Aging in Place by Keri L Story, MS, OTR/L

What is aging in place? The ability to live in one’s own home and community independently, safely, and comfortably, regardless of age, income, or ability level (CDC 2013).

The aging population or silver Tsunami consists of 46.2 million people ages 65+ (2014) with the baby boomers now being ages 52 to 74. The people 65 years and older are expected to double from 46 to 98 million by the year 2060. This means more than a million older adults will be added every year. This is a lot of people to take care of throughout our country. So how do we do this to the best of our ability?

First, we need to understand the aging process, both normal and diseased, in order to understand who will and will not need care. The normal aging process includes age related sensory changes such as vision, hearing, touch, taste, and smell. One may also experience cognitive changes and declines in short-term and long-term memories, slower thinking, and slower speed of recall. With these changes occurring, lifestyle habits also change. In other words, the normal or natural aging process creates difficulty for one to live safely anywhere, home or in a facility should they stay healthy longer than a person with a disease.

Age-related diseases consist of ailments such as Arthritis, dementia, cardiovascular, osteoporosis etc… if you know anything about these diseases and how they can create debilitating deficits in the body, you understand why this population will indeed need help either at home or in a facility.

So what does this mean to you? This means it will become imperative to give this annually growing population options as to where they would like to live. I think we can assume that most of this group will choose to age in their own place/home. Keep in mind this can be a very big decision as it depends on one’s finances, family/community support, type of home one has and the progression of their normal and/or disease aging process. What may seem like an easy decision to stay can turn into a not so good idea. Having said that, to keep someone in their home we will need more caregivers, Home Modification companies, and other safety precautions in place.

My professional recommendation would be to do the following in order to assist someone in making this decision: have a family meeting to discuss one’s wishes, educate the family on their options considering one’s health and/or decline, evaluate the safety of the home, discuss the costs for the care and home modifications vs cost of facility, and encourage honest conversations as well as taking 24-48 hours to make a decision if applicable. This supports best practice strategies as it is giving the older adult autonomy and a sense of still being in control of something in their life. Especially if they cannot control what is happening to their body as it is aging. As a registered nurse, social worker, or another medical team member it is important to do your research for each individual case and come prepared to answer all the questions that will probably be asked during such a meeting. I would also recommend checking in on the family, depending on the health of the older adult, every 3 to 6 months to ensure the situation is still appropriate.

By Keri L Story, MS, OTR/L

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Broken and Healing

Did your mother’s femur break and then she fell down or did she fall and then her femur broke? I asked this question just a couple weeks ago as I was meeting with the son of a potential client. He was trying to take care of her with the support of family, but they were struggling. The doctor had given strict instructions for her to stay off the leg which made living at home very difficult. When we take calls like this it is easy to see what is broken, but we focus on caring for our clients while they heal.

Care N Assist was contracted to do a sunrise and sunset service. This means we scheduled to help her get up each morning, and get cleaned up and dressed for bed each night. Our Home Care Aide would be sure to set her up for a good day of healing each morning. Clean, dressed and fed, because it takes proper nutrition, activity and rest to be able to heal.

Proper rest is interesting to discuss when dealing with broken bones. Most people know that a bone needs to be immobilized until it is healed, but I am talking more about getting quality sleep. When you are in pain and have difficulty repositioning yourself in bed it is hard to get the proper sleep. I recommend taking a pain reliver at bedtime and/or using ice to improve your ability to sleep. When you wake well rested you will be better able to face the day.

In the case of this story, a femur fracture like hers needs to be stabilized and non-weight bearing, so the proper activity for her was to limit leg activity, so I would recommend an arm chair exercise program. Maybe Chair Chi or some other program for about 20 minutes each day. Doing 5 minutes four times a day could be easier and just as effective. Doing this will help to stimulate appetite and it will decrease the side effects of pain medication too.

Proper nutrition is what most people will talk about when they want a fracture to heal fast. According to the Andrews Institute for Orthopedics and Sports Medicine you should consider eating Kale, Spinach, Milk, Broccoli and Green Bell Peppers. They have reasons for each one of these that you can read more about at:

Having a fracture is never fun. It can be very painful and for older adults it can threaten their life and lifestyle. I look forward to seeing this particular client recover completely. Our hope is that she will not need our services for very long and if she needs assistance again in the future we will be available.

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Providing Engaging Care

I may not be the most sensitive person in the world. Truth is, I want to write this article about being engaging and sensitive, but because I am a guy and I may not be as good at being sensitive as many of my female coworkers I’m concerned you may not hear what I have to say. For starters, I’m not saying that all guys are insensitive. We can be very sensitive and engaging. What I’m saying is, I recognize that I have a certain capacity for “caring,” but then I will often instinctively look for ways to disengage. This fact is what I believe makes me the perfect person to talk about engaging and caring.

