A Caregiver’s Christmas

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?

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

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

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

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

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

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

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

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

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

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

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?

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

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

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

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

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

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

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

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

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

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

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

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

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Caregiver Shortage to Affect Everyone

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

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

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

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

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

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

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

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

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

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.

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?

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

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

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!