Selecting a Care Center

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

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

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

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

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

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

      

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.

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.

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.

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

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.