Rosaleen in Salem Gazette and Marblehead Reporter

I was installed as the Second Vice President of North Shore Women in Business and there were a few really nice write ups.

I have always served the group, however now I see that I will definitely have more work!! This is a great group for me to talk with women about adult caregiving and issues that they may be facing with aging parents.

Alzheimer's Caregiver Connections Update

The conference last week was amazing. Despite the threat of a nor'easter, the Holiday Inn in Peabody was full. The speakers were amazing. The one thing that all the medical professionals talked about was the holistic (meaning many approaches) treatment of Alzheimer's disease. It was clear that the medications of today can slow the disease from it's path, but they all talked about diet and exercise as being part of the treatment. They all spoke about how leaving an Alzheimer's patient in front of the TV all day just adds to the progression of the disease and loss of skills.

They also talked about how changing an Alzheimer's patient's environment too much (going between children's homes), though might sound like a good idea to you and me, can be confusing and dangerous for the Alzheimer's person because they cannot do "new learning". Keeping things predictable is important. Dr. Paul Raia calls this Habilitation Therapy. This link is to a good article on the subject.

Joanne Koenig-Costa, the author of Learning to Speak Alzheimer's, gave the wrap up address. There wasn't a dry eye in the house when a longterm, care partner/spouse talked about her end-stage Alzheimer's husband and how their relationship now works when he can no longer talk or communicate. She talked about how love still exists. No one could have laid out the heartbreak of Alzheimer's disease to a family better than someone who has walked the path with a loved one and is now facing the end.

The one sad thing about the information is the prediction that there will be 14 million people in the United States with Alzheimer's disease in the year 2050 if we don't have a cure. Living longer is great, but the price we may have to be to do that is very steep. The grief that it may give our families is tremendous, because Alzheimer's does not last just a year....it can progress for up to 20 years.

One of the most beautiful things about our conference is the message that care partners need to take care of themselves first! The speakers kept giving the example of the airplane oxygen masks and how we should put ours on FIRST, then help the other person. Please find a support group if you are a care partner. You can find one through the Alzheimer's Association.

Caregiver Connections- November 3rd

Right at Home is very involved in the North Shore Alzheimer's Partnership's Caregiver Connection every year. This is a wonderful educational event for people who are caregiving loved ones who are living with dementia and Alzheimer's. This year we have wonderful speakers, including Dr. Paul Raia from the Alzheimer's Association, Dr. Wayne Salzman from Lahey Clinic, and Dr. Lewis Hayes from AllCare Hospice.

Our families have gotten tremendous resources and comfort knowing that they are not alone in their caregiving struggles. It will take place at the Holiday Inn on Route 1 in Peabody. Pre-registration is recommended because we were full last year. Call 781-281-7890 to register. The cost is $10 for families and $20 for professionals and the hours are 8:30 AM to 1:30 PM.

Parade Magazine Piece About Adult Caregiving

Did anyone see the piece that Parade Magazine did last month on Adult Caregiving? I thought that it did good job of bringing to light the difficulties that so many of my families are faced with and were not entirely prepared to deal with. It talks about how caregiving can even be life threatening. It states that between 40% and 70% of caregivers have clinically significant symptoms of depression and depression often leads to a neglect of the caregivers own physical and mental health. It also stated a financially devastating fact- over a lifetime, family caregivers sacrifice and average of more than $500,000 in total income. The conclusion to the article is that we all need to spend more time thinking about what we will do when and if we become a caregiver, because the federal government is basically leaving middle America to "figure it out". States are actively trying to support caregivers through many innovative programs and companies are trying to help their employees that may be caregiving an adult. It is a situation that we all have some exposure to, but it doesn't seem that we have any one answer. There are good links in the article that I will add to my blog.

Recent Speaking Engagements

I have been asked to do a number of speaking engagements over the past month. It has been a great experience. In early September, I spoke to John Hancock Insurance employees in Boston in an educational program on Medicaid and Medicare. It was part of their employee assistance program to help inform them about health insurance issues that they may face when helping an elder or looking more down the road for themselves. I thought it was a terrific topic to discuss, because I find that so many families don't know anything about the Medicare and Medicaid until it is time to use it. To start to think about the "gaps" in care and how to prepare for it is important. I was able to share my experiences with families who were in crisis mode because they never planned to manage their family member's health care. Information will not change the "suprise" moment when we start caregiving another adult, however information on Medicare and Medicaid will take some of the fire out of the crisis.

