Just a Little Bit of Respect

If your caregiver doesn’t feel respected, he or she is not going to feel good about the job. And unless your caregiver is a saint, these negative thoughts will float down to your child. Thank your caregiver for doing a good job and be considerate of your caregiver’s feelings and time. Like everyone else who works, your caregiver wants to know that his or her efforts are noticed and that you have faith in him or her.

Parents sometimes lose sight of the fact that their caregiver is not merely an employee. If you trust your caregiver with your child, don’t ask for receipts for everything he or she buys for your house. Or, if you come home early and want some time alone with your toddler, don’t make your caregiver stay on until the end of the official workday, as if using a time card.

Although many mothers say that they are much more involved in the caregiver relationship than are their husbands, caregivers expect to be treated with respect by both parents. One caregiver felt incredibly hurt by the following incident: “I twisted my ankle on my way to work. It hurt terribly all day. At five o’clock the husband walked in and saw me with my leg up on a chair. He barely said hello. I could tell he was angry. The next day the wife asked me why I seemed to be sleeping on the job. I felt very bad that the father couldn’t confront me himself. I thought we had a good relationship.”

Making Your Caregiver Feel That He or She Counts

Have your caregiver’s wages ready on payday.
Come home when expected.
Give enough advance notice about your vacations for your caregiver to plan time off as well.
Don’t let your child put the caregiver in a humiliating situation. For example, don’t let your toddler have food fights with his older sister and then expect the caregiver to clean up.
Be sure that both you and your partner greet your caregiver each morning.
If you work at home, don’t interfere constantly.
Let your toddler know that he must listen to the caregiver’s nos.
Let the caregiver know in advance when you make playdates.
Ask whether your caregiver minds having playdates with parents rather than with other caregivers.
Leave emergency and daily money.
Have food for your caregiver to eat.
Ask your caregiver about his or her own family.

I know you care about your children. I’m a parent too. I’ve more tips about parenting smart kids to share with you. Start guiding your children to success!

The need to raise survival rates among caregivers aged sixty-five and over who care for loved ones with dementia and Alzheimer’s is urgent. Why? A significant number die before they’re finished caregiving.

Symptoms of Caregiver Stress or Burnout

Shortened patience, lengthened anger.
Inability to sleep.
Caregiver Dementia
Drinking and/or smoking more or self-medicating.
Denying there’s anything wrong with loved one.
Denying the need for help.
Hopelessness, ongoing depression.
Eating poorly.

The average length of time a caregiver cares for a loved one with Alzheimer’s is six and one-half years. That’s 2,373 days. It’s hard to hold onto hope that things will get better when you’re facing an uncertain time frame.

Remember, those stress surveys from the late seventies and early eighties? I recall a condensed list of 25 stressful life events. We were instructed to place a check mark by each event that occurred to us within the past year. Among the 25 events were the following.

Death of a Loved One
Marital separation or Divorce
Financial difficulties
Job Loss
Geographical relocation
Family conflict
Illness in the family

Back then when life was more stable (even during those double-digit inflationary years), the assessment tool instructed us that checking more than two items meant we were suffering from high levels of stress and should seek help. Can you imagine? Today, we could easily check five or ten! The difference surely paints a picture of living with greater stress, today.

Examples of Caregiver Stress

Below are a few examples of caregiver stress and burnout.

LACK of SLEEP

While my father lived in our California home, we lay awake nights because he would get disoriented between night and day and wander. He’d jiggle the door knob of our bedroom door, which we were advised to lock most nights in order to catch up on lost sleep.

Burdened by worries, I lay awake most nights. There was so much to do that I feared I wouldn’t remember it all. (I had a calendar and I wrote lots of To Dos, but when that spark of an idea strikes in the middle of the night, I didn’t want to forget!)

LOST PATIENCE LEADING to ANGER

My father would go through stubborn phases. With my husband David helping me, we had an outlet in each other. We were able to temper our anger but when we grew so exhausted and couldn’t, we did things that turned out to be funny.

