Monday, August 24, 2009

Are Home Health Care Agencies the Next Business "Bubble?"

Ads for Home Health Care agencies are all over the Classifieds sections of local newspapers these days. Not only are these businesses wanting you to hire their caregivers to assist you our your loved one at home, they want YOU to work for them! Suddenly, the market for Certified Nurses' Aides (CNAs) is huge, and training sessions are springing up everywhere to prepare those who wish to enter the workforce in this capacity.

This is good news, right? With so many people out of work, hasn't the boom in this market has come at a great time? The answer is both "Yes" and "No." CNAs can make between $7 and $10 or more an hour, working in nursing homes, assisted living facilities, and private homes. But not everyone is suited for this work. And therein lies one of the "rubs." Working as a nurses' aide is not glamorous, by a long shot. It is hard work, with lots of heavy lifting and sometimes unpleasant duties. While there are situations where CNAs care for delightful patients who are a daily joy, CNAs often clean some big bottoms and deal with every bodily fluid imaginable. Patients who are suffering from dementia may be violent, or at best, unpleasant and unruly. Facilities are notoriously understaffed, so a CNA may be in charge of the care of well over a dozen patients during a shift.

There are those who become CNAs because they truly enjoy the work... and/or, like my niece, they are working toward a nursing degree, and this job is great experience and helps pay the bills. For countless others, this is "just a job." The difference between "just a job" flipping burgers at McDonald's or stocking shelves at Wal-Mart and being a CNA is that CNAs are caring for someone's parents or grandparents. And let's be honest, we all want our loved ones cared for as well as possible. Should we come to a point where we need extra in-home care for Grandma or Poppa... or worse, they require nursing home care... we expect high-quality treatment. So we want CNAs who are working with our loved ones because they WANT to be there and enjoy caring for them... not those who needed a job and this one paid best. And we don't want this care managed by a company that is impersonal and cares more about the "bottom line" than the quality of services rendered.

While there ARE legitimate, well-run, caring businesses opening to provide caregiving services, particularly home health care, this business trend also shows signs of becoming the next "bubble." Our population is aging rapidly, and as baby boomers begin to get their AARP cards and enter the world of senior discounts, Medicare, and retirement villages, all sorts of markets are developing to meet their needs. And high on the list in the years ahead will be services and care that can allow seniors to continue to live in safety and good health within their own homes.

This trend has not escaped the notice of entrepreneurs who see an opportunity to start a new business venture and, hopefully, make a nice chunk of change. So we see Bob leave the real estate company where he was an agent to start a Home Health Care agency. He gets all of the requisite permits and hires a dozen or so CNAs to represent him and actually do the work while he manages the office. Sounds simple enough, right? Maybe... but this situation is ripe with opportunity for misstep.

A person with a good business "sense" and organizational skills may very well be able to surround himself/herself with qualified people who will "make the company look good." But suppose Bob doesn't have a Registered Nurse on staff or the consultation services of other qualified medical personnel. Who will check on the CNAs in the field to ensure that their work is appropriate, caring, and meets standards and guidelines for quality care? Will Bob have the knowledge and skills necessary to comply with all insurance regulations, bill clients fairly, and troubleshoot problems? Will Bob be genuinely concerned with providing quality care for his clients at a fair rate? Or will he charge $25 an hour, pay his aides minimum wage, and pocket the difference? Will the aides who work for Bob be experienced, caring, professional assistants? Or will they view their work as an hourly wage position that requires showing up, doing the least that has to be done, and collecting a paycheck to feed their family?

Do not misunderstand me. I am a huge proponent of home health care. Without this service, my 97-year-old grandmother would have been placed in a nursing home more than a decade ago, and I am quite sure she would not be alive today. Quality home health care is invaluable, and my grandmother has wonderful, caring, professional CNAs who see to her needs several days per week. Her aides work for an agency managed through our county health department, and Medicare pays for their services. Sadly, the aides do not get as much of the hourly rate paid by Medicare as I feel appropriate, but that is another debate completely. My grandmother's care also includes frequent visits by registered nurses who assess her health in-depth, administer necessary injections (B-12, flu, etc.), and notify her doctor when anything seems amiss with her physical well-being.

