Why Do We Work @ Care N Assist

It seems to be a hot topic on LinkedIn and other places to talk about employee retention. I am seeing article titles like:  Five Reasons People Leave Their Jobs, or The Top Ten Ways To Keep Your Team Engaged.

When I held my weekly team meeting on Friday morning with my Office Managers and Corporate Officers, my topic was; Why a Home Care Aide choses to work for an agency. I shared statistics and quoted people who research these things. No one seemed surprised by this information. Hiring and managing Home Care Aides is the work we do everyday.

After that, my question to them was, “Why do you work for Care N Assist?”

I expected to hear something along the lines of what motivates me. I have been talking about our goal to help people live at home incessantly for the last couple years. I made a huge deal of getting a client home from a Skilled Nursing Home so many times the response from those around me went from cheering to looks of “We get it… Okay?!”

But I didn’t hear that from this group. One person did say, “Of course, I care about helping people live at home, but…” they went on to talk about what really motivated them. My first reaction was to be sure I framed the question right when I asked it. I questioned myself as to whether or not I had been clear. Then the next person and the next all answered and still nobody seemed to have my answer to the question as their answer.

The majority of their answers were profoundly simple. They talked about having fun at work. They enjoyed their co-workers and felt that they were friends. A few turned my face red as they explained that they worked for Care N Assist because of me, saying I was a great boss… Just in case you are wondering, nobody was given a raise just for saying those things.

These responses surprised me; maybe they shouldn’t have surprised me, but they did. It was refreshing to hear about their friendships. The running jokes and camaraderie is authentic and I certainly enjoy participating in them on a daily basis.

I have often been concerned that I put more pressure on my staff than they would wish to endure. I hold a very high standard when it comes to serving our client’s needs. It seems a combination of clear expectations and some fun has made a winning formula. I’m sure that my wife bringing in chili for lunch a few times may have had something to do with this  positive response too.

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Living In Clothes

How should our clothes fit as we age? Can we still have swag when our body starts to demand certain accommodations? An elderly person may still appreciate style, but find it is hard to keep up. Not that I am recommending skinny jeans for anyone at any age, but have you ever thought about why your Aunt Vergie wears a dress every day.

I personally have to buy my pants a size larger in the waist in order to accommodate my prosthetic leg. I’m not going to mention the actual size, nor do I wish to discuss the other reasons I have had to increase my pant size. My point is that the clothes you choose to wear can help you to be able to live better in them.

Here are a few recommendations from my years of nursing experience…

It is common for persons who are elderly to get cold easily. To help I recommend wearing layers. Materials that are soft underneath and materials with some structure which will resist the elements on the outside. It is also important to avoid clothing that will restrict circulation.

Arthritis or other disabilities impacting dexterity make it difficult to manage zippers and buttons. I remember my grandfather taking his jackets and removing buttons and replacing them with velcro stitched into the material. This allowed him to wear clothes with style without the difficulty of putting them on and taking them off.  

What if you had a colostomy pouch. Suspenders on a larger waisted pant would allow it to function without getting bound up or disconnected due to constriction at the waist. Women may chose to wear a dress, or a high waisted pant that will ride above the pouch.

What if you have back pain. Clothes that are too tight or clothes that have elastic in the waist can press on your hip or spine. Bulky clothing can cause postural problems when sitting or lying down. Be careful to remove old garments and undergarments from your wardrobe if they are causing you problems. Focus on wearing things that match your body structure that will support your posture and allow you to move without causing pain or restriction.

What if you have urgency with urination. Ease in the bathroom may begin to make decisions about what clothing you wear. An elastic waist-band can reduce time required in the bathroom. Be sure your unmentionables are easy to manage also. Darker colors will more easily hide any notice of an accident and would also be something I would recommended when going out in public.

Maybe you have dialysis three days a week and need to be able to expose your fistula or a dialysis port. If you have a port it may be important to wear a shirt that buttons up in the front. If you have a fistula then your arm will need to be exposed without pushing up the sleeve and constricting your blood flow. Usually a sweater or light jacket that you can pull one arm out of with a short sleeve shirt underneath would be appropriate.  

If your clothes fit right, you should hardly notice them as you go about your day. Of course, it is nice from time to time when you get a compliment on the color of a shirt or maybe the style of your shoes. Those things can still happen. Medical complications or age shouldn’t keep you from putting on something nice.

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Working with Disabilities

Individuals with disabilities can have many challenges in life. One of those is living independently in the community. We have the privilege of providing a service that makes this possible for some.

Many advancements have been made in this area in the last 50 years. Things such as, handicap access to public buildings and advancements in technology for those with physical impairments. Though difficulty still exists, the solution is the same as it has been for as long as history documents it. The solution is having real people provide the hands on care that is needed; this is what Care N Assist does.