On September 21st, I spoke to the Haverhill Rotary Club about Adult Caregiving. The group was very welcoming and asked many good questions. I brought the Adult Caregiving Guide that Right at Home has produced with Secure Horizons. In the end, I didn't bring enough. It was a really nice group. You can download a copy of our Adult Caregiving Show Me Guide by going to the national Right at Home website and you will see the PDF option on the left.

Next week, I am speaking on a panel for the law offices of Vincent Bonazzolli. His office specializes in estate planning and he runs informational seminars for his clients and their families. His office is in Lynnfield, MA and I have found him and his office staff to be extremely professional and great to work with.

The other members of the panel will be Dianne Savistano of HealthAssist. Healthassist offers expert consulting, coaching, information and assistance to demystify healthcare and help consumers make the best decisions for their health. She is particularly helpful with helping people with a hard diagnosis (cancer) and helping them navigate through the insurance and the healthcare decisions.

Eileen Berman of Independent Living Solutions. Eileen is an excellent Geriatric Care Manager that works with families all over the North Shore. Right at Home works with her to help many clients.

Dick Cote of Good Life Providers will also be on the panel. This service provides home safety, modification and property maintenance service specializing in the needs of senior home owners. Ongoing maintenance is critical to maintaining a safe and comfortable home as well as enhancing the property value while preventing minor problems from developing into major headaches. I am honored to be presenting with them all

North Shore Women In Business Membership Drive

I am the chair of the Membership Committee and we are running a drive for new members. Any guest can come to our September breakfast at the member price. Also, if you join in September, you will get a great tote bad with the NSWIB logo filled with promotional items from our members. Come check us out. Go to our website at www.nswib.org!

New Developments at Right at Home

We have added a new key staff member here at Right at Home. Meet Lynne Nieman our new Community Relations Coordinator. Lynne joins us after 12 years of medical administration. She also is a Reiki Practioner that has been doing demonstrations for elders at different long term care facilities.

She was attracted by Right at Home because she has always felt great compassion for Alzheimer's patients and wanted to help the cause of finding a cure. Last year she started selling the Alzheimer's Bracelet with a portion of the proceeds going to the Alzheimer's Association. All of our female employees are now wearing the bracelet proudly! It is beautiful! Email Lynne if you want to find out more about the bracelet at lnieman@rightathomemass.com.

Lynne has a great sense of humor and will be out in the community educating people about Right at Home and how we can help people stay independent and safe at home.


OCT 1- Lynne's story was picked up in the Marblehead and Swampscott Reporter!! Her picture looked great!

CEU Program- Differentiating Dementia, Delirium and Depression among the Elderly

Differentiating Dementia, Delirium and Depression among the Elderly

This is a great educational program for professionals working with older clients in a long term care environment. At the completion of this program the participants will have an enhanced understanding of the underlying etiology of Depression, Dementia and Delirium. You will be able to identify the difference in their presentation and treatment. A comprehensive review of diagnosis, treatment and pharmacological interventions for each condition will be discussed. This program is offered by Education Solutions for Long Term Care in accordance with the Massachusetts Board of Registration for Continuing Education, 244-CMR.
1 Contact Hour
Presented by Susan Jamison RN. MS. CS.

****WHERE:19 Front Street, Salem, MA
****WHEN: September 20, 2007 at 8:00 AM
*****RSVP: Lynne Nieman 978-744-5151 or
*************lnieman@rightathomemass.com
SPACE IS LIMITED

Free Breakfast Provided
Validated Parking at East India Mall Garage

Live-In Versus 24 Hour a Day Home Care

We have many families call us asking us what is the difference between these two different types of care. It can be confusing when a family is calling several different home care agencies, as sometimes it seems to the families that a live-in is just a less expensive model. THIS IS NOT THE CASE- there is a difference in care expectations for that employee and the acuity of the client's condition is the key deciding factor.