One afternoon, after my father threw a tantrum and demanded that David show him his room, I followed them down the hall when the urge hit to strangle my father. I called out “David” so my deaf father could not hear. When my husband turned to look he began to laugh seeing my fingers loosely around my father’s neck. Confused by David’s laughter, my father stopped to look and then turned back to see me. Feigning innocence, my guilt-ridden smile confused my father who looked back at David laughing. Then he began to smile. Surprised by his sudden shift of emotions, I too began to laugh until we were all laughing!

I do not recommend hurting your loved one. I placed my hands loosely around my father’s neck to see what David’s reaction might be. The laughter that followed diverted a stressful moment, giving us a constructive outlet to redirect mounting frustrations. But, what if I were the only caregiver and didn’t have a support partner like David? It is easy to see how one caregiver can grow exhausted and lose patience and even grow angry.

EATING POORLY

Like us, most caregivers don’t take care of themselves as they should.

David and I made sure to sit with my father and eat well-prepared balanced meals since we were concerned about his nutrition. Isn’t this sad? We care more for others than ourselves.
After we placed my father, we went back to our old ways of one meal a day. This was not an ideal arrangement to maintain our strength as caregivers. Despite not having 24-hour responsibility for my father’s care, we still felt tethered to him.

CAREGIVER DEMENTIA

Just as people with Alzheimer’s suffer memory loss, get disoriented, and even hallucinate, so did we! The label, caregiver dementia, is used to describe Alzheimer’s-like symptoms experienced by caregivers.

David began hallucinating. David wrote letters to me while I was on travel. They were frightening as he detailed the night he felt pinned down under the bed covers and people taking his things (a common complaint of those with dementia). I was not immune either. I backed into the garage door three times, destroying two power antennas, and needing one back-end repair and one new garage door.

Although, it is normal for caregivers to experience stress and burnout, you don’t have to suffer.

We grew more and more exhausted each day and realized something must be done for my father’s and our safety. David and I started showing signs of Alzheimer’s trying to keep up with my father’s care!

Fortunately, we explored our options. After considering in-home care (I worked out of our small home and needed quiet concentration time), board and care (not secured and my wandering father might get out and not return), assisted living (at least 50 miles away at the time), and nursing care, we settled on the last–a secure facility that would look after my father 24/7.

The National Family Caregivers Association states that 48% of caregivers care for a spouse or partner. A caregiver dealing with chronic illness or disability may find themselves in an unanticipated situation of great responsibility. The circumstance is aggravated for young spousal caregivers as they manage multiple roles such as the parent of young children, employee, and home maintainer and of course spouse and caregiver. Fulfilling these roles is a challenge and there are other factors which may affect how well the caregiver can execute them. Spousal caregivers face unique challenges as no other type of caregiving involves the same degree of intimacy. The young caregiver is also challenged by age, maturity and strength of the relationship, personal experience and his or her expectations.

These are 6 powerful steps to be taken if the young caregiver wants provide a more effective, less stressful and more fulfilling care to the loved one.

1. Make an honest self-assessment of your own strengths and weaknesses; emotional, physical and mental. This must be done in writing using all available media and resources that will produce a clear, concrete analysis of the personal situation and fitness to proceed. This must include every integral part of the caregiver or potential caregiver’s life. From employment status, financial responsibilities, children and personal health; all must be accounted for and put in writing. This shall also include personal life expectations and plans for the future. Limitations must be acknowledged and concrete plans to address them must be made.

2. Have an open, honest conversation with the partner in need. This should include diagnosis, prognosis, treatment and life expectancy if known. Issues such as finances, insurance policies, will and advanced directives must be discussed and be cleared. Final arrangements such as funeral must be included in this conversation if in order or appropriate. This conversation must also address how intimacy and sexual and emotional needs will be met. This aspect of care giving could be one of the most challenging and the cause of great stress and emotional pain during the care giving experience especially for the young caregiver.

