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.

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.

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.

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.

Focusing on ALL our Caregivers

This month - November - is National Family Caregiver Month, according to the Family Caregiver Alliance.

The FCA estimates about 44 million family members are caregivers in the US; over 80% of all caregivers are family members, as opposed to paid caregivers.

That 80% mark is something to pay attention to, however, I think we need to recognize those who have devoted their careers to being paid caregivers. They are the nurses aids, the in-home caregivers and the other people, men and women, who support families in providing hands' on care to those who need it most. Without them many families could not continue to provide care, or would become so exhausted with their caregiving tasks that they themselves would be at risk.

The paid caregivers - the professionals - are the ones who come to work every day at low paying jobs, with little societal respect, to perform the most intimate tasks on people who often hit at them, yell at them, or verbally wish they weren't there.

These are the people that, in the structure of senior care, are at the lowest point on the staff payroll. That often, unfortunately, translates into the lowest position of respect as well.

Let's take this month to celebrate all of these individuals, too. Let's thank those who do this work for their efforts and dedication, and maybe provide them with some support in their own lives (do I hear a rallying call for MORE TRAINING?!).

If you're a family caregiver you know first hand how very hard this job is. You also know the profound gratitude one feels when a dedicated, loving professional chooses to make a difference by being a paid caregiver.

Join me in saying "thanks" this month.

Choices

Here's one advantage to our jumbled system of senior care: we have a lot more choices now. Less than 50 years ago seniors either moved in with family or moved into a nursing home. There were no other options available.

Today, in-home care is readily available in almost every community in the US. Assisted Living has added another level of care to the mix, allowing seniors to live in an independent, residential environment while accessing support services. Granted, the level and type of support varies widely - from state to state and even from building to building - but no longer does a person needing care have to move into a skilled nursing community to receive assistance.

Barbara Quirk, a geriatric nurse practitioner, writes about yet another option that boomers may well choose in the future: shared housing arrangements.

The fact is that it is not a bad idea to consider moving in together with lifelong friends and hire whom you choose for your helpers. This may be a far better option than the traditional assisted living. For starters, you would be with people you know and enjoy, rather than strangers.

My immediate response is, "Yes, but then I'd still have to cook and clean!" I like the idea of someday moving into a senior living community where I simply show up at the dining room when I wish, and leave the day-to-day worries to someone else.

My mom has been living in a cottage in a retirement village now for over 6 months. She was sharing her experience with friends who had come to visit her for the first time - and who were speechless at how friendly everyone there was to them.

"We were just walking down the sidewalk and people would stop to talk. Come to find out, we have friends in common with more than one person living here!"

My mom is happy, has tons of new friends, and says she truly feels like this is now "home" for her.

My friend, on the other hand, receives calls daily from her mom who, recently widowed, is alone and lonely on her countryside home.

“I lied to my mom for the first time yesterday when I told her I was busy and couldn’t go with her on an errand,” she said. “I was simply worn out from daily calls for help – but mostly for companionship.”

Caregiver stress and the medical ramifications are well documented today. This stress affects families who are trying to balance it all, as well as paid caregivers who don’t have access to the training or support that they need to do a demanding, often thankless job.

I like what Barbara Quirk says in her comments about shared housing and other options we have now:

With all of the housing options available today, plus a few that haven't even been thought of, it pays to at least consider what would be acceptable to you.

And, perhaps even more importantly, consider – and discuss - what would be acceptable to your loved ones. Giving that some attention now may take some of the stress off all of us when needs arise in the future.

Mother, daughter, grandmother, granddaughter - trying to do it all

In Dr. Mike Magee's presentation at the recent Center for Aging Services Technology (CAST) conference (of which Eric Dishman, a Principle Research Scientist at Intel, is Chairman) he talks about the coming aging of America as a challenge not just of people living longer, but of the family expanding from 3 generations to 5 or 6. The 3rd generation woman is rapidly becoming the “new” sandwich person – stuck between caregiving issues with her mother AND grandmother; her child AND grandchild.

Wendy, a program manager in our office, is a classic “new” sandwich member. She helps her mother provide care to her grandmother, who fell and broke her hip about 6 months ago and refuses to go into a supportive living community even though she requires around the clock care. Wendy’s mom has quit her own job to help care for grandma; hired caregivers round out the day.

Meanwhile, Wendy has 2 children, one of whom is married with a 3 year old son and another child on the way.

To say that Wendy is busy with family support issues is an understatement. Wendy says her two biggest issues being in the super-squished position are TIME and EMOTIONAL/PHYSICAL ENERGY. Here’s what Wendy has to say about her life today:

Your kids move-out (more or less); you are among the 40+ crowd and life looks GOOD!

Having gotten married at a young age and immediately starting a family this is the first time you don't have the major responsibility of someone else's life. You are cruising along, you take a new job you are excited to be able to - for the first time - throw yourself into a job/career without feeling guilty because you should be home when the kids get home from school or you sneak out of work to make that all-important game. It is essentially a new start, a new beginning and it looks exciting.

Hold it!

I receive a phone call from the "help I've fallen and can't get up" company that monitors my grandmother so she can remain at home independently.

Yup, she's fallen and broken a hip. The cycle begins for full-time in-home care. Because she can afford it, it makes perfect sense to her.

However she lacks the ability to understand the management of such a task. My mom, her daughter (who has never in her life worked a full time job or has ever been in a job where her responsibilities were managing people, medical care, and finances) is now faced with all of them.

Since I have experience in all, she calls me.

If only it were that easy.

Mom has two siblings. I can make suggestions and recommendations based on my experience and my mother understands, agrees and respects my knowledge.

Her siblings cannot get past the fact that I am no longer the snot-nosed little kid who wanted to play in the dirt with boys rather than play Barbie's with the other female cousins.

In their eyes I think I will remain 10 years old forever. I know nothing, and the battle begins.

Now we work at how creative my mother and I can become in her suggestions (which are really mine) and convince the other decision-makers of the right choices.

Then there are the calls: “The caregiver didn't show up - can you help take care of grandma?”

I want to help grandma. I want to help my mom. Sure I can help.

Hold it!

My son, who is a young father, has just gotten a new job. A really good job. They offer over-time on Saturdays!

"Sure would be a great way to get ahead, Mom," he tells me.

His wife already works Saturdays in trade for Mondays off to be able to spend more time with their 2 year-old son.

Here it comes....”Can you baby-sit?”

I want to; I love spending time with my grandson - I want to help my kids "get ahead." Sure I can help.

Hold it!

My daughter calls from college.

"Mom, I'd like to move home for 4 months and go to school near home until next fall. Can you help?"

She is the most independent young woman I know. She doesn't ask for help often. I want to help my daughter; she deserves my help as she has likely been put on the back burner for the last few months. Sure I can help.

Hold it!
Attempt to maintain a marriage through this? Have friends? Throw myself into my job? Nice idea.

I often feel as though there is not even close to enough of me to go around. My mom stops by to have me help complete some paperwork from the physician’s office. We walk into the kitchen where the light is better.

I look up at her – “Wow, Mom, when did you get old? You look really tired,” I think to myself.

It’s 9:15 p.m. and she is just on her way home after a full day of caring for grandma. I immediately think to myself, “I need to help more.”

On Saturday afternoon my son and his wife stop by to pick up their son. My daughter-in-law is 7 months pregnant. I look at them and think to myself, “They are amazing kids; they're doing so well.”

I look into their eyes, both of them, and wonder, “When did you grow up? You look really tired.”

I need to help more.

This is a glimpse of the sandwich generation. I could go on and on but there’s just not enough time...

Who Will Care for Your Mom?

Even though I’ve been in the business of senior care for the past 20 years, it all took a personal turn for me recently.

Last fall, my parents were in an auto accident that left my mother severely injured. After several weeks in the hospital, she was ready to be discharged. With oxygen, IV medications and a three-person transfer requirement, we had no option but to find the best skilled nursing center available to her.

We had a choice of three nursing homes that had contracts with her insurance provider. Having been in the business of long term care for two decades, I called a few of my contacts and picked the best option – I thought.

Over the next two months, I realized on a personal level what I’ve known on a professional level for years: Good training of staff is NOT optional if you want good care – it’s a requirement.

This week, NBC Nightly News is airing a special series on “Trading Places: When kids care for aging parents” (http://www.msnbc.msn.com/id/17121113/). Clearly, I am not alone in realizing that training – of the people caring for MY loved one – is a very personal matter. Over 36 million Americans over age 65 feel this need personally, as do the families of some 5 million Americans over age 85. By the year 2020, over 10 million disabled seniors will present the largest disabled group in the history of this country.

As America’s Baby Boomers age, the system of care will be taxed beyond what we can currently conceive. How will we adequately staff these care settings, let alone train and retain qualified workers?

Who will care for YOUR mom – and mine?

Developing systems that train, motivate, engage and excite the people providing this care will no longer be optional, it will be essential.

We have begun a journey to help create this system; more importantly, we have begun our journey as individuals – and as a company – to work to improve the lot of caregivers throughout this system of care.

Join us. (http://www.aQuireTraining.com)