Truth is here, I know myself well enough to see my strengths and weaknesses and feel comfortable talking about them. Other people (females) who work in the caring services field must also have some degree of this same issue going on inside of them too. When I see this instinctive act of disengagement by a Home Care Aide, HCA, play out in one of our client’s homes, an alarm goes off in my head. I usually see this as I am making phone calls or performing supervisory visits to their homes. It is also immediately apparent when the connection between the client and the HCA is healthy. This makes me very happy.

The ability for us to find employees who will engage at work in a caring way is truly the number one factor for success at Care N Assist.  The reason this field is dominated by women can only be a testament to their ability to engage and care. During one of our recent management meetings it was said, “women will bring the change that is needed in this crisis.” She was referring to the cultural shift we are seeing played out on political stages right now in the United States and the impact it has had on the way we hire employees and do business. I was thrilled to think that the person saying this was so confident. I was also stunned to realize what our world needs may be the same thing that we are trying to teach our Home Care Aides, HCA’s.

We want our HCA’s to be engaging, caring and to think creatively. Most problems that occur in our client’s homes do not have simple answers. While our HCA may be doing something as common as preparing a meal or cleaning the house, they are really negotiating the emotional and painful process of their client giving up control in an area of their life. They may simply be providing support with bathing while more importantly they are helping their client to maintain their dignity.

The fact that we must find a creative way to match and introduce each new HCA shows how much of a concern it is for our clients. One way we have implemented our creativity is by creating a program called “Care Connects.” The program’s sole purpose is to connect the best HCA for each client using their personality, skill level, location and other factors. Though it’s not always perfect, it greatly helps us to produce good matches right from the beginning. If our HCA doesn’t engage in a way that is satisfactory with a new client during their introduction, then our caring service suffers. It’s never our intention for services to suffer, it is difficult to gain a person’s confidence in situations that demand so much transparency and engagement.

At the risk of over-using the word “engaging” our management team in each office spends hours engaging with our HCA’s by texting, calling, and meeting with them daily. We also, use the competitive nature of our HCA’s to set up a system of continued learning and rewards. We have to be sensitive to their needs if we are going to expect them to be sensitive to the needs of our clients.

The bottom line is, our Home Care Aides are great because of the time and energy they put into meeting our clients’ needs. Everything we do with our sophisticated policy and procedure book and our fancy computer program is only as good as each person we employ. Connecting with our clients in a meaningful way is how we work. This is the culture that has built an award-winning company. Care N Assist will continue to be successful only as long as it provides engaging care.

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Fastest Growing Occupation

“There are currently about 2.5 million home care workers in a workforce that is the fastest growing occupation in the nation,” according to Carol Regan, Government Affairs Director at PHI (Paraprofessional Health Institute). Care N Assist is seeing this growth. We continue to see our offices working hard to recruit, train, and then use turnover prevention tactics to stay ahead of the growth we are seeing.

Recruiting home care aides has changed since we opened in 2005. I remember having a file full of applications which required no advertising for help wanted. I would pull them out and “cherry pick” the best applications before calling and setting up interviews. That is not the case today.  

Today, we spend several hours each week working to recruit the best possible home care aides. We use internet and multimedia platforms to advertise to our prospective employees. We often put people on the job the same week they inquire about work.

Many people are coming to us with little or no experience in healthcare. We don’t require them to have a license or degree for most of our work, but it is important for them to be able to perform the tasks which our clients require with proficiency. We have a training module that recognizes the skills they come with, and seeks to improve and direct those skills depending on our client’s needs.

Keeping these workers on the job requires just as much, or more, effort than recruiting them does. Carol Regan says, “The situation for these workers is somewhat difficult: they’re really low-paid, most are part time, and there’s a tremendous amount of turnover.”

As entry-level healthcare workers, they are at the bottom of the pay scale, but Care N Assist exceeds the average with its pay when comparing us to the Home Care Pulse’s Annual Report. We recognize that a part time job is not what all employees want, but it is the flexibility of scheduling that attracts most of our star employees. When you read Regan’s material she states that there is an average 50% turnover rate in the industry. I am proud to say that our recent efforts have reduced that to an average of 22.5% in our offices.

I predict that we will continue to see the number of home care aides in the workforce increase, with the rising trend in clients desiring to receive services in their homes. As part of this trend, we continually innovate our service to meet client’s desire to live in their own home for as long as it is feasible. The win-win here is multifaceted: safe and satisfied clients where they want to be, this gives people jobs that fit their lifestyle, and truly gives them experiences that satisfy those who are caring in heart.

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Drink Water First

Drinking 8 ounces of water first thing every morning is good for your overall health for several reasons. Doing something simple like drinking water can motivate you to make other good decisions for living a healthier lifestyle. Below are just 5 reasons why drinking water is so important for the body.

First, drinking water improves circulation. Water carries away toxins in your body and improves circulation to the areas of the body that need to be renewed with nutrients. This is a great reason to drink water before eating each morning.

