California Governor Makes Assisted Suicide Legal

Senior caregivers working as professional caregivers can share many stories of seniors and their families who have struggled with when to embrace hospice care and accept the process of dying.  Aging gracefully comes with accepting mental, emotional and physical health realities that do not arrive wrapped in gracefulness.  

America's seniors receive either Medicare health care or Medicaid (for low-income seniors with few assets). If a senior has been diagnosed with a terminal condition with two years or less to live, they may accept hospice care.  Hospice care respects the dignity of the senior to maintain their comfort as they journey through their illness, accepting their body will eventually be unable to function without assistance and accepting that they do not want additional assistance to remain alive.

As advances in medicine and technology are allowing us to live longer, the new questions arising are focused on how do we want these longer years to be?  The recent best-selling book "Being Mortal" by Atul Gawande, a medical doctor (and excellent writer), focuses on how we should begin the conversations with our loved ones on how we want to age.

California's law joins the law in the state of Oregon to give their residents the right to "death with dignity".  This week Governor Jerry Brown stepped forward to sign the bill his state's assembly had approved.  The governor accepted the opposition of some in order to respect the right for mentally competent adults who have been diagnosed with a terminal illness with six months or less to live to have the choice to accept lethal prescriptions.

Hospice caregivers who have been with someone dying can share stories of hearing the death rattle noises coming from a terminal patient as they lose their ability to swallow.  Doctors, nurses and hospice professionals who support the death with dignity movement bring an approach to care that supports caring for someone as they are dying by providing comfort, just as we try to provide comfort when caring for those who will recover from an illness.

Barbara Coombs Lee, a nurse who serves as the president of Compassion & Choices, shares the story of Brittany Maynard, who through her terminal cancer diagnosis stepped up to be the force behind the movement to change the laws in California to allow for residents to choose to die with dignity.  She wanted her family caregivers to know that she had planned ahead for a dignified death.

Brittany's video had 100 million views.  You can learn more about Compassion & Choices initiative to support death with dignity in additional states in the U.S.A. 

The Senior Caregiver Turnover Problem

Ask anyone who has anything to do with senior care about the biggest challenge facing the industry right now and you’ll get this answer: caregiver turnover.

Why is it such a problem? Have you ever dealt with the elderly? Let’s say you don’t like change — your favorite grocer goes out of business, your dry cleaner moves — annoying as hell but not exactly life-changing. Now imagine it’s the person who helps you with your activities of daily living — the person who bathes you, who feeds you, who wipes your bum — that kind of personnel change can be terribly, well, personal. Now imagine you are elderly, frail, and extremely vulnerable. That kind of change can shake you to your core.

As a senior care employer, caregiver turnover affects the bottom line. It costs to hire new caregivers, to recruit and interview them, run background checks, and train them to care for their senior clients. It costs home care agencies approximately $3,500 to replace one hourly employee.

Turnover rates for private duty in-home caregivers have been steadily increasing, from 39.4% in 2009 to 61.5% in 2014, according to Home Care Pulse’s 2015 Private Duty Benchmarking Study. Annual turnover rate can vary between 60% to 100% from state to state, according to research from the Institute for the Future of Aging Services.

Increasing caregiver shortages for long-term care demands we find out why caregiver turnover is so high and seek remedies to keep quality in-home caregivers happy and on the job. 

There are many theories as to why caregiver turnover is so high. Of course, most studies show that low wages, lack of benefits, and no overtime pay contributes greatly to senior caregiver discontent. Since 2000, there has been a 23% increase in home health care employment, while salaries have remained the same at about $21,000 a year, according to research conducted by the Center for Business and Economic Research at Ball State University.

The National Private Duty Association has said that requiring employers to pay time-and-a-half for overtime could mean that some seniors will have to have more than one caretaker because they require more than 40 hours of care a week, or costs for the family would be so high, seniors would not receive all the help they need.

What would help with in-home caregiver retention, besides higher pay?

