Seniors May Need Help Overcoming Post-Holiday Blues

It's the day after Christmas and Right at Home is already bringing you down with news about depression - what's that all about? Well, it's certainly not our intention, but we did find the following article by Robert Preidt published in HealthDay News that we thought was relevant for this time of year, especially as so many of you may be leaving your parents or grandparents after the holidays and may not see them again for a while.

For many seniors, the holiday season can trigger melancholy as they think about lost loved ones, struggle with health issues or worry about money problems, according to the American Geriatrics Society.

To help overcome the seasonal blues, the AGS Foundation for Health in Aging offers the following advice:

* Get out and socialize or invite family and friends over. Those who find it hard to get around should ask relatives and others for help traveling to parties and events.
* Volunteering can help improve mood. Contact the United Way or call local schools or religious organizations to ask about opportunities nearby.
* Don't drink too much alcohol because it can actually lower your spirits.
* Accept the fact that many people feel blue during the holidays and there is nothing wrong with not being "merry."
* Talking to someone about your feelings may help you understand the reasons why you feel sad.
* Watch for warning signs of depression. While holiday blues are temporary and mild, depression is more serious. Signs of depression include: persistent sadness; lack of interest; frequent crying; changes in appetite, weight or sleep; constant feelings of fatigue, restlessness, worthlessness, or guilt; suicidal thoughts.
* If you're depressed, contact your health-care provider. Depression is treatable.

The AGS Foundation for Health in Aging also offers tips for people with older loved ones who experience sadness during the holidays:

* Invite them out and to gatherings. Remember to take into account their needs, such as transportation or special diets.
* Lend a hand by offering to help with shopping and preparations for get-togethers in their homes.
* Encourage them to talk about their feelings. Acknowledge their sadness, including a sense of loss if family or friends have died or moved away.
* Suggest your loved one talk with a health-care provider. Many older people don't realize when they're depressed. Let your loved one know depression is a medical illness and there's no shame in having it.

Merry Christmas from Right at Home

Right at Home in Glendale wants to wish everyone a warm and happy Christmas.

Unique Christmas Gifts for your Grandparents

It's almost Christmas. You've bought gifts for your kids, your friends, your parents, maybe even your siblings. But don't forget your grandparents. Often times, it truly is the thought that counts, but as this article from Associated Content points out, sometimes you need to think outside that proverbial box when it comes to great gifts for your grandparents.

Need an idea of what to buy at Christmas for grandparents or other elderly friends and relatives? Some of the elderly have given up the hobbies they used to have, and may have moved to a smaller houses or apartments or live with family with little room for anything new.

If your grandparent is short of money, they may appreciate a card with a gift card or voucher for groceries. A surprise check to a utility company may come in handy for them. The gift giver can also make up a basket of the person's favorite food and drinks. When making a food basket, keep any dietary restrictions in mind.

A gift of a cleaning service or handyman (or a caregiver from Right at Home)might be appreciated by an elderly person who finds it hard to do any of these things for themselves. You may also print out a gift certificate and offer to do the cleaning, cooking or gardening yourself.

Elderly people tend to say they don't need a thing. But everyone including the elderly appreciates small luxuries. A gift certificate to a hair salon or even a spa for a facial or a massage is a great idea. Even a gift basket made up of moisturizers and bath supplies would be welcome as skin gets drier as we age.

Most elderly people stay home more often, some would like to get out more but don't socialize as much as they used to. A gift of an evening out would be welcome to a senior who has not been to a movie and dinner in a long time. Find out what the person likes and purchase tickets in advance. Maybe the person would like dinner and a movie, a play, concert etc..

A most unusual or interesting gift would be to purchase lessons for the receiver. A tennis or golf lesson, a ballroom dance class. Even learn to fly a plane! Talk to your grandparent and find out what their secret dream is.. You could possible make one of their dreams come true!

Elderly people also like music, movies and books just like younger people. Find out their favorite artists by talking to them. You would be surprised at what you find out. Getting an old album or movie or a signed book may just make their Christmas special.

Whatever you do just remember that grandparents are people too and sometimes the best gift of all is spending time with their family and friends making memories in front of the tree.

Knowing Alzheimer's

Right at Home Glendale owner Doug Dickstein had the great pleasure of working every now and then with Griffith Park Senior Center's Stephanie Vendig during his tenure as co-chair of the Silver Lake Neighborhood Council in 2006-08. Stephanie also writes a monthly column for the Los Feliz Ledger, a local paper serving the Los Feliz, Atwater Village and Silver Lake areas. Below is a re-print of her most recent article.

Alzheimer’s, for us older adults, is cause for anxiety, especially since this disease, a brain disorder that affects memory, thinking, and reasoning skills, is connected to our aging.

According to the Alzheimer’s Association’s 2009 report just released, nearly 5.3 million Americans suffer from Alzheimer’s disease; most develop symptoms after age 60. This number is expected to double within 20 years. In fact, 50% of us, 85 and older, will probably succumb to Alzheimer’s or other related dementia conditions. Total healthcare costs are three times higher for Americans with Alzheimer’s and other dementia than for other people age 65 and older, putting a financial burden on both families and programs.

Alzheimer’s is prevalent for various reasons. People are living longer. This means that more people will exhibit the full impact of dementia because it takes time to develop. Previously, you would die of other conditions before you die of Alzheimer’s. Because women live longer than men, their incidence is higher. In addition, the large group of “Baby Boomers”—78 million—is now reaching the age when the disease becomes evident. And finally, there is no cure at this time to restrain the increase.

In early stages, called “mild cognitive impairment,” the person shows a pattern of deficient memory and reduced performance on cognitive tests, but is still maintaining activities of daily living. In addition, depression, irritability, anxiety, aggression, and apathy are more apparent. Where once it seemed useless to get a diagnosis as early as possible, it is now worthwhile because studies into the earliest stages of the disease suggest that certain behaviors may slow cognitive decline, or that specific medication might slow the progression.

The saddest feature of Alzheimer’s and dementia is the toll on the person’s family who become caregivers. As a person’s behavior becomes more unpredictable, it is the caregiver who must increasingly be the manager of the person’s life. The stress and the time necessary to make sure that the person is safe and functioning is all consuming.

Check out Leeza’s Place about support groups and activities for the caregiver. (323) 932-5414 or ywyte@leezasplace.org. The Los Angeles City Dept. of Aging, with its multipurpose centers, provides resources for training, support groups, case management, and in-home respite care or adult day care: (213) 252-4030 or (800) 510-2020.

For comprehensive information on Alzheimer’s Disease and other related dementia conditions, go to www.nia.nih.gov/Alzheimers, www.alz.org (Alzheimer’s Association), www.mayoclinic.com, www.nlm.nih.gov/medlineplus. If you don’t have a computer, come to GPACC and get help there.

Senior Classes Offered by No. Hollywood Poly Adult School

Brain Fitness:
Based on UCLA’s Department on Aging, this course offers information on brain structure, ways to protect and practice memory skills, to live well. Tuesdays, 10 a.m.-11:30 a.m., The Piedmont, 6750 Whitsett, North Hollywood and Wednesdays from 10:00 a.m. to 11:30 a.m. at the Valley Storefront, 12821 Victory Blvd, North Hollywood.

Popular Music Appreciation:
Historical study of America’s Tin Pan Alley composers, using film, documentary, lyrics, life stories and discussion format. Tuesdays from 3 p.m. to 5 p.m., The Valley Village Senior Apartments, 12111 Chandler Boulevard, Valley Village and Wednesdays at The Sunrise, 4610 Coldwater Blvd, Studio City.

Piedmont Music Ensemble (Chorus):
Learn about rhythm, breathing techniques, harmony singing while rehearsing the great songs of the 1930s and 1940s as well as Beatles music. No professional experience necessary. Tuesdays, 4:30-6:30 p.m., The Piedmont, 6750 Whitsett, North Hollywood.

Intergenerational Tutoring:
Job-training in tutor-mentoring with opportunity to practice skills with high school students needing assistance with exit exams. Thursdays 10 a.m.- 12 p.m., The Valley Village Senior Apartments, 12111 Chandler Blvd., Valley Village.

Help During the Holidays

As we get closer and closer to Christmas and New Year's, we want to remind everyone that Right at Home is here for all of your in-home care needs. From light housekeeping to transportation to meal preparation to assistance with bathing and dressing, Right at Home can supply your loved one the qualified, trained and thoroughly background checked caregivers that you need.

The Holiday season is a time to de-stress and enjoy your time together with your family and friends. Rest assured, Right at Home is here to help you when you need us. We take calls 24 hours a day, 7 days a week, 365 days a year. Even on Christmas Day or New Year's Eve, we'll have someone there to answer your calls.

So if you do need a caregiver, don't hesitate to give us a call at 818-956-5905.

Happy Hanukkah

Right at Home in Glendale would like to wish everyone celebrating Hanukkah a safe and joyous holiday.

New Research Study is Seeking Participants

Right at Home would like to bring your attention to an online research study . Participants will receive a $10 Amazon.com gift card.

Chapman University in Orange, California is conducting a research study that examines interpersonal communication patterns of people who have provided unpaid long-distance care to an individual who is age 55 or older in the past year. The purpose of this study is to learn more about your interactions and experiences as a distant caregiver. They are seeking volunteers to complete an approximately 15 to 20 minute online survey that includes questions about demographic and relational information, your interpersonal communication with the individual receiving care, and your health.

To qualify for this study and receive compensation, you must meet the following criteria:
1. Be age 18 or older;
2. Live long-distance from the care recipient; and,
3. Have provided unpaid care for a friend or family member who is age 55 or older in the past year.

Distance caregiver participants who fit the above criteria and who provide valid email addresses will receive a $10 Amazon.com gift card via email within 1-2 weeks of completing the online survey.

If you would like to participate, please click on the following web link:

Please note: Survey responses may be randomly verified before participants are compensated. Individuals may participate only once and receive one gift card.

If you have any questions or concerns about this research, please contact the study coordinators at bevan@chapman.edu or sparks@chapman.edu.

Increase In Diabetes Will Fuel Explosion Of Alzheimer's Dementia

We thought this article, written by Dr. Scott Mendelson, would be a very interesting read for everyone. We see so many clients suffering from both diabetes and Alzheimer's and this article discusses some interesting parallels between the two. Dr. Mendelson is the author Beyond Alzheimer's.

In a new report published in the December issue of the journal Diabetes Care, it is predicted that in the United States the number of people suffering from Diabetes will double over the next 25 years. This is bad news for those of us concerned about the looming epidemic of Alzheimer's Dementia.

Diabetes is a disease of metabolic function in the body that is defined as an inability to control levels of sugar in the blood. However, Diabetes does far more than disturb blood sugar levels. Diabetes adversely affects the functions of virtually every organ in the body. Consequently, it is a major risk factor for heart disease, stroke, and other illness, among which are various forms of dementia.

There are actually two types of diabetes. Diabetes Type I, often referred to as Juvenile Onset Diabetes, is most often seen in children and young people. This form of Diabetes results from a loss of pancreatic function and subsequent decrease in the production of the essential hormone, insulin. The other, far more common form of Diabetes is Diabetes Type II, or what is sometimes referred to as Adult Onset Diabetes. Diabetes Type II is not primarily due to a lack of insulin, but rather to a loss of the body's sensitivity and response to insulin. Whereas Diabetes Type I is usually caused by infections or autoimmune diseases of the pancreas, Diabetes Type II is almost always the result of poor diet, stress and lack of exercise. That is, it is generally the result of poor lifestyle choices. It is Diabetes Type II that is expected to grow in such disturbing fashion over the next 25 years.

Diabetes Type II is a major risk factor for Alzheimer's Dementia. Indeed, having Diabetes Type II is thought to at least double the risk of developing Alzheimer's Dementia. Over the last ten years we have greatly increased our understanding of the relationship between Diabetes Type II and Alzheimer's. The most obvious reason that Diabetes increases the risk of Alzheimer's Dementia is because it increases the incidence of heart disease; high blood pressure; high levels of fat in the form of triglycerides in the blood; decreases in the levels of the good cholesterol, HDL; and increases in levels of the bad cholesterol, LDL. All of these factors are individually known to increase the risk of Alzheimer's Dementia. These conditions also increase the risk of stroke and other forms of damage to blood vessels in the brain, which thus increases the risk of vascular dementia. Unfortunately, vascular dementia accelerates the pathological changes that occur in Alzheimer's Dementia. Thus, vascular dementia is itself a risk factor for Alzheimer's Dementia.

It has more recently become apparent that insulin itself plays an important role in brain chemistry, and that disturbances in the body's response and sensitivity to insulin may play a role in the pathology of Alzheimer's Dementia. Thus, in respect to the growing epidemic of Alzheimer's Dementia, the predicted increase in the incidence of Diabetes is particularly ominous. The hallmarks of the damage done to brain tissue in Alzheimer's Dementia are plaques of abnormal amyloid protein, and tangles of abnormal forms of the brain protein tau. Insulin plays an important role in maintaining normal forms and functions of those proteins. A lack of insulin or insufficient sensitivity to insulin in the brain results in increased build up of amyloid plaques.
Interestingly, the enzyme that breaks down insulin in the brain after it has served its purpose, an enzyme known as Insulin Degrading Enzyme (IDE) is also able to destroy amyloid plaques. Insulin stimulates the production of IDE, and when there is insufficient insulin activity, there is also a decrease in the presence of IDE that could help reduce amyloid plaque build up. Another curious relationship between amyloid and insulin is that amyloid protein resembles insulin closely enough to bind to insulin receptors in the brain and block the effect of insulin. Thus amyloid plaques further decrease the brain's sensitivty to insulin. Insulin also prevents the production of abnormal neurofibrillary tangles of tau protein by inhibiting an enzyme in the brain known as glycogen synthase kinase-3 (GSK3). GSK3 adds phosphate to tau protein and "hyperphosphorylation" of tau protein causes it to tangle.

Beyond its direct effects on amyloid plaques and neurofibrillary tangles of tau, insulin serves as a growth factor in the brain that helps maintain nerve endings where neurons communicate with each other. Maintenance of these nerve endings is essential for what is referred to as "neural plasticity". Neural plasticity allows us to learn and adapt to changing conditions, and without it our brain function deteriorates. Insulin acts to reduce inflammation in the brain. It is known that inflammatory processes play a major role in the progression of Alzheimer's Dementia.

Although increases in the incidence of Diabetes Type II will almost certainly increase the number of individuals who will develop Alzheimer's Dementia, there is also a hidden danger. In most cases, Diabetes Type II arises in individuals who have first developed the condition known as Metabolic Syndrome. Metabolic Syndrome is the presence of high blood pressure, abdominal obesity, high triglycerides, and low HDL cholesterol. The other characteristic of Metabolic Syndrome is high blood sugar. However, the levels of blood sugar in Metabolic Syndrome are not high enough to reach those necessary to diagnose Diabetes. In fact, Metabolic Syndrome is often referred to as "pre-Diabetes".
The underlying cause of Metabolic Syndrome is thought to be insulin resistance, and it is largely due to poor lifestyle choices, that is, too much sugar, too much saturated fat along with it, too much stress, and too little exercise. The frightening fact is that along with the doubling of cases of Diabetes Type II, there will also be an enormous and less apparent growth in the number of individuals with Metabolic Syndrome but not actual Diabetes. Unfortunately, Metabolic Syndrome, even when it does not progress to full-blown Diabetes Type II, is also a major risk factor for developing Alzheimer's Dementia.

The answer to this looming health catastrophe, which will destroy both lives and financial plans, is the dissemination and implementation of common sense protocols of preventative medicine. We must reduce our intake of sugars and simple carbohydrates; reduce our intake of saturated fats, particularly when consumed along with simple carbohydrates; fight obesity and maintain ideal weight; promote exercise and stress reduction; and build a health care system that is dedicated to prevention of disease and monitoring for signs of risk factors for disease that can be improved or reversed. If these steps are not taken, our society faces a heartbreaking and extraordinarily expensive future of ill health, regardless of what type of health care plan congress is able to establish.

Caregiver of the Month for November

Right at Home is pleased to announce that the caregiver for the month of November is George S.!

George has worked for Right at Home for a little over a year now. Already a Certified Nurse Assistant (C.N.A.), George is currently in school to become a Licensed Vocational Nurse (L.V.N.). Despite this hectic schedule, George has worked a variety of cases for us, including most recently filling in a 24-hour shift over Thanksgiving!

George almost never says "no" to a case, willing to travel from Inglewood to Woodland Hills; from Eagle Rock to Santa Monica; without ever a complaint. He's also received nothing but praise from our clients, who call him "a gentleman", "a super nice guy" and "a class act." He is one of our most reliable caregivers and we always know our clients are in good hands when George is on the case.

Congratulations to George S.!

December Issue of Caring Right at Home Now Available

Be sure to check out our latest edition of the Caring Right at Home eNewsletter at www.poststat.net/RightAtHome. In it you’ll find informative articles on Long-Term Care, holiday visits may be the time to discuss home care, confusion and forgetfullness: the right diagnosis is important, and coping with medical challenges during the holidays. Let us know what you think!

Assessing the Holidays

All business have "seasons." Beach resorts make most of their income during the summer while ski resorts make their bounty during the winter. Gym memberships have a tendency to "perk up" after January 1st (new year's resolutions and all) and of course the gift under the tree for many retail business during Christmas season is supposed to be increased sales.

In the homecare industry, however, business is not nearly as predictable. Let's face it, most people can't predict when they may become ill or injured and find they're in need of a trained caregiver. Still, in homecare there are some general business trends you notice. The summer, for example, is usually a little slower for whatever reasons.

And in that same breath, business tends to pick-up over the holidays and into the new year. The reason seems to be that often times sons and daughters (or grandsons and granddaughters) come home for Thanksgiving or Christmas and find that a particular family member may not be doing as well as when the last time they saw them. Perhaps they're not moving quite as well or their eyesight seems to be a little less sharp and concern starts to grow.

Obviously, when coming home for the holidays, ideally one hopes to rest, relax, keep the drama to a minimum and enjoy the time with family and friends. Still, if you are concerned about a particular family member and whether or not they may need a little extra assistance, there are a couple of small things you can observe that might help give you an indication.

* Does the house, kitchen or even bathroom look a little more unkempt than usual.
* Has laundry begun to pile up
* Do you notice that maybe their pill boxes seem to be filled when they should be empty or empty when they should be filled
* Are they no longer changing clothes daily and maintaining personal hygiene

These are obvious but important examples that it might be time to at least consider having someone come in once a day, once a week or even just once a month to offer some assistance. From meal preparation, light housekeeping and even medication reminders to more personal care needs, a caregiver can offer your loved one not a life of dependence, but rather the ability to maintain independence.

At Right at Home, we offer free, in-home assessments. We'll come to the home and meet with family members and together help figure out what, if any, assistance may be needed. And there's no obligation for you to sign-up with Right at Home to provide a caregiver at the time of the assessment or ever. But if you do find that bringing a caregiver in would be a good idea, we'll be there to help if you want us to. To set-up an assessment with Right at Home, feel free to call us anytime at 818-956-5905.

Happy Thanksgiving from Right at Home

All of us at Right at Home in Glendale wishes everyone a happy and safe Thanksgiving.

Setting Your Mind at Ease

As owner of Right at Home in Los Angeles, I’m on-call 24 hours a day/7 days a week. Even if another employee is taking calls during the evening or weekend, I know that they may reach out to me anytime if an issue arises beyond their authority to rectify.

Back in November, I took my first vacation in over 2 years. While still reachable, I was going to be outside of California. Although I had confidence in our employees, I was still nervous leaving them “on their own.”

As I thought about this, I realized my feelings of unease probably don’t compare to how family members of our clients feel when they leave their loved one alone for the first time with a caregiver. Yes, it’s true that Right at Home caregivers are trained and criminally background checked; covered by liability and worker’s compensation insurance; licensed and bonded. But that doesn’t assure they’ll bond with their family member in need of help.

From clients who’ve had the same caregiver for over a year to clients who’ve asked for a different caregiver literally every other day, we’ve seen it all. That’s why we always do an assessment when possible prior to placing a caregiver so we can meet the family, meet our prospective new client and select the best caregiver for their needs. And its why, even when on vacation, the owner of the company is always just a phone call away to address any concerns a family member may have.

As we exit the holiday season and enter into 2010, Right at Home will continue to do everything in our power to make sure your loved one is receiving the highest quality of care so you can be at ease while you’re away.

Veteran's Aid & Attendance Benefit

The Veterans Aid and Attendance Benefit is a benefit paid in addition to monthly pension. Benefits are available for Veterans and surviving spouses who require the regular attendance of another person to assist in bathing, dressing, meal preparation, medication monitoring or other various activities of daily living. This benefit is available to individuals who reside in assisted living communities, personal care homes, skilled nursing facilities and those receiving personal in-home care.

Any War Veteran with 90 days of active duty with at least one day during active War time (WWII, Korea, Vietnam, Gulf). A surviving spouse of a War Veteran may be eligible if he/she remained married to the Veteran until his/her time of death and has not remarried. The individual must also meet medical, service and financial qualifications.

Right at Home is committed to meeting the needs of those we serve to improve their quality of life. As part of our commitment, we want to make Veterans and their families are aware of this little known benefit available that can help them pay for care services. A veteran may be eligible for up to $19,728 a year, a Veteran with a dependent spouse may be eligible for up to $23,388 per year, a surviving spouse of a veteran may be eligible for up to $12,672 a year and two veterans married to each other may be eligible for up to $30,480 a year. Right at Home wants to connect Veterans with the people that can help Veterans qualify for these benefits.

If you want to learn more about the Aid & Attendance Benefit, call Right at Home at (818) 956-5905 or email info@rahglendale.net. We can get you in touch with the appropriate accredited claims agent to help you determine your eligibility and guide you through the process to help expedite your claim.

Happy Columbus Day!

It's been an unusually quiet day at the Right at Home Glendale offices today. I assume that probably has something to do with the oft-talked about, but not always celebrated holiday of Columbus Day.

So with a little extra time to take a breath today, everyone at Right at Home in Glendale would like to wish the hundreds...not thousands...no millions of readers of our blog a very happy Columbus Day and we look forward to a great last 2 1/2 months of 2009.

The Responsibilities of Ownership

A few years back while working at Game Show Network, we had a "Fire Drill." I don't mean that the fire alarm went off in our building and someone we worked with donned a green helmet and began directing us out while my co-workers slowly made their way to the stairs saying things that ranged from "A fire drill now, I'm in the middle of something due today." to "I hope it really is a fire so I can be off all week."

No, in business acumen, a "Fire Drill" is a fairly lame metaphor to describe a time when some sort of business "emergency" has occurred and everything you're working on needs to be dropped and all hands are called on deck to put out the "fire" of this particular emergency.

The fire drill I refer to had to do with a radio ad that was playing in Las Vegas that incorrectly stated that Game Show Network could be seen on Comcast cable, when in fact the cable company for the area was actually Cox cable. Due to a delicate relationship between Game Show Network and Cox at the time, this was more than just an unfortunate embarrassment and thusly a new radio ad needed to be created immediately and sent to the station that day.

So I called the owner of the production company that created the ad. I remember while speaking to him that there was a fair amount of noise in the background and hullabaloo all around. "Okay, okay," he said to me in a somewhat perturbed tone as I mentioned to him the problem. "I'm at the Dodger game right now, but I'll leave and we'll get something to you before 5pm."

The Dodger game, I thought to myself. I'd hate to be him. Buy those tickets, think you're spending a relaxing afternoon at the ballpark and then some schmo like me calls you up and makes you give up you're half-drunk, $11 beer just to re-record a 60-second radio spot. That's tough sledding.

Yet that's exactly the situation where I find myself today. Because at 3pm this afternoon, I too will be at the Dodger game. And this is no ordinary game, no mid-Summer Wednesday tilt against the lowly Pirates of Pittsburgh. This is a playoff game, against the slick pitching, high-powered Cardinals of St. Louis. And let me tell you, the last thing I want around the 3rd inning is a call from my office with the homecare equivalent of a new radio ad needing to be produced.

So what do I receive at 8am this morning. The "fill-in" caregiver (because the regular caregiver is on vacation) for one of our more difficult clients tells us minutes before her shift that she's got to go to the "emergency room" for an undisclosed illness and can't make her shift. I'll reserve comment on the legitimacy of the excuse, but thankfully our fine office was able to get another qualified caregiver over there and she arrived only a few minutes late. I commend both my office and that caregiver for their quick work.

Then, I receive another call at around 12pm from another client informing me that they need service at a different location than usual - some 48 miles farther away. When I inform them that we might not be able to send the same caregiver - who lives over 60 miles away from this new locale - they don't seem to quite understand why that is.

And first pitch is just 2 hours away.

Still, Right at Home here in Los Angeles is ready to go and certainly not depended on me to operate smoothly. My office staff is prepared, our schedules are set and we don't anticipate any issues for the rest of the day. Still, I full well know as the owner of this company that the buck stops with me...even if I sometimes wish the buck would stop with that other guy in row 9, seat 17 wearing the blue & white dodger wig.

But I made a promise to our clients. That one way or the other, we would always make sure a qualified, licensed and bonded caregiver will be there to take care of their loved one even if it means I have to stop what I'm doing and help tend to one our clients personally.

So, there will be no beer for me today and I'm prepared that my hot dog may have to be left behind half-eaten. But that's the deal I made and all in all, it's not so bad.

Oh, and by the way, GO DODGERS!

The Selling of In-Home Care

The "phenomenon" of in-home care is not new. There is no debate that the aging of the Baby Boomers certainly has everyone from their sons and daughters to Medicare Customer Service Reps bracing for the inevitable onslaught of care that is needed. It is a safe assumption that most people aren't going to want to leave their home to take up residence at an Assisted or Skilled Nursing community if they can help it.

However, there have been homecare agencies in Los Angeles that are 10, 20, even close to 30 years old. What has changed is the volume of home care agencies in Los Angeles and the abundance of choices families now have which no doubt at times probably seems more cumbersome than helpful.

As discussed in previous blogs, it doesn't take much of anything to start a homecare agency in the state of California as there is no separate license and no government regulatory agency overseeing it. The result of this is significant competition among homecare agencies for new clients.

At one point in an earlier life, I worked in television and for a while I was a sales rep at a cable network in a department called "Affiliate Relations." The job of a sales rep in Affiliate Relations was usually to convince a cable company (Comcast, Time Warner, Cox, and so on) to carry the cable network you were representing on their cable system. The people in charge of these decisions was usually the Vice Presidents and/or Directors of Marketing and while the launch of a new network on a cable system was of major importance to a sales rep like me, it was often times little more than an annoyance to the marketing person at the cable company.

To get these meetings, you'd call an assistant, maybe meet first with a middle manager or coordinator, and eventually beg, annoy, befriend and cajole the person long enough until you'd eventually get a meeting, which was usually a formal affair involving power point presentations, fancy, logo-infused pens and often times a not so cheap lunch or dinner.

Yet no matter how tasty the dinner, fancy the presentation or unique the gift, these cable marketing folk were fundamentally interested in one thing: How much would it cost them. And because of this, my retort often times focused on how we could offset, defray and even reduce those costs one way or the other. It's not that they didn't care at all about what the actual programming was on the network, but they were largely MBA's who'd spent long parts of their career in one organization often brought up to look at things in one very distinct, linear and "cover-your-you-know-what" way.

Now home care is a different business than cable television. First of all, it's largely a referral business. Only a small portion of your clients likely come by calling you directly after a Google search. Most will get your number from a social worker or case manager working for a medical or retirement organization. Yet any thoughts one might have of some "higher" call or moral standard that your average Hospital Case Manager, Nursing Home Social Worker or Hospice Nurse may possess are going to be disappointed.

You have a better chance of throwing a message in a bottle into the Pacific Ocean and getting a response than you do of calling and leaving a message for a Case Manager or Social Worker as a sales representative. Regardless of whether or not they're too busy or you're not deemed important enough is irrelevant.

The result of this is that a home care agency rep has no choice but to truly cold call. That is to say walk into a hospital or assisted living facility or wherever, and hope you can catch a wayward social worker, friendly physical therapist or wary case manager and pitch them your companies wares on the spot.

In addition, because the sales process is so informal and disorganized and there are so many different agencies (not to mention medical transport companies, durable equipment suppliers, and so on) coming in unannounced it forces you to go back again and again and again...and yes again so your agency can be remembered and, in theory, referred.

However, it is at this point where the similarities between these referral sources and our old marketing friends at cable companies begin to look alike. Because what do you think the number one question our account representative receive from social workers, case managers, discharge planners, resident care directors and the rest? Are you licensed and bonded? No. Do you carry liability and workers comp insurance? Nuh-uh. Do you background check your caregivers for criminal records? Hardly ever. Do you pay your caregivers a fair and legal wage? Not once.

Their number one question is almost always - "How much do you cost?"

Now I've always found this to be a rather startling question when you consider the source. Social Workers, Nurses and the like are educated people. They may or may not be caring people or compassionate people, they may or may not even be good at their jobs. But what they most certainly are not is financial planners. They seldom have access or a full understanding of a families financial situation or their personal beliefs on how money should be best spent. Therefore whether or not an agency is a "good deal" or "too expensive" is based on really nothing other than that individual nurse or social worker's personal perception and nothing at all to do with the family's perception or, far more importantly, their needs.

Please don't misunderstand me. Nurses and social workers, occupational and physical therapists, even hospital department assistants, are in the majority of cases decent people. They are often overworked, saddled with antiquated office technology and probably underpaid. But I bring this up to let you know that if you or your loved one find yourself in a hospital on the verge of being discharged and decide (or are told) you need extra assistance in the home, it's perfectly reasonable and a good place to start by asking for a list or brochures or reccomendations from your case manager or social worker. However, understand that those recommendations may be based not necessarily on the quality of the care or integrity of the caregivers that an agency can provide but rather on someone's personal perception of "value" or on someone's personal opinion of the agency sales representative or even on how often that agency brings gifts or food to their office.

So keep an open mind and be sure to ask the questions that are important to you. You probably wouldn't blindly take the advice of a car salesman when buying in a car and you should use a similar level of healthy skepticism when picking a homecare agency. By asking a few more questions of the agency at the beginning of the process may mean you have a lot fewer questions to deal with when caregivers are actually in your home.

Healthy Aging: Simple Lifestyle Changes Improve Quality of Life

A healthy lifestyle begins with small steps and setting achievable goals. Getting started is easier than you might think, even for the elderly. It is never too late for seniors to take control of their health and focus on the positive aspects of aging instead of the myths and negative stereotypes. With the right mindset, seniors can embrace growing older and start on the journey to healthy aging using items found around a typical home.

“Living life to the fullest as you age can be challenging, yet exciting. Making an effort to better your health can improve your quality of life greatly,” said Douglas Dickstein, President of Right at Home, a provider of in-home care serving the Greater Los Angeles area. “Awareness and education are important to empowering seniors to age gracefully.”

The following household items and activities can act as simple ways for seniors to begin their healthy aging journey.

Physical:
Before undertaking any type of physical program, seniors should talk to their doctor. There may be activities seniors should avoid due to personal health situations.

• A notepad and pen – Stay on track by writing down goals and recording your progress.

• Two cans of soup – Actually, any canned goods from the pantry serve as great hand weights and can be used help to improve arm strength. While sitting in a chair, place both arms out flat in front of you and lift the can up about six inches. Repeat five times. Remember, it’s not a race, start slow and increase your repetitions as you are able.

• Kitchen timer – Start with five minutes of exercise and increase time as ability warrants. Making slow, steady progress builds a routine and endurance.

• Glass of water – Among other health benefits, staying hydrated can prevent temporary memory impairment. Try to drink at least six to eight 8-ounce glasses of water daily.

• Healthy snacks and meals – Eat a balanced diet that is rich in fruits, vegetables, whole grains and fibers and low in saturated fat, trans fat and cholesterol. Make foods that are flavorful and simple to prepare. If your loved one needs assistance preparing healthy meals or snacks, consider hiring caregivers that for a few hours a week to help with advanced meal and snack preparation.

Mental Fitness:
• Deck of cards – Games keep the brain working and cognitive skills healthy. Play a game of Solitaire or flip the cards over and match numbers or suits to improve memory.

• Calculator – Maintain cognitive skills and financial health by keeping close track of monthly expenses.

• Newspaper – Reading exercises the mind and helps the ability to focus. Most newspapers also include a daily crossword puzzle, which helps delay memory impairment.

Overall Well-being:
• Calendar – Record doctor’s appointments, including preventative care visits. Also keep track of loved ones’ anniversaries and birthdays.

• Pillow – Getting seven to eight hours of sleep each night is important. Commit to a regular sleep schedule and develop a bedtime ritual, such as listening to soothing music or taking a bath.

• Telephone – Staying connected with friends and family is good for emotional well-being.

There is a higher probability of healthy aging success when there is support and encouragement from a senior’s loved ones. Families and friends can cheer on the seniors in their lives by giving them a “Healthy Aging” basket that includes some of the items listed above.

A simple matter of mutual respect

Customers in all lines of business can be difficult. When A&E aired the reality television show Airline it largely consisted of irate passengers berating Southwest Employees. One can't turn on an episode of Kitchen Nightmares without seeing some unhappy restaurant patron bemoaning the quality of their food. And how upset would you be if you drove a new car off the lot only to have it break-down a week later, installed a new washing machine that leaked water or bought season tickets to the Detroit Lions only to watch them become the first team in NFL history to lose all 16 games they played.

Of course, it isn't the Southwest Airline employee who your screaming at who's responsible for the bad weather or the planes mechanical error. It isn't the waiter's fault that the food isn't edible, or the car salesman's fault that the factory sent them a lemon or even the ticket takers fault that the Lions hired the worst General Manager in the history of professional sports. But sadly, they're the underpaid person who has to take the abuse and try to satiate you in some way.

In homecare, however, the anxiety of family members searching for assistance for their mother or father, grandfather or grandmother, spouse or child, is far greater than that of someone eating out or watching a football game. And unlike the research one might do before planning a trip or buying a car, when it comes time for mom to get some extra help, there's usually been no research conducted, there's virtually no "common" knowledge of what to do, and usually the time to make a decision is immediate.

So we understand when family members might lose their temper or wear their stress on their sleeve. We realize that much of homecare is "private pay" and the shock that crosses a family members face when they realize how much Medicare DOESN'T pay for can be off-putting to say the least. And we certainly realize that family members want the best possible caregiver for their mom (and want to pay as little for it as possible).

However, the truth of the matter is that caregivers are people too. They can also have "bad" days, feel stressed out about personal issues, or just not feel comfortable (or properly compensated) working a particular case.

It's important to remember that at the end of the day, the primary goal of both family member and agency is to provide the best possible service of the person receiving in-home care. There are reasons an agency such as Right at Home charges a certain rate and believe it or not, it's not solely to "maximize" profit. There are costs associated with liability insurance, worker's compensation insurance, bonding in addition to paying the caregiver a decent wage so that they are more likely to stay and not run to the next job that offers them 25 cents more an hour. In addition, one of the reasons a family signs on with an agency is because there is back-up in case the regular caregiver gets sick or has a family issue of their own and can't come in one day.

If you as the client are honest and respectful towards us as the agency, then in return we can work through difficulties together and ultimately have a far more harmonious - and far less stressful - relationship. And the real beneficiary of that strong relationship will the person receiving the care.

Finding the Right Caregiver

Catch this sneak preview of an article that will be included in the next Caring at Home newsletter coming out this fall.

Hiring caregivers is not without its drama. At Right at Home in Glendale we’ve encountered many “interesting” experiences over the years. From caregivers not showing up to work to caregivers coming up with bizarre excuses as to why they can’t work, we’ve seen (and heard) it all. And we’ve learned from those experiences and it’s the reason why we’ve come to take such care and diligence in selecting who can work for Right at Home as a caregiver.

When someone lets a caregiver come into their home, it can be an uneasy experience. At Right at Home, we understand this and go out of our way to assure you that our caregivers will do their job professionally and compassionately.

We always prefer to start a case with a free, no-obligation home assessment. This gives us a chance to get to know the client and family personally and allows us to supply the individual with the right caregiver for their particular needs. In addition, it allows the family to feel comfortable with us and associate us as your partners.

When the caregiver does start, you can be confident that all of our employees have gone through multiple competency exams, reference checks, criminal background checks and training courses. And if you’re not satisfied with the caregiver we send, we can always make a change without hassle.

Sometimes a caregiver and client hit it off immediately. Sometimes it takes awhile until things begin to come together. And occasionally, we determine its best for all involved to make a change. Regardless, we want you to know that Right at Home will always be there to do whatever it takes to make sure that you introduce someone you love to someone you can trust.

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Finding Hope

I should be having a fine day today. We signed-on two new clients and while I'm working on a Saturday, it is allowing me to catch-up on some much long overdo work.

However, things are not as rosy as they should be. A week-and-a-half ago my wife and I adopted a new puppy. She had been rescued the previous month from the Baldwin Hills pound the day before she was going to be put to sleep.

She is a cute 7-month old basenji mix named Mira. We thought she would be a perfect match for our current dog Chloe and at times it has been. But at other times, it's been anything but.

Mira is very toy jealous and has spent much time trying to dominate Chloe. In addition she lunges at other dogs when we walk her in more than just a casual or playful manner. Worse, while Mira and Chloe have had some spirited play sessions, twice they've gotten into vicious fights. Last night was the worst - with Chloe needing to go to the vet and my wife also getting injured trying to break up the fight.

When she spoke with our trainer about the incidents, the trainer was not positive. While dogs like Mira certainly can be rehabilitated, the level of aggressive behavior she's showing would take a lot of time - time that realistically we probably don't have. While I'm not willing to give up on Mira, I have to admit I need to seriously think if we can do this. Luckily, there's a foster home waiting for Mira if we can't continue but the idea of giving up on her is very hard for me to accept.

Our problems with Mira, though, pale in comparison to the new case we're starting in Beverly Hills later this week. Our client is having a serious surgery after being diagnosed with cancer. However, her cancer isn't nearly as difficult for her as the fact that her husband is suffering from Alzheimer's. He's had it for the last few years and things have gotten to a point where even without the illness it has become increasingly difficult for her to handle. This has not only played havoc with her health, but has created severe depression.

As I explained to her, as cold as it might sound, she needs to take care of herself now. There's a limit to how much can be done for her husband and while you don't want to give up, Alzheimer's can take a cruel course. As the Alice Munro book (made into a movie starring Julie Christie just a few years ago) illustrates, sometimes the most caring thing to do is not always so clear-cut.

Our client doesn't need to let go of her husband just yet as the husband in the novel ultimately does and maybe things will level out with his illness. Regardless, she'll need not just assistance for her own illness but respite from her life for a while. Her ability to find hope and a sense of calm within herself will be a process that will neither be short nor easy, but it is attainable.

It makes my concern over a 7-month old puppy seem trite in comparison. But just like a foster home awaits for Mira, help is also out there for our clients and millions of other spouses who find their dream of growing old with their mate be derailed due to illness, both physical and mental.

Right at Home can't change diagnoses or create cure-all medications but we can play a role in allowing someone to find the time to find hope that there is plenty of life out there still to live.

Checking my own personal distresses to help those with so much greater need is, at times, one of the more difficult but also more rewarding parts of this business and I hope we'll do well by this new client and anyone else who ever calls Right at Home looking for help...and hope.

Hiring Your Household Employee “Under the Table” May Cost More Than You Think

I recently spoke with Robert E. King, the founder of Legally Nanny, a law firm representing household employees and domestic employment and homecare agencies. King specializes in household employment legal and tax issues and has served as an expert witness in household employment matters.

He wrote an excellent article in the Riverside County Bar Association Journal which emphasizes why it is so important to hire in-home care help from a licensed, bonded agency who's caregivers are employees of that agency (not independt contractors).

Both he and the Journal allowed me to re-print the article and we thought it would be of interest to many. We are re-printing it here in its entirety.

You’re a busy attorney trying to juggle work and family. To help care for your children, you hire a nanny. Or perhaps your parents are getting older and need some help around the house, and you hire an elder care provider or companion to care for them.

Because you think you’ll never get caught, you’ve heard that it costs so much more to hire legally, and hey, let’s face it, you weren’t planning on being Attorney General any time soon, you think it’s safe to hire someone under the table. Think again.

The decision to hire someone “under the table” – although it may seem easier and cheaper – ultimately is penny-wise and pound-foolish. If (and most likely, when) you get caught, you will have committed federal tax fraud and endangered your ability to practice law. Even if you don’t get caught, you’ll be missing out on legal and tax advantages that would have applied if you were paying legally. In short, don’t do it.

Admittedly, hiring a nanny, elder care provider or other household employee legally can be daunting. There are many legal, tax and insurance questions that can make employing someone seem like an onerous task. On closer examination, however, hiring a nanny or other household employee can be a straightforward process that benefits both the employer and employee.

Getting Caught
There are many ways – such as your nanny filing for unemployment (a very common occurrence in today’s difficult economy), social security, disability or workers’ compensation benefits – that even an amicable parting between you and your nanny could result in you facing an investigation for unpaid taxes. And these are just the unintentional examples. They don’t include your disgruntled nanny, upset over some perceived slight, quitting and turning you in herself – or worse yet, trying to blackmail you. Or the neighbor or co-worker or family member who is envious or has always had a grudge against you reporting you. Or perhaps the IRS decides to audit you and notices the same amount of money flowing out of your bank account every two weeks and gets suspicious.

Under any of these scenarios, the result is the same: You get caught and face considerable consequences.

The Consequences
Because you must report household employment taxes on your personal federal tax return, failure to pay the appropriate taxes constitutes federal tax fraud. At a minimum, the consequences include payment of all back taxes, penalties and interest, and they can include federal charges of perjury and tax evasion, fines of up to $250,000, imprisonment for up to five
years, and a criminal record for the rest of your life. There is no statute of limitations for failure to report and pay federal employment taxes.

The professional consequences are equally severe. For example, Business and Professions Code section 6068, subdivision (o)(4) requires that if you’re charged with a felony such as tax fraud, you must report the charge to the State Bar, potentially jeopardizing your ability to practice and earn a living. Additionally, if you’re even considering becoming a judge or holding elected or appointed office, having a “Nannygate” story break about you, just as it did with Bernie Kerik,
Zoe Baird, Kimba Wood, or Linda Chavez, can ruin your reputation and career.

Regardless of your interest in higher office, as an attorney, you trade on your reputation for integrity, and being labeled a “tax cheat” isn’t good for anyone’s business.

Advantages of Hiring Legally
Happily, there are a number of advantages to hiring a nanny or other household employee legally. For example, you may be able to save taxes by putting up to $5,000 pretax per family per year into a Dependent Care Account (“DCA”) to help pay for your nanny. Alternatively, you may be eligible to claim the federal Child and Dependent Care Tax Credit, for a minimum tax credit of 20% for the first $3,000 in qualifying expenses for each of up to two children per year. Most importantly, you get to spend more time with your family and sleep well at night knowing that you’ve done everything legally. Don’t underestimate how Riverside Lawyer, February 2009 worrying about getting caught and the consequences of hiring illegally can take a toll on you personally and professionally.

Your Bottom Line
Perhaps the most common fallacy about employing a nanny or other household employee legally is that it will greatly increase your expenses. A review of the additional costs, especially in light of the significant potential tax savings, reveals this contention to be inaccurate.

Social security, Medicare, and state and federal unemployment taxes add approximately 9% of a nanny’s salary to the typical household employer’s costs. However, by maximizing your tax advantages, the true “burden” of hiring a nanny can be substantially less, as little as 4% of your costs.

An example best illustrates the true cost. The approximate 9% tax burden on a nanny’s $30,000 annual salary likely would cost her employer roughly $2,700. However, the employer could shelter $5,000 pretax in a DCA and use this money toward paying the nanny.

The employer normally would pay approximately 30% in taxes on $5,000 in earnings, taking into account the employer’s personal income taxes and other payroll taxes. Thus, the employer’s tax savings from using the DCA would be approximately $1,500. Subtracting this $1,500 savings from the roughly $2,700 paid in taxes yields an effective “cost” of approximately $1,200, or 4% of the nanny’s annual compensation.

Thus, in this typical example, the bottom-line cost of hiring someone legally is approximately 4%
more, a small price to pay for the peace of mind that comes along with hiring your nanny legally.
Remember, paying employment taxes isn’t an option, it’s the law.

For more information, you may contact the firm at (714) 336-8864 or at info@legallynanny.com.

Passing Away

When you work in the Senior Care business there is one fact-of-life that you cannot escape - and that is the end of it.

Recently, my stepfather passed away. An amazingly outgoing and friendly man, he was diagnosed with pancreatic cancer and passed away 3 weeks later. On his final morning in his home, he suffered tremendous stomach pain but waited until my mother woke up before telling her that he thought he should go to the Emergency Room. After a few days in the hospital he refused any treatment and only requested pain medications and passed away. The doctor called him "very brave" for his decision.

Dealing with the elderly and how you handle your final years is - if nothing else - an eye-opening experience. And if I've learned one thing it is that the saying "Life is for the living" is about as accurate a cliche as there is. Rich or poor, male or female - if we are so limited at the end of our life that we're forced to live much of it at home or - less desireable - in a nursing home - than no matter how much money we've saved, no matter how many different caregivers we have, there is little we can do except try to be as comfortable as possible.

In the last week, 2 clients of ours also passed away.

One was our client for 10 months and we'd cared for her son and daughter (both stricken with cancer) as well. All she wanted to do was stay at home with her dog and she was able to fulfill that wish until she passed away peacefully in her sleep.

The other was a client of ours for 36 hours. On Hospice and dealing with a myriad of ailments including a collapsed lung, she requested that her oxygen be removed and slowly went away from this world. Similar to my stepfather, she was by all accounts a gregarious person who demanded to be discharged from a Respiratory hospital less than a week before despite her doctor's protestations. She knew she was going to die but she was going to do it on her terms.

Within that same week, we started cases with 4 additional clients - ranging from a 26-year-old male dealing with a devastating injury to seniors who still have plenty of fuel to go. In the homecare business, clients come and clients inevitably go.

But what my stepfather, as well as our two dearly departed clients, teach us is that life is indeed for the living - and what that means and how we choose to deal with the end of it is unique to each and everyone of us.

When Caregivers Fail to Show

There are a lot of frustrating things to owning any business, but unique to owning a homecare business is that your employees are scattered throughout your service area. And when your service area is as large and diverse as Los Angeles, that causes more than a fair share of stress.

At Right at Home, we have an automated check-in system. When a caregiver arrives at the home of a client, they call a toll-free number from the clients home (not their cell) and clock in and out remotely. If they're late, I receive a text message and email notifying me of this. It's one of the many things has made Right at Home so respected throughout the industry.

While almost every day some caregiver somewhere is late and occassionally caregivers get their schedules mixed up and don't show up (and on a very rare occassion have chosen to tell us they quit by simply not showing up to a case and we never hear from them again), we work hard on screening our employees and have a relatively few such incidents.

With that said, the most unsettling times are the weekends when the office staff is off. And when you toss in a holiday weekend such as this Easter weekend, you stomach begins to immitate a Shawn Johnson floor routine.

This happend to us today when a caregiver failed to show for her normal Saturday shift with one of our most difficult clients. When we called her, she told that our staffing coordinator had said she had the weekend off. We informed her that it was just Easter Sunday she had off, not the entire weekend but by that time it was too late - she had made plans for the weekend and was unable to fill the shift.

At Right at Home we never leave a case uncovered and after seven (7) unsuccessful calls, our Director of Patient Care Services filled the case herself. And while this didn't particularly please the client (who felt she could just have easily been left to her own devices anyway) the daughter was thankful for our quick action.

It does beg the question, though, do a lot of other business encounter such scheduling issues?

A Year Navigating the Los Angeles Caregiving Maze

A little over a year ago, I opened up a business that would provide trained and licensed caregivers to take care of elderly adults in their homes throughout Los Angeles county. I had never worked in this industry before - the extent of my experience working with seniors being primarily limited to occasional discussions with members of the Silver Lake Seniors group while I served as co-chair on the Silver Lake Neighborhood Council - but nevertheless in January of 2008 I registered Right at Home in Glendale as a business with the California Secretary of State.

But it seemed like something I would like to do and certainly the need existed. Besides, after 10 years working in sales and marketing in television, the prospect of both working for myself as well as working outside the entertainment industry was beyond appealing.

Over the course of the past 12+ months, I've learned an immense amount regarding caring for seniors and disabled adults as well as the sometimes bizarre world that is senior care in Los Angeles. The lack of regulation, the lack of efficacy and at times the shocking lack of judgement shown not just by homecare agencies operating under the table and relatives of patients who would just rather their mom or dad go away, but of hospital nurses, assisted living facilities, hospice companies and more.

Please don't misunderstand me. I'm not indicting the entire industry by any means. Still, if you walked the past year in my shoes and witnessed some of the things I have, your already skeptical view of the medical industry wouldn't likely decrease.

Still, today marked a day as to why this industry not only does employ many a fine person, but also gave me some indication that my company is beginning to form leaves on the branches we've so tirelessly attempted to grow.

After dropping off some brochures at Good Samaritan Hospital, I met with William Hwang, the President of Advantage Home Health. I stopped by without notice and he was kind of enough to sit down with me and discuss our services and how we could work together. Cold calling is tough and not always pleasant and sometimes the reaction you receive will do anything but warm your heart. So to have William take the time to speak with me - and with a smile to boot - set the tone for a positive day.

Afterwards, while driving to my next sales stop, I received a call from Bob King, a lawyer specializing in domestic care law out of Orange County. I had contacted Bob after reading an article he'd written in the Riverside County Bar Association journal regarding the "high price" of hiring care "off-the-books" (read illegally). He could not have been more generous with his time as we discussed the vagaries of wages for Live-In care and allowed me permission to use his article in my future presentations.

After another stop, I made my way to St. Vincent's Medical Center for a presentation to their Physical Therapists. I invited two (2) others to join me - Thomas Tilahun from Oceanside Home Health and Michele Lefever from ResponseLink. It was the first time I'd partnered with other companies on a presentation, but something I've wanted to do. I'd had success working with other neighborhood councils during my public service days as well as partnering with other companies in my television career and didn't see why more of this couldn't be done among those serving various parts of the homecare industry.

While Physical Therapists are not necessarily the first folks I look to market to at hospitals. That honor - or burden depending on how you look at it - goes to Social Workers, Case Managers and Discharge Planners. However, PT's can also be of help and I was thrilled to work with Dee Gilmore at St. Vincent's in setting this up. It was a nice group of folks who listened politely to all three of us, while devouring the pizza, soda (Pepsi, Diet Pepsi and, that's right, Sierra Mist too) and cinnamon sticks we bought for them from Pizza Hut (it was supposed to be cheese sticks, but they were out of cheese sticks, so they could give me 2 more pizza's, but I didn't need 2 more pizza's, well then what about cinnamon sticks, what's a cinnamon stick, it's like a cheese stick but with cinnamon-it will only takes us a few minutes to make them, why not put cheese on them instead of cinnamon, I make you cinnamon sticks). Thomas is a great guy and while I just met Michele and didn't want to overextend my relationship with her as I do work with another emergency response company, it seemed like we would work well together. All in all, it was a successful trip.

Finally, as I made my way back to the office, I received a call from a woman looking for a caregiver in Canoga Park. After a discussion that, if we were in a scene from Enchanted April could be described as nothing less than "delightful", we set up a meeting for this Thursday.

The highs and lows of running your own business can be extreme - and it doesn't help that I'm not always the most even-keeled person in the world despite what my outside demeanor may appear. Still today, I very much look back at it being a culmination of a year's worth of incredibly hard work and a steep learning curve. Not one thing I accomplished today could I have done a year or likely even 6 months ago. And for that, I am grateful. Plus, its inspired me enough to start this blog which I've been ruminating about since the day I opened.

So while most my posts will be about my clients, or the struggles of both owning your own business as well as the specific issues regarding homecare in Los Angeles, I figured a review of my day as microcosm of our companies growth over the course of a year would be a good place to start.

And with that, I've just received a text message that 2 of my caregivers scheduled for an overnight shift beginning at 11pm are both late. Time to stop the blog and get back to work.

The Eternal Satellite Bill

Before I began operating Right at Home in Los Angeles, I worked in television for 10 years, primarily working with cable and satellite companies. I always found the way they ran their business and their outlook towards their customers to be "interesting."

I found this article from Ron Burley in AARP Magazine that I thought might strike a particular chord for both those who've been frustrated in dealing with their cable or satellite provider as well as for Los Angeles Laker fans.


When we inevitably step from this world to the next, we may hope to leave legacies for those we love. An obligation to pay for satellite television service is likely not among them.

* Submit a Question to Ron Burley
* Ron Burley's On Your Side
Bi-Weekly Column (AARP.org)
* Subscribe to the AARP Money Newsletter

Yet that's exactly what AARP member Jayne Sakoda and her family were saddled with following her uncle's death. His one passion was watching Los Angeles Lakers basketball, Sakoda wrote me from Cerritos, California. So in May Sakoda's husband ordered Dish Network for her uncle at his assisted-living facility, since he couldn't do it himself. Regrettably, he died less than two months later, yet Dish Network refused to cancel the contract in Sakoda's husband's name. The company wouldn't even let the Sakodas transfer the two-year subscription—worth almost $1,000—to another account.

Managing Accounts for Loved Ones

1. Establish accounts in their name—whether it's for utilities or subscriptions—but request "user" access that will let you handle the accounts.

2. Set up a filing system for account statements, passwords, PINs, and customer-service phone numbers to save you headaches later.

While the policy is rarely detailed in customer agreements, companies selling services by subscription often cancel them without penalty in the event of a customer's death. Unless Dish Network believed the whole family lived in the care facility, it seemed that the customer-service department had a lapse of common sense. Going on that assumption, I contacted Dish Network. Four days' worth of e-mails and phone messages went unanswered until I tried Robin Zimmerman in corporate communications, whose name I found on a press release on Dish Network's website. (When customer service doesn't help, dig online for a different phone number.) She cleared things up in a day, apologizing to the Sakodas, canceling the charges, and disconnecting the service.

Was it a case of temporary insensitivity or a misbegotten policy? Despite the reversal, Dish Network never offered a clear explanation