Secondly, drinking water helps to prevent constipation. Washing your digestive system with water each morning will stimulate bowel activity. It also softens the contents of your bowels to make it easier for your body to eliminate waste. Be aware that in the older adult population drinking too much water when the bowel is already slow can cause problems due to water absorption instead of nutrient absorption.

Thirdly, drinking water can alleviate pain. First thing in the morning it is common to feel achy. Your body needs that drink of water to wake it up and get things moving. As it helps your muscles to relax and improves circulation to your nervous system you will feel the difference.

Fourth, drinking water can reduce the signs of aging. Your skin can accumulate toxins causing age spots. Dehydration is also a cause for uneven or rough skin appearances. Getting off to a good start by drinking water every morning will give you the best chance of maintaining hydration and you will stay younger looking.

Lastly, drinking water can help with weight loss. Drinking water before breakfast, or any meal for that matter, gives you a fuller feeling therefore causing you to eat less and fires up your metabolism. Also, adding lemon to your water can help because lemon contains pectin fiber that decreases food cravings. Adding both can improve your ability to curb your appetite.

If you are not a breakfast eater or if you are a coffee drinker… consider doing this one small thing to improve your health. A glass of water a day, first thing in the morning. Smile as you do it because you are doing something great. Relax as you do it and feel the benefits all day long.

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This summer, Care N Assist reaches 12 years in business. Summer is a great time to reminisce about all of the good times of the last year like establishing the Marshall office and launching a Lansing office. My favorite memories are centered around the times we were together as a team for meetings, lunches, trainings, and softball.

I remember Team Day in February 2017 when the management from all 5 offices met together in Kalamazoo. The newest version of our cultural values was unveiled. Designed to be a decision making model, it keeps our company’s goals and the focus of our elite processes in check. But just in case anyone forgot, the day was not all about sitting and learning. I still laugh as I think about CPR in an elevator, the potential client Glenn wouldn’t help, Stacey getting lost in the parking lot. Of course all of these things were part of an exercise to develop a sales strategy.

As winter broke and spring arrived in 2017, we have seen many clients come and go. It is wonderful to see so many of them recover and regain their independence, and it is equally wonderful to be the support service for others as they spend their last weeks on earth. We are halfway through the year and already we have provided care for over 400 clients.  

Now it is time to play another company wide softball game, East vs West. This will be our third annual game. As it stands West has one victory and East currently holds the trophy for winning last summer. All the competition and supposed bad umpire calls aside… I am looking forward to an energetic and fun Sunday afternoon at the end of August.

One last thought as our twelfth year comes to an end, Kirk Golden sent me a quote several years ago that says, “Business grows at the speed of leadership.” I don’t remember who he was quoting anymore, but I realize today that it is true. Care N Assist has grown, but more importantly, like a storm system that back builds before hurling all of its power to the earth we have been growing internally:  Cultural growth, training, and the strength of our team.

I remember very well the slow start which was as a second income for me, but is now a new unexpected career. The people that have entered my life through Care N Assist as employees, clients, or cohort have enriched my life. I look forward to the next year to see what this team can make happen.

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Pathway to Independence

When illness or injury strikes, you don’t have to surrender to it. There are things that you or your loved one can do to recover and/or maintain independence. Having to depend on others for support and assistance can be frustrating but it doesn’t have to be something that you resign yourself too. You can be prepared and recovery is possible.

I have seen many people on the day after they are discharged home from the hospital or rehabilitation center. It is common for them to be exhausted. Some try to do too much that first evening home. A trip to the pharmacy, navigating stairs to enter the house, and then preparing dinner or cleaning up. Then they spend the next three days trying to recover from doing too much.

I say give it time. It takes three days to recover for every day you were down. At least, this is what my rehab doctor told me. I thought I would prove him wrong, but he was right. I was in the hospital for 60 days, and I spent another nine months recovering at home before I was able to get back to work part-time. Of course, there were ups and downs during that time that extended my recovery, but the fact remains that your body requires time and attention to get better.

I have been telling my clients for years that it takes three things to get better after being sick: Good rest, good nutrition, and good activity. Not necessarily in any one order. I suppose some days you will need more sleep and other days you will need to fulfill your physical therapy requirements. The truth is that you cannot ignore any one of these three without it causing you to fail to recover.

Rather than focusing on what you have lost, if you want to recover, it is important to focus on what you are able to do. Keep doing what you can. Realize that any decision you make is a little bit of independence. Going to the grocery store with a Home Care Aide, HCA, to drive and push the cart means that you get to choose your own purchases. This choice is powerful. Giving the HCA a list and having them go for you, means that you have to trust they will spend your money wisely and they will not make a mistake when choosing the brand or quantity of anything on your list.

Asking for help is not the same as admitting defeat. Help should allow you to maintain your course of recovery. An HCA can work alongside you to support you as you handle normal daily activities. Their involvement will lessen as you improve. Their work will ensure safety and encourage you as you meet your goals.

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