We at Caregiverlist hear from a lot of caregivers. Of course, caregivers cite better pay as a big contributor to better care, other factors are also important. Here are some suggestions in-home caregivers have for senior care agencies that would entice caregiver retention:

Offer Ongoing Training
No one wants to feel stuck in a rut. By receiving ongoing training, caregivers feel supported and know that they are developing their professional skills. The majority of caregiver turnover occurs in the first 60 days of employment, most likely due to lack of confidence in being able to provide competent care. Training increases that confidence.

Give Recognition
No one goes into senior care to become rich. Caregivers are interested in helping people and most go into the job because they had experience with family caregiving. A simple “Thank You” and acknowledgement of a job well done can increase caregiver satisfaction.

Provide Mentorship and Community
In-home caregiving can be a solitary endeavor. Of course relationships are built between caregiver and client, but it’s nice to know that one is not alone in the challenges and successes experienced as a caregiver. Providing opportunities to share caregiving stories, brainstorm solutions to common problems, and find professional camaraderie may help agencies retain quality senior caregivers.

If you are a senior caregiver, what would help keep you on the job? Share your ideas in the comments section.

Honoring CNAs During National Nursing Assistants Week

We know the value of the professional nursing assistant. These are the men and women who work tirelessly to assist the elderly and frail under the supervision of RNs and LPNs. For many seniors (especially for those seniors who are aging in place, at home), the best CNAs provide care that greatly increases the quality of life for the most vulnerable of our population.

The 38th annual National Nursing Assistants’ Week runs from June 11-18, 2015 and  kicks off on June 11 with National Career Nursing Assistants’ Day, a day to recognize the dedicated nursing assistants who have committed 5 to as many as 58 years of their lives to the care and well-being of others. This year’s theme is “Nursing Assistants @ the Heart of Care,” Celebrating 38 years as a professional organization for nursing assistants and other direct care workers in long term care.

Now more than ever, direct care workers need to advocate for themselves and their vital importance in the lives of the fastest growing demographic in America — seniors.

William Painter, past president of the board of the National Network of Career Nursing Assistants, urges all professional caregivers to be proactive in making others aware of the indispensable contributions made by those in professional long term care. Here are his suggestions:

  • Use the Language of  Respect and Cooperation on a daily basis when working with clients, coworkers, families and the community
  • Make sure that you and your co-workers are registered to vote.
  • Educate yourself and co-workers about the political issues that affect your jobs and the care you give. (Check news stories. Pay special attention to articles about wages and benefits, overtime pay, parity, staffing ratios, safety on the job, and  job-training.
  • Get to know your lawmakers! Call your legislators. Write letters. Find out who the influential people are in long term care and contact them. Get a small group together and make an appointment to visit.
  • Practice your message and avoid complaining – be assertive and professional. It is your government and your money being spent! Don’t be chicken! They hear from the other “experts”, but if they are ever going to understand how it really is, they have got to hear directly from you!
  • Look for and create opportunities to speak to churches, civic organizations, seniors groups, etc.

The employment opportunities for certified nursing aides and assistants are plentiful. CNAs work in hospitals, nursing homes, assisted living communities, adult day care centers, and in the home through senior home care agencies. Over 2.5 million women and men are currently employed as CNAs.

If you are contemplating a career as a certified nursing assistant, be aware that you’ll need a high school diploma or equivalent, you’ll have to pass a background check and medical exam, and various vaccinations are required, depending on the requirements in your state.
Certified Nursing Assistant training requirements vary from state to state, and there are many CNA schools that will help prepare you to pass your state’s Department of Health certification and licensing exam. Program costs vary widely but some financial aid may be available.

Is a CNA career right for you? Visit Caregiverlist’s Caregiver Training Center to learn more about CNA job duties, take a look at some free senior care training briefs, and take some CNA sample and practice tests.

And if there’s a special Career Nursing Assistant in your life, take this opportunity to thank them for all they do and, moreover, help advocate for respect for their role in quality long term care.

California Caregivers Still Waiting for Overtime Pay

Many senior caregivers in California are waiting for their promised fair wage and overtime pay.

