Don't "fall" victim to the flu!

It's October, and while we're enjoying the beauty of fall, we're also thinking ahead a few months and planning for flu season. If you haven't done so already, please consider the benefits of getting vaccinated for the flu. On the HealthMap Vaccine Finder, you'll find an easy-to-use searchable map of all of the locations where flu shots are currently available, with all of the detailed information you need. It also provides information about locations that offer shingles, pneumonia, and several other important vaccines.

Some important information about the 2013-2014 flu season (source: www.cdc.gov):

• Flu season generally peaks in January-February, although seasonal flu activity can run from October through May.
• The Centers for Disease Control recommends a yearly flu vaccine for everyone 6 months of age and older.
• Manufacturers project that they will produce between 135-139 million doses of influenza vaccine for the U.S. during the 2013-2014 season. This year's trivalent vaccine is made from the following three viruses:
• an A/California/7/2009 (H1N1)pdm09-like virus
• an A(H3N2) virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011



Kathleen Sebelius demonstrates
the "vampire" sneeze.

• a B/Massachusetts/2/2012-like virus.
• Epidemics of flu happen every year, and their length, timing, and severity are variable.
• Practice good health habits to stop the spread of germs: Avoid close contact with people who are sick. Stay home when you are sick. Cover your mouth and nose with a tissue when coughing or sneezing, or do so into the inside of your elbow. Wash your hands often, and use an alcohol-based hand rub when soap and water is not available. Avoid touching your eyes, nose, and mouth. Maintain good overall health, by staying physically active, managing stress, drinking plenty of water, and eating nutritious food.
• If you do get sick, there are antiviral medications to treat the flu, which may make the illness milder, help you feel better faster, and may prevent serious complications such as pneumonia.

At Elder Care Guides, we encourage all of the members of our staff to receive an annual flu vaccination, and work with our clients and their health care providers to determine which vaccination(s) are best for them.

Stay healthy!

Medication Management: The Role of the Care Manager

From ensuring medication safety and compliance, to identifying ways to keep medication costs affordable, care managers play an important role when it comes to medication management.

As health care advocates, we work closely with prescribing physicians to communicate important information such as health and functional status, known allergies, and other medications and supplements being taken. In our often fragmented health care system, the care manager can ensure that multiple health care providers are communicating, and working with the same information.

In the home, we ensure that physicians' and pharmacists' orders and special instructions are included in the care plan, providing assistance with medication set-up by the care manager or medication reminders by the in-home caregiver as needed.

And as clinicians, we can spot possible medication-related problems early, detecting potential issues and addressing them with the physician or pharmacy. Our consulting geriatric pharmacist is available to provide expert medication review, and can follow up with providers regarding recommended changes. Should new side-effects or symptoms arise, we can follow up right away, to help prevent serious medication-related problems.

Medicare's Open Enrollment period is fast approaching (October 15 - December 7), and this is another area where care managers provide an invaluable service to our clients. During this annual opportunity for Medicare enrollees to change their health plan and prescription drug coverage for 2014, care managers are available to talk with their clients and their families about their current coverage, and review their options for prescription drug coverage. When necessary, we'll work with local insurance specialists, or bring in our consulting pharmacist for recommendations. With the implementation of the Affordable Care Act and the forthcoming opening of the state's health benefit exchange, Covered California, we're prepared with the information and resources we need to support our clients in making sound decisions about their health insurance coverage.

Birthdays are good for you



This post dedicated to Mrs. M.

Having recently celebrated the 100th birthday of one of our clients, and next week celebrating my own (with a much less impressive number), I'm giving a lot of thought to these tours around the sun, hoping that I'm carrying with me through my own aging process even a fraction of the wisdom that's been passed along to me during my years of work in geriatric care management.

A few months ago, Richard Lederer, a local linguist, writer, and entertainer, posted the following on his Facebook page, in celebration of his 75th birthday. I share it with you today in the spirit of "about-to-be!"

I’m button-burstingly proud to announce today, Sunday, May 26, I turn 75 years of youth. Five years ago, I passed through the portal of my biblical threescore years and ten, and I've reached the point in my life when I have stopped lying about my age. Rather, I brag that I am so full years. I’m no longer a spring chicken; I’m a winter chicken. I’m no longer wet behind the ears; I’m dry behind the ...years. I’m no longer knee high to a grasshopper; I’m sky high above a grasshopper. I’m not a has-been. I’m an about-to-be. Yay! Yippee! Huzzah! Woo-hoo! What a ride!

