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    Jan 3 2015

    Make 2015 Your Year for “Aging Reality”

    Posted by Merrily Orsini

    Aging is not what it used to be

    “When is Old?” Needs to be Rethought

    Whether aging yourself, running a business that services those who are aging, or creating products or services that serve an aging population, there is one thing for certain, you need to understand aging and what that means. Agism is rampant in our thinking and our communication. Ask anyone what age is old, and it will inevitably be at least 10 years past where that person is. The younger the person, the younger the age “old” is perceived to be.

    Recently at the H3IT Summit in DC, I listened as enthusiastic students created products and services through technology that will serve the aging population. Age they are targeting? 65+
    The Wall Street Journal has a wonderful article on the advances in relationships between grandparents and grandchildren, and technology is being used widely to communicate. Whether social media, Skype and Face Time or online groups, the ease of keeping in touch is expanding to all ages. No longer is technology usage just for the young. It has reached into all ages, all economic strata, and it is making a difference in how people perceive aging.

    Death is certainly the reality and the end of life, but death is not really related to age. I had a dear, dear friend die on December 22nd, and she was 66  years old and sitting at her computer, with no presenting health issues.  Jerome H. Stone, a founding president and honorary chair of the Alzheimer’s Association died at 101 yesterday. The difference between that 66 and the 101 is what I am referring to as Aging Reality, and what needs to be conveyed in 2015.

    We are a diverse society. We are a technical society. We all age at different rates based on our lifestyle and genetics. We know that to “keep young” you have to socialize, use creativity daily, eat right, exercise, have some spiritual connection and think positively using humor as a tool. Aging is in the mind, but it is also in the body. A painful existence is not conducive to keeping young, keeping positive, and using humor.

    So, start taking baby steps in realizing that aging is not the criteria for needing services. Frailty is. One can be frail at any age, and need assistance. Targeting “old folks”, whether for a business, or just to be conversational, needs to change to “targeting needs”. The age factor is one of the least important in determining what services one may need.

    corecubed specializes in aging care marketing. What that means, is that we are focusing on those businesses that service the growing industries that are accommodating the needs that arise from frailty. Medicare certified home care services apply to those over 65 with post acute care needs. Hospice services are for those at the end of life. Private pay home care services are for those who need care, regardless of age. We find targets, regardless of age, and hone in on how best to reach those targets.

    So, make 2015 your year for “Aging Reality” and rethink your stereotypes as to what age is old, and to what an “old person” can do and looks like.




    Dec 30 2014

    Start the New Year with a Focus on Branding Your Home Care Agency

    Posted by Merrily Orsini

    Make all the pieces fit with branding

    Solve the Mystery of Marketing with Branding

    Just tying up some loose ends for some MOST clients, and realized, that, once again, branding is something that most home care businesses do not completely understand. When you do understand branding, and then systematically implement it, it truly works. Well branded businesses (it is proven) do have greater success, partly because a good brand generates more permissions and more opportunities than lesser known brands. One of my favorite articles from several years ago, makes it easy to understand, discussing the “Five Permissions” that a well branded company can expect.

     Access. Having a good brand makes doors open easier. Whether trying to sell something or just talk to someone, being from a well known and recognized entity opens doors. In home care, it is harder, because having a brand is harder, but, consistency is the key, and when consistently using a well-developed brand, the entry to referral sources becomes easier.

    Latitude. Because a well branded company means a more trusted company, those from that company can expect more latitude in taking chances. Having proven oneself to the public means that more permissions will be granted in areas unproven.

    Recovery. Permission to recover is granted to a well-branded company. A smaller business may not be given permission to restore confidence when a mistake does happen. And, in home care, mistakes do happen. Getting permission to make it right is sometimes golden for a long term relationship.

    Scale.  Trust and perception are built into a well branded company. It’s this greater trust in the brand that allows permission to grow and take on bigger projects.

    Set standards. Unknown services, products or technology are oftentimes given a chance simply because a well branded company has a proven track record and it is believed that the company, if they are recommending a product, service or technology, are doing so because they believe will eventually be a standard.

    Also, to understand branding, you have to understand it from both the buyers’ and the sellers’ perspective. From the buyer’s perspective, the brand reinforces what the buyer will get. From the seller’s perspective, the brand should serve to educate the potential buyer and perhaps even reduce the impact of price on the purchasing decision.

    Doubters of brand value will argue the real reason behind the greater margin is better quality of service, or reduced risk based on track record. No doubt, these come into play. At the same time, alumni from these companies will attest that the differences are not as great as might be imagined. The bigger difference occurs at the margin – and in terms of “permission”.

    If you want to discuss your agency and your branding, contact the home care marketing experts at corecubed. We certainly do know how to help you develop a brand platform and execute. Happy New Year!




