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.

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.

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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.

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.

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

Caregiving Comes from the Heart

Elder Care Guides' Human Resources Director Elizabeth Reynolds was recently interviewed on Business Networking Radio. In the interview, Elizabeth touched on some of the characteristics of a great professional caregiver, and the career path for graduates of programs like Newbridge College's Medical Assistant program. In addition to training and professional experience, Elizabeth has an eye for identifying candidates with relevant personal experience providing care to a disabled loved one, and the less-tangibile "heart" qualities that are essential to the services that we provide.

To download an mp3 of the interview (air date 7/20/11), please click here.

For information about opportunities for professional caregivers at Elder Care Guides, please visit the "Career Opportunities" page on our website.

Good News for the Elder Care Industry

The first wave of the Baby Boomers turns 64 this year. It won't be long until they start the biggest retirement exodus this country has ever seen. It's time for companies to prepare, because the Boomers are being replaced by a much smaller generation of unskilled workers. With the unemployment rate close to 10%, it's hard to imagine, but in just 8 short years our country could have as many as four million more jobs than workers to fill them.

So what's the good news for us in the elder care industry? First, the idea of a traditional retirement is outdated. The 60-somethings want to continue to work, and make a difference. They want flexible, creative work that accommodates their lifestyle. I can think of a fabulous profession that meets all that criteria...professional caregiving! Additionally, many of the soon-to-be retirees already have experience, in caring for their aging parents.

As an HR professional, it is my duty to keep on top of up to four generations that are in the current workforce, and understand the needs and traits of each. In the elder care industry, however, the most common generation is the Boomers. Let's inform these new retirees of this growing, purposeful career and help reduce the gap between open jobs and skilled workers.

The Aging Caregiver Workforce

In the elder care industry, most focus on the clients, or the elders, and rightfully so. It is them for whom we care, center our business on, and assist in finding their purpose as they move through their elderhood. But what about the caregivers? At what place in their life journey are they?

Research shows that 22 percent of home care workers, or caregivers, are 55 or older. And that number is expected to grow to 30 percent over the next decade. Traditionally, most companies may be reluctant to hire and older worker for fear they aren't as productive, slower to catch on to new technologies, and could cost the company more in health benefits. Not so in the elder care industry.

Older workers are not only preferred, but sought out as caregivers. The typical older worker not only has experience caring for aging family members, but understands the stresses families are under, has respect for age, and doesn't see age as a disability. Most often, a good match can be found between an older caregiver and an elderly client, because of the greater chance for common interests and hobbies.

Additionally, the caregiving profession is often the perfect fit for an older worker. The flexible hours, the part time hours for those not needing health benefits, and most importantly, it creates a sense of purpose, caring for someone who values their help, something they enjoy doing, and do well.

A Great Time to Be A Caregiver

"The Great Recession," as it's now dubbed, has affected all of us in one way or another. The healthcare industry, especially home care, is expected to grow exponentially over the next decade. Employment statistics show the caregiving profession grew 26% from 1996 to 2006, thanks to aging baby boomers and the 85+ group, which is the fastest growing segment of the population. According to the Bureau of Labor Statistics, caregiving is the second fastest growing occupation in the country, and is projected to grow by 51% between 2006 and 2016. This is due to a multitude of factors, which primarily include the ability to treat and manage many health conditions at home with the help of a professionally trained aide, and elders increasing desire to remain in their homes where they can keep control and independance in their lives.

Caregivers provide a greatly needed relief to family caregivers, a consistant source of companionship to elders, and expert skills assisting with activities of daily living, all combined with a warm, friendly touch. These factors and more make staying at home the most appealing option to elders, vs. relocating to an assisted or skilled nursing facility. These labor statistics further prove that not only is professional caregiving an honored occupation, it is in great need and promises to be a wise career choice for years to come.

You can read more about professional caregiving and the nations employment outlook in the March issue of Caring Magazine.

The Giving and Receiving of Care

On Tuesday afternoon, I made a home visit with a gentleman who has been a client of ours for nearly two years, and who has bonded deeply with his companion caregiver. As he described to me his gratitude for all of her assistance over the time that she's worked with him with tasks like bathing, preparing meals, and accompanying him on daily walks, I perceived his sense that the giving and receiving of care was a one-way street. I turned to his caregiver, and asked her to tell us something about what she has received during the time that she has been working with him. She told us about all of the things she has learned about San Diego from this client (an avid historian), her new appreciation for the beauty of a Protestant religious service (she is Catholic, but attends church with him at his chapel every Sunday), and about how much her English (which is her second language) has improved over the 18 months that they have been working together. Although her English is nearly grammatically perfect, she told him early on in their relationship that she was working to further improve it, and asked for his help when he noticed improper pronunciation or usage. She told us how invaluable she has found his assistance in this regard, how much she appreciates his kind ways of correcting her and teaching her about some of our language's oddities.