Back in January, United States District Judge Michael J. Leon ruled that in-home care workers are essentially companions and thus exempt from the Department of Labor’s mandated minimum wage and overtime pay for hourly workers. This is great news for third party employers like the Home Care Association of America, who state that if wages go up, so must the cost of care billed to seniors and their families.

California has one of the most stringent overtime pay laws in the nation.  According to the Department of Industrial Relations, a California employer must pay overtime at 1.5 times an employee’s regular rate of pay for any hours over an 8 hour workday or over a 40 hour workweek. Double-time is paid for hours over a 12-hour work day or when an employee works the 7th day in a week. The minimum wage in the state of California, as of July 1, 2014, is $9 per hour (an increase from $8), and an increase to $10 per hour is scheduled for July 1, 2016.

As reported on, more than 400,000 California caregivers are waiting for the ruling to be overturned. Until then, they are making 2014 wages with no overtime compensation.

It is an unfortunate debate, as in-home senior care workers make it possible for the elderly to stay at home and age in place. Even with minimum wage and overtime compensation, the in-home senior care industry saves families (and the state) money considering Caregiverlist’s® recent California Nursing Home Rating and Cost Index puts the average cost of a private room in one of the 1,320 nursing homes in that state at $257.57 per day, with some of the higher-end institutions charging over $400 per day. Of course, in-home senior care provides the one-on-one care that many elderly respond to best.

We at Caregiverlist, along with  the more than 400,000 caregivers, entreat California’s Governor Brown to fulfill his original commitment to treating in-home caregivers to the same benefits as all other hourly workers in California. The funds are already in the budget and cannot be used for other purposes. All of California’s in-home care workers anticipate the ruling to be overturned on appeal.

Chefs Make Housecalls for Seniors

One of the reasons a senior may finally choose to move into assisted living is for the meals. The elderly who live independently may decide that by the time groceries are bought, pots and pans are put on the stove, food is plated and plates are cleaned, it’s just too much trouble to cook for one. Many times seniors will microwave some high-fat, high-sodium, prepared and processed food. Not good for nutrition and certainly not good for the soul.

Chefs for Seniors out of Madison, Wisc. has been getting a lot of press lately, and with good reason. Their mission? They want seniors to stay independent a little longer by offering a service dedicated to improving seniors’ lives through food (emphasis theirs.) They’ve recently been featured on NPR and in Senior Housing News. The family-run company staffs vetted, licensed, professional chefs to come to shop and cook for seniors, right in their own homes.

Whole, healthy, homemade food is of course preferable to industrial, processed, mass-produced food stuffs. But taking a meal is so much more than the simple act of eating. Taking every meal alone, no matter how nutritious, delicious, and convenient it may be, can be a lonely proposition for those who are used to communal meals.

Perhaps with Chefs for Seniors, the community is had in the making. Owners Barrett and Lisa Allman, as well as their son Nathan, seem to understand that the relationship between a seniors and their caregiver (in this case, the person preparing their meals) is important and consistency is an issue. Outside of special circumstances, the company tries to maintain that unique client/chef relationship.

“Routine is important for seniors, so we try to keep the same chef coming to their home every week,” Allman told Home Health Care News’ Jason Oliva.

The chef can visit twice a week, weekly, or bi-weekly, based on the senior’s need and preference. After an initial consultation, a senior-specific menu is prepared, a chef is assigned, and then the culinary friendship is forged.

Like many senior care services, this one was born from family need. Allman told NPR that the inspiration for Chefs for Seniors was his wife's grandmother. She entered assisted living ten years ago, when she could no longer cook for herself. The family knew she could have stayed in her own home longer if she had access to nutritional and tasty meals.

But don’t give up on senior communities. Many assisted living facilities have also discarded the notion of industrial food for their residents. Chefs like Carol Koty at Lockwood Lodge at Masonicare at Newtown are providing restaurant-quality meals to the seniors for whom they cook. Caregiverlist recommends you thoroughly check into all your senior care options, from in-home care, specialty care (like Chefs for Seniors), independent and assisted living, and nursing homes for your specific eldercare needs.