A private-care franchised Home Health Care company recently opened for business in my community, and all reports indicate that qualified, caring CNAs on staff are providing excellent care to local residents. The fee is $15 an hour. I have no idea how much of that is paid to the caregiver and how much the business pockets, but at such a low hourly rate, neither can be getting rich. But I am happy to hear that those in our community who need this service now have another option.

So what are we to do? When we find ourselves needing home health care... either personally or for a loved one... where do we turn? Here are some questions to ask potential Home Health Care provider companies as a starting point...

  1. How long has the company been in business?
  2. What is the owner/manager's background for operating such a business? Does this person have personal experience with Home Health Care?

  3. Is this person a Certified Nurses' Aide and/or a Registered Nurse? Does the owner/manager have other medical background?
  4. How large is the staff? What are the qualifications of the staff? Is everyone certified? Does the staff include nurses and other medical personnel? Is everyone properly certified and licensed?

  5. What are the rates for services? Are staff members adequately compensated? Is experience and good job performance rewarded?

  6. Are references available? Can current clients be contacted for feedback?

  7. What is the mission statement of the company? Is the goal of the business to service its clients with utmost quality and care, or did this simply seem like a good new business arena to enter?

The Home Health Care business is just one of many that will "ride the bubble" of meeting the needs of an aging population. Others will surely follow... and this is a good thing. But we must be diligent in ensuring that our goods and services are worthy of our hard-earned dollars... and that our needs, and those of our loved ones, are met with care and professionalism. Home Health Care may indeed be a "business bubble," but it appears to be a service that is here to stay. How well these services are delivered will be mandated in large part by the recipients. Over time, we can hope that the cream will rise to the crop, and those wishing to merely make a quick buck will fall by the wayside.

Wednesday, August 12, 2009

All That Is Left...

This is pretty much all that is left of a family dinner that my grandmother prepared last night. She phoned me early afternoon and said she was preparing dinner for my mom and her husband, Lee - did Greg and I want to come? I told her I would check with Greg, and she said, "I don't know what you and your momma will eat (mom is diabetic - I have a corn allergy). I'm fixin' green beans, corn, sweet potatoes and a lemon pie." I asked her if I could bring some chicken, and she said, "Well your momma is bringing ribs. I told her I would just go out and get some ribs, and she said she already had ribs cooked." (How did Mam-ma think she would "go out" and get ribs? Mom says she never mentioned getting them to her... Mom offered to bring ribs, and Mam-ma accepted.)

I called Mam-ma back to tell her we would come for dinner and that I would bring some roasted chicken breasts, and I had checked with my mom, and she said she would take Mam-ma some potatoes to cook (Mam-ma's comment was... "I only have 2 Irish potatoes.") We hung up, and Mam-ma called back ... "You can't eat cornbread, can you?" "No, but that is okay," I assured her, and she said, "Well, now... I'm gonna make a pan of rolls, too." Now, for those of you who make homemade rolls, you know what a process this is! Granted, the more you do it, the faster you become, and Mam-ma has done it for 90 years, probably, but it's the stirring of that stiff dough that gives us trouble... and for someone nearly 97 with limited arm strength, it's a definite challenge - or should be. But as you can see, the results were light, fluffy, melt-in-your-mouth delicious... and she sent the leftovers home with us! Yippee!!!

Call #4 was to ask if my sister and her husband were babysitting grandson Timmy. I told her I didn't think so, and I asked, "Can you not reach them on the phone?" She replied, "Well, no, but I haven't tried... I wondered if they would want to come to supper, too." I told her to call and ask them, but... "do you have enough food?" She said, "Well... I don't know... but if we don't, at least we'll all be together." When we arrived, not only were my sister and her husband there, but my niece Jasmine and baby Timmy were there, too... and we had more than enough!

