One Step at a Time...

It's been an interesting two weeks with my family.  Last week, we were keeping Timothy, and he was fussy.  We think it was a combination of teething and some booster shots he had gotten.  But he ran a low-grade fever and slept restlessly, then he would be happy for a few minutes before napping again - mostly in our laps.  I left him with Greg to go and do my grandmother's errands on Friday afternoon.

Before I even opened her back door, I smelled gas. When I went in her kitchen, one of her burners was turned on, but not lit. She said, "Oh, I'm sorry." I told her not to apologize, but we have to be careful about those burners! I ran the exhaust fan some and turned on all four burners to try to burn any excess gas that might be floating around the stove... don't know it that's the right thing to do, but it seemed right.

I tried to talk to Mam-ma about our joining our new Community Center, and she said, "Well, I really need to see it first." I asked - had she and Ruby not been out there to look it over? No, Ruby has... she's already taking classes. I explained to Mam-ma that it's $10 a month, with a 3-month minimum, but she can well afford $30 a month. HOWEVER, those classes Ruby takes are extra... another $10 a month. I told her, "For $10 a month, you can walk on the track and swim in the pool. You could also play racquetball and basketball, but I don't see you doing that." She laughed. She said, "What I think I need is that pool. Ruby says that really helps her."

I don't think I ever made her understand that Ruby is not swimming laps or just floating around... she is taking water aerobics... and there is an extra fee for that, which Mam-ma can afford - but she won't like it. I suggested she go with Ruby to a class and just observe and see what she thought. She said, "Well, I really thought that YOU would take me out there to look it over." I told her I could not do that on that particular day, because I had Timmy at home and after her beauty shop I would have cold groceries. But I told her that if she and Ruby had not gone by the end of the week, I would come early on the next Friday and take her to see the facility.

So as I left, I said, "I bet you and Ruby can get out there sometime this week," and she said, "Well, I doubt it. Ruby goes to exercise class... then she goes to swim... and then she goes to work for her friend Gladys. She's got too many irons in the fire." So I'm thinking... if Ruby goes to exercise, THEN to swim, and then to Gladys' house to work, it's not going to work for Mam-ma to go with her anyway. This may all be a total bust. I know what's coming... Mam-ma is either going to want me to take her to the Center every day to walk, or she is going to finagle someone else to do it - like one of her deacons!

Actually, God humbled me by placing my friend Anna ahead of me in the check-out line at Wal-Mart.  Anna is a little older than my mother, and she has been like a second mother to me - our families have always been close. She and her husband have an adult grandson living with them.  He has a daughter nearly two years old, and for some reason, he only sees her every other weekend.  Supervised visits are required, and Anna and her husband, are the supervisors.  So every other weekend, this 70-something couple (who have a myriad of personal health issues) are hosts/supervisors to their great-grand-daughter, their grandson, and the grandson's mother and her husband!  Here I am, much younger than Anna, and she is caring for a child who is almost two every other weekend. GEEZ... I have no room for a pity party! I told her, "Bless your heart!" and I meant it!

Later in the week, I picked up an application for membership at the Community Center.  I realized that Greg and I were not going to utilize the pool for swimming laps, nor would we drive across town to walk on the indoor track when we have our own treadmill.  And I could not see my grandmother getting to that Center several times a week to walk/swim without a huge ordeal for her and everyone else.  So I called her and asked, "Do you want to go to the Center and look around?"  She said she did not... it was too hot (we've had triple digit heat for about two weeks running), and she had about decided the Center was not for her (thank you, God!).  So we opted to dismiss this project.

This past Friday, I went to get Mam-ma for her hair appointment, and she was confused and whining about how she "can hardly go." When I opened her medicine compartments, she had missed a LOT of medicine last week... Saturday, Monday and Tuesday mornings, and Tuesday, Wednesday, and Thursday nights! I showed her - she argued that she had NOT forgotten - and then she said, "Well, I'm sorry." Again, I told her, "Don't apologize, but when you say you are out of sorts and can't go, this might be why. Your body gets used to having this medicine three times a day." So now my mom is calling her every morning, and I'm calling her every evening to remind her to take her medicine. She won't like it, but it beats her going to the nursing home, which is the next step. I honestly don't think that Mam-ma would last six months in the nursing home... and neither does anyone else in the family.


My grandmother's comment about the medicine was, "Well, I haven't died yet!" I told her no, but she wasn't feeling great, either. This is just typical for someone who is nearly 98, and it could be so much worse.  My mom's aunt is in the nursing home here and dying of bladder cancer. In fact, she was transported to Little Rock for a surgery over the weekend- they cauterized a tumor in her bladder to try and stop some bleeding. It was very traumatic for my aunt - and every procedure is painful and frightening to her.  When my uncle died a few years ago, his son swore he would never be back - not even for his mother's funeral.  He lives on the West Coast.  A daughter who lives in New York has written letters to her mother - but she had not visited since her dad's funeral, either, which was 2005 - until this weekend.  I think the son is now planning to visit later in the month - if his mother is still alive.  Basically, my aunt has had no immediate family to see about her for years now.

I can't imagine this, but I know it happens ... and I know there are often mitigating circumstances, so I am not passing judgment.  I am just praying we can keep my grandmother living safely in her own home as long as possible.  And if/when she has to go to a nursing home, I know our lives will change dramatically as we do what is necessary to keep her happy and comfortable there.  Meanwhile, I am realizing just how fortunate and blessed we are, especially in comparison to many others. I'm leaning on God and praying faithfully ... and taking things one step at a time.  So far ... so good!

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.