Some of us try to turn back our life’s odometer. Others of us want people to know why we look this way. We admit that we have bumps and dents and scratches in our finish and the paint job is getting a little dull. And sure, the fenders are too wide to be in style and our seats are sagging. The battery no longer holds a charge, and the headlights have dimmed. The hoses are brittle, and much of the original tire tread is worn away. The transmission stays in low gear and doesn't easily shift to high. We don’t convert our fuel as efficiently as we used to, and climbing any hill is liable to cause sputtering. And whenever we sneeze or cough, our radiator seems to leak.

But you know what? We've traveled many, many miles, and some of the roads weren't paved. Wisdom and laughter are our shock absorbers. We've become classics.

And we’re not alone: Today, 518 million men and women worldwide are 65 or older, including more than one out of every eight people (13.4 percent) in the United States.

The poet Robert Browning wrote, “Grow old along with me! The best is yet to be. The last of life, for which the first was made.” While growing older is mandatory, feeling old is optional. Attitude is ageless. More than two millennia ago, the Greek playwright Sophocles wrote, “One must wait until the evening to see how splendid the day has been.” Only at sunset is the day truly golden. The later the hour of the day, the longer the shadow you cast.

Gentle Reader: You’ll never be younger again than you are right now! You may be over the hill, but that’s better than being under the hill – and it’s not till you’re going downhill that you really pick up speed! Birthdays are good for you: The more of them you have, the longer you live.

There is only one way to live a long life, and that is to age. And there is only one way to age – with a smile. If you are able to laugh at yourself, you’ll never cease to be amused. After all, you’re only old once.

Adapted from The Gift of Age (Marion Street Press)

Caring for our employees in the workplace

Ensuring workplace safety
is a unique challenge for
in-home care providers.

The pending resignation of our mayor here in San Diego has made national headlines of late. It's been the source of many jokes and some public embarrassment, but also provides an opportunity to reflect on the need to protect and care for our employees in their workplaces. The allegations being made against Bob Filner paint the picture of a manager who ran an office filled with fear, intimidation, and harassment. At Elder Care Guides, we are committed to a work environment that is safe, secure, and free of unlawful harassment or discrimination. As an employer of many clinicians and hands-on care providers who work in private homes, we face a unique challenge in ensuring that we’re providing a safe and positive work environment. The Care Manager plays a key role in assessing the home and addressing any potential safety concerns that may put either the client or the caregiver employee at risk. Clients with advanced dementia or serious mental illness occasionally exhibit difficult behaviors, and even a well-trained and experienced caregiver can benefit from the 24/7 availability of the Care Manager, to whom they can reach out for support and guidance.

Our obligations to our employees run far deeper than just providing a safe and secure workplace. We believe that employees who understand and utilize their personal strengths are fundamental to our success, and that their full engagement enhances the services we provide. When we are making a “match” between our caregiver employees and the clients that we serve, we are paying close attention to the strengths and personalities of both. It brings tremendous satisfaction to help a client find that “just right” caregiver, and it’s even more gratifying when we’ve also done the same for our employee.

The Care Management Career Path

A question that I, and many of my care manager colleagues frequently receive: "So, how did you get into this field, anyway?" Unfortunately, care management is a profession about which most of the public is still unaware, and when people learn about our critical role as advocates for disabled adults in the health and long term care systems, I usually get one of two responses: "I wish I'd known about you five years ago when I was caring for my own mother!" or "Sounds like interesting work. What kind of training does it require?"

It's a great question, with a complicated answer. Professional care managers come from a variety of backgrounds, including social work, nursing, gerontology, therapy, and psychology (among others). Professional care managers have several years of experience working with disabled adults in a supervised, clinical setting. And professional care managers are certified through one of four recognized programs.

A certified professional care manager differs from a patient advocate, a senior advisor, a patient navigator, or an elder advocate, designations without the same education, experience, or stringent certification requirements. There are many good people who care deeply about the health and well-being of our elders working in these fields, but effective advocacy through a complicated diagnosis or difficult family dynamics requires more than a kind heart, or some personal experience in caring for a member of one's own family. It requires clinical knowledge, a deep understanding of the health and long term care systems, the ability to maintain an objective perspective, and accountability to a set of professional standards and ethics.
 

