiver you know first hand how very hard this job is. You also know the profound gratitude one feels when a dedicated, loving professional chooses to make a difference by being a paid caregiver.

Join me in saying "thanks" this month.

Boom?

2007-11-02T10:22:00.000-07:00

Our local newspaper arrived in the mail yesterday - it comes weekly on Thursdays, and is full of news about our community's kids' sports activities, from pre-school soccer through high school sports.

It's also the vehicle for a monthly insert that has always been titled "Senior Lifestyles."

Yesterday the insert had a new title: "Boom!"

Clearly, we boomers are now the "senior lifestyles" target audience, as all of us are approaching those lovely Medicare years, and some have even arrived. Tellingly, while content inside dealt with issues we face - caring for our parents, figuring out when and how to start drawing Social Security - the full back cover was an ad from a plastic surgery center.

While I’m a little (OK, a LOT) disconcerted about now being both a boomer and a “senior” (I’m not, though – really, I’m not!), it is telling that as WE age, the language will change.

It will change because we’re demanding changes in the way we’re viewed, and in the way we’re treated.

And as senior care professionals, we’d better be tuned into those changes and be ready and prepared to change OUR language of caregiving, too.

Because the language, the expectations and the outcomes will change, whether we’re in the lead, or frantically trying to keep up.