Such a seemingly simple thing as a family supper... such a day-long chore for the woman who prepared it. Mother and I cleaned the kitchen as Mam-ma tottered in and around us, finding containers for a "dab" of this and a "dab" of that to save as leftovers. I showed her the leftover roasted chicken breasts and broth I had brought and suggested she combine all of the vegetables with the meat and create a stew... a dish she seems to be enjoying of late because she can chew everything in it. The dentist says her jawbones are eroding after years of grinding food with her dentures, and her "teeth" now slip and slide and create blisters on her gums frequently. So she likes soft foods that are easily chewed, and the stew is hearty and nutritious for her. Mam-ma put everything into the refrigerator individually, but hopefully she will make a stew today.

One day I think that my grandmother is declining... and she is... and then I look at all she still does for "96 and a half," and I am amazed and bewildered... and extremely grateful. As she sat and held Timmy in her arms last night - all 15+ pounds of him - and never faltered, I thought, "Her arm strength may still surpass mine!" I was reminded that hard work is good for the body - and the soul - and we must never quit! I probably need to make more rolls... but then, that perpetuates the need for even more "work!"

So it was a good evening. We gathered, we ate, we played with the baby. We were together, and truly, it was enough.

Monday, August 10, 2009

All a Matter of Perspective...

I've been catching up on correspondence with others on the Caregiving forum at keeps me humble and helps me to appreciate the situation I have and how relatively well things are going with my grandmother - at least now. These posts and the genuine problems of others also point out to me that even when things are operating smoothly, my grandmother will somehow find ways to try to create a problem! Maybe she is one of those people who thrives on chaos!

Thursday we were headed down a neighborhood street as we returned from the beauty shop. We passed a tree service crew cutting pine trees in front of a home, and Mam-ma said, "I sure would like to have that cedar tree in my back yard cut. Ricky (my cousin) says someone who knows about electricity and all would have to to it." I reminded her that the tree is really my mother's to deal with, and that her plate was so full right now that I doubted she would consider it. (Mom owns the house in which my grandmother resides.) Then when we got out of the car, she pointed to that pine tree where her outdoor light and flower bed are, and she said, "And that tree needs to be cut down!" I asked why, and she said, "It's dead!" I looked at it, and it is NOT dead... and I told her, and she said, "Well, every time it storms, limbs come out of it." I told her that's just how pine trees do... every limb has green needles on it... it is NOT dead.

Mam-ma was fairly confused Thursday about a few things... she told me she had fixed a gift for a couple who is having a Golden Wedding Anniversary celebration - Bill and Gail - "you know, they are Sis's mother." Sis is actually BILL's mother! But I let that one slide. As I left, I voices talking. I started to get into the car and still I heard voices. I looked around and finally walked back into the garage, and Mam-ma was stepping out her door and talking away. I went back and asked what she was saying, and she said, "I was just wondering what you spent your money on." I realized she was asking about the birthday money she gave me a month ago. I told her "odds and ends... some scrapbooking things I wanted and such." She said, "Well... whatever (her reaction to many things)... I didn't know if you would buy something big with it or what." She gave me $40 and another $20 "for you and Greg to go out to eat." I felt bad that I couldn't tell her something specific I bought with it, and I said, "Hmmm...well...I bought a blouse yesterday, so maybe that was it." She said again, "Well whatever." I guess I should have made a point to tell her SOMETHING that I bought. Forty dollars is a lot of money to her, so it was a big deal.
Maybe I can come up with something to show her that I've bought recently and say it was with my birthday money. I'm getting a thank-you card ready to stick in the mail. I will say this for her... she almost ALWAYS mails us a thank-you card when we give her a gift for her birthday, Christmas, or any other holiday.