Every member of Elder Care Guides'
clinical team is a member of NAPGCM:
Amy Abrams, Jean Alton, Terry Ehlke,
Cassie Farrell, Norman Hannay,
and Susan Valoff

There are many paths that one can take to becoming a professional care manager, and we work in a variety of settings, including private companies and non-profit organizations. The work is challenging and demanding, but individuals who enjoy problem-solving find it very rewarding. Membership in the National Association of Professional Geriatric Care Managers (NAPGCM) is an important first step.

If you or someone you know are interested in learning more about the profession of care management, NAPGCM will be hosting a free informational webinar on Tuesday, October 15th. 
Click here for information and to register.

Nine Years of Service (Part 3 of 3)

This month, our company celebrates nine years in business. As a founding partner of Elder Care Guides, I've enjoyed this opportunity to reflect on how far we've come, and how much we've accomplished for and with our clients. In this final post, I'll recount three more of my favorite memories from my first nine years as a part of this company:

7) Several years ago, in an effort to reconnect a frail and disabled elderly woman to a forgotten passion, one of our care managers helped a client who lived in a skilled nursing facility procure the supplies she would need to take up a unique form of painting she had mastered as a young woman. I will never forget the transformation that this client underwent, as she not only revived her old skills, but in fact taught them to her own art therapist. We arranged an art show at her facility, wherein several of her pieces were displayed and sold. I was so proud of our team, for not only providing for this client's basic care needs, but for helping her connect to this part of herself that she was able to pass along to the next generation.

8) Not long ago, a dear client whose care I had managed for many years passed away, and when I walked into the office the next morning, I was met with hugs from my colleagues, who shared funny memories of him, and joined me in my grief. I loved not only the fact that I was not expected to "be a professional" in that moment, and instead felt free to process the sadness of the personal loss, but I also loved the fact that every member of the Elder Care Guides team actually knew him. In our many years of providing care management and caregiving services for him, everyone on our staff had met him, knew his family, and understood his quirky personality. I'd often spoken of the merits of our team approach, and had never felt it more profoundly than in that moment.

9) Last year, I was elected to the Board of Directors of the National Association of Professional Geriatric Care Managers (NAPGCM), the organization that provides standards of practice and ethics for care managers, promotes certification, and provides continuing education for care managers nationwide. I'm deeply proud of Elder Care Guides' commitment to service and professional leadership with NAPGCM and in our local community.

Cheers to a great first nine! Here's to many more.

Nine Years of Service (Part 2 of 3)

This month, our company celebrates nine years in business. As a founding partner of Elder Care Guides, I've enjoyed this opportunity to reflect on how far we've come, and how much we've accomplished for and with our clients. In this series of posts, I recount nine of my favorite memories from my first nine years as a part of this company:

4) In 2007, Susan Valoff (who was then a colleague working at another local care management agency) and I co-chaired a committee that planned the annual educational conference of the Western Regional Chapter of the National Association of Professional Geriatric Care Managers (NAPGCM). To do so, we enlisted the help of several of our local care manager colleagues, providing many of us with our first opportunities to get to know one another. From this very positive experience of working together, we formed the local unit of NAPGCM, which continues to meet six times per year for professional education and collaboration. I'm deeply proud to work in an industry that is collaborative, rather than competitive, at its core. (Not to mention that just a few years later, Susan would join our team at Elder Care Guides, becoming a partner in the business and the foundation of our great clinical team.)

5) In 2008, we moved from our humble home office beginnings into a beautiful leased office space in Liberty Station. Our office in Historic Building 28 is a set of restored barracks, built when this property was the Naval Training Center (NTC). It was an area of San Diego that is full of historical importance, and personal memories for our clients (many of whom were WWII veterans), and their families.

6) Three years ago, one of our caregiver employees received the award for Outstanding Home Care Service from the California Association of Health Services at Home (CAHSAH). The award is given in Sacramento annually to an individual who is "directly involved in day-to-day care and has consistently provided outstanding service to patients in their homes." An employee of Elder Care Guides since 2004, today she continues to embody our philosophy of client-centered care.

