Family inHome Caregiving Blog

I've written many times before on my blog about exciting medical breakthroughs which have been made by studying our genetics.  The most recent discovery will help those diagnosed with prostate cancer, many of whom found out by having a PSA screening test.  More than 200K men are diagnosed with prostate cancer each year, and now they can undergo a new genetic test which will tell their physician whether they will get aggressive or low-risk prostate cancer.  This may allow some to delay or forgo surgery altogether.  If the cancer is extremely slow growing and the patient is elderly, for instance, it simply may not be worth the risk of surgery to try and go in and remove it.  Instead, their doctors can use what is called "active surveillance" where the tumor is regularly monitored for changes.  The test, which is being developed by Genomic Health, showed in a panel of 395 patients that 26% could use the active surveillance strategy and not undergo surgery right away.  This is quite a breakthrough as doing invasive surgery is very risky for the elderly. 

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Many doctors are going completely electronic with medical records and prescriptions.  Some have taken this one step further, writing blogs, newsletters and even sending out emails to patients.  New guidelines posted in Annals of Internal Medicine, however, urged physicians to use caution recommending that they not friend patients on Facebook, text them with extreme caution and e-mail them only if their patient understands the risk of lost privacy.  Issued by the American College of Physicians and the Federation of State Medical Boards, the recommendations are likely to carry a lot of weight.  They say that because of the abbreviated content used in text messages, the contents could be misconstrued by the patient.  The guidelines are aimed mainly at younger doctors who may be so used to using social media that they don't think twice about texting or emailing a patient.  I think a better way to communicate electronically is using encrypted online web sites.  There are many software packages available that allow physicians and patients to communicate online while still ensuring their privacy.  My personal physician has such a service.  He's able to share medical records with me, and I can email him back with questions.  It works quite well.  I agree that texting or emailing confidential medical information could be extremely risky and it certainly could result in a backlash from the patient if the physician hasn't gotten their permission before hand.   

