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May 26 2015

End-of-Life Care: Necessary Discussions Often Avoided

Posted by Merrily Orsini

Stop avoiding end of life care discussions.

Stop avoiding hard discussions around end of life care.

As we age, perhaps the greatest single discussion we can have with our grown children is what we want done—or not done—to us, for us, and on behalf of us, as we approach our last decades, and the possibility of needing assistance, and the inevitability of our passing.

End-of-life care discussions not only give us peace of mind that our medical and health wishes will be fulfilled, but also give our children, or other caregivers, peace of mind on exactly what we would like to have done when they eventually face a myriad of healthcare decisions on our behalf, particularly if we develop a cognitive impairment that takes away our ability to make sound decisions for ourselves.

To improve the quality of end-of-life care, and to promote the need for caregivers and patients to have such discussions, the independent Institute of Medicine recently released a comprehensive report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. From the report brief:

 Many people nearing the end of life may not be physically or mentally capable of making their own care decisions. In addition, family members and clinicians may not be able to accurately guess what a person’s care preferences may be. Therefore, advance care planning is critically important to ensure that patients’ goals and needs are met. Although advance directive documents can be useful, they should allow health care agents and care providers to make informed decisions in certain circumstances and should not take the place of open, continuous communication. According to the IOM committee, the advance care planning process can begin at any age or state of health and should center on frequent conversations with family members and care providers.

Sadly, many patients and their caregivers haven’t had this critical discussion. You might expect your doctor to bring up end-of-life care issues, but many don’t or aren’t comfortable bringing up these issues, possibly worried that the patient or their caregiver will take it as if the doctor has given up on them.

End-of-life care discussions should include:

What you want your life to be like as you age?

Would you like to stay in your own home?

Who would you choose as your caregiver?

Who is in charge of your estate, and have you designated a durable power of attorney?

Who is in charge of your healthcare decisions, and to whom will you give your health care proxy?

Have you filled out a living will, being as specific as you want about your future health care and medical treatments (Do you want doctors to do everything possible to prolong your life, nothing at all in the event of a terminal illness, no artificial respiration, etc.)?

In the event of a heart attack or stroke, do you want to be resuscitated and have you filled out a “Do Not Resuscitate” form, otherwise known as a DNR?

For those who haven’t had the discussion, home care agencies offer a great starting point when the patient requests your services. With tact and grace, many home care agencies have home care social workers who can help facilitate the discussion and point clients to services they didn’t know existed while having a discussion they might have thought too difficult to have. In fact, I find the opposite to be true. In the absence of end-of-life care discussions and documents, patients and their caregivers are often left with difficult decisions during emergencies and even day-to-day tasks. Children often have opposing ideas as to what a parent would have wanted, and family issues explode in a time of crisis when a parent’s last wishes (unknown) are vehemently championed on opposite sides.

In many cases, end-of-life care decisions are left up to doctors, both those who do and don’t know the patient, with devastating consequences, according to a recent Boston Globe op-ed by Dr. Angelo Volandes, who is on the faculty at Harvard Medical School and Massachusetts General Hospital. Because doctors are tasked with saving lives, even those with a terminal illness without a DNR often go through the extensive trauma of resuscitation that does little to prolong their life but adds pain and misery to their final days.

Volandes tells of a terminal cancer patient who was resuscitated four times but died 48 hours later, of his cancer. But the process of “saving” him resulted in multiple broken ribs and “a tube or catheter in almost every part of his body, for a grand total of eight plastic intrusions, including an endotracheal tube (lungs), two central intravenous lines (veins), an arterial line, a nasogastric tube (stomach), a foley catheter (bladder), a rectal trumpet tube, and a tube placed in the sac of his heart to drain fluid.” He was “fixed,” Volandes writes in the op-ed, but at what cost to his suffering and that of his family?

Dr. Volandes’ new book, “The Conversation: A Revolutionary Plan for End-of-Life Care,” is also a great starting point and resource to begin your end-of-life journey. The way you intend it.

These conversations aren’t easy, and indeed, there are those who want everything done to prolong their life and those who want nothing done at all, and a wide spectrum in between. Stating the who, what, where, when, and why makes the road ahead less difficult for the patient, the caregivers, and the extended family.