Japanese Seniors to Get 5 Million iPads

Apple and IBM are partnering with Japan Post to provide 1,000 seniors with free iPads for six months beginning in October. If successful, the program could increase senior users to five million by the year 2020. iPads will be equipped with IBM-produced apps specifically geared to the elderly such as reminding seniors to take their medication, help them keep in touch with family, and assist them in finding local senior services in an effort to improve the quality of life for Japan’s senior population.

Apple CEO Tim Cook, IBM CEO Ginni Rometty and Japan Post CEO Taizo Nishimuro (who is almost 80 years old) announced the program in New York on Thursday. Japan’s elderly make up 25 percent of entire population. That’s about 33 million seniors. That number is projected to grow to 40 percent over the next 4 decades.

Japan Post Group, a government-owned postal service, bank, and insurer will train 400,000 of its employees on the iPads. They in turn will deliver the devices to the elderly. Currently, Japan Post service workers make elderly wellness checks and reports back to the senior’s family. This “Watch Over” program costs families $1,000 yen, or $8, monthly. It is not known if the iPad program will increase those costs.

“This initiative has potential for global impact, as many countries face the challenge of supporting an aging population, and we are honored to be involved in supporting Japan’s senior citizens and helping enrich their lives,” Apple CEO Tim Cook said in a press release.

According to the World Health Organization (WHO), the proportion of people aged over 60 years is growing faster than any other age group in almost every country. Between 2000 and 2050, the proportion of the world's population over 60 years will double from about 11% to 22%. The number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period.

Mashable gave us a peek at the iPad interface which includes large buttons, an emergency call capability, and other senior-friendly and senior-empowering features.

Image: Mashable, Lance Ulanoff

The proposed iPad program certainly can’t take the place of a one-on-one in-home senior care, but for millions of independent older people, especially with those whose families distance care, I think it will be a great care supplement.

Celebrating Earth Day with Seniors

Here in Chicago, we awoke on Earth Day to a light dusting of snow on rooftops. This is April in the Midwest. Consider my plans to garden with my mother dashed. But not to worry — there are still plenty of ways to celebrate Earth Day with seniors and support the environment along with its protection.

Earth Day is celebrated on April 22nd around the world, and has been since United States Senator Gaylord Nelson held the first environmental teach-in on April 22, 1970   It is now, according to one of the original organizers Denis Hayes, “the largest secular holiday in the world, celebrated by more than a billion people every year.”

Senior caregivers are always on the lookout for special activities for their care recipients. I’ve culled some great ideas from around the web (along with a few suggestions of my own) and come up with some Earth Day undertakings to commemorate the day.

Plant Something
My original plan for today was to plant a tree. There are lots of reasons why planting and maintaining trees are especially good for our environment, not the least of which is that trees can help combat climate change by absorbing carbon dioxide while releasing the oxygen back into the air. Added bonus: trees conserve energy. According to Tree People, three trees placed strategically around a single-family home can cut summer air conditioning needs by up to 50 percent.

Eat Sustainably
Shop locally for produce. Farmer’s markets will not only have great seasonable fruits and vegetables, you’re saving the greenhouse gasses it takes to transport food by truck and industrial agriculture causes massive topsoil erosion. Also, just for today, keep dairy and meat consumption to a minimum. According to the United Nations Food and Agriculture Organization, meat production accounts for about 18% of the world’s greenhouse gas emissions, and the grains used to feed the livestock require an incredible amount of fuel and water. So just for today, consider going vegetarian (or close to it.)

Today would be an ideal day to go through accumulated stuff — you know, the clothing, appliances and goods that are no longer used and donate them to a worthy group. Just make sure you double-check with family before you schedule a pick-up or drop-off. You don’t want to make the mistake of getting rid of a beloved family heirloom or valuable item.

Senior caregivers connect the elderly to their environment every day. A great caregiver will look for opportunities to celebrate special days like Earth Day. Look to your local Areas on Aging for ideas and events to celebrate the health of our planet.