Nine Years of Service (Part 1 of 3)

This month, our company celebrates nine years in business. As a founding partner of Elder Care Guides, I've enjoyed this opportunity to reflect on how far we've come, and how much we've accomplished for and with our clients. In these next few posts, I'll recount nine of my favorite memories from my first nine years as a part of this company:

1) Our first day in business together, I woke up in the morning excited to head over to the home of Norman Hannay (Elder Care Guides' founder and President) to get to work. Full of energy and enthusiasm, I headed outside, only to find that my car wouldn't start. I called Norman, we had a good laugh, and then spent our first couple of hours as business partners getting my car towed to the mechanic. It was a frustrating start, but from the beginning, it was clear that we were creating a place where employees would feel cared for and supported.

2) Receiving our first call. A social worker from a local hospital system called to describe a difficult situation she had on her hands, and to ask if it sounded like an appropriate referral to a geriatric care manager. We served her patient for years, helping to get his dirty apartment cleaned up, finding him a companion caregiver who was a perfect match for his personality and interests, and keeping his long-distance family caregiver connected and informed. We kept Mr. S, who had lived alone all of his life and had resisted assistance, safe and happy in his home for several years, and I still think of him often.

3) Our first company holiday party (in 2004) was just myself, Norman, and my husband -- the three of us sharing a meal together around Norman's dining table. Every year since, I've thought back to this old memory as our company has grown, and note that our holiday gatherings today involve a big, bustling room full of people that I'm very proud to call my colleagues.

The Myth of Independence

The month of July always starts off with a bang, as Americans celebrate the anniversary of our nation's founders having declared our independence from Britain all those years ago. The word "independence" comes up in nearly every conversation that I have with a family, as a professional geriatric care manager. Many of the phone calls and e-mails that we receive from concerned caregivers center around the dilemma of independence: wanting to allow an aging or disabled loved one to retain as much independence as possible, while ensuring their health, safety, and well-being. Sometimes we talk about independence as a living arrangement: "My grandmother is 95 years old, and still lives alone in her own home." Other times we talk about it as a feature of one's personality: "My father would never ask for help with anything." Families frequently see what they describe as "independence" as an obstacle to connecting their loved one with the resources and supports that they need.

As deeply as I understand this dilemma, I often challenge families to re-frame their thinking around the concept of independence. A person who lives alone in a private home without the assistance of a caregiver is not necessarily independent. A person who prefers solitude to socialization is not necessarily independent. And a person who has difficulty asking for - or accepting - help from others, is also not necessarily independent. It is a rare human being who could actually be considered "independent," contrary to our popular myths about ourselves as Americans. Throughout our lives, we rely upon others - our families, the other members of our economy, and society at large - to help us meet most of our basic needs of food, clothing, and shelter. We are, in reality, entirely interdependent upon one another, and this does not change as we age. The ways in which we rely upon those around us certainly change, but the fact of our needing their assistance does not. By shifting the way that we think and talk about dependence, I believe that we can begin to break down the emotional barriers to the giving and receiving of help.

Ten things you might not know about Elder Care Guides

Proud to have been nominated as a top ten finalist in this year's "San Diego's Best" Union-Tribune readers poll, we'd like to share ten things that you might not know about Elder Care Guides, and why we are deserving of your vote as the top In-Home Eldercare Services provider in San Diego County:

1) Independently-owned: We are an independent, locally-owned company, which affords us the freedom to be flexible, creative, and keep our clients at the center of our business at all times.

2) Interdisciplinary team: Our professional team represents a variety of disciplines, including social work, nursing, gerontology, recreation therapy, and counseling. Our collaborative approach to geriatric care management means that each of our clients benefits from the experience, training, and perspective of this well-rounded team.

3) Access to the top professional caregivers: We have a staff of experienced and vetted professional caregiver employees, and are also able to partner with some of the top home care agencies in San Diego as needed in order to find the perfect match of skills, experience, and personality for each of our clients.

4) Leadership: Each member of our clinical team is an actively involved member of the National Association of Professional Geriatric Care Managers (NAPGCM). Our President is a Fellow of the association, our Vice President of Client Services is on the association's Board of Directors, and our Vice President of Clinical Services is the chair of NAPGCM's local unit. We are committed to promoting high standards and ethics for professional care managers across the country.

5) Certification: All of our care managers are either certified, or are certification-eligible and actively working toward the completion of their certificate under the supervision of Susan Valoff, LCSW, our Vice President of Clinical Services. Although certification is voluntary, Elder Care Guides covers the cost of certification for our staff, and believes that there is value for our clients and their families in the ongoing supervision and education that certification requires.

