Dear Support for Home,

Would you consider putting link to my blog on your site as a blogroll link/resource for your readers?

If you’d like, check out my blog:  http://www.mesothelioma.com/blog/

Best,
Cameron

Page 2 of the attached PDF contains that OpEd from Barry.  It is very much worth reading if you or your family have or may need home care soon in the state of California.

Well done, Barry.

Barry Berger OpEd

Best wishes.  Bert

This Excel spreadsheet is a tool that families can use, together, to establish baselines for performance of Activities of Daily Living and is a great way to start a conversation with loved ones who may need home care help, now or later.

In addition to this tool — partially as a result of it — we were asked last year to work with a Public Television crew to create a video on the issues of planning for aging-in-place and home care.  Frankly, we were delighted to do so, not because it makes us at Support For Home look like the best thing since raisin bread, but because we are passionate about this topic.

We hope you find the video useful for discussions in your own family.

Best wishes.  Bert

There are two that I want to point out today, however, that do not always get enough attention.  They are serious challenges that make the job (paid or unpaid) of the caregiver even more difficult than it otherwise would be.

1.  “I don’t need any help.”

At Support For Home, we work with a lot of family caregivers, providing counseling and advice to them on how to be most effective and maintain their own health and well being.  We also, of course, provide home care through our professional Home Care Aide employees.  One of the most frequent and serious impediments to their ability to provide quality care is the client (or loved one) who insists that she, he or they do not need any help.  “I know I / we will someday, but not yet,” is an all to frequent refrain.

So, the caregiver is trying to provide homemaker, companion, concierge and personal care, as appropriate, while the loved one or client is trying to usher the caregiver out the door.  The skills of negotiation, redirection and persuasion needed would do a diplomat proud.  In the meantime, the caregiver is using great deal of energy just getting permission to provide the care.  No wonder it is an exhausting endeavor.

2. Home Care is not House Care.

In home care, we do perform homemaker services, such as light housekeeping, cooking, laundry and so forth.  For many loved ones or clients, support for the Instrumental Activities of Daily Living involved in maintaining a home are critical to the ability to live at home.

At the same time, in California, at least, the provision of care by a “personal attendant” under Wage Order 15 (labor code) restricts general care of the house to 20% of the time worked by the caregiver.  This is one of the distinctions between a home care agency, such as Support For Home and other members of the National Private Duty Association (NPDA), and housekeeping / maid services.  We take care of people. Housekeepers take care of houses.

Unfortunately, many loved ones and clients do not understand the distinction very well — sometimes intentionally.  If a family caregiver or professional Home Care Aide is focused on washing windows, they are not helping with transfers or personal care or perhaps a large-piece jigsaw puzzle with their loved one or client who is suffering from Alzheimer’s.

So, if you are a caregiver, I greatly respect and admire you.  You are doing work — for the family or a client — that the vast majority of us are not equipped to handle.  If you know a professional or family caregiver, give them a pat on the back and a smile.  They are exceptional people.

Best wishes.  Bert

• A disaster looms …
• US Dept of Labor’s New Rules
• Either I or They Don’t Get It!
• and, earlier, Home Care in California

It is difficult to overstate the lack of wisdom in the proposed new rules.  It is important to understand that this is not about home care companies.  This is about the ability of clients and their families to get trusted, high quality home care without dramatically increased costs.

As if it needed to be, this truth was driven home this afternoon when one of our clients called.  We provide 24-hour care for his wife and, to a lesser degree, for him.  So the conversation went very much like this:

Me:  Hello, Al [not his real name].  It is always good to hear from you.  How are you?

Al:  Terrified!

Me:  What happened, Al?  Is there something you need us to do?

Al:  I was just reading about the new rules from the Department of Labor.  Are these real?

[We discussed the rules and timelines and probabilities at length, including the fact that he and his wife would not be able to avoid paying overtime, even if they hired caregivers directly, as Al and his wife would definitely want to hire professional caregivers.  Professional caregivers cannot be exempt from overtime, under the new rules, no matter who is the employer.  Additionally, Al and his wife do not want to be the employers. The want Support For Home to continue to be responsible for payroll, insurances, making sure there are backups, and so forth.]

Al:  Bert, if these rules go into effect, it will “sink the boat” for us.

Me:  I understand, Al.  If enough of us — especially families and clients — submit negative comments to the Department of Labor, maybe they will withdraw the proposed rules.  You can do that at this site.

Al:  I going to do that right now.

Knowing Al, he has already finished adding his comments.  If you or a family member or a loved one could be impacted by a dramatic increase in home care costs — and reduced income for professional caregivers — please do the same.

Best wishes.  Bert

Granny lived to the age of 103.  Along the way, she was the provider of blackberry cobbler, unending country dinners, firm discipline and incredible humor.  On her 100th birthday, the family (the Clan) gave her a huge party.  Everyone had a great time.  At one point, my father was talking with Granny (his mother), with the conversation going like this:

Dad:  So, Mama, do you know how old you are today?

Granny:  Well, yes, I think I’m about 55 today.

Dad:  Actually, Mama, I don’t think your 55.  After all, I’m 70 now.

Granny:  Well, Honey, that’s your problem!

That was one of Dad’s favorite stories, forever after, and one that everyone loved and laughed at hearing, whether it was the first time or the 20th.

Every family should have THE STORY.  Granny is long gone, and Dad died almost two years ago.  We do not have them, anymore.  But, we will always have THE STORY.

What is your family’s?  Let us know.

Best wishes.  Bert

removing the “companionship exemption” from the Fair Labor Standards Act (FLSA).  This change, while perhaps well-intentioned on the surface, threatens the quality of home care for many of America’s seniors and disabled adults and will put thousands of people employed in the home care industry out of work.

The proposed rule sounds fair, superficially, as I discussed in previous posts here and here about this issue.  It really is a false issue, however.  In California, minimum wage is $8 per hour.  For hourly shifts, we actually pay $11 or $12 per hour (more than unionized home care workers make, by the way).  How can mandating minimum wage and overtime for personal attendants help our employees.  Right now, they can work as many hours as they want.  If overtime is added, the cost will prohibit us from allowing employees to work more than 40 hours, since we will not be able to pass the cost on to the consumer.

As Laurie points out,

Modifying the exemption will have unintended consequences. In 29 states, including California, an agency will employ a live-in caregiver for a 24-hour shift. If the overtime exemption is eliminated, the agency will staff this case with three workers in eight-hour shifts instead. The workers’ pay will drop and the client will lose continuity of care and the safety it provides with three workers rather than one.

Loss of an affordable in-home non-medical care option will force many seniors and people with disabilities into institutional care, which is often paid for through Medicare, Medicaid or another government program. This puts the burden on taxpayers.  At a time where the nation is taking a hard look at cutbacks in these programs, this is a cost Americans can ill-afford.

President Obama’s Administration really needs to look beneath the surface of what sounds good, emotionally, and what union political supporters may want, to determine the real impact — for employees and for clients and families.  For our employees currently working 24-hour shifts, for example, they will go from $192 per shift to an 8-hour shift making half of that amount or less.

We hope that Home Care Aides, clients and families — everyone who understands the need for great home care — will comment on the proposed US Department of Labor rules by clicking here.

Best wishes.  Bert

Here’s an excerpt:

The concert hall at the Syndey Opera House holds 2,700 people. This blog was viewed about 11,000 times in 2011. If it were a concert at Sydney Opera House, it would take about 4 sold-out performances for that many people to see it.

Click here to see the complete report.

As I said, very few clients and families will be able to afford that cost.  The new US Department of Labor rules will keep the overtime exemption for caregivers hired directly by the client / family.  So, the option that will be financially attractive, on the surface, to clients and families, if the new rules go into effect, will be to become the employer of record, themselves.

I say “on the surface” because there are real dangers in that approach, and the US Department of Labor and the White House do not appear to get it — either that or they do not care.  So, what dangers lurk under the surface of that approach — the client or family becoming the employer of record?