A client who is coming out of a rehab or hospital, back home, generally needs 24 hour a day care to start, if 24 hour a day care is recommended by the discharge planners. The expectations of the client and their family should be that the home care worker is available to them 24 hours a day and awake during sleeping hours. This type of arrangement will be accomplished with a combination of a handful of employees, because the home care workers need to be available to the client and their families 24 hours a day. No one worker can provide safe, professional care without sleep and time to themselves. A client that gets up several times in the night and keeps an erratic schedule with lots of hands on work is in need of 24 hour a day care. The family is charged an hourly fee for 24 hour a day care. There does not need to be a bedroom for the caregiver and it is expected that the home care worker will provide their own meals. 24 hour a day care can be set up by Right at Home schedulers within 24 hours of a family's initial phone call to us.

After that client has re-established themselves at home in a routine, they may be eligible for live in home care. Live in home care exchanges room and board for a lower overall home care fee. The worker "lives in" the client's home during the period of days that they are working. The client must have a separate bedroom for the worker and it is expected that worker will eat the client's food.

The expectation of how much the live in will work is different from 24 hour a day care. Live in home care workers work 8 hours a day. This is spread throughout the day to help the client with their Activities of Daily Living. The other 16 hours of the day are for leisure and sleep, though the worker is still in the house. A client that needs help getting prepared for the day, showering, medication reminders, meal preparation, supervision (dementia clients), and needs help getting to bed is perfect. Live in home care workers are harder to come by, because the agency needs someone that can commit to be away from their home for several days at a time. This is a worker that will devote themselves to that one client for a long period of time. It takes us about a week (or sometimes more) to set up a live in situation The family is charged a per day fee for live in care.

Sometimes families call me and specify that they think that these two types of care are the same. At Right at Home, both types of care happens under the supervision of our RN supervisors and they get quality agency care with all the protections for the family, ie workers compensation insurance and general and professional liability insurance. The expectations and worker are very different to give safe care to the client.

Sometimes, I have heard of agencies that start live in care and then, after the care is in place, they tell the family that the case is too hard and move them to 24 hour a day care. Right at Home will generally get the call from the family looking for an alternative to the shock of the new financial commitment. We feel that if the standards are shared with a family before care begins and agencies present "live in" for what it really is- a living arrangement with 8 hours of care, and not a "cost savings" option, then clients can get the best care when they need it.

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Medication Adherence in Boston Globe

This is from yesterday's Globe. This relates directly into our new prepackaged medication solution. When I checked the Web, I saw this was picked up all over the country. Medication adherence is being called a crisis. Right at Home really needs to get the word out that we can help families make sure that their loved one takes their medications correctly through reminders and our medication solution.

Millions fail to use medicine correctly

New report calls problem a crisis

By Lauran Neergaard, Associated Press | July 31, 2007

WASHINGTON -- Consider it the other drug problem: Millions of people do not take their medicine correctly -- or quit taking it altogether -- and the consequences can be deadly.

On average, half of patients with chronic illnesses such as heart disease or asthma skip doses or do not use their medication correctly, says a report to be issued later this week that calls the problem a national crisis costing billions of dollars.

The government is preparing new steps to try to persuade patients and their doctors to do better.

But with contributors that range from hurried doctor visits to confusing pill bottles, there is no easy solution.

"We go into this with some humility," says Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which is planning what she calls an "in your face" campaign to improve medication adherence. "It's really pretty appalling how badly we do."

This goes far beyond the issue of affording prescriptions. People often buy their drugs but misunderstand what they are supposed to take, or how. Or they forget doses. Or start feeling better and toss the rest of their medicine, or skip doses for fear of side effects.

It is not just a problem of poverty or poor education. Even the rich and highly educated skip their medicine. Perhaps the most high-profile example is President Clinton, who stopped taking his cholesterol-lowering statin drug at some point and later needed open-heart surgery to avoid a major heart attack. Statins offer significant heart protection, but about half of patients on statins quit using them within a year.