 

 
May 19 2015

When “Notorious” is a Good Thing

Posted by Merrily Orsini

There is no question that notorious can be noted for good.

Do not question being notorious if it means known for good work.

Normally, being called notorious means you’ve done something wrong. Recently, corecubed received a client inquiry who said we are “notorious in our niche” for supporting and marketing quality in home care. I’ll take that “notorious” as a compliment.

To survive in the future in home care, quality is the key. And that necessity for quality spans the spectrum from operations to direct care, and specifically includes specially trained caregivers, specially trained care planners, and specially trained marketers who understand the buying process and meet the potential buyer where he or she is in the cycle, whether an adult child or a referral source.

For home care especially, education is key to marketing since the adult child searcher (and oftentimes the referral sources) usually does not really know what they need or what the future holds. Those looking for a homecare agency or provider want the assurance of quality home care for their loved one. Quality care, and marketing that quality care effectively and efficiently, is what will help your homecare business stand out from an incredibly crowded (and becoming ever more so) field.

According to the latest figures from the Centers for Medicare and Medicaid Services (CMS), in 2010 there were more than 10,800 Medicare-certified home health agencies throughout the United States. In that same year, nearly 3.5 million beneficiaries were served, and more than 122.5 million home care visits were made. There are no accurate statistics for home care that is not regulated, home care for which one pays a fee. Estimates by the Home Care Association of America place the number of private pay home care agencies at somewhere between 8-10 thousand.

The CMS website says it emphasizes quality care for all Medicare recipients, and uses the following criteria to determine quality: effectiveness, efficiency, equity, patient-centeredness, timeliness, and safety.

At corecubed, we’ve long emphasized these same quality parameters in positioning our home care clients and in creating strategy to market our homecare clients to their clients. We work with homecare clients to support their efforts at maintaining and improving quality standards, and articulating those standards via various social media marketing tools.

corecubed also keeps up with the latest homecare and hospice studies, through participation in organizations such as the Home Care Association of America (HCAOA) and the American Society on Aging we further enhance our expertise to the homecare and aging care business clients we serve.

We also keep up with the latest issues on healthy and productive aging, from top research organizations such as The Institute for the Future of Aging Services. And I frequently attend and speak before industry leaders and organizations, including HCAOA’s annual meeting and exposition and the annual Aging in America conference hosted by the American Society on Aging. Again, all in an effort to help you better help your clients. For many years I have also spoken at state home care association conferences (this year in Pennsylvania and upcoming in Florida), and attended many others where I have not spoken, just attended for the industry contacts and information they present.

Our amazing staff at corecubed doesn’t rest on its laurels: We all actively pursue the latest in what it means to produce quality and deliver quality. Our exclusive Most For Your Marketing program was created specifically to market home care, and has helped agencies in 35 states grow successfully, with remarkable results. There’s no other program like it anywhere.

So if all of this makes us “notorious,” then put corecubed at the top of your “Most Wanted” list of homecare marketing agencies. Contact us today to find out how we can make notorious work for you.

 
May 12 2015

Positioning Yourself as an Expert! Come Say “Hello” at the PHA tomorrow in Lancaster, PA.

Posted by Merrily Orsini

Merrily Orsini and Sam Smith discuss how YOU can be ready!

Merrily Orsini and Sam Smith want YOU to attend the PHA conference!

When it comes to selling home care services, positioning yourself as the expert is one way to stand out from the crowd. Of course, you have to BE an expert in order to do that, and that expertise takes strategy and time to accomplish. Tomorrow I speak at the Pennsylvania Homecare Association Annual Conference in Lancaster, PA, with my colleague Sam Smith from Axxess. Axxess is a major sponsor of the Future of Home Health Project that the Alliance for Home Health Quality and Innovation (AHHQI) is implementing. That project has the potential to move the health care delivery system closer to one that has a focus in home-centered care. As an industry thought leader, I love taking opportunities to speak about the future of home care, and to extend my personal brand while doing so. 