3. Take inventory of all the available resources that could be of help or assistance. Reach out to family members, friends, church, support groups and other organizations. Research and make a list of all community services and organizations available including web sites, phone numbers and contact person’s name. Keep the list available for immediate reference if needed. Create a record with names, phone numbers, email address and other important information of all those that have offered help or are known that will provide help. Be specific on the type, frequency and duration of the help offered, such as picking children from school, taking children to sports practice or dance classes, grocery shopping or accompanying patient to doctor’s appointments. Make the person or persons accountable for the help offered. Keep track of available help. This should include name, date, time and duration and type of help. Learn to ask and accept help.

Caregiver resources:

NFCA – National Family Caregivers Association
WSA – Well Spouse Association
EA – Elder Care Advocates
NIA – National Institute on Aging
AOA – Administration On Aging
NAC – National Alliance for Caregivers

4. Learn and develop time management skills. From the time the caregiver initiates its journey, effective time management will be its best asset. Calendars, schedules and notes should be part of the daily routine. Knowing in advance what, where, when and who will reduce by a great deal the incidents of chaos and crisis. Everything must be written or entered in some kind of tracking system such as the computer or phone calendar or alert system. Make good use of Yahoo or Google calendars and organize the daily routine. Different calendars could be set up for different uses. It is of paramount importance that every aspect of the daily routine is accounted for and a realistic time that each task will take to be accomplished. This must include time to do nothing, time to recharge, regroup thoughts and to rejuvenate. This will help not only the caregiver but also those that will assist and provide help. The person or persons helping should have a clear idea on what needs to be done and how long will it take.

5. Take charge and be ready to make changes and make adjustments in all areas of life. If employed, the caregiver shall have a conversation with his or her immediate manager or human resources representative at the place of employment; present the situation, be honest, assertive and flexible. Explore the possibilities for shift adjustment, reducing work hours or taking accrued vacation time or a leave of absence. Another option for the employed caregiver could be the Family Medical Leave Act or FMLA created in 1993 to assist certain workers in the United States to meet their obligations of caring for a sick family member. Not every worker is covered under this act or eligible for its benefits. The caregiver must speak with the employer to ascertain eligibility.

6. Recognize and admit life’s fragility. Make time for nurturing the spirit and the mind. Share the time available with loved ones and create memories. Take time to reconnect with self and others. Write or read a book, a poem or listen to music. Look at the sky and count the stars or take a walk under the rain. At the end nobody is certain how much time is left. Be the best caregiver that you could be.

Ileana Perez is a Registered Nurse, a Certified Health Coach, and a Health Educator. Having served as the caregiver of her late parents, Ileana knows firsthand the struggles that a caregiver faces while providing for the elderly.

Caring for senior citizens or disabled individuals can be difficult and often results in emotional and physical strain known as caregiver stress. This stress can cause one to feel frustrated or angry, guilty, lonely, and exhausted. And, although caregivers are generally in good health, research indicates that caregivers are more likely to experience depression and anxiety, have higher levels of stress-induced hormones, and have a higher incidence of obesity. Still, one research study has found a difference in health between caregivers who felt stressed and those who did not. Senior citizens who felt stressed as a result of taking care of a disabled spouse were more likely to die within four years of the study than their counterparts who did not feel stressed. For reasons like this, it is important that caregivers providing elder care or care for a disabled individual understand how to avoid and cope with caregiver stress.

Symptoms

If you are caregiver it is likely that have caregiver stress if you experience the following symptoms:

Altered sleeping habits
Weight loss or gain
Constantly feeling worried, overwhelmed, or sad
Being irritable and easily angered
Frequent and unexplainable headaches or other bodily pain

If you feel like physically or emotionally harming yourself or the person you are caring for, talk to your doctor immediately. He or she will be able to refer you to a health care specialist that can help.

Preventing and Alleviating Stress

Caregiver stress is associated with many serious health problems and should never be dismissed as “just stress.” Rather it is important that those providing care for senior citizens or disabled individuals take steps to reduce their stress.

If you feel like physically or emotionally harming yourself or the person you are caring for, talk to your doctor immediately. He or she will be able to refer you to a health care specialist that can help.