The globe-trotting tuberculosis patient who was briefly quarantined in May after ignoring doctors' orders not to travel by airplane is out of the hospital now but, like all patients with hard-to-treat TB, must take his remaining antibiotics while health workers watch. So many TB patients skip their pills when they feel better -- but before all the bacteria are wiped out -- that health departments now enforce what is called "directly observed therapy."

For most diseases, however, patients must choose to take their medicines. The new report combs a decade of research to conclude people generally do a lousy job.

Clancy hopes to make "take your medicine" a new priority. Her Agency for Healthcare Research and Quality is starting discussions with the new report's authors, the Food and Drug Administration, and health groups about what steps to take.

© Copyright 2007 Globe Newspaper Company.

Right at Home in Marblehead Reporter

Right at Home's opening in Salem, MA was featured in the Marblehead Reporter. It was nice to see Jay quoted and talking about our Telephony system. Telephony is our electronic time carding system. When a Right at Home aide goes into a home, they dial into a specific 800 number. They put in their employee code and tell the system if they are punching in or out. This system even works if the phone is blocked because it uses E911 technology to read the telephone it is being dialed from. The call is only valid if it comes from the client's telephone.

The call then is automatically logged into our scheduling software. If a call does not go into our system within 15 minutes of the start of a shift, then there is an outcall to our supervisors. We can proactively call the client, aide or family to find out if everything is OK. This technology has given us the first proactive monitoring system that we could implement for all shifts, at all times. This increases our client's security immensely and it has been extremely well received by families.

Large Amounts of Money in the Home

I heard a terrible incident today regarding an elder (not a Right at Home client) that kept several thousand dollars of cash in their home. For whatever reason, the hiding place for this money became evident to the home care worker in the home. It is sad to report that the temptation became too much and the elder had their money go missing.

The reason that I share this is to warn potential families that keeping large sums of money in the home is not a good choice. Because the client above used a reliable agency, they are protected by insurance. There were criminal background checks done on the employee, however an incident still occurred.

Many elders and families hire individual through the Internet or through a referral. They do not have an agency's protection. Home health aides are usually in a personal, low income situation. They are just like any other group - the vast majority of them are honest, hard working people, but unfortunately a very small percentage make wrong choices.

The bottom line is.....whether it is home health, contractors, repair people....any service people...please don't keep large amounts of cash in your house. It is the safe choice.

Right at Home Moves to Witch City

Jay and I returned from Paris and immediately got our crew together for our move to Salem, MA. Or should I say back to Salem. Before we moved to Marblehead, we rented a great apartment on Chestnut Street. Jay and I were married at the Hawthorne Hotel in 1996 and today I am on the Board of The Phoenix School on Margin Street.

After 5 years in Beverly, we had outgrown our space and really needed to find a place where our team could work with a little more elbow room. Our space was once for our home care aides to get schedules and pickup checks, now we use it for those things, plus family meetings and educational programs. Our new address is 19 Front Street in Salem. We occupy the entire third floor of the building.

As a longtime North Shore resident and former Salem resident, it is great to see the revitalization of the street. I have always loved walking downtown Salem. Our business neighbors include the Front Street Coffee House, J. Mode women's clothing store, Fiddleheads florist (beautiful stuff) and the ice cream parlor. Downtown Salem, though freaky at times, is a marvelous place to walk and browse. There are practical shops (clothing, jewelers) and businesses that survive on the magical and Halloween theme. The Peabody Essex Museum and their new remodel has been named one of the ten best museums in the US for children. I can attest that it is a great place to go to on a cold, New England weekend day with two antsy kids.

We are now settled in and our clients never even felt a bump in service (though we may have felt the bump of the printer breaking, etc) . Now we only need to deal with the parking tickets.....

Doctors' Awareness of Alzheimer's Disease

I was at the Alzheimer's Partnership meeting today and the discussion came up regarding how the Alzheimer's Association can educate physicians on the resources for families that are facing an Alzheimer's diagnosis. It seemed very discouraging that our local doctors ( in a sweeping statement) are not interested in utilizing the Association and their resources. There was a lot of frustration in the room. Education of our local North Shore community is our goal, so we will keep trying. Putting packages in the doctor's waiting room was brought up, but a doctor's referral to the Association would be so much more effective.

