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Creating fun for frail seniors

2012-04-27T20:03:29Z

As caregivers we are often so focused on the physical wellness of our clients that it is easy to forget to create fun moments in the client's day. It is a gift to be able to bring laughter and joy to a person's day, and to help them forget about their pain and frailty for a brief moment in time. Do you know what makes your client laugh? How did they used to have fun when they were fit and healthy? What activities have they always enjoyed, listened to or talked about? Even if it is not possible to create the exact same experience, you can bring something similar if you are creative. Stage a sing-a-long to his/her favorite music - get all dressed up and take some photo portraits. Rent or borrow old movies or musicals - whatever your client likes. Play card games or board games - bring out an old family album and have your client record his/her memories for future generations (with their permission of course). All it takes is a little creative thinking and a little knowledge of your client. Give it a try!

Seniors need to shop too!

2012-04-24T18:14:14Z

I seem to be one of those "approachable" people you find in supermarkets - you know, the one that the elderly customer targets for help in reaching that elusive item on the highest (or lowest) shelf. I often wonder what it is about me that singles me out - I am usually so intensely focused on my shopping list (or my 4 year old daughter) that I imagine I would be the last person anyone would ask for assistance. Nevertheless, here I am again reaching for the Quaker oats.
Not that I mind - on the contrary, it makes me wonder what supermarkets are doing to attract and serve their older clients. They seem to be good at luring the youngest members of our society with eye-level candy displays at the check-outs - but what's happening for seniors and those who are less mobile than the rest of us? After all, we all have to shop for groceries.
The luckier seniors have help from family or friends for their weekly shopping, or they employ a licensed caregiving agency like Hearts of Gold Caregivers (Hood River, Oregon) to assist them in these kinds of tasks. But many seniors do not have that luxury, and I wonder how many of them are making do with the things they can reach rather than the things they would like.
Do you know of any supermarkets that make special arrangements for seniors? I would love to hear about them.

Fraud!

2012-03-09T22:15:03Z

I was disturbed to hear on the news last night about an elderly couple whose caregiver systematically defrauded them of around $250K. Caregivers can often be a lifeline for the elderly, and the lines between professionalism and friendship can become blurred. In this case, it seems the caregiver made extra withdrawals from the couple's account, $500 here, $500 there, and it wasn't until the couple's son took over the finances sometime later that this came to light.
So, as a concerned family member or friend, how can you be sure that this doesn't happen to your loved ones?
Though cases like this cast a shadow on the whole caregiving industry, luckily there are steps you can take to limit the risk of this happening to someone you love.
- Firstly, be sure that the caregivers employed work for a licensed agency. Properly licensed agencies must adhere to various recruiting requirements; here at Hearts of Gold Caregivers in Oregon we conduct nationwide criminal background checks and drug screening before placing a caregiver. We also follow up with employment, professional and personal references that a prospective employee gives us, and we require them to complete an online personality-type test that helps us (and them) determine if they have the right profile to be a good caregiver. There are no such requirements for individual caregivers who do not work through an agency.
- Always ask an agency for references or testimonials. Find out if there have been any complaints made and/or upheld against them. If so, what was the nature of the complaint? At Hearts of Gold Caregivers in the Columbia Gorge, we are "Home Care Pulse" certified, meaning that an independent third party surveys a random 10% of our clients (and caregivers) each month to find out if they are satisfied with the services they receive.
- If the caregiver is going to need to purchased things on behalf of the client, you can set up a pre-paid credit card, which makes it easier for the caregiver to buy the things that the client needs (such as groceries), but it sets a monetary limit that cannot be extended. The person with financial responsibility would receive the statement and top up the card as necessary.
- If the elderly client will allow, have a family member or trusted third party set up as the person with financial responsibility on any agreements. If you are the person with financial responsibility, make sure you know about all the accounts your loved ones have, and monitor the statements so you can see what's going on. A really helpful tool available on the internet is mint.com. If you have internet access to bank accounts then mint allows you to hold all the information on one site, and you can categorize expenses. Its an easy way to see if there are any unexpected expenses happening.
- If you can, drop in on your loved ones when the caregiver is working. A reputable agency will follow up regularly with clients and staff to make sure that everything is going well, but it is always a good idea for family members to drop in without notice sometimes to see for themselves.
- make sure that any agency you employ has a policy that prohibits the caregivers from accepting gifts from clients.
- If you have any doubts about a caregiver, for whatever reason, even if you just don't think they are the best fit, you should ask to have that caregiver replaced. A reputable agency should respond positively to such a request.
Remember, the majority of caregivers are law-abiding, honest and truly caring people; but it makes sense to take some simple precautions when inviting a stranger into your loved ones' home.

The dangers of heating pads for the elderly

2012-03-02T19:24:13Z

I want to make people aware of the dangers of using heating pads with the elderly. Often the elderly clients of Hearts of Gold Caregivers (serving Hood River, The Dalles, White Salmon and all surrounding areas in the Columbia River Gorge) suffer from aches and pains that are relieved by heat, and they often ask caregivers to switch on their heating pad for them. Whilst heating pads may seem to be a good answer, there are risks involved if they are not used correctly.

The most obvious danger is in the condition of the pad itself. Make sure that the wiring is not frayed or damaged, and if the pad is old consider replacing it with a new one. Always keep the protective cover on the pad, and never sit or lie on it or use safety pins to keep it in place.

Length of exposure is also a risk factor, especially for the elderly, whose skin is much frailer. Even at low temperatures, extended use of a heating pad can cause problems, including severe burns. Anyone with a medical condition or history that includes diabetes or stroke should be especially careful. If in doubt, check with your doctor whether a heating pad is a good idea for you.

Other options for heat therapy include gel or wheat packs that can be microwaved (but they can get very hot, be careful), and the good old fashioned hot-water bottle.

If an area is bruised or swelling, apply a pack of ice (in a zip-lock bag and wrapped with a cloth), or a bag of frozen peas wrapped in a cloth.

See www.ehow.com for more information about the dangers of heating pads.

Do I have what it takes to be a caregiver?

2012-02-28T00:49:07Z

All kinds of people make great caregivers. At Hearts of Gold Caregivers, we look at an applicants life experiences as well as their work experiences. You don't have to be a qualified CNA or nurse to be a caregiver - but you do have to have genuine compassion, patience, common sense in abundance, and be trainable. (We do, of course, carry out thorough background and drugs screening tests before hiring anyone).

We are looking for people who genuinely care about the elderly and want to be part of making their lives easier - what we are NOT looking for is people who just need a job. The more we do this work the more understanding we have of what qualities the right person must have. A "qualified" caregiver will not automatically get the job over a "non-qualified" caregiver, if we don't think that the qualified applicant has the right heart for the job.

Our office in Hood River, Oregon is accepting applications right now. So, if you have spare time that you would like to spend assisting the elderly in our community to live a little easier, why not apply? If you have what it takes, we will train you. Call 541-387-0207 for an application form or to learn more about what being a caregiver is like. Look out for our periodic job fairs too, held in Hood River and The Dalles.

Guardianship/conservatorship

2012-02-24T21:14:40Z

In Oregon, as in many states, there are "Client rights" that any in-home care agency must abide by. They are essential, of course, but there are grey areas that family members need to know about.
Supposing you live out of state and want to arrange care for your elderly mother. You contact a local agency and have them arrange to do an assessment. At that point, your mother makes it quite clear that she does not want any care; she is managing fine and the last thing she wants is a stranger coming into her home to "take care" of her. That is perfectly understandable - but what happens if the determination from the home care assessment is that your mom really needs assistance? What then? Well, unfortunately, there is not much you can do about it. If your mother is still in charge of her finances and medical care, she has the legal right to direct services, accept or refuse services as she sees fit.
At Hearts of Gold caregivers we see this situation quite often. An elderly person is in dire need of help - usually when the call comes the need is urgent. But when it comes to it, the person flatly refuses to engage the services of an in-home care agency. If we have serious concerns about the safety of an elderly person in this position, it would have to be reported to adult protective services so that they could conduct an evaluation.
There is no easy answer to this situation. Ideally a family member should seek to have guardianship/conservatorship, which would give them the legal right to make decisions on behalf of the elderly person. This is easier when the elderly relative is on board - it can be arranged through the courts if necessary, but that can be a drawn out and emotionally draining process.
The key is to begin open discussions with your parents while they are still in a good position and able to manage their affairs.
As a foot note, many people believe that they have the power to make health decisions on behalf of their relatives if they have a power of attorney. Be careful though - a financial power of attorney does not give the holder the right to direct medical care.

Caring from a distance

2012-02-22T00:58:54Z

Often, family members find themselves having to deal with a parent's deteriorating health from a distance. So, how do you do that, especially when you have no idea of what your loved one might need? Independence is the key. A geriatric care manager specializes in assessing an elder persons needs and making recommendations for their health, finances and legal needs. As a licensed in-home care agency we are more than happy to evaluate your loved one for in-home care, but sometimes the bigger picture needs to be addressed to. In these cases we will quite often advise a geriatric care manager be brought in. In the Hood River area we recommend "Age with G.R.A.C.E".

go to www.caremanager.org to find a qualified geriatric care manager in your loved one's area.

New Washington state training requirements

2012-02-15T18:41:43Z

From January 2012, there are new requirements for training caregivers who work in Washington state. In summary, caregivers who are not exempt (e.g. certified nursing aides) will now have to have 75 hours of training within a few months of working with clients. It is a good idea for caregivers to have training. There is a huge responsibility in placing caregivers in an elderly person's home, where supervision is minimal by the nature of the job. It is essential that caregivers have the skills as well as the moral strength and character to provide such a needed service to the elderly. However, in my opinion this legislation could have some adverse effects.

Firstly, although 75 total hours training is required, only 5 hours have to be completed before a caregiver can be placed with a client (the remainder has to be completed within 120 days). If the aim of this legislation is to protect clients, then it seems to me that caregivers should have much more than 5 hours of basic training before being allowed to work, unsupervised, with their clients.

Training is not available on-line, but has to be done through recognized training centers throughout the state. In our case, this would mean sending our staff about 70 miles for training (from Hood River to Vancouver, the nearest training center), which would probably entail overnight accommodation as well as payment for the training, travel time and mileage. Training centers do not all offer the same courses, so staff may well have to go to different centers to get all the required training.

All this adds up to increased cost of service to clients, since companies will have to pass on the increased cost of employment. Even if agencies decide to employ only certified staff who are exempt from the training requirements, presumably they will demand a higher salary than a non-certified employee, and again, this will all equate to a higher cost for the client.

For some agencies all of this may be just too much, and they may decide to pull out of Washington altogether.

In the meantime, private, individual caregivers remain exempt from any of this legislation. They can charge a lot less than an agency (the client often does not realize that he or she is responsible for employment taxes, insurance etc just like any other employer), and they are unregulated. There are a lot of very good, private caregivers out there; but there are also people who are unscrupulous and see working with the elderly as an easy way to make some money. Only yesterday, we were approached by a gentleman whose mother had been befriended by a seemingly caring lady, who ultimately defrauded her of a large sum of money.

In summary, the worst case scenario is going to be a proliferation of unskilled individuals working as caregivers, which I am sure is not the aim of this legislation. When people have to have services from an agency, for instance if the care is being paid for by a long-term care insurance company, the costs are going to be much higher and this will impact on the amount of care that they can afford. All this does not add up to a better deal for the client.

For our part, we have looked closely at the training and credentials of our caregivers working in Washington state and intend to comply with the requirements. But we will have to consider carefully taking on any new clients, or caregivers, from Washington state.

These are my views based on my understanding of the legislation, which may be lacking. I welcome constructive feedback.

Home Care, Home Health, Hospice - what's the difference?

2012-02-14T16:27:13Z

What is Home Care? Is it the same as Home Health? Hospice? How does Home Care work, and how does it relate to Home Health and Hospice?

What is Home Care exactly?

Home Care is a service that provides the client with companionship and assistance with day to day activities. Typical services include: light housekeeping and laundry, planning and preparing nutritious meals, helping the client to take exercise, grocery shopping, incidental transportation, assistance with bathing and dressing. Care is provided on a visiting basis wherever the client lives. Home Care is a good option when a client can no longer live alone effectively but is not ready to move to an assisted living facility. Think of it this way – home care is like having the benefits of assisted living brought to the client’s own home, tailored to his/her needs and his/her schedule so they get just the care they want when they want it. Home Care is not covered by Medicare or Medicaid, but may be covered by a client’s veteran’s benefits or long-term care insurance policy, especially when the alternative is expensive assisted living.

How does Home Care differ from Home Health?

Home Health agencies provide skilled nursing services and at least one of the following therapeutic services: Physical therapy; Occupational therapy; Speech therapy; Home Health aide services. As with home care, services are provided on a visiting basis, generally in a client’s own home or in a temporary residence. Visits by Home Health are generally short and intended to provide brief treatments or care. Home Care, on the other hand, does not normally cover medical services, and the emphasis is on providing companionship and care on an ongoing basis. Both types of care are very necessary and complement each other.

How does Home Care work in a Hospice situation?

Hospice organizations can provide acute, respite and Home Care for a client in the final stages of life, as well as bereavement services and counseling for family members. They often do not have the resources, however, to dedicate a large amount of time to each patient, and an external Home Care agency can bridge that gap.

Home Care can be accessed on its own or in concert with Home Health or Hospice services. Caregiving services can be very flexible and can be provided from as little as 2 hours per visit. Overnight shifts or even 24/7 care are available if needed.

Choosing an in-home caregiver

2012-02-13T22:46:18Z

When you decide to bring a caregiver into your home to care for you or your loved ones, it can be a daunting task to pick the right person. As well as the obvious criteria, such as cost, you will have to weigh up whether this person is going to be a good fit, and whether they have the necessary skills and common sense to give you the confidence to leave them in charge for a period of time.

If you choose to interview a number of people (which is a good idea), its a good idea to have a list of questions to ask. You should ask the same questions of everyone, otherwise you are not judging "apples with apples". Interviewing can be a minefield, however, as there are a lot of questions that you cannot legally ask an applicant. A google search on 'acceptable interview questions" is a good start. Remember to ask situation type questions, which do not have a yes/no answer. Such questions may start "what would you do if....." or "what would you do in this situation....". You can then ask questions that are specific to your situation, to get an idea of how this person would react and deal with an event that may occur.

It is important to know that the person you bring into your home does not present any risks to you or your loved one, so it is important to carry out background checks and drugs screening tests. You will need to get the applicant's permission to follow up on references - again, have standard questions that you ask every referee. Be aware that most employers will not divulge a lot of information - it may just be limited to the employment dates. A good question to ask is "is this person eligible for rehire?"

Once you decide on the right person, be sure to put together an agreement or contract so there is no confusion about what the person is going to be paid, and how often. Try and nail down all the details as much as possible - is there a travel allowance? Is there time off for meal times? Paid holiday?

Finally, be aware that as an employer (which is what you are if you hire a private caregiver), you are responsible for the employees taxes and insurance. Insurance is a very big issue - if the caregiver falls or otherwise hurts him or herself whilst in your home, you could be responsible for costs of treatment or even lost wages.

If you are feeling that there is a lot involved here, then you are right. It can be a minefield to hire a private caregiver - although there is no doubt that it can work. The benefits are that it is a cheap option - and if you find the right person, it can be a great relationship. But quite frequently things do not turn out as well as hoped, and things can go wrong, leaving you feeling vulnerable.

Luckily, there is another option, and that is hiring an in-home care agency to provide your in-home care needs. A reputable agency will carry out all the interviewing and background checks that are required, including drugs screening, and will make sure that the caregiver is insured to work in your home. they should work hard to make sure that the caregiver is a good fit for your situation - and if it isn't, they should provide a replacement. You have a contract with the agency rather than the caregiver, so you never have to talk about money with the caregiver. There is also ongoing training and supervision, to make sure that the caregiver is doing what they are supposed to do. Make sure that the agency is licensed in your state, and has a good reputation. Do not be afraid to ask for references or testimonials, and take note of what other people might be saying about the agency. Make a point of meeting the owners or managers - if you feel comfortable with them then you will feel more confident with the staff that they send. Also, if you have long term care insurance, most companies will only accept care that is provided through a licensed agency.

The downside is that care is more expensive through an agency; but you do not have the burden and responsibility of being an employer.

More on long-term care insurance

2012-02-13T21:36:38Z

When you choose a long-term care policy, your premiums are based on some decision that you make about the care you want. For instance, you will probably be able to set the elimination period to end after 20, 30, 90 or even 120 days - or may be able to choose a zero day elimination period. The longer the elimination period, the cheaper the rates will be - but you have to remember that you are responsible for covering the days of service before the insurance kicks in. Often times, when policies were taken out a long time ago, the client has forgotten the fine print - and it can come as a shock when they have to pay for services for a period of time before the insurance company picks up the bill. Many people actually cannot afford to do that - and so they never take advantage of their policies.

Also, you need to be clear about what will happen when you make a claim. Will your monthly payments stop automatically, or will you still have to make them while you are receiving care?

Another fine print item is the duration of care. There is usually a maximum term allowed under the policy - a cap if you like - so that the benefits may be used up and you still need the same, if not more, care.

One thing that can catch people out is the daily amount benefit in their policies. You may have a policy that entitles you to up to $100 per day - but that does not mean that you will automatically get $100 per day as soon as you need help. Like home insurance, there is often a "loss adjuster" involved, who takes a look at the Plan of Care, and sometimes doctor's notes, and decides how much the company will pay per day. They will let you know in writing how much that will be, but communication from insurance companies can be slow and you may have already engaged services at the full rate. You will then be responsible for anything that the insurance company does not pay for.

If your needs change, you will typically need a re-assessment by the in-home care company to be submitted to the insurance company for approval.

It is a good idea to sign an "assignment of benefits" form as soon as you decide to have a home care agency work for you. Your long term insurance company will have their own form, but you can usually also use the company's form also. An assignment of benefits form will allow the in-home care company to invoice the insurance company on your behalf, and receive payments for their services directly. Alternatively, you can have the insurance company make payments to you instead - but you must remember to forward these on to the company that provided your services. In either case, you will be personally responsible for any services provided that are not covered by the insurance company. And that could be significant - if bathing assistance is a required ADL on your care plan, and you decline a bath, you will be responsible for the cost of that whole visit if the insurance company does not pay.

So, in conclusion, if you expect a long-term care policy to cover you for in-home care services, make sure you know exactly what the policy covers. Any reputable in-home care agency should be able to help you with reviewing your policy as part of their service.

Long term care insurance - the fine print

2012-02-09T21:06:28Z

Here at Hearts of Gold Caregivers we regularly work with clients who have long term care insurance. Often, policies were initiated many years ago, and the all important policy document long since filed and forgotten. However, the policy is really the starting point for us in assisting the client to have their in-home care paid by their insurance.

The first thing to note is that all policies are different, and all insurance companies are different, but there are some common threads.

Typically, the policy will include an "elimination period". That means that the client is responsible to pay the first days of service themselves. A common elimination period is 30 days. It is important for the client to check with their insurance company as to the elimination period, and also what qualifies. For instance, you may have a policy that covers 3 hours a day - but you may not have to have 3 hours of care per day during the elimination period. That can save you money.

Also, the type of in-home care that you need is important. Most policies will only cover you when you need assistance with "activities of daily living" (ADL's). There can be subtle differences between companies on what counts as an ADL but most include bathing, continence, toileting, eating, transferring (e.g. between a bed and wheelchair) and dressing. Further, the policy will require the policy holder to need help with a given number of ADLs per visit. We usually see companies requiring 2 or 3 ADLs.

So, how do you know if your needs qualify under your policy? If you are employing an in-home care agency, they should come and do an in-depth assessment of your needs. This could take between 2 and 3 hours, and should be free. From there the agency should draw up a Care Plan based on the assessment, that stipulates exactly what is needed each time a caregiver visits. The Care Plan should be submitted to the insurance company with your claim - any reputable in-home care agency will do this for you, and liaise with the company, if you have long term care insurance.

Next time, we will talk about other things that you need to be aware of when considering if your long term care policy will cover in-home care services.

Older folks are just like the rest of us - only older

2011-06-22T20:34:34Z

I don't know about you, but I dread the thought of relocating to a new home. Sorting through all of my stuff, packing it, selling it, giving it away or throwing it away would take days… weeks. The longer I live in one spot the more stuff I accumulate and the deeper I find myself "dug-in". I have lost track of the number of times I have had to pack and move. To be sure, I do not look forward to the next time I have to move.

I think most people feel the same way. Older folks are no different. Many of our clients have been living in the same home for 20 – 40 – 60 years or more. And at their age, with all the history that they have enjoyed in their home, there is no way that they are going to pull-roots and go live in some “home”. Unfortunately, this is just what happens so often when older people reach a point in their lives when they struggle to properly care for their home or themselves. Well meaning family, friends, senior service organizations, etc. will place older people into foster homes, assisted living or nursing care homes to keep them safe, healthy and hopefully – eventually – happy.

Home care is a relatively new option that many people are still unaware of when it comes to providing care for seniors. Enrolling a home care agency that provides caregivers who can provide tailored care for an elderly person is often the easiest, most cost effective solution to caring for seniors. The best part is, the service will enable them to maintain their independence and in their own home for as long as possible. And that’s what we’re all about.

Welcome to Our New Blog Site

2010-11-09T13:41:00Z

The time has come for us to upgrade our website by adding a blog. There is a lot of information out there to help seniors and the families of seniors. We are committed to bring some of the more relevant information to you through this blog. We hope you enjoy our blog and invite you to share your comments with us.
Best Wishes

Welcome

2010-11-08T05:25:43Z

Welcome to my blog. Please check back soon for new entries.