Following this important conference, Smith and I travel to DC to attend the American Academy of Home Care Medicine Conference where the AHHQI team will be in force. It is this marriage of home care and physician (or nurse practitioner) involvement that is one tenet in the home-centered care movement. And, this change in home health care and the health care delivery system is something worth noting whether you are a provider of home care, or a vendor to the industry, or just a person aging in America.

Other tenets that bear emphasis are: a change to more Interdisciplinary teams that work to achieve effective physical, functional and psychosocial evaluations/screening; a change to results that interface with an individual’s needs and goals translated to time-sensitive interventions; more effective ‘hand-off’ or transition to community physician and/or family ‘power’ caregivers following crucial conversations and episodes; and a focus on medical support keeps people alive, and psychological and social support that enables them to live.

Back to using positioning as an expert to sell services…when you are an expert and you educate instead of directly selling your services, the digital marketing aspect of today’s tactics, allow people to find you when they have a need.

As a home care agency, try educating on some aspect of frailty or disease that might be of interest to your targeted groups. For instance, elder law attorneys may want to know options for finding good care. There are liabilities and risks associated with hiring private aides that attorneys or trust officers may not have realized. And for senior groups, how about discussing when one knows it is time to seek assistance. What are signs of stress and burnout or malnourishment? And how does one seek assistance. And what does ‘assistance” mean? Are there contracts and set hours, or can the person seeking care have input into the caregiver and the duties?

For some specifics, first make a list of all the things that you do know, and then look for ways to get in front of people to educate them about what you know.

Below are some tips to help you identify – even create – good speaking opportunities, and overcome your anxiety to deliver a lecture that’s informative, persuasive and effective at getting inquiries that may turn into new business.

  • Seek out venues where you’ll reach your target audience. A home care agency has a number of target markets to reach. Several come to mind immediately: funeral home directors, children of elderly parents, associations that cater to those who have frailties, like Alzheimer’s, Parkinson’s or cancer. Call them and find out if you can speak at their next meeting. If not, target some and start building relationships with the goal to speak in front of them, eventually. Timing is crucial, so just be aware of opportunities and do not be afraid to ask.
  • Choose a topic that’s of interest to the audience. You simply can’t deliver a speech on why your agency is the best, or on what your agency does. You need to give a speech that’s informative about an important issue in which the audience is interested. If your audience is senior citizens, give a speech on how proper nutrition can improve bone density. If it’s physicians, talk about how they can improve patient satisfaction by referring families to home care rather than nursing homes.
  • Partner with other speakers. If you’re giving a speech on fall prevention, consider partnering with a local homebuilder who can provide tips on redesigning the home to eliminate obstacles for elderly loved ones with limited motor skills. They’ll likely jump at the chance to do it for the good PR – plus, it will cast your agency in a positive light while positioning you as an expert.
  • Consider inducements. Inducements such as refreshments, door prizes, raffles, etc. provide an incentive for people to attend your event. The more attendees there are, the greater the likelihood is that you’ll win new clients. It may mean forking over a little bit of cash, but that could be money well spent if it translates into new business. And giving away a plant or a flower and asking them to put their information on a card to be eligible will give you contact information after the talk.
  • Bring an informative handout. The main purpose of the seminar IS to win new business, so giving the audience something to take home with your information on it will let them know to call if any needs arise.

corecubed’s MOST program is all about positioning as an expert. We have created many presentations, with handouts, and even have many of them approved in several states for CEs. We have done all the work, including a great process for how to get engagements, how to communicate about those, and what to do as a follow-up.

No one wants to place the care of their elderly loved one into just anyone’s hands. By talking and looking like an expert who is knowledgeable, experienced, compassionate and thorough, your company can cement its place as the go-to agency for in-home care.

I love the aging care industry, and with 34 years’ experience, I AM an expert. You may not have the years or the experience, but you have to start somewhere. If you are in Pennsylvania for the PHA Conference, or in DC for the AAHCM , stop by and p and say hello!

 

 

 
May 6 2015

Senior-Care-To-Go May Not Be the Way To Go

Posted by Merrily Orsini

Choosing Elder Care is Different Than Choosing Child Care

Knowing Consequences of Choices for Elder Care Just Mades Good Sense

Last year, a Forbes tech blog proposed that the senior care market may become the next billion dollar technology opportunity, with at-home elder care services the largest segment of a market expected to reach $319 billion in the United States by 2016.  Many of these technologies, such as advanced home monitoring systems or body sensors to measure vital statistics, have the potential to benefit seniors and their caregivers and may help reduce costs and hospitalizations..