On another note, I will be celebrating a birthday with a zero at the end of it in PARIS next week!!

À bientôt

Prepackaged Pharmacy Products Save Lives

We are offering our clients a great new prepackaged pharmacy solution. This is so unique as an in-home solution, that I a really excited about it. Our client's families are always looking for a solution to help the burden of medication management. The reasons that this is needed is:

1) Virtually all seniors take multiple medications (the more meds, the more possibility of mistakes, non-compliance)

2) 1/3 of seniors needing assistance to stay at home need help with their medication management and reminders

Our Right at Home Prepackaged Solution:

1) Maintains people's independence by improving their health because it
increases compliance, because the medications are all set up
2) Provides peace of mind for the caregiver
3) Provides a cost savings on medication

Compliance Saves Lives!! (Taking Medications Correctly)

1) 10% of all hospital admissions are a result of non-compliance
2) 23% of all nursing home admissions are a result of non-compliance
3) 125,000 deaths a year are a result of non-compliance

See what WebMD has to say about medication compliance and how prepackaging meds dramatically increases the correct use of medications!!

This is a puppy picture of Lola, the wonder therapy dog that I work with on Wednesdays. She and I visit the good women of Renaissance Gardens Assisted Living at Brooksby Village
on Wednesdays. This is part of my service in the community that has given me so much. The women that I see all tell me about the dogs in their past and keep track of my stories about my kids and work. It is very rewarding.

You can have your dog certified for pet therapy through a number of organizations. Lola has been trained but she still has to pass her test (she gets very excited when she sees another dog). I will have to work on training her out of that!!

Snacking For Seniors

I saw today a link from Reuters regarding Snacking for Seniors. We find that we are always concerned with the diet of our senior clients and snacking seems to help us. Our clients rarely want to eat a lot at a meal, however the small meals that they take, sometimes do not provide enough calories or nutrients to provide the energy they need to complete their days activities.

At Right at Home, we find that if we provide small "meals" several times a day helps our clients take in more calories, PLUS they are more open to one banana or toast and tea, than a big meal. Since seniors sometimes eat less than the rest of us, pick the yummiest and most nutrient rich snack you can find. Happy Snacking!!

North Shore Elder Services 30th Birthday Party

Last night we attended North Shore Elder Services 30th Birthday Bash. Right at Home was one of the sponsors. The theme was the 70's. North Shore Elder Services is the local ASAP (Aging Services Access Point) for Marblehead, Salem, Peabody, Danvers and Middleton Massachusetts. Many elders and caregivers were there, along with all the elder services providers. It took place at the Peabody Council on Aging. They served the food that they serve every day for the elders at the Adult Day Health and the other COA functions- chicken, pasta and vegetables. It was pretty good. There was a lot of joy there- laughing, dancing (the band was great) and conversation.

Anyone wondering where to start with elder services in Massachusetts should call their local ASAP. You can find out which one services your town by going to the 800 Age Info site run by the Commonwealth of Massachusetts. The ASAP's can tell a family if they qualify for services like transportation, homemaker and personal care services, Meals on Wheels or adult day health services. Even if someone does not financially qualify for subsidized services, there are support groups and many other resources to be found.

Home Care this Week

As the founder of a successful senior home care agency in Massachusetts, I get to see the most wonderful situations and the saddest situations that occur with our seniors. It is heart warming to see the families that sacrifice their lives for their elder who suffers from advanced dementia and it is heart breaking to see the elder that lives alone and has no one that cares for them except their home health aide.

This week I met a family that has been caregiving their 90 year old mother with Alzheimer's Disease for five years. From 9 AM to 5 PM, one sister does all the care. Her mother is advanced and losing her language skills, so she needs to be supervised every minute. This daughter is relieved by her brother and his wife for the overnight shift and the weekend. The care and example that this mother must have given her children must have been extraordinary. Their dedication is unwavering. The son and his wife have not slept at their own house for five years.

When I look at my kids, I wonder if they would do that for me? Would I want them to?