    Dec 23 2014

    Important Companionship Exemption Ruling Affects Home Care

    Posted by Merrily Orsini

    Companionship Exemption exemption allowed for 3rd party employees

    The effect on home care by the Companionship Exemption Ruling is great

    The home care industry has been actively fighting the Dept of Labor’s administrative ruling that prevented 3rd party employees (employees of agencies) to take advantage of the Companionship Exemption, a law that allows for payment taking into account the nature of the job, where a person is not actually working, but rather may be sleeping, or just “in attendance”. Copied below are two releases sent out last night, one by HCAOA and another by NAHC:

    From the Home Care Association of America, “We are pleased to announce the federal U.S. District Court of the District of Columbia decision today in the case of the Home Care Association of America et al v David Weil, et al.  Today’s decision grants the home care community’s motion for partial summary judgment and vacates the U.S. Department of Labor’s efforts to deny third-party employers access to the existing companion care exemption under the Fair Labor Standards Act (FLSA).  The Department’s rule, modifying the FLSA, was set to take effect on January 1, 2015.  While a clear victory for the home care community, this decision does not vacate the entire regulation and does not resolve concerns with the Labor Department’s updated definition of companion care. In his decision, Judge Richard J. Leon states “Undaunted by the Supreme Court’s decision in Coke, and the utter lack of Congressional support to withdraw this exemption, the Department of Labor amazingly decided to try to do administratively what others had failed to achieve in either the Judiciary or the Congress.” Judge Leon further states “The language of the exemption provision is quite clear: ‘any employee’ who is employed to provide companionship services, or who resides in the household in which he or she is employed to perform domestic services, is covered by the exemption.”  HCAOA and the home care community have long held the Labor Department’s regulatory actions in this area were outside the bounds of the law.  Today’s decision provides hope to many who had feared they would no longer be able to afford home care services due to the Labor Department’s overreach. Please stay tuned for further information from HCAOA as we consider further steps and await response from the Department of Labor on this ruling relative to implementation on the remainder of the FLSA rule.

    For more information on the decision see the following:

    From the National Association for Home Care and Hospice, ” NAHC and all of the members of the home care community celebrated today when they learned that the U.S. District Court for the District of Columbia struck down onerous new overtime rules promulgated by the U.S. Department of Labor (DOL).

    “What this means is that the rule, which would have taken affect January 1, 2015, will be set aside and that older Americans will once again enjoy access to personal care assistance in their own homes,” said Val J. Halamandaris, President of the National Association for Home Care & Hospice (NAHC), a plaintiff in the lawsuit. “This is a victory for elderly and disabled persons who rely on home care,” said Halamandaris.

    The lawsuit challenged a rule that would prohibit the application of two overtime compensation exemptions: companionship services and live-in domestic services. It would have applied whenever caregivers were employed by anyone except the direct consumer of their services-90 percent of care would have been affected by the new overtime rule. This change would have created higher care costs that would have been borne by consumers and financially strapped government funding programs, such as Medicaid.

    “This victory proves the value of industry unity,” said President Halamandaris. He commended the International Franchise Association and the Home Care Association of America who worked together with NAHC to file this suit against the U.S. Department of Labor. He also offered special praise for NAHC Vice President for Law, William A. Dombi, who managed and coordinated the litigation effort. “United, fighting on behalf of the elderly and disabled we cannot fail, divided, we cannot succeed,” said Halamandaris.

    Halamandaris said that he and other members of the coalition are looking forward to the next phase of the lawsuit which will be designed to fully restore the companionship exemption which has survived in federal law for almost 50 years. A related goal is to make it possible for agencies to once again provide live-in care for those seniors who need it.”

    This is a major victory for many home care agencies and those who receive care at home and comes at a time that allows for agencies to continue providing uninterrupted service to those who so need it.

    Happy holidays!


    Nov 19 2014

    3 Days in the Life of a Home Care Futurist

    Posted by Merrily Orsini

    Merrily Orsini, Home Care Futurist

    Home Care Futurists Merrily Orsini

    It took a Facebook posting by an old high school friend to remind me what a full and exciting life I lead. You see, I have a passion for aging care and that passion takes me to some very interesting places and includes me in some futuristic planning meetings. The upshot of all this is a professional life that is action packed and that allows me unusual insight into where we are headed as we boomers age. The home care and health care world is struggling to figure out how to handle the onslaught of aging people that are soon to be not only on the horizon, but upon us, After all, we are in to the boomers (those born between 1946 and 1964) era of turning that magical number of 65, and as the years move on, so do those aging boomers.

    I’ll just cover a week in time, but, this week will showcase a trend for us as we age in place. First, the Saturday all day meeting with the University of Maryland, Baltimore Campus (UMBC) was a workshop on home health and hospice technology (H3IT). There are actually many folks that are focusing on how to leverage technology to assist in our aging dilemmas. And, not only telehealth or eHealth or telehomecare, but also communication, and standardized processes for interdisciplinary teams to keep the patient and his or her needs at the center of the care. Telehomecare (or whatever you want to call using devices, even smart phones, to communicate on care issues) are seen, not only as monitoring or data collection devices, but also as a way to extend the care. Currently care delivered at home is one-on-one care. Telehome care should allow less one-on-one care so that less staffing can accomplish what we do now with people. Less staffing, but not less caring is the idea. Extending the care through technology, communication with the patient and the care team, and intervening when necessary and appropriate. After all, it is the disparity in available caregivers and the need for them that poses the greatest risk for a focus on in-home care. This is a subject for a sales webinar today, if you are interested.

    The issues of caring for frail folks at home seems simple. However, think of the workforce- it is distributed (not provided at one location like a hospital, but rather in a location that someone calls home), and it is largely unsupervised. The practicality of having the right person at the right time at the right place is hard enough without another person needed to supervise the sole care provider in the home. Technology can help. The location and time that care is delivered can be verified. The care given or provided can be monitored, and the tasks can be verified, with all accomplished remotely through current technology. Soon we may also have affordable video monitoring for all agencies to allow for sporadic checks on the tasks provided and some quality checks on the caring and kindness provided as well. After all, the way care is delivered should also be an integral part of the job.

    What happens if the designated caregiver cannot get to the patient? Or if there is an emergency that keeps anyone from coming? Technology can at least proved some communication and assurance, and a check that meds are taken and food is consumed. Technology can also be used to monitor the effects of new meds or to check on a patient just home from the hospital or nursing home. Just having someone who knows what should be done for care and what events are outside the norm for that health situation will help a newly frail person to start regaining independence. Telehomecare can also provide some safety checks that may not be present currently.

    Some of the issues with current technology systems stem from accumulating too much non-prioritized data. What is most important from a care standpoint oftentimes gets lost in the reimbursement and documentation regulations. Critical to care is determining what needs to be checked, with some alert for any changes in condition that would be an alarm for potential health or safety dangers. Right now we are trying to get every system talking to each other in the same terms, and until that happens there is little chance of getting meaningful, summarized data. We do need to decide on standards and adopt some common language that spans the clinical and the non-clinical.

    The H3IT conference had attendees from Jordan, Ireland, Russia, Canada, and Mexico as well as almost every aging focused university in the country. It certainly is a great way to identify what is important in development of systems that will assist in our world’s efforts to solve some of our troubles before they become overwhelming. The side conversations at the breaks were almost as meaningful as the presentations and poster papers presented.

    Monday brought a meeting at CHAP that also was focused on technology. How do we assist the agencies that seek to achieve quality and maintain it? How can we assist the surveyors tasked with pulling random records and assessing processes do their job better? Can the in- home technology be leveraged to expand on providing better patient care? Can we identify best practices by analyzing processes used by home health agencies that are at the top of the quality curve? What role does technology play in quality care, and how can that be proven? There are several accrediting bodies that service the in-home care industry, and quality is definitely one of the keys for future success. State regulations vary and there are few national regulations that govern in-home care, so the wise agency will focus on quality improvement and ways to maintain and improve quality with some way to verify that. Technology should play an important role in verifying that quality measures are, in face, in place.

    For years the physicians were at the low end of adopting technology to do their job better. Now that EHR is a mandate for physicians, it is the home health agencies that are lagging. Many of the programs used by the larger established systems are legacy (programmed on old code) and not equipped to be as flexible as needed in today’s world of global interoperability. Early telehealth equipment is large, cumbersome, complicated and not very user friendly. Technology needs to be easy to use, integrated into the home environmental and easily converted to monitoring as needed. And, once again, a summary of important data is needed. All of that monitoring and all of that data collected is not important if it is not analyzed for actions. Is the patient out of normal functions for some readings? Has behavior changed? Have sleep or eating patterns changed? Has there been rapid weight gain or loss? And what does that all mean? Then, take this back to providing quality care and how can we assure that, with all this intervention and care at home that the patient is getting the best quality? Lots of unanswered questions, but good questions to create a path for success for the future.

    On to a meeting at the FDA to showcase how GPS can be used to verify visits in home care. Because there are no diagnoses stemming from the information transmitted from the home to the office for electronic visit verifications (EVV), the EVV systems are not FDA regulated. However, they are very interested in the technology as a platform for the future. The API interfaces available and at the fingertips of the home care aide or nurse while in the home, opens up a whole new world for the patient in the home. Verifying that a visit takes place and having the patient sign off that the nurse or aide was there is just ones component of technology used in the home. Access to teaching guides in many languages makes the interaction meaningful if the patient needs to know how to treat a wound, or how to best exercise following a stroke. Access to resources for making life at home easier is available through technology. With the right technology, one can even order and schedule any equipment needed in the home.

    Just entering into the FDA building was an adventure. It seems that Clinton made requirements for every federal building to be ultra secure following the Oklahoma disaster where access to a federal building was easy. Photo IDs were scanned, questions asked about the info on the ID and the collection of those visitor passes post visit assure that no one could represent anyone else, remain in the building undetected or enter with any weapon, pretty impressive system itself.

    All in all, the action packed three days in the life of a home care futurist is not a typical three days. However, it does showcase the variety and interoperability needed for a successful future in home care. That future will have technology at its core, and quality as its mantra. I have to say thank you to my friends at AXXESS for allowing me the flexibility to travel to the important agency meetings and then to listen to my suggestions for how their technology can continue to be state of the art.