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Tomorrow is a very important day for Family inHome Caregiving as well as every other company in California which does in home private duty caregiving.  Two opposing bills will be heard in the Assembly Appropriations Committee tomorrow at 9:00 a.m. in room 4202 of the State Capitol.  One we have been lobbying vigorously for (AB 322 sponsored by Assembly Member Mariko Yamada) and one we have been lobbying vigorously against (AB 241 sponsored by Assembly Member Tom Ammiano). AB 322 is a bill sponsored by our trade organization CAHSAH (the California Association for Health Services at Home) and is a well-written bill which requires companies like mine to be licensed and regulated.  We welcome this because there are a lot of companies posing as legitimate in home care companies which are actually referral services.  They are allowed to bill the client but keep the employee as a 1099 consultant.  They are supposed to disclose to the client that they do not have workers compensation, liability insurance, bonding, etc. (this is the responsibility of the senior).  Unfortunately, many companies do not do this, which is why I feel the business needs to be regulated.  If one of these so-called employees slips and falls in the home, the senior could be sued.  They are also left wide open if the employee steals because there is no bonding insurance in place.  This bill would require companies to have a physical address, authorization from the Secretary of State to conduct business, and have any owner of 5% or more of the company pass a DOJ background check.  Caregivers would also be required to pass a DOJ check, demonstrate competency in required skills, pass a TB test and have sufficient language skills to communicate with the Client.  This is important.  Prior to starting my company, I had another firm providing caregivers for my grandmother.  They sent out one caregiver who didn't speak a lick of English at one point.  I couldn't believe it.  All of the requirements in this bill seem to make common sense.  This is in stark contrast to the Ammiano bill which is co-sponsored by Senator Price, the one who supposedly wrote a bill last year that we lobbied against.  I say supposedly because he could not answer many questions about the bill which were posed to him by the Senate Appropriations Committee.  He instead referred the questions to a representative of the Service Employees International Union (SEIU).  I was there to witness this myself, and it was mind boggling. AB 241 is similar to AB 889 which we fought so hard to defeat last year.  It did pass but, thankfully, Governor Jerry Brown vetoed it.  This bill will dramatically raise costs for senior citizens, violate the privacy rights of our caregivers and cost companies like mine quite a bit of money because of the vast amount of paperwork which will be required, much of which is unnecessary in my view.  One of the worst aspects of the bill, and there are many, is it would remove the overtime exemption that companies like mine have had for decades.  The exemption was put in place so that we could provide workers that could do 12 or 24 hour shifts or even live in the home, without making the cost outrageous for the senior.  We pay them a shift rate, which is essentially a salary.  Without this exemption, it would not only make it very expensive for the senior, it would be devastating for those who have Alzheimer's disease or dementia.  Many of these people can't afford to pay double what they are paying now for 24-hour care so we would be forced to have people coming in and doing 8 hour shifts so that there was no overtime involved.  This means there would be, at a minimum, six different workers coming in during a given week.  That doesn't include others which we would need to train as a backup in case someone called in sick.  This would likely be 2 to 3 more people.  We specialize in caring for seniors with Alzheimer's disease and dementia and, speaking from experience, they can get very violent if their routine is disturbed.  Going from having a few friendly faces to 8 or more would be extremely jarring and even scary for some seniors.  I hope this bill doesn't pass and this doesn't happen.  Another ridiculous provision in this bill is that it mandates meal time and rest break periods for caregivers.  Imagine having a caregiver go off to lunch, leaving a befuddled senior with Alzheimer's disease alone by themselves wondering where their caregiver is.  We have an exemption from the California meal time and rest break periods for good reason.  These seniors simply cannot be left alone in most cases.  We are often hired because the elderly person has had a recent fall, and the family wants 24-hour supervision so that it doesn't happen again.  Of course, we could send another caregiver from home to home relieving people for their breaks, but this would not only cause a huge increase in the cost for the customer, it would also add many more caregivers to each job.  As I stated before, this simply is not good for the senior, particularly if they have Alzheimer's disease or dementia.  A cumbersome aspect of the bill is that every time there is a change in the number of hours the client wants, you must sign a new service agreement.  Our business is one of ups and downs.  A client may want 10 hours of service one week, and eight the next, and then 11 the following week.  To be constantly sending out new contracts when there are minor changes to the schedule would cause a huge amount of unnecessary paperwork.  Copies of the employee's references will need to be included with the service agreement if this bill passes.  This means that if someone calls in sick and we need to replace them with a new caregiver for just one day, we would have to send out a new service agreement including the references for the employee who was filling in for just that one day.  I can envision having to hire a full time person just to keep up with sending out new service contracts.  This, of course, would add to the cost the client is paying and I don't really see the added benefit.  The bill also requires not only documentation of the current care plan, but a backup plan in case employees call in sick or don't work out.   These decisions are often made at the time someone calls in sick or doesn't work out.  They are done in conjunction with the client, but I don't see how this can be done at the time the initial service agreement is signed because you simply don't know who will be available to fill in.  Another terrible aspect of the bill is that it would require the posting of the caregiver's name, agency and geographic location along with any pending or finalized disciplinary actions.  In addition to violating the caregiver's privacy, it requires you to post pending disciplinary actions, even though they may be without merit.  If the caregiver is later found not guilty of the allegation, the accusation must still stay on the web site, a black mark on their career forever.  This seems so unfair.  Whatever happened to innocent until proven guilty?  The bill also requires caregivers to wear name tags (AB 322 only requires employees to carry a company ID card).  Many seniors don't want others to know they have had to hire a caregiver and they will be very uncomfortable with this requirement when going out shopping and doing errands.  Finally, this bill authorizes random and unannounced inspections from the Department of Social Services (DSS).  If every single piece of paperwork (and there will be thousands of them) is not in order, we could be subject to fines of $900 per day.  Please contact your state Assembly Member and Senator and urge them not to pass this bill.  Unfortunately, Senator Yamada was the only Democratic Senator to vote against AB 889 last year.  With the Democrats in power in Sacramento, this bill has a very good chance of passing.