We go to our client’s homes to provide a service that will support them. This means seeing them on their best days and on their worst days. We may be helping them to accomplish their personal goals or helping them to stay independent as they debilitate. Seeing a client on a bad day can make our work difficult, so we have to prepare our Home care aides to manage that successfully.

We teach our Home Care Aides to assess before responding. This means being a good listener. If they listen well, then they can guide their client in problem solving. Staying calm is also an important skill. Any frustration the client may be directing at us, is rarely caused by us, so I tell our Home Care Aides to let it go. Our help can be a positive and powerful force in our client’s lives. We just have to be willing to play the role of cheerleader in order to combat the depression that often goes hand in hand with disabilities.

Saying the word disabled is not something I like to do. As an above the knee amputee, I refuse to admit my own disability, except in conversation where I find another person may be encouraged to know about it. I wish to focus on my abilities, and work hard to limit my disability. This concept is well known in our business. We are expected to focus on our client’s abilities. It is our job to help them to maintain their abilities and to provide support where they may lack strength or function.

Working in this environment requires problem solving and flexibility from our Home Care Aides. We have to be encouragers and confidence builders. Stacey Zsigo, RN can often be heard telling our aides during training that it takes a caring heart. Having a caring heart is difficult to teach our employees, but it is what makes Care N Assist a wonderful company to work for.

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Home Visit & Medications

Most people know that it is bad when medications prescribed by a physician are not taken as prescribed. It is equally as bad when a physician prescribes new medications without knowing that their client hasn’t taken their current medications properly. It only gets worse when a physician prescribes medications without knowing what another physician has already prescribed.

There can be many moving parts in this process. It is not something that can be blamed on the physician or the patient in most cases. What is for sure is that a skilled nurse can spot these medication mistakes during a home visit.

For example, I drove to visit a new client for medication management a couple months ago. He had been spending all his energy working to get healthy after a spinal stroke. His understanding of his medications was not good.

When I arrived he had two different lists of medication in his home. The lists had problems which I recognized immediately. For one, three different antidepressants were prescribed. He also had multiple pain medications and muscle relaxers prescribed. And last, he was missing three medications.

I spent the next two weeks calling and faxing his doctors and pharmacy. I was trying to straighten out his lists by confirming each medication on the list. It took two weeks because I would have to wait 2-3 days for each response after faxing or calling with a request. When it was all finished, I sent a copy of the revised medication list to both of his doctors and to his pharmacy.

I know this will happen again. The medical system that he is connected to is too busy to see him as important. He is not the kind of patient that will create a fuss to get noticed. It is just a matter of time before one of his doctors or his pharmacy overlooks his needs.

It will be a change in insurance coverage, or a change in his condition that will most likely cause the next problem. Good news for him, he has a skilled nurse making home visits who will be watching for problems if they arise.

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Wealth of Knowledge

It is a very well documented thing that as baby boomers retire they are taking a great wealth of knowledge, wisdom and leadership skills with them. Recently, I had one of those boomers, a daughter-in-law of a client, email me on the weekend asking me to call her on Monday. She had concerns to talk about.

I remember grinning to myself and put a reminder in my phone for Monday afternoon. This kind of interaction is something we invite at Care N Assist. When our clients and their caregivers feel like they can call, I get excited. It’s their respect I want to earn, and that can only be earned when you can talk about both compliments and concerns.

Most of our clients or their family members give us good information. It’s up to us to interpret their message and to find its usefulness. If we start spewing out excuses or fail to listen we are missing out. The value of their comments and the lessons they teach are worth our time.

Most of this generation’s problems are not new. Technology has changed many things, but it doesn’t change the human condition. How we relate to each other and the effort we put into our work does not change. We are fortunate, that in our business we can learn from our clients. Many of them are eager to share their opinions.

I would say that very few of our clients or their family members would qualify them selves as leaders. It’s the combined knowledge and experience that grabs my attention. Their comments are often worth their weight in gold. We just have to take the time to listen.

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Care N Assist Ranks No. 2498 on the 2016 Inc. 5000

NEW YORK, August 17, 2016Inc. magazine today ranked Care N Assist NO. 2498th on its 35th annual Inc. 5000, the most prestigious ranking of the nation’s fastest-growing private companies. The list represents a unique look at the most successful companies within the American economy’s most dynamic segment— its independent small businesses.

Daniel Story, CEO of Care N Assist said, “I was thrilled when I heard we made the list. We are growing, and it is because of our commitment to having a culture of caring. Its more than kindness, it sets us apart from our competition as a company who sees our client’s passion for being able to live at home and gets to work making that possible.”

The Inc. 5000’s aggregate revenue is $200 billion, and the companies on the list collectively generated 640,000 jobs over the past three years, or about 8% of all jobs created in the entire economy during that period. Complete results of the Inc. 5000, including company profiles and an interactive database that can be sorted by industry, region, and other criteria, can be found at http://www.inc.com/inc5000/list/2016/.

“The Inc. 5000 list stands out where it really counts,” says Inc. President and Editor-In-Chief Eric Schurenberg. “It honors real achievement by a founder or a team of them. No one makes the Inc. 5000 without building something great – usually from scratch. That’s one of the hardest things to do in business, as every company founder knows. But without it, free enterprise fails.”

Care N Assist has contracts with State agencies, and has Preferred Provider agreements with the Veterans Administration, Long Term Care insurance and Auto Insurance companies. These contracts give us a broad range of services to our potential clients and a great resume.

Stacey Zsigo, RN, COO says, “We only hire people that I would be comfortable sending to my own grandmother’s home.” Our Care Connects program makes matching each client to a Home Care Aide smooth as we pay attention to our client’s values and passions along with their need for support services. This program along with our specialized trainings and in-services make us an Elite In Home Care Team.

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CPR or DNR

Every time I am in a client’s home I have to talk to them about things they don’t like to talk about. It just happens most people don’t like to talk about having to go to the hospital, or worse, dying.  So as I go about creating or reviewing their emergency procedures, I end up having to make them uncomfortable. Since I don’t like making people uncomfortable I have created my own way of asking these questions.

The most important of these questions being, “Do you have a DNR, Do Not Resuscitate, order or would you like us to do CPR, Cardio Pulmonary Resuscitation?” Most people are intimidated by such a question. They start talking about their living will or Medical Durable Power of Attorney. I usually thank them for sharing this information, note it on my tablet, then I redirect them to a simpler question.

I don’t use big words or mention what is legal or not legal without a doctor’s order. I simply ask what they would want us to do. It goes like this, “What would you want my Home Care Aide to do if you fell and were hurt?” Unfortunately, many of the people I meet have experienced falling and being hurt. This is often the reason they call Care N Assist and ask for help.

Most, are quick to say they want us to call 911, or press their Emergency Pendant. They will pull the pendant out of their shirt or show me the base unit sitting on their counter. Once in awhile I will have someone say they want their son or daughter called first.

If they haven’t thought about this question before and don’t have a firm answer, this gets the ball rolling in the right direction. If they say “call family” I know they are less likely to want aggressive treatment. If they say emphatically to “call 911” I know that they are probably going to agree with a majority of my clients who want as much help as is possible.

So I proceed with the real question, “What if something else happened? What if you stopped breathing or your heart stopped and you collapsed?” I have gotten such a variety of answers from this question. Most will tell me they want our Home Care Aide to help if they can. If they say this “Yes 911, and Yes CPR” is what I write on their Care Plan.

Having just sat through another CPR training class with our Home Care Aide’s, I’m happy to say they are ready to help if needed. As our CPR trainer, Mike Bussing, always says, ”You can give that person one more Thanksgiving or Christmas with their family.”

Some of our clients will respond, “No. I don’t want CPR,” or “I have a DNR Order.” They usually have a good reason for having this opinion. For some it is a practical reason like having osteoporosis and a small frame, which would make recovering after CPR very painful. Others choose this because of illness or they believe they have lived a full life. In this case I document in our Care Plan, “Yes 911, and No CPR.”

If this is the case, I explain how it will work. We will not perform life saving CPR, but we will have to notify the proper authorities which means calling 911. Simply put, Emergency Medical Services, EMS, will show up and will be obligated to do CPR when they arrive unless they are shown a copy of a DNR order. Having this posted on the refrigerator makes it easy to find in an emergency.

Sometimes when family members are present during the consultation, they will question their loved one’s decision regarding CPR or DNR. This can be a good thing because what my client wants or prefers should be clarified before a situation happens. I am a strong advocate for my clients’ wishes to be written in the Care Plan and ensuring it will be carried out by my Home Care Aide. Having said that, I remind the client and family that I update Care Plans every 3 months or so to give them an opportunity to discuss things further.

Last, I do have clients who want “No 911, and No CPR” documented in their Care Plan. Usually this means Hospice is involved in their care. In place of calling 911 we will call the hospice nurse. This can be a great support service since everything is planned and organized to be taken care of without fail.

I enter every house knowing I have to ask these questions. I never know what a new client will say. A few of them will surprise me. Most of them are happy to hear we have regular CPR trainings with our employees. My job is to keep things simple and document clearly what their wishes are. It will be our Home Care Aide that will be responsible to help when that time comes.

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