A Little Introspection is Good

I have a radio interview coming up in a couple of weeks, and the host sent out an information request with some very thought provoking, interesting questions. It is not always comfortable talking about yourself, but the questions were so well thought out that it seems like a good thing to include a bit of the reflection it brought about here.


A. Some of the basics of what our Support For Home Home Care Aide employees do is very similar to other home care agencies. It begins with performance or assistance in the performance of Activities of Daily Living (ADLs) and Instrumental ADLs. However, there are a number of differences in the approach of Support For Home, including:

  • We were educated by Dr. Lee Lindquist, Head of Geriatric Medicine, Northwestern University School of Medicine, that if an agency such as ours does not understand that we are part of the healthcare delivery system – and commit to that role – the agency is failing to perform as it should.
  • That role is non-clinical home care / health care, as part of an integrated team focused on the continuum of care for our clients / patients.
  • Our role is to be an extension of the eyes and ears of health care clinicians, actively observing any change in conditions (physical or behavioral) of our clients and reporting those changes to family and to the clinicians involved in our clients’ care.
  • Philosophically, our approach to our clients’ care is also different from most other agencies, even those with good reputations. That philosophy is summarized in one of our blog articles:

In that article [as readers of this blog already know], I point out that our goal, in supporting our clients, is to make their “stay” on each of life’s downward facing plateaus as long as possible, postponing any physical or mental decline.


A. Over the next five years, the industry of senior care / home care will evolve in the following ways, and, as a member of the Board of Directors of the Home Care Association of America (www.homecareaoa.org), I will be ensuring Support For Home is in the forefront of driving these changes:

  • Home care agencies will come to understand that they are performing non-clinical home care, not “non-medical” home care, which is the current self-image.
  • Health care clinicians will also develop a better understanding of the importance on non-clinical home care within the integrated health care delivery system. As a result, physicians will prescribe, as appropriate, non-clinical home care to their patients, just as they now prescribe medications, home health, hospice, or other elements of a patient treatment plan.
  • CMS (Medicare), Blue Cross / Blue Shield, Kaiser, Sutter, and other forms of medical insurance will begin to provide benefits for non-clinical home care, recognizing that the real goal of health care – better outcomes at lower costs – can be better addressed by inclusion of non-clinical home care in their benefit plans.


A. There are many such stories, thankfully. This is a hard industry, but an emotionally rewarding one. Two stories come to mind involving families thanking us, one while we were still providing service and one after a family’s father had passed away.

In the first case, our care had been a marvelous experience for us, from the very first day, when we sat down with five of his adult children and their spouses, to be interviewed (it turns out 6 other agencies were also interviewed, before they selected us). This client’s wife had died a month or so before, and he was in depression, as well as unable to handle his own ADLs and Instrumental ADLs. After we had been providing care for quite some time, the daughter-in-charge (there usually is one J ) sent us an email that included the following:

On behalf of the entire … family, we want to thank you so much for being such a careful and attentive caregiver for my dad … He always speaks so glowingly and appreciatively of the time you spend with him. His stories are always full of descriptive details about how you make his days comfortable and interesting and affirming… You have freed him (and us) from our anxiety about his daily care and have become integral to his physical and mental health. At his point in life, there is a fine line that divides the desire to keep going from the boredom that leads to a slow and sad drifting away. My dad … enjoys each and every day now and you are one of the main reasons this is so.

In the second case, we provided care for a gentlemen with severe COPD. He was very prone to pneumonia, so watching carefully for any change in condition was critical for his health. After quite a while in our care, a gentleman died. His daughter and son wrote a long message to us, which they graciously agreed to have published on our blog at (https://supportforhome.wordpress.com). Below are a couple of short excerpts:

We [the family] decided we would do all we could to make him comfortable at home. He didn’t have many surviving friends and enjoyed staying in the house, reading and watching television. Life in a facility would have been a trial for him, and he was already too weak to take advantage of collective outings and other amenities of those living situations… He was not a gregarious man and enjoyed reading and reflecting by himself. He would never have been able to adapt to a collective living facility.

With time he came to consider the people who came to the house as friends, rather than just hired help, and looked forward to their arrival. He tried not to burden them with too many tasks and spent as much time as possible playing cards or chatting with them. It made staying in his own home much more enjoyable for him during the 18 months he lived after his wife’s death.

If he had lived longer, he would have had to share nearly all his time with caregivers in the house, but it would have been far better for him and for us than placing him in a noisy facility with complete strangers for the last few months of his life.

 The clients in both of those stories have passed away. That is one of the sad truths in this industry. You are “signing up” to care for folks who you know you will inevitably lose. Caregivers experience loss frequently and deeply – sometimes even when the client does not pass away. I remember talking to one of our Home Care Aides who was in tears at the end of a several month assignment. Our job was to help him recover from hip replacement from a fall he experienced visiting his daughter here in California. We did our job, he got well and went back home to Wyoming. But our Home Care Aide was in tears because, as she put it, “I only got to hear half of his life’s stories!”


A. I do not think I am unique or even very interesting. The “oddest” thing is probably that we (my co-owner and I) left Intel Corporation and the high technology field to start a business in which we knew we would make a lot less money. That has always reminded me of the old New England joke:

Dairy farmers do not make a lot of money. Many of them are just hanging on from year to year. A dairy farmer won millions in the lottery, and the press wanted to know what he was going to do now, since he could afford to do anything and go anywhere. What was his answer? “Well, I guess I’ll just keep on dairyin’ until it’s all gone!”


That dairy farmer was already doing what he loved. The money just helped him do it.

I hope you are doing what you love. Best wishes. Bert



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