Mam-ma had wrapped up a little china cup and saucer from her cabinet for the anniversary party, because they were rimmed in gold and it is the Golden Anniversary. And she had me buy two towels at Wal-Mart today for another shower on the 29th - for the daughter of her church's Minister of Music. We got them all bagged up and ready to go. It tok forever, but Mam-ma hobbled to her spare bedroom and gathered a sack full of gift bag options and another bag filled with tissue paper. In my opinion, little ladies like Mam-ma shouldn't even be concerned with taking a gift, but you know that would never fly! And Mam-ma was adamant that the wedding anniversary bag had to have a gold bow... "because it's the Golden Anniversary." So we got both bags filled, tissued and ribboned, and she was satisfied

Bless her heart... Mam-ma is just declining - no two ways about it. She looked awful when I picked her up, and she said, "I'm havin' this mess (her hair) cut off today." And the hairdresser did give her a short haircut, but it looks very nice. And she had not taken her medicine Wednesday night OR Saturday night. She said Saturday night she got busy with the wedding (and domino party that preceded it!). I admit, I should have thought to remind her to take her meds, since she went from that domino party to the wedding. But I don't know what happened the other night. She had complained almost the whole way to the beauty shop about how she didn't sleep the night before and kept getting up and reading and just didn't know what was wrong. I pointed out it could have been not taking her medicine... that was a Coreg for blood pressure, her Nexium for acid reflux, and her Synthroid for her thyroid. She said, "Well, I"ll take it tonight." I told her to only take the medicine for THIS night... not to try to make up for lost ground!

Mam-ma also had me get bow-tie pasta for her at the store... she said she can no longer roll out her dumplings for chicken and dumplings. My sister told me afterward that you can buy really good frozen dumplings at Wal-Mart. I didn't know that, but I will investigate. (My friend Karen is amazed that she is 97 and has eaten chicken and dumplings all her life. I pointed out she has also cooked with LARD! Longevity is obviously not solely about the diet!) I've made Mam-ma stew a couple of times with bow-ties, and she had never eaten them before, but liked them. She has pretty well NEVER eaten pasta in her life until recently, and she has always said, "I don't like spaghetti." I never even knew her to enjoy macaroni and cheese. But she asked if I thought the bow-ties would work for dumplings, and I told her they would not thicken like dumplings, and she said, "Well, I'll add some flour and water." So I bought her two boxes. I told her if she plans to have leftover chicken and dumplings the next day, don't add too much thickener, because the noodles will absorb liquid overnight. So we will see how this goes. I should be cooking for her more often... I say I am going to, and then "life" happens and I don't, but I must really make a concerted effort to do that.

So now my mom is home from her summer Workamping assignment, and Mam-ma is busy conjuring up things for Mom to do. It started with a funeral over the weekend that Mam-ma called Mom about and mentioned in a forlorn voice that "I should go, but I don't have a way." Mom didn't even know that my grandmother knew the person who had passed, but he was Mom's classmate, and she was going, so she offered to take Mam-ma along. Almost instantly, Mam-ma thought of several reasons she SHOULDN'T go... the heat, the crowd, and more. All she really wanted was to "yank the chain" a bit and make Mom feel like she was neglecting her! She did NOT go to the funeral. And Mom said she was completely miffed when she learned that Mom is going to Branson for a few days this week. Nothing changes for Mam-ma whether Mom is home or away, but she makes a really big deal out of it... I guess it has some "guilt" value!

Sunday at church, our new pastor was asking me what Greg and I do, and I told him that one of the on our list is to care for my 97-year-old grandmother who lives at home alone. He was stunned... "Ninety-seven, and she lives at home alone? I have to go SEE her!" I told him we could arrange that - that she is a hoot - but she attends the Baptist church. (We are Methodist.) He quickly shot back, "I don't care... I still want to meet her." I told him what I meant was that she will try to recruit him for HER church! He laughed and said, "That's fine... I still want to meet her!" So we will do that sometime, and I have no doubt that Mam-ma will ADORE Bro. Tommy. However, it will not score any points for her pastor, Bro. J.R., who is already "on her list" because he doesn't visit her at least once a month! Now, he probably sees her every Sunday at church, but she feels he should take time out from all of his duties to stop in and SIT with her for an hour or so at least once a month. I wonder... has she considered he would have to schedule an appointment between HER other visitors, phone calls and galavanting?!