Preventing and Alleviating Stress

Caregiver stress is associated with many serious health problems and should never be dismissed as “just stress.” Rather it is important that those providing care for senior citizens or disabled individuals take steps to reduce their stress.

Taking a problem-solving approach to caring for others helps to decrease stress. For example, if someone with Alzheimer’s continues to ask the same question again and again, answer the question but then redirect him or her. Say something like “Lets get this laundry started,” or include the person in a simple task like folding clothes.

If you are caring for someone with a certain disease or disability, be sure you understand their condition. Use your doctor, the library, or the Internet to educate yourself. Also, your hospital or doctor’s office may give classes that teach you how to take care of someone with the condition your loved one has.

Tips for Reducing Stress

Research and use community resources that are available for both the person being cared for and the caregiver.
Do not be afraid to ask for and accept help. Often, friends and family members are willing to provide assistance like taking the elderly or disabled person on a walk once a week or picking up groceries for you.
Ask family members to contribute to the costs of taking care of the relative who needs help.
Say “no” when necessary, it is important not to take on too much responsibility that can lead to additional stress.
Identify what you are able to change and what you cannot. You cannot change another’s behavior, but you can change how you respond to it.
Do not take on too much at once. Rather, break big tasks up into smaller steps and set realistic goals that you can stick to.
If you begin to feel guilty, remind yourself that there is no such thing as a perfect caregiver and you are doing your best.
Establish a daily routine and make prioritized “to do” lists.
Stay connected with friends and family members, and make time each week to spend time with others in a capacity that is relaxing and enjoyable for you.
Join a support group for caregivers; it can help remind you that you are not alone. Also, other caregivers can offer support and advice for how to cope with what you are going through.
Finally, take care of yourself. Eat well-balanced meals, maintain a healthy weight, and get enough sleep. Talk with your doctor about any sickness or feelings of depression or anxiety that you may be experiencing.

Taking a BreakSometimes, it may be necessary to take a break from caregiving to reduce stress. Respite care provides relief services for people who need rest after caring for others. There are various types including:

In-home Respite Care. This type of elder care generally involves in home health care services from companionship to nursing.
Adult Day Care. This type of elder care is often held in community centers, and sometimes transportation to and from the center is provided.
Short-term Nursing Homes. These types of nursing homes provide care for senior citizens over the short-term and are useful when a caregiver has to go out of town for few weeks.

If you are feeling overwhelmed working and taking care of a relative, it may be helpful to take a break from your work. Ask Human Resources about different options for taking leave. The federal Family and Medical Leave Act allows one to take as much as 12 weeks of unpaid leave to care for a loved one.

Hiring an in home health aide will also ensure your loved one is cared for, if you cannot always be there or provide the care yourself. Home health aides can provide care for as little as a few hours a week to 24 hours a day. They provide assistance with personal care, like bathing or brushing teeth. They offer housekeeping services, like laundry and light cleaning. They also act as companions providing social interaction. Finally, they assist with administering medications and other treatments. You can hire a home health aide through an in home health care agency or independently, generally independent caregivers are less expensive.

Caregiving Services in your Community

Asking your doctor or case manager about resources in your community is a good place to begin locating additional caregiving services. Some of these services may be free while others require payment. Local churches, synagogues, and community centers may give free services for senior citizens or disabled individuals. The government also provides many benefits at the federal, state, and local levels for senior citizen elder care and care for disabled individuals. To find out more about these, you can contact your local Area Agency on Aging. You can also look into respite care or in home health care services available in your area in your phone book.

Paying for Home Health Care and Other Caregiving Services

Medicare, Medicaid, private “Medigap” policies or health insurance, or long-term care insurance may cover some of costs of in home health care. Other costs will have to be paid for out of pocket.

In home health care costs depend on the services you use. Non-medical workers like companions or housekeepers are much less expensive than medical workers like nurses. Also, the cost of using in home health care agencies vary, but is generally more expensive than using an independent caregiver.