6) On-call system: Our clinical team is available 24-hours per day, 365 days per year, to respond and assist our clients and their families in the event of an emergency. We handle our after-hours on-call system internally, meaning that day or night, when families reach out to Elder Care Guides for assistance, they will reach a professional who is familiar with their individual situation, and ready to respond.

7) Service areas: Elder Care Guides provides comprehensive assessment, care planning, and care management services not only to older adults with physical and cognitive disabilities, but also has the expertise to work with adults with serious mental illness and developmental disabilities. We have been providing care management services to families throughout San Diego County since 2004.

8) CAHSAH certification: Elder Care Guides is a certified home care provider through the California Association of Health Services at Home (CAHSAH), a voluntary certification that demonstrates our commitment to sound business practices that protect the safety and welfare of our clients.

9) BBB accreditation: Accredited members of the Better Business Bureau since 2008, we are proud of our A+ rating.

10) Company culture: For the members of our team, Elder Care Guides is more than a place of employment. It's an opportunity to grow, learn, and be of service while working alongside some of the best professionals in the field. We are dedicated to a company culture that emphasizes professionalism, autonomy, collaboration, and full employee engagement.

**********************

The voting process is simple. CLICK HERE to visit the "Healthy Living" categories of the poll, and go to "In-Home Eldercare Services," where you will find us listed. You'll need to register on the website (it only takes a moment) the first time you vote. You can vote daily between now and July 7th, and to place future votes you need only log on with your email address and password. We appreciate your support, and welcome you to tell friends, family, and colleagues about the contest as well.

If we may answer any further questions about our company or the services that we provide, please feel free to leave them in the "Comments" section below, and we'll be glad to provide further information.

Creating a positive professional culture

Elder Care Guides is seeking a qualified Care Manager to join our team of professionals. This is either a part-time or full-time clinician who will perform assessments, care coordination, care planning, and related care management activities for a caseload of elderly, chronically mentally ill, and/or disabled clients, while ensuring quality and appropriateness of services consistent with Elder Care Guides' mission to create a sense of purpose for all of our clients. For a link to the full position description, please click here.

For the members of our team, Elder Care Guides is more than a place of employment. It’s an opportunity to grow, to learn, and to be of service while working alongside some of the best professionals in the field. We are dedicated to a culture that emphasizes:

• Professionalism. Our staff brings a high level of expertise to their work, and the members of our management team are leaders in the professional community.
• Autonomy. Although employees are given structure and supervision, we encourage the independent working and management styles of our professional team.
• Collaboration. We share in the responsibilities of managing multiple assignments and running a strong company, remaining at all times accountable to one another.
• Engagement. We encourage our employees to identify, understand, and develop their individual strengths, and apply those talents to their daily work.

We believe:

• Employees who understand and utilize their personal strengths are fundamental to our success, and their full engagement enhances the services we provide.
• Professional caregivers who are employed by an agency and work as a team with a geriatric care manager deliver the best outcomes for our clients.
• The standards and ethics of the National Association of Professional Geriatric Care Managers provide a solid foundation for our clinical and business practices.

We’re always looking for people who are committed to our mission to improve the lives of our clients through services that center on the goals of the individual, and which foster a lifelong sense of purpose. We invite you to find out more about us.

Long Term Care Planning: What's Covered, and What Isn't

We were invited to write a series of brief articles for the monthly newsletter of our friends at MDK Insurance Services, describing the continuum of long term care, and how to navigate oneself through it. You can sign up for the newsletter on their website, and each month we provide a copy of the article here as well. Please share the information with someone you know who is thinking ahead about how to plan for (and pay for) their own or a loved one's long term care.

Volume VIII: What's Covered, and What Isn't

In previous issues, we’ve described the various settings in which long term careis provided, often referred to as the “continuum of care.” Many are caught off guard in the midst of a health care crisis by a sudden and surprising lesson inwhich types of care are covered by Medicare or other forms of health insurance, and which require private payment.

The simplest way to understand whether a particular type of care will be covered is generally this: if a physician orders it, it requires the services of a licensed healthcare provider, and its goal is to treat an acute condition, then Medicare or health insurance will cover at least a portion of its cost. If those conditions are not met, then it is not covered.