Most clients and families are not set up to be employers.  Even if their intention is to be honest, their are going to be mistakes made.  If they try not to be honest — or do not know how to act as an employer — here is what we are going to see:

1.  Caregivers’ Social Security is not going to be paid, nor will the employer’s portion.  At some point, the caregiver is going to find this out — probably after a lot of pain.  At that time, the government is going to come swooping down looking for past taxes, penalties, first-born grandchildren to hold hostage, …  (Well, OK, they may settle for second-born).

2.  Caregivers are going to hurt themselves, tripping over an ottoman or pulling clothes out of a dryer or …  The caregiver (the clients’ / families’ employees) are going to file a Workers Compensation claim.  Most families are going to assume their homeowner’s insurance kicks in to cover.  Surprise, surprise, it does not.  Homeowner’s insurance will not touch domestic employees, and that is what the caregiver is.  So, the Workers Comp folks ask where all the back taxes are — and, of course, they add some serious penalties (I hope their are enough grandkids to use as collateral!).

3.  The client / family will decide that they do not really like the current caregiver (their employee), so they fire her.  No problem, as long as they live in an “employment at will” state.  If not, things could get interesting.  But, let us say that employment is terminated successfully.  The former employee goes down to file an Unemployment Benefits claim, as is her right.  The State calls the client / family and asks where the taxes are to support the new claim (and, you guessed it, there are penalties).

4.  Because the client and family were not experienced in hiring caregivers, they did not do an adequate background check to make sure they were hiring an honest person.  $20,000 of precious family heirlooms are now missing, and everyone knows where they went.  Remember the problem with homeowner’s insurance we talked about above (it does not cover domestic employees issues)?  There is no dishonesty bond in place, either because the family did not know they should have it or it was just too expensive for them, as a single client.

All of the above problems would have been avoided if the US Department of Labor had not published new rules raising the cost of working with a legitimate, honest home care agency (members of the National Private Duty Association – NPDA) that provides protection against all of these problems (there are more dangers, but I am getting too depressed to keep going).

The comment period is under way at the US Department of Labor.  We hope many folks involved in elder care and home care, as well as clients and families now receiving care, will get involved.  This is not about home care agencies (including us at Support For Home).  The co-owner of this agency and I came from the high tech industry, where, frankly, we made more money.  We do what we do now from passion.  That passion is why I am writing this post.

Best wishes.  Bert

Too often, however, there are prices that are paid for such care and devotion, and those prices can be paid by the person receiving care, as well as the family caregiver.

The prices I am talking about involve damage to the relationship — husband and wife, mother and daughter or son, grandfather and grandchild.  As a home care company, we have seen it too many times, and it is a terrible, sad thing.

The sacrifices of family caregivers, in terms of time, energy, careers, hobbies, social activities, … are well known.  They can be painful, and not all family members are capable of making those sacrifices.  Honestly, I do not know my own limits, but I do not feel in the same league as many of these daughters, spouses, sons and others who step forward.

As we work with families and home care clients, however, we too often see the greater sacrifice — almost always unconscious.  That sacrifice involves the relationship, itself.  When a daughter steps into a caregiving role for her mother, for example, there is an inevitable change in the dynamic of the relationship between the two people.

I have not seen any formal studies of the stages of evolution of the relationships between caregiver and receiver — if any reader has, please do pass it forward.  If it has not been studied, academically, it certainly should be.  What I / we have seen, however, is too many instances where the child/parent or spousal relationship has diminished way too much, shrouded by the caring — but very, very different — relationship of caregiver and recipient.  Too often, there is a certain brusqueness, a reduction of respect that creeps into the “new” relationship.

One of our goals, at Support For Home — and I know we share it with other principled home care agencies — is to protect the family relationship.  Adequate respite care is critical to keeping a daughter seeing the elder as “Dad” and vice versa.  It is that relationship that created the caregiving role in the first place, but it should not end up being submerged by that new role.  Find ways to keep the original relationship alive — including getting enough help!

Best wishes.  Bert