In addition to Medicare and Medicaid, the federal government provides the National Family Caregiver Support Program. This program helps states to provide services for caregivers. Every state offers different types of services, many include respite care, support groups, individual counseling, caregiver training, and help accessing additional benefits. To be eligible, a caregiver must:

Provide care for a senior citizen at least 60 years of age or older
Provide care for or any person with Alzheimer’s disease
Be at least 55 years of age and provide the primary care for a child under the age of 18
Be at least 55 years of age and provide the primary care for a disabled adult aged 18 to 59 years old

With aging comes the strong likelihood that we will need a caregiver; someone to help with daily tasks and personal hygiene. Often it is not practical for family members and friends to provide all the assistance that a loved one needs. Finding a caregiver usually falls on females in the family as they are the main caregivers.

Care provider agencies provide this type of assistance. However the transition can be fraught with frustration when family members make incorrect assumptions that caregivers are trained, trustworthy and do not need supervision. Additionally in many cases, the person needing the care resists the idea and can cause difficulties in initially making the transition to accepting care. Many times the agency caregiving relationship is misconstrued as a family relationship versus an employer to employee relationship and individuals receiving care often cross the boundary creating issues that result in situations of potential conflict of interest, safety or abuse.

Meet the company owner. Establish a relationship with the owner and the supervisor of the home care agency to create an environment that supports open communication about concerns, possible solutions and alternatives. Request the educational background of the company owner and ask why they are qualified to provide this service? Never hesitate to call with issues. Ask how often they will contact YOU to request feedback. You should receive a personal call immediately after initiation of services and then on a regular schedule not to exceed 90 days.

Ask for qualifications. Request a copy of the company liability and workers compensation insurance. Ask if caregivers are background checked and what specifically is checked for example criminal background, driving record, credit background, drug testing. If the agency runs only a criminal background check they may be missing a poor driving record that may indicate irresponsible behavior, substance abuse or a credit record that may indicate poor money management. Issues with any or all of these may potentially expose your family member to issues of safety, abuse or neglect.

How is time kept and billed? Companies with a high degree of supervision use automated time and attendance systems whereby the caregiver calls in from the home of the client and calls out when leaving. This serves as a time clock to ensure that you are not being billed for time the caregiver is not in the home. It also alerts the agency if their caregiver does not show up to work as scheduled. Paper systems are more commonly used, however if this is the case request a copy to be included with your invoice so you can review the information.

Do not cause issues for your caregiver. I have often witnessed clients telling their caregivers to leave a shift early but not to mark time accurately so they are paid for the entire shift. This causes issues of dishonesty for the caregiver who knowingly falsifies paperwork at the request of the client. Be a good client and don’t cause these issues for your caregiver or their agency.

Create a task list. Many times the individual receiving care cannot make a task list for the caregiver often resulting in unproductive time. Make a list for the caregiver and your parent or family member. Share this with the agency to make your expectations clear and to ensure that the agency can provide the assistance needed. Some agencies provide companionship only and not other caregiving tasks, know which you are hiring.

Put together a photo album or a journal describing your loved one’s life, interests, accomplishments, family and friends. Providing a history for caregivers invites them to bring a genuine understanding of the care they are providing. Or better, yet, make this a project that your loved one and the caregiver can do together to validate the importance of the life lived by your family member.

Maintain a professional relationship. No matter how close you or your loved one becomes with the hired caregiver the caregiver is NOT your family. By creating and maintaining a professional relationship you ensure results that are in your best interest and avoid the potential of financial or personal abuse. Never, except at the holiday when it can be documented and approved by the agency, give gifts, tips, unused household items as you are training the caregiver that accepting items is okay. IT IS NOT!

By instituting these tips you might feel as though you are personally training the agency and caregiver. You are! Each individual and situation is different and many hired caregivers are average people without extensive training.

It is important to create an outline of the care you expect; adult caregiving can be difficult and challenging and is definitely not for everyone. If you are dissatisfied with your caregiver contact that agency and request a replacement. The best way to provide quality of care for your loved one is to establish a genuine understanding expected outcomes of the care being provided and the implementation of professional boundaries.