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Today's issue of the Monterey Herald had a story entitled, "More folks heading into old age alone."  It's a story we at Family inHome Caregiving are all too familiar with.  Sadly, many of the elderly end up without a spouse and often have no family or relatives nearby to call on for help.  And even if they do have family nearby, they aren't always willing to be there to help.  The article profiled 80 year old Billie.  Her husband is deceased and she told the reporter that her grown daughter made it clear to her that she was not going to be her caregiver.  "She thought that was too much responsibility for her.  It's just devastating," Billie said.  Brian Fant, an attorney, told the reporter, "Those of us who practice elder law are no doubt seeing the fallout of this reality.  That is, more and more isolated or alienated senior adults who either have no one, or have no one who can or will care for them," he said.  Approximately 20% of American women have no children at all, so this trend will increase as baby boomers continue to retire.  Some seniors have no alternative but to hire a private duty caregiver.  Unfortunately, many seniors are resistant to help, believing they will do fine on their own.  We often-times aren't called on until after a fall or some other incident serves as a wake-up call that they aren't as young as they used to be and they can't do everything alone.  That's why we believe that it's important to discuss your wishes with your family while you still are mentally and physically healthy.  If you don't have anyone, you should contact an attorney who practices elder care.  He or she can set up a living trust, POLST, medical and financial powers of attorney and other documents which will ensure that your wishes are carried out.  This should actually be done regardless, because these papers can become important if you are incapacitated.  If you do hire a caregiver, make sure they are through a company which is licensed, bonded and insured.  We continue to hear horror stories about elder abuse.  In addition to that problem, if you hire someone privately you will need to get your own bonding insurance, conduct your own background checks, fill out payroll tax reports and get workers compensation and liability insurance.  It can be very expensive and time consuming.

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A new gene has been discovered which could help African American's afflicted by Alzheimer's disease as well as leading to new treatments for those in various races which have this horrible disease.  A collaborative study by researchers from University of Miami and other schools and published in the Journal of the American Medical Association reported the discovery of the gene ABCA7.  One of the senior authors of the study, Dr. Margaret A. Pericak-Vance, Director of University of Miami's John P. Hussman Institute for Human Genomics, told a reporter she believes the discovery will lead to treatments specifically designed for African Americans.  Although Alzheimer's disease occurs at a similar frequency as in other populations, there are important molecular differences amongst people of different races which could lead to different treatments for various races.  There are going to be a lot of things that are similar across different races, different ethnicities," Dr. Pericak-Vance told a reporter.  "But there's also going to be some population differences.  When it comes to the point where we can translate these discoveries into therapies and prevention we will need to understand all these nuances in order to find the right drug or the right therapy for that individual person," she said.  I wrote recently on my blog about a luncheon I attended which was put on by the Alzheimer's Association called A Reason To Hope.  The name stems from the fact that they do believe we will be able to find a cure, although with government spending cuts, we desperately need help from the private sector.  Regular readers of my blog know that both my grandmother and my father had this terrible disease when they passed away, and I have been working diligently with the Monterey Chapter of the Alzheimer's Association to raise money to find a cure.  In addition to being the largest private funder of Alzheimer's research in the United States, they have support groups and a 24-hour hotline (800-272-3900) where a dedicated staff can help you if you are struggling with caring for a loved one with the disease.  Family inHome Caregiving will be sponsoring the Monterey Memory Walk on October 12.  For the past two years, we have been the number one fundraising team in Monterey and we hope we will be again this year.  We have just started our fundraising team.  If you would like to walk with us, to join our team or to donate, please click here.

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Many of the nation's largest investors in nursing homes are pulling the plug on investments in the sector due to healthy cuts in payments from Medicare and Medi-Cal.  The Wall Street Journal ran an extensive piece on the problem, pointing out that companies like Health Care REIT Inc., which provides leases to roughly 250 nursing homes nationwide, was severely pulling back from the sector.  Ventas Inc., which has about 300 nursing homes under lease said it won't be making new acquisitions in the sector but will be investing in assisted-living properties which don't rely on government payments.  It's not surprising, but it will put quite a bit of pressure on the industry.  There have been stories in the paper about people being put out on the street after their facility went into bankruptcy.  An even greater concern is that the quality of care will be reduced for nursing homes which are receiving government payments.  At Family inHome Caregiving, our goal is to keep people in their own homes and independent as long as possible.  I have seen many good nursing homes and many bad ones, and typically when they are bad they are really bad.  Those on the lower end are likely to get extremely bleak and depressing, and I wouldn't want to have a loved one staying in one.

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I was happy to see that there was record attendance at this year's "A Reason To Hope" held at the Hyatt Regency in Monterey on Wednesday.  This is one of two major fundraising events put on each year by the Monterey Chapter of the Alzheimer's Association.  It has two major goals: 1) to raise money to support this great non-profit and 2) to help raise awareness about the disease and that there is a reason to hope.  This year Chuck Warner, who suffers from early onset of Alzheimer's disease, gave an inspiring talk.  For more on the story of this local attorney who had to give up his law practice because of the disease, click here.  Another tearjerker was Emily Hunter who lost one parent at an early age and now has found out the other has Alzheimer's sung an inspiring song called "I'm Still Here".  I applaud the Alzheimer's Association for putting on another great event.  There is a reason to hope because we do believe a cure will be found for this terrible disease.  Unfortunately, there is currently no cure for Alzheimer's disease, and the few drugs that are on the market are only partially effective and are temporary in nature.  Most only work for a year or so, and going in and out of dementia can be terrifying.  At Family inHome Caregiving we have many patients with dementia, Alzheimer's disease and Parkinson's disease.  It is so sad to watch people as they progress through these diseases, and it's extremely hard on the family members and the caregivers.  Regular readers of my blog know that both my grandmother and my father had this terrible disease when they passed away, and I have been working diligently with the Monterey Chapter of the Alzheimer's Association to raise money to find a cure.  In addition to being the largest private funder of Alzheimer's research in the United States, they have support groups and a 24-hour hotline (800-272-3900) where a dedicated staff can help you if you are struggling with caring for a loved one with the disease.  Family inHome Caregiving will be sponsoring the Monterey Memory Walk on October 12.  For the past two years, we have been the number one fundraising team in Monterey and we hope we will be again this year.  We have just started our fundraising team.  If you would like to walk with us, to join our team or to donate, please click here.

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An important discovery has been made in the field of cancer research.  Researchers now believe that various types of cancer will now be seen as diseases defined by their generic fingerprint rather than by the organ in which the disease it originated in.  The study of endometrial cancer and myeloid leukemia, published in Nature and The New England Journal of Medicine, is part of a massive research project being carried out by the National Institutes of Health to analyze DNA aberrations in many types of cancer.   Already, the project has yielded important information in breast, colon and lung cancer that link them to other types of cancers.  The most recent study found that many patients with endometrial cancer had a mutation in a gene which had only been seen before in colon cancers.  This disables the body's ability to repair DNA damage which results in 100 times more mutations than are normally seen in cancer cells.  "That was a complete surprise," Dr. Douglas Levine of Memorial Sloan Kettering Cancer Center, who worked on the study, told The New York Times.  He said the study showed that cancers are more usefully classified by their gene mutations than by where they originate.  One upside of this finding is that different types of cancer may respond to the same drug if they have the same gene mutation.  I am constantly amazed by the research findings that are being released based on DNA analysis.  We could see a giant leap forward in treatments for many types of cancer over the next decade based on DNA analysis. 

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A new hormone has been discovered in mice that researchers believe may help us find a better solution for treating diabetes, a disease which affects 25 million people in this country, according to the American Diabetes Association.  It causes sugar to develop in the blood which can lead to heart disease, kidney failure and even blindness.  The new hormone, reported in the journal Cell by a team led by Peng Yi from Harvard University, is called betatrophin.  It triggers the growth of new cells which produce insulin in the pancreas.  Researchers believe that it could result in a drug that could be injected once a week or even once a month versus the three times a day injections most diabetes patients endure.  Although it's still a long way from being a commercial product, it does give new hope for those with diabetes. 

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President Barack Obama has been under a number of attacks for his health care reform rules (the Affordable Care Act).   There are both good points and bad points to the Act, but the good points seem to outweigh the bad, in my opinion.  There was a great story today in The New York Times about a hospital in New York that was calling up elderly patients with heart conditions and asking them not to scoop snow out of their driveways.  Obviously, they had their own self interest in mind (hospitals are now being paid based on readmission rates) but I thought it was a great example of how the health care system can improve the greater good at no cost to others.  We don't get much snow in California, however, many of our senior clients can be very stubborn and sometimes want to bite off more than they can chew.  I applaud their efforts when they are in good health.  We have one client who is 104 and has a personal trainer come in and do weight lifting, which I think is great.  But others recently released from the hospital want to do too much, too soon, which can have brutal consequences.  Thank you, Barack Obama, for working with the medical community to save tax dollars while at the same time keeping senior citizens safe.

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