5 Special Mother's Day Gifts for Family Caregivers

Mother’s Day is fast approaching and there may be people in your household deciding on a gift for mom — some are even treating their mothers early. If you are one of the many American woman who provide essential senior care for an aging parent, care for your own children, and work outside the home, now is the time to start dropping hints about what gifts would rock your May 10.

I’ll say it — I think those of us who spend the entire year caring for others deserve at least one day of some thoughtful appreciation. Numbers culled by the Family Caregiver Alliance  estimates 33.9 million adult caregivers, or 16 percent of American adults provide unpaid care to a recipient aged 50 and older. That informal care is valued between $148 billion and $188 billion annually and an estimated two-thirds of those family caregivers are female. Mother’s Day is the perfect time for some serious payback.

While flowers and jewelry are always appreciated, if asked, consider giving these suggestions for special Mother’s Day gifts.

Mommy's Day Out
About 75 percent of caregivers who report feeling stressed emotionally, physically, or financially are women. When you are making less at work and spending more at home, the last thing you have is expendable income for movies, plays, or concerts. Those important outings are food for the soul. Tickets or gift cards good for nights out (dinner and a movie? cocktails and the opera?) for two makes a great present.

Indulge Me
I know spa treatments are are pretty typical Mother’s Day gifts. But how about treatment for two? Mom and grandma can get a home visit from a mobile spas. It's especially decadent as they can bring massages, facials, and mani-pedis right to the home for no muss, no fuss pampering.

Help Around the House
Spring cleaning for family caregivers might mean cleaning two homes. What would make a great gift? How about a cleaning service, just once, for one or, what the heck? both places! Getting a break from my most tedious, back-breaking, time-consuming job would certainly make it to the best-of-the-best gifts list.

A Gift That Keeps Giving
Mother’s Day comes and goes and life gets back to it’s usual routine, but a “gift of the month” membership will make someone feel appreciated for 3, 6, and 12 months. The most popular of the gift clubs is the Wine of the Month Club, of course, but there is a Coffee of the Month Club, Cheese of the Month Club,  even a Hot Sauce of the Month Club. Gift of the Month Clubs let the recipient know their contributions are acknowledged for more than just one day.

Can Somebody Else Do This?
Respite care can be for a weekend, a day, or even an hour. Family, friends, or neighbors can certainly provide respite care, but a quality home care agency can provide a fully vetted professional caregiver to step in and relieve some of that caregiver stress and help prevent caregiver burnout by providing support for a senior's Activities of Daily Living.

We at Caregiverlist® wish all the mothers and grandmothers out there a happy Mother’s Day. If you have some special gift suggestions, we’d love to hear about them in the comments.

Home Care Workers Join Fight for $15

Tax day is April 15 and when many low-wage workers look at their year-end W-2 it’s easy to ask, like Rachel (who worked in a coffee shop) did on an early episode of Friends, “Who is FICA, and why is he getting all of my money?” It’s disheartening to open that weekly paycheck to see, after all you hard work, you have barely made enough money to survive.

That’s the impetus behind Fight for $15 — the global protest to raise the minimum wage to $15 per hour. Organizers and protesters are using America’s tax day to highlight income inequality. Both union and non-union home health aides will join fast food workers, big box employees, adjunct teachers, non-union construction workers, airport workers and other low-wage earners in rallies and strikes to demand the nation join cities like Seattle and San Francisco in raising the minimum wage to $15/hr.

In New York, home health aides will rally at 4 p.m. at Central Park West near Columbus Circle, backed by George Gresham, head of the 1199 SEIU health care workers union. “Our sign for this march says ‘Invisible No More,’ Mr. Gresham told the NY Daily News. ” “We’re marching with union and nonunion health aides (because) so many of us rely on or are going to rely on the care these workers provide. We can’t ignore that they have needs, too.” He went on to say that many families are shocked to find out just how much their trusted home care aides make.

But unlike fast food workers, or the employees of Walmart, the employees of quality home care agencies don’t see their bosses on the list of the highest paid CEOs. In fact, most home care agency owners are franchisees, and while profitable, they don’t make the top 10 most profitable franchises — those are primarily fast food restaurants and personal service franchises like SuperCuts and Anytime Fitness.