Care provided within a skilled nursing facility (SNF) is frequently an area of confusion. Up to 100 days of a short-term rehabilitative stay in a SNF while recovering from an acute illness or injury after a hospitalization will in large part be covered by Medicare, but long-term “custodial” care for an individual who requires assistance with daily tasks that cannot be provided within other settings is not, and must be paid for privately. Home health care (licensed nursing or therapy services provided on a short-term basis for rehabilitative purposes) is generally a covered health insurance/Medicare benefit, as is hospice care.

Care provided within residential care facilities, including assisted living apartments, board and care homes, continuing care retirement communities, and residential dementia care, is not covered by Medicare or other health insurance. Non-medical home care services are also not covered; this includes services to assist with activities of daily living such as bathing, toileting, and ambulating, and is often referred to as “custodial” or “private duty” care. Professional services such as those provided by a geriatric care manager or fiduciary require private payment, as do most community-based adult day programs and transportation services. These “non-medical” settings are where the majority of long term care services are provided, so thoughtful planning about how they will be financed is essential.

Next month we’ll wrap up this series with a look at the costs of long term care, and tips for developing a personal plan.

Dehydration in the Elderly: Know the Signs

It's June, almost summer, and a great time to remember how significant of a risk dehydration is for the dear elderly that we care for. A call from a caregiver reporting a very healthy 84 year old's trip to the hospital today reminds us how quickly things can change. Reviewing the basics will increase awareness and support the power of prevention.

According to Jeannete Y. Wick, RPh, who wrote the article" Prevention and Management of Dehydration," the elderly are at greatest risk for dehydration, and those 85-99 years old are six times more likey to be hospitalized for dehydration than people aged 65-69.  Dehydration is fatal in 18% of these cases, not having been addressed early enough. Most importantly, this problem can be prevented. Knowing the signs and having a plan can help prevent this very common problem.

Signs:

• Confusion - Frequently an early sign. Pay attention to even mild cognitive changes.
• Poor skin turgor-  May be difficult to assess, but skind that feels warm and moist may be a good sign.
• Dry mouth
• Changes in vital signs - Usually a lower blood pressure and an increase in pulse.
• Concentrated urine
• Dizziness or fainting

Risk Factors:

• Increased age - The elderly have lower body water content compared to younger people.
• Cognitive impairment - Difficulty remembering when or how much fluid they have had to drink
• Medications - Diuretics, laxatives, blood pressure medications, some demetia medications
• Dysphasia - Difficulty in swallowing
• Decreased ability to sense thirst
• Increase in activities
• Depression
• Change in schedule
• Diarrhea

Prevention strategies for caregivers:

• Make monitoring fluid intake a priority
• Know the signs and symptoms
• Offer water every hour; even when the elder does not say they are thirsty
• Add lemons, strawberries, orange slices, or cucumbers to make water more appealing
• Offer food like, jello, yogurt, melons
• Make water available at all times especially if going on an outing, walk, or running errands
• Pay attention to temperature changes

Water is a basic nutrient of the body and is critical to human life, supporting digestion, the transport and use of nutrients, and the elimination of toxins and waste from the body (Kleiner, 1999). Let us remember to pay attention, and help prevent this big problem in the lives of the elderly.

Celebrating Nurses

 

National Nurses Week started yesterday, an annual celebration that is planned around the birthday of Florence Nightingale (the founder of modern nursing), on May 12th.

A unique strength of Elder Care Guides' geriatric care management services is our interdisciplinary approach to our work. In addition to nursing, our clinical staff represents the fields of social work, marriage and family therapy, public health, geriatric counseling, and nutritional science. While each of our clients develops a relationship of trust with a professional geriatric care manager who coordinates and monitors their care over time, they also benefit from the expertise of our full team. Our approach is a highly collaborative one, with weekly team meetings, close clinical supervision, and ongoing support and consultation. Our 24-hour on-call system is managed internally, so that clients experiencing a crisis receive a response from a professional who is knowledgeable about their specific needs.

Nursing is a critical component of this collaborative approach, and our nurse care manager Susan Bill, RN, brings invaluable expertise and perspective to the Elder Care Guides team. She earned her nursing degree from the University of South Carolina, and is a licensed Registered Nurse in California. A skilled and knowledgeable advocate for her clients, Susan builds relationships with a warm and empathetic approach. National Nurses Week is a good opportunity for us to publicly recognize her talents and skills, which Susan's clients and her families experience for themselves every day.