To Help Eldercaregivers, Practice Listening, Advocating, and Sharing Hope

When a friend, family member, or neighbor accepts the responsibility of caring for an elderly relative or friend, many of us automatically look for a way to help and find we don’t know what kind of assistance to offer. If you have a friend or neighbor who is caring for a parent, grandmother, aunt, or elderly spouse and want to offer your support, begin with these recommendations and let your imagination create others.

1. Call and ask the caregiver how the patient AND the caregiver are feeling. Most people ask only about the ill person, forgetting that it’s equally important to care for the caregiver. Studies show those caring for an elderly parent or relative suffer higher levels of stress, anxiety, and illnesses than non-caregivers. You can help add comfort to the harsh emotional and physical burdens of the daily caregiving routine by a simple act of recognition-remembering to ask the caregiver, “How are you holding up?”

2. If you have to leave a voice-mail message, don’t ask the caregiver or ill person to “call me back.” Caregivers are usually overwhelmed with daily chores and responsibilities. Asking for a call back just adds another obligation to their “to do” list. Instead, say, “Don’t worry about calling me back. Just know I’m thinking of you and I’ll call you back another time. If you need a shoulder, or just want to vent, I’m here for you.” Instead of adding another item to the caregiver’s long “to do” list, you’ve sent a message of friendship and compassion. Remember, you’ve made a promise, so be sure and call back within a day or two.

3. Your time may be the most practical and valued gift of all. Let the caregiver know you’re going to the grocery store on Tuesday and offer to pick up her groceries while you’re there. Be sure and get a list and ask if specific brands are important. Ditto for dry cleaning, prescriptions, or other errands. When you prepare dinner for yourself or your family, it takes very little time to cook extra portions, freeze them and drop off a bag of dinners as often as you can.

4. If you’re comfortable sitting with the patient for a few hours, offer your time so the caregiver can leave the house and take a break. Be frank about you will do and what you don’t want to do: You may be comfortable reading to the patient, or watching TV with her, but uncomfortable feeding or toileting her. Explain your feelings, saying, “Pat, I want this to work out well so I can offer to help again. I’m happy to sit with your mom, read to her, or watch TV with her, but I’m too uncomfortable to help with any hands-on assistance. I’d also like to be sure I can reach you if I have a problem. Is that okay with you?

5. Resist the urge to tell the caregiver horror stories about your cousin or friend’s aunt who went through the same or a similar illness. Third or fourth hand medical stories, particularly those told by lay people, are rarely accurate. We all react to medical problems differently. Your cousin might have had an adverse reaction to a medication that someone else tolerates without incident. Or, your friend’s aunt may have hallucinated after she took an over-the-counter product that millions of other people found beneficial without incident. Don’t add fear and dread to the caregiver’s already considerable worries.

6. Recognize that when illness strikes, family members or caregivers may be so overwhelmed that they cannot help themselves or their loved ones. At those times, they need an advocate. You can provide emotional and practical help by helping them find one. Log on to the Internet and find out what resources are available for the caregiver and patient. Look for treatments, medical centers, support groups, general information, medical trials, time saving tips, caregiver bulletin boards and advice from illness-related groups, then print the information out and give or send it to the caregiver. If you find information you believe is particularly important, highlight it. If the caregiver doesn’t use it, don’t press the subject, just let it go and feel good about yourself for trying to help.

7. Say something encouraging or warming. You don’t have to reach for what to say, the answer is all around you. Medical science is now reaping the reward of decades of research and is continually blessing us with new and better treatments, sometimes cures that enable patients to manage many medical problems while maintaining a satisfactory quality of life. So tell your friend to have hope for the future, because tomorrow or the next day, the doctor might call – as he did for my sister a few months ago – and say, “We’ve got something new for you. Come on in.” And when my sister met with the specialist, the “new, improved” medication” worked for her and improved her life dramatically. Never give up. My sister had been waiting for ten years.

8. Finally, be available to listen. Caregiver’s often feel bewildered, overburdened, afraid, and alone. Learn to sit still and listen. