Monday, December 21, 2009

Christmas Treasures

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.

Tuesday, December 8, 2009

The true meaning of Christmas

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.

Tuesday, July 21, 2009

A Fair Wage for Caregivers

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.

Tuesday, June 30, 2009

Of caregiving and budgets

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.

Tuesday, June 23, 2009

Join the healthcare debate

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.

Thursday, June 18, 2009

Managing the Growth of Home Care Companies

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.

Tuesday, June 9, 2009

Caregiver training essential

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!

Tuesday, June 2, 2009

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

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."

Tuesday, May 19, 2009

The high cost of caregiving

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.

Wednesday, May 13, 2009

Boomers and technology

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.

Wednesday, May 6, 2009

May focus on older Americans

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.

Wednesday, April 29, 2009

Need for qualified eldercare outpacing trained, available caregivers

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.

Tuesday, April 21, 2009

Certified Personal Care Aides offer advantages to consumer and providers

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.

Wednesday, April 15, 2009

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

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.

Wednesday, April 8, 2009

THAT’S my caregiver?

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.”

Thursday, April 2, 2009

Careers in caring: investing in ourselves builds human capital

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.

Tuesday, March 24, 2009

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

“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.

Tuesday, March 17, 2009

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

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.

Tuesday, March 10, 2009

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

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.

Tuesday, February 24, 2009

Certification offers hiring advantage to unemployed

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?

Wednesday, February 18, 2009

Caregiving hits sandwich generation hard

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.

Wednesday, February 11, 2009

Training for the healthcare future needs today

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.

Tuesday, January 27, 2009

The risk of wandering in Alzheimer's

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.

Wednesday, January 21, 2009

Senior care providers contributing to the change

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!”

Friday, January 16, 2009

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

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 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.

Monday, January 12, 2009

Aging and healthcare: an impending crisis

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.

Wednesday, January 7, 2009

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

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.