Long Term Care Planning: Specialty Community-Based Long Term Care

We were invited to write a series of brief articles for the monthly newsletter of our friends at MDK Insurance Services, describing the continuum of long term care, and how to navigate oneself through it. You can sign up for the newsletter on their website, and each month we provide a copy of the article here as well. Please share the information with someone you know who is thinking ahead about how to plan for (and pay for) their own or a loved one's long term care. 

Volume VII: Specialty community-based long term care

Last month’s issue provided an overview of the basic types of long term care facilities. Here we review a few models of specialty care that are available in the community.

There are several types of specialty Skilled Nursing Facilities (SNFs) in California. A Distinct Part/SNF (DP/SNF) is a hospital-based unit, rather than a freestanding facility. Intermediate Care Facilities (ICFs) provide inpatient care to those who need nursing and supportive services, but who don’t require continuous skilled nursing care.

A Continuing Care Retirement Community (CCRC) is a configuration in which Independent Living, Assisted Living, and Skilled Nursing Facility services are provided on one campus. A resident contracts for care regardless of changing needs, usually for their lifetime. Most CCRCs have a large entrance fee, ranging anywhere from $100,000 to $1 million. CCRCs are regulated by California’s Department of Social Services Continuing Care Contracts Branch.

Some residential care facilities offer specialized services for people with dementia. Dementia Care can be provided within a freestanding facility, or as a separate unit within an Assisted Living facility. Staff are trained to work effectively with people with Alzheimer’s and other types of dementia, and activity programs are tailored to the special needs of the residents. Buildings have secured perimeters to prevent unsafe wandering.

Hospice Care provides comfort and support to patients with terminal illness that is not responding to cure-oriented treatment. Hospice may be provided within the home or in a facility setting, with the goal of maximizing quality of life through effective symptom and pain management. Services provided by an interdisciplinary team address the emotional, spiritual, and social impact of the illness upon the patient and their family.

The Cost of Probate

First, let me say that I am not an attorney or a financial planner, but I am curious. I was given a handout at an estate planning group by Kim Ward, a licensed Realtor with Horizon Real Estate in La Mesa, California. This handout provides a brief rundown on the costs of probate, and the purpose of this post is to state briefly some of its main points.

My purpose here is to increase your awareness of the costs of "going through probate."

1. Probate costs are very high. Maximum statutory fees that attorneys can charge for probate, per the California Probate code section 10810, are 4% for the first $100,000, 3% for the next $100,000, 2% of the next $800,000, 1% of the next $9,000,000 and 1/2% of the next $15,000,00. A separate fee is established by the courts for anything over $25,000,000.

2. If executors are part of the probate, both the attorney and executor will receive fees, thereby doubling the costs.

3. The estate's value is determined by the inventory and debts are not included. An example: If a house is appraised at $1,000,000 and it has a mortgage of $800,000 the assets for determining the probate attorney's fee is considered on the $1,000,000.

4. Estates are appraised by probate referees who are appointed by the State Controller. These probate referees also receive a fee based on 0.1% of the assets appraised.

5. It usually takes longer to probate an estate than to administer a trust.

If nothing else, I hope these statements will lead you to contact an attorney to review probate costs and consider the less costly alternative, establishing a TRUST.

November is National Home Care & Hospice Month

Elder Care Guides joins our colleagues in the California Association of Health Services at Home (CAHSAH) in celebrating National Home Care and Hospice Month during the month of November.

"During National Home Care and Hospice month, we take time to honor the thousands of individuals in home care and hospice who, on a daily basis, provide remarkable care in people's homes. Thank you for all that you do."
-- CAHSAH President Joe Hafkenschiel

Every day, Elder Care Guides' geriatric care managers and caregivers are actively engaged in our mission to better the lives of elders living with physical and cognitive impairments, providing services that center on the goals of the individual, and foster within them a lifelong sense of purpose. We see firsthand the impact of our team approach, of finding "the right match" and seeing a client transformed -- whether it is through healthier eating, more physical activity, opportunities to connect socially, or just a hand to hold in the last hours of life.

We're proud of the time, care, and attention to the details that matter most to our clients that our Human Resources department expends in selecting skilled and qualified professional in-home caregiver employees. Day in and day out, they work hard to enhance the quality of our clients' lives, and they have our full support, 24-hours a day, 7 days a week. We take this commitment to a highly professional and well-supported staff very seriously, as they are key to fulfilling our mission.

As such, we strongly support AB-899, the Yamada Home Care Services Act of 2011. This legislation will require California's Department of Social Services to license and regulate home care agencies, holding the agencies responsible for ensuring that their professional caregiver employees are qualified and reputable. For information about this legislation and how to support it, please visit: California's Legislative Information page at: http://www.leginfo.ca.gov/bilinfo.html

Long Term Care Planning: Community-Based Care Settings

We were invited to write a series of brief articles for the monthly newsletter of our friends at MDK Insurance Services, describing the continuum of long term care, and how to navigate oneself through it. You can sign up for the newsletter on their website, and each month we provide a copy of the article here as well. Please share the information with someone you know who is thinking ahead about how to plan for (and pay for) their own or a loved one's long term care.

Volume VI: Community-based care settings

Previous installments of this series have described the resources available to those planning for care at home, and the goal of this issue is to describe the basic options for community-based long term care. Those who choose to move out of a private home and into a "senior living" setting do so for a variety of reasons. For some, it is a financial decision, while for others it is a lifestyle choice - freedom from the day-to-day responsibilities of managing a household, or the opportunity to interact socially with more people on a daily basis.

Independent Living communities are also sometimes referred to as "retirement communities." Some amenities such as communal dining, light housekeeping, transportation services, and planned activities may be available, but no personal care is provided. In these communities, residents must usually be able to ambulate independently.

Residential Care refers to a range of different housing providers that are licensed (in California by the Department of Social Services' Community Care Licensing division) to provide assistance with activities of daily living such as bathing, dressing, and medication management. A Board and Care home is a small residence (usually a single family home) with between six and twelve residents and a small staff of attendants. An Assisted Living facility is a larger community that usually offers several different levels of care and more supportive services.

Skilled Nursing Facilities are sometimes referred to as "nursing homes." They are licensed (in California by the Department of Public Health) to provide skilled nursing and supportive services for those who require assistance with most - or all - of the activities of daily living.

Next month we'll explore some additional specialty community-based residential services that are available, and then we will move on to a discussion of fees and funding sources for each level of care.

Are Your Employees Orange?

We have spoken earlier about the great research done by Chester Elton and Adrian Gostick in The Carrot Principle, a book about employee engagement and the effects of recognition in the workplace. The authors have done it again, this time in The Orange Revolution, which discusses teamwork. The book encompasses what makes a great team, and how an "orange" team, or one with a high sense of unity in a common goal, achieves breakthrough, positive results.

Teams exist in almost every organization, in every arena. The elder care industry is no exception, especially when you consider geriatric care management, and the team it takes to care for an elder in their home. Elton and Gostick found that once an initial level of basic competence is met, there are 5 key factors every team needs in order to achieve "orange" status and be effective:

• Goal Setting (knowing where the team is going)
• Communication (wise use of your voice and ears)
• Trust (believing in others and being trustworthy)
• Accountability (doing what you say you will do)
• Recognition (appreciating others' strengths and contributions)

A geriatric care manager and an organization that employs caregivers to the elderly has a key responsibility to ensure their employees are humming the same tune when it comes to those five factors. Supervisors who set clear goals, encourage and provide detailed communication, build trust, hold team members accountable, and recognize great work will undoubtedly have an engaged team environment built around the client.

Since October brings us lots of orange in pumpkins, Halloween, and harvest colors, I encourage you to survey your employees and client care teams to see if they are engaged and orange, too.

Age of Champions

It's time for another Elder Care Guides movie suggestion! "Age of Champions" is an uplifting story of a group of athletes—a 100-year-old tennis champion, 86-year-old pole vaulter, and a team of basketball grandmothers all chasing gold at the National Senior Games. The film captures the triumphant spirit of these competitors as they tackle the challenges of aging with grace, humor, and optimism. Win or lose, they inspire us to follow our dreams and find purpose at any stage of life.

"Age of Champions" is showing at the San Diego Film Festival this Saturday, October 1st at 12:30pm at the downtown Gaslamp Theatre. Buy your tickets now, and discover how you can build on your strengths, find your purpose, and become a champion too.