This struck me as an important lesson for us all, and brought to light a concept that is well-illuminated by William Thomas, M.D. in What Are Old People For?, his groundbreaking 2004 critique of the American long-term care system. He writes that "... the bulk of the suffering experienced by those confined to long-term care environments is due to the plagues of loneliness, helplessness, and boredom," and calls for a radical transformation in not only the provision of care but our deeply held beliefs about aging. The antidote to helplessness, according to Dr. Thomas, is the opportunity to give as well as to receive care. 

I watched my client's face light up in a huge smile as the caregiver spoke that afternoon, and knew that he was seeing for the first time the positive impact their time working together has had upon her as the care giver, as well as himself as the care receiver. It gave me a chance to reflect on the ways that we as care managers, and all of us who care about an older person, can create opportunities for late-life development. The moments are all around us.

The Caregiving Journey

Announcing a free town hall forum for those providing care to a person with Alzheimer's disease or a related dementia, "The Caregiving Journey: Practical Advice from Experts in the Field." This informational morning session will feature local professionals providing information for caregivers to protect themselves and their loved ones.

Thursday July 30, 2009
8:30 a.m. to 12:30 p.m.
Lake San Marcos Resort Conference Center
1025 La Bonita Drive
San Marcos, CA 92078

Featured speakers:

• Alan Berkowitz, MD (Geriatric psychiatrist)
• Dawn Carnerie-DeStefani, BSW (Social worker and adult day center manager)
• Neil Levine, MD (Internist)
• Scott Stewart (Elder law attorney)

Topics to be covered:

• Overview of the different stages of Alzheimer's disease
• Nutrition and hydration in Alzheimer's disease
• Long term care costs and planning for the future
• Legal decisions following a diagnosis of dementia
• Exploring adult day care centers

To RSVP, call Health Care Group at (858) 565-4424. Three hours of continuing education credit will be offered for professionals through the California Board of Behavioral Sciences and the Board of Registered Nursing.

Health Care Group, Glenner Alzheimer's Family Centers, AARP, and the Southern Caregiver Resource Center are presenting this event, and free adult day care will be offered at the Glenner Alzheimer's Family Center in Encinitas. Call (760) 635-1895 to arrange.

The Culture of Caregiving

The caregiving profession is one that attracts individuals from all types of cultures. One quality they all have in common, however, is their desire to help the elderly in a way only a few can.


One needs to dig deep in the screening process to find out about experience, and the quality of that experience, in order to determine if the candidate would make a good caregiver for your company. Sometimes, the best caregivers won't articulate their experience in a way that portrays their desire and/or ability to do the job. Upon initial judgment, many candidates might be turned away. Once their personal history and background are considered, however, their experience can be more than sufficient to be an outstanding caregiver.


A perfect example of this was when I didn't schedule an interview with a potential caregiver because she told me she didn't have any experience. However, since she was referred by a current, long standing employee, I reconsidered later and invited her for an interview. Upon asking her again, "Do you have any experience caring for an elderly individual?" Her response was, "Well not really. Just my husband who was over 70, had Alzheimer's, and was bed bound for the last 4 years of his life." BINGO! She is now one of our highly respected, dependable caregivers.


Caregiving comes from the heart. If an individual's culture and experience come from the same caring, positive attitude, you can rarely go wrong.

Caregiver Appreciation

The most important customers any company has are its employees. If your employees are given the highest quality customer service (employee relations), benefits and guidance, your company will flourish. This is certainly true in the elder care industry, when the employees are caregivers.

Caregiving is an extremely demanding position, both physically and emotionally. There are many ways in which a company can express appreciation to their caregivers. The most obvious choice is offering benefits, which come in many forms including medical and dental insurance, holiday pay, tuition assistance, educational offerings, and regular performance reviews. Additional appreciation avenues can include soliciting feedback via quality assurance surveys, caregiver appreciation parties, holiday gifts, and sending birthday cards.

An important way Elder Care Guides is showing Caregiver appreciation is through our quarterly newsletter, dedicated solely to our caregivers. Included within the newsletter is an announcement and spotlight on a chosen "Caregiver of the Quarter," one who has gone above and beyond in their work with their client, or employment in general.

A little goes a long way in Caregiver appreciation, and the dividends can come back tenfold. A happy caregiver is not only likely to refer quality prospective Caregivers, but future clients as well. Caregivers who feel valued produce high quality service, which translates directly to your clients and subsequently, their families.