Senior Style

In-home care options explained With people living longer with more chronic complex medical conditions than ever before, if you are "lucky" enough to live long enough, you will undoubtedly need help with "ADLs" — Activities of Daily Living — bathing, dressing, feeding, medicating, hydrating, etc. Likely too there are needs for transportation, shopping, cooking, cleaning and more. Thus, the real question here is like the song from the Clash: "Do I Stay or Do I Go?" I believe there needs to be a paradigm shift in our approach to and understanding of these options. Do not wait until these choices are made for you! As a family, we need to discuss and decide before we wind up in the hospital and a case manager is telling your oldest daughter that mom either needs to have home care set up upon discharge tomorrow, or she is going to be sent off to a rehab facility to convalesce. The in-home care provider is composed of three tiers: The home care organization, a domestic referral organization, or a private duty caregiver. A home care organization (HCO) is the safest, and most expensive way to hire a caregiver. A HCO accepts all the risk in service; they hire, pay and insure the caregivers who show up in your home. They replace caregivers when necessary and provide backups when needed. Their service is licensed and inspected by the state and tax deductible to the extent allowed. How to find a good one: n Ask how long they have been in business and how many caregivers they employ. Like most businesses, longevity and size are good indicators of both quality and their ability to serve your needs. n Talk to the boss. Hopefully the boss is the owner, and an independent operator. Having both owned a franchise in the home care industry and been an independent, I firmly support the latter. The independent doesn't have to increase its price to pay a royalty to a franchisor on top of their need to make a living. Moreover, with an independent home care agency, your hard- earned dollars don't disappear into the ether only to return as endless TV commercials for a corporate franchisor. n Ask your doctor, hospital case manager or skilled nursing manager whom they recommend. Unfortunately, digital rating systems don't translate well into home care. As an example, I would never ask one of my clients who just lost a loved one to "write me a Google review," or "Yelp me." We are talking about serving others, in their home — not learning what to order at the newest restaurant. A domestic referral organization will provide you caregivers who may perform similar duties as a home care provider, but here is the twist: the caregivers are paid directly by you. This means you are responsible for things like payroll taxes, worker's compensation insurance, loss or theft, etc. In today's California pro employee state, you also must consider the risks associated with not paying things like vacation pay, sick pay and overtime. Further, the California Supreme Court has narrowed the definition of an "independent contractor," making a regular part time or full time care provider "independent" problematic. You should pay less than a HCO, but you are assuming the burden of risk associated with an employer. The "private duty" caregiver option may be found on the internet or as a referral from one of your friends. Oftentimes, your colleagues are going through the same experience you are and will recommend the caregiver that their uncle or family employed directly. Typically, the private duty caregiver is the lowest cost option. It is also the riskiest; in addition to the issues of the DRO above, there is usually no backup replacement when the caregiver calls off a shift. Moreover, there is no background check or fingerprinting available for the private duty caregiver unless you do it yourself. Moreover, like the DRO, you are technically not entitled to a deduction for the costs associated with this personal service. How do you know your loved one is in a sub-par facility? Like having help at home, the key to a facility is the people — those who own, operate and work there. The short list of signs that you may be in a sub-par facility are: n The owner/ operator is someone you never seem to be able to find. Or the executive director is a new employee on an ongoing, regular basis. Quality and stability start at the top, and in my experience, the best facilities have the most stable owners and managers. n Are the rank-and-file employees "warm and fuzzy" or are they just going through the motions? Are there managers who know their employees' names? All of us want to feel loved and safe, and it is the express duty of a facility manager to make sure that their employees feel and share that love so that they may reflect it with their residents. n Take a close look at the facility — is it in good shape, inside and out? Even if it is old, is it well maintained and cared for? Do the personal alarm systems work? Have you tested your loved one's bedside or room alarm? You might find this picayune, however you must be assured that if there is a problem someone is going to show up quickly. Whether you or your loved one chooses to spend their golden years at home or in a facility, the best thing you can do to ensure the best experience is to talk with your care providers, set reasonable expectations, and most of all remember that how you treat you caregivers or facility will go a long way to getting you to be treated the way you want. We used to call this "The Golden Rule." Dare I say practice the Golden Rule for your Golden Years? n After nearly 20 years as a successful wine industry executive, Peter Rubens developed his first home care agency in 2004, renamed At Home Caregivers in 2011. During the last 16 years, At Home Care- givers has become one of the oldest, independently operated li- censed home care organizations north of the Golden Gate Bridge. Rubens has served on the Board of Directors of Senior Access and helped found and lead the Marin Home Care Collective. He is a founding member of the Marin Home Care Association and is also a local and national member of the Home Care Association of America. A Marketing Supplement of the Marin Independent Journal | marinij.com Senior Style October 17, 2021 11

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