While these technological advances may help seniors stay in their homes longer or, perhaps, reduce the amount of hands-on caregiving that is needed, other technological tools under the banner of making senior care easier should really give anyone who is interested in care at home some pause for concern. Afterall, senior care is not one size fits all care.

We are already well into the Senior-Care-To-Go market via online tools and smartphone apps to book yourself or your loved one a caregiver. For those of us who have clients, patients or with loved ones who need care, we really should all slow down before jumping on this latest technology bandwagon.  Care.com, an online selection, matching and scheduling tool which initially began as a way for parents to find babysitters for their children, also offers senior care (and pets). It’s a one-stop shop, but seniors have vastly different needs than children or the family pooch. There are so many variables that need consideration, and the greatest of these is a diminished mental capacity that sometimes occurs with age. Although not everyone who ages has issues with cognition, for those who do, getting a caregiver in the home is more than just a placement. There are safety concerns, not only for the elder person him or herself, but for the assets and “stuff” that has accumulated over a lifetime.

While Care.com’s website does offer a senior safety checklist you can pass onto the caregiver you hire, there’s no guarantee that caregiver will read it. Many home care agencies carefully vet, certify, and train their caregivers to provide seniors and their families with the best care. You can do background checks with Care.com, but how sure can you be of the training needed? How can you know what kind of care is needed? An absence of past malice shouldn’t be the only criteria used for determining the quality of care. Many home care agencies do the additional legwork required to ensure quality care is given. Care.com bought Breedlove services so they can now offer assistance with the complicated process of paying, withholding, etc of taxes and legal obligations of an employer. Home care agencies, however, for the most part also take care of that to reduce the risk of a family member getting stuck with unexpected payments that are legally mandated for employers, but that are usually not associated with the underground economy of caregivers.

CareLinx.com is another online start up that, as its own website states, “is disrupting the +$100 Billion in-home come care service delivery market” through connecting families and caregivers directly online. Home Hero provides similar services in California, with plans of expanding nationwide, offering video screening of potential candidates for in-home caregiving. Home Hero touts it’s the “fastest” way to find in-home caregivers for seniors. Sounds great, in theory. But caring for seniors shouldn’t be just price tags where the lowest price wins. Those of us with decades in the home care trenches know, it often takes time and a gentle hand, and face-to-face interaction between your loved one and potential caregivers to determine the right fit. And, it is not only the right fit, but backups for emergencies, training for care that is specific to the need, and assistance with activities in the home that are meaningful to the senior who needs the care.

While these new models may make securing your own caregiver more affordable and efficient, many of these models lack the adequate controls that are inherent with the traditional home agency model in keeping the frail elderly safe. In the end, if you can’t address the safety and security of your elderly loved one, you haven’t gained much in affordability and efficiency.

Elder care is not a one-size-fits-all solution.   (Did I say that already?) Depending on financial ability to pay for services, support  systems in place (family caregivers or others—neighbors, best friends, etc.), disease state, mental state, and location and access to services,  the caregiving solution is different for most. Caregiving shouldn’t just be about scheduling ease, like booking a reservation at your favorite restaurant. Great caregiving should be about a comprehensive plan and backup plans to ensure the health and wellbeing of our often vulnerable loved ones.

So, finding a “match” online might work for some, but only if there is:
1. Supervision and monitoring of the situation for abuse–financial, emotional, and physical;
2. Oversight for daily expenditures and reconciliation of goods purchased versus goods consumed; and
3. Someone to fill in should the matched caregiver have an emergency and not be available or not show up at all

corecubed works with home care agencies to promote their valuable services that not just anyone can do. We also have a wealth of knowledge on operations and care provision, and assist our home care marketing clients provide a truly quality service.

If you have a home care company or know someone who does, let us know how we can help in this changing marketplace. Senior care shouldn’t be about dialing for dollars or the quickest way to book a caregiver. It should be about the human touch.