So today I am praying for those on the Caregiving forum and others who are dealing with extraordinary challenges... like the woman who is trying to manage the care of her three teenage boys AND her 70-something mother who is physically debilitated and in need of daily assistance in order to function on a basic level in her home. I am thinking of those who are sitting in a hospital with an ill or injured family member, uncertain of the future, while their own family struggles to make it through the day back at home. I am thinking of a 50-something grandmother who is caring for her new grandson on the weekends so his mother can work, while she is also managing the care of her husband, who has cancer of the liver. Somehow in the scheme of things, wrapping towels and teacups, making a stew and writing a thank-you card for birthday money don't seem all that important.

Monday, August 3, 2009

Enjoy the Lulls...

We are once again in a "lull" at my house, meaning things are going fairly well for the moment, and I am not complaining! So last week I took advantage of an extra hour to check up on messages in the Caregiving forum to which I belong on If you have never visited this website and investigated some of the forums there, you should do so as soon as possible. Great information - great people and suggestions - a winning combination for all of us! As I read through the messages, I was particularly struck by the post from a woman who is the main caregiver for her 73-year-old mother, who is on oxygen, uses a walker, has arthritis, scoliosis, heart problems, and has been plagued by severe depression and anxiety all of her life. There is a housekeeper, but the daughter is basically trying to manage this woman's care. In addition, she is rearing her own three sons, who are ages 18, 16 and 12. The oldest son has suffered from depression since 4th grade, and the middle son has high functioning autism. AND... she has a job, as well! Feeling better about your situation?

This woman was inquiring on the forums about hiring a CNA for in-home care. Her mother was concerned that there would not be enough work for an aide to spend four hours per day with her. I was still trying to digest that she is only 73 and has such serious problems. My own mother celebrated her 70th birthday this spring just before setting out for a summer of Workamping at an Opera camp and conducting interviews in the area during her spare time for articles to contribute to the half-dozen or better magazines for which she writes. And did I mention that her fourth book has just been published?! So being so debilitated at age 73 blew my mind for a moment... until I remember how debilitated my own maternal grandparents were in their 70s.

I also thought of my mother-in-law who is 83 and has recently taken a train trip to visit her 100-year-old aunt in another state. Additionally, she restored four antique trunks in recent months. And we haven't even gotten to my grandmother, who is "almost 97," as she points out readily. Last week when I visited, she had cooked cornbread, green beans, and a chocolate pie (and we're talking scratch here - no pudding mix for her filling!). So this really made me stop and think about how relative age is... and how easily someone can end up in the "Sandwich Generation" - especially if the health of a parent fails early in life or suddenly. I am truly grateful for my own situation and the relative health and activity level of the seniors in my life!

Saturday, my grandmother played dominoes all afternoon with her "buds" - a group of ladies who are almost all in their nineties. The party was hosted by a sweet little lady who has to be in her eighties at best and suffers from some form of cancer that is steadily taking her life. She is taking chemo treatments and spent the entire week in bed, but she rallied to host this domino party - she said getting ready and preparing snacks and desserts kept her mind off how badly she felt! Mam-ma got home from the party about 4:30 p.m., and I picked her up for the wedding of a young friend of my niece's at 5:30. The bride has been like another great-grand-daughter to Mam-ma, and the family had delegated a special seat for Mam-ma at the wedding and the reception... next to the family. Mam-ma had a ball and when I took her home at 8:30 p.m., she declared,"I'm really not all that tired... all I've done is sit!" I bet she slept like a baby! And speaking of babies, my great-nephew Timmy made his wedding debut Saturday night. The photos are of him with his mother AND his great-great-Mam-ma!!!

Speaking of family... the bride's mother is a single mom who reared this beautiful 19-year-old girl with the help of her parents. Now these parents are facing their own health issues and caring for their two adult sons, both physically and mentally challenged since birth and now in their late 40's or early 50's. Imagine planning a wedding while working nights as an RN and helping your parents care for these men and attend to their own failing health! I am thinking the mother of the bride may be ready for a straight jacket! And I am counting my blessings - aren't you?!