Families primarily pay for homecare services out of pocket and are on already moderate or fixed incomes. High caregiver turnover means a disruption to senior care — care that is not a choice (like a hamburger), but a necessity. So what’s the answer to paying home healthcare aides like senior caregivers and CNAs more money without passing that cost on to the consumer? Many minimum wage workers supplement by utilizing public assistance in order to make ends meet. Can and should the government step in to supplement some of that hourly pay? We already know that senior home care is more cost-efficient than institutional care, like nursing home placement. The only way to keep great people in this demanding yet rewarding field is by paying them a living wage.

Caregiver pay is typically more than the nation’s minimum wage, with 30% earning more than $7.25 per hour. But is it enough? According to Fight for $15, the answer is no. The fact that so many American workers need public assistance while still working a 40 hour week means that the system needs a change. Income inequality is at the basis of this fight. And in the U.S., that disparity is the worst in the world. What do you think is the answer?

Are You Ready to Live to 100?

Sto lat, they sing in Poland for your birthday. One hundred years, one hundred years — may you live one hundred years! What I once thought a crazy birthday wish is closer to becoming reality, especially if you are a woman living in one of the world’s developed countries like Japan or the U.S.

In Michigan, 115-year-old Jeralean Talley takes the title for World’s Oldest Person. She became the oldest person in the world when 116-year-old Gertrude Weaver from Arkansas passed away early in April of pneumonia. Prior to that, a Japanese woman, Misao Okawa was the worlds oldest person. She died on April 1, 2015 at 117-years old. And although she lacks the paperwork to back her assertion, Mexico’s Leandra Becerra Lumbreras claims to be 127 years old.

Life expectancy is increasing around the world due to improved health care (including immunizations,) sanitation, access to clean running water, better nutrition, and avoiding behaviors that are known to increase rates of mortality, such as smoking.

But there’s a difference between reaching the average life expectancy in the U.S. (about 80) and becoming a supercentenarian (anyone who has been validated to have lived to be 110 years or older) — about 30 years. The Gerontology Research Group at the University of California, Los Angeles tracks supercentenarians around the world and, as of their last update on April 6 (as of this writing), 52 people (50 women, 2 men) are over the 110 year mark. There are many who claim to be just as old or older than Ms. Talley, but there’s no documentation to prove their birth date.

There is, of course, a difference between living a long life and having a long life worth living. These extraordinary thing about the supercentenarians I’ve researched is that they all seem to be pretty healthy and happy, with sharp minds and disease-free bodies. Thomas Perls, is a professor of medicine and the director of the New England Centenarian Study at Boston Medical Center, the largest study of centenarians worldwide. Their studies show that a combination of genes and a healthy lifestyle contributes to aging well. They have found that among supercentenarians, health span = lifespan. They write that they believe that instead of the aging myth “the older you get the sicker you get”, it is much more the case of “the older you get, the healthier you’ve been”.

So let’s get the long-life tips right from the sources. Here’s what the three oldest living people say have contributed to their long life.

Jeralean Talley, 115, b. 5/23/1899, Michigan
"It's coming from above," she told the Detroit Free Press. "That's the best advice I can give you. It's not in my hands or your hands." She also credits her long life to living by the golden rule.

Susannah Mushatt Jones, 115, b. 7/6/1899, New York
“I don’t have a secret,” Ms. Mushatt Jones told Time magazine. “Believe in the Lord.” And while she never drank or smoked, she eats four strips of bacon every morning, followed by scrambled eggs and grits, and gets at least 10 hours of sleep each night.

Emma Morano-Martinuzzi, 115, b. 11/29/1899, Italy
Ms. Morano-Martinuzzi claims eating raw eggs and avoiding men has kept her young.

Of course, studies show that longevity runs in families, and if your parents lived to be 100, chances are that you will too, as will your siblings and your children. Personally, I’ll be happy to test the daily bacon theory. Do you know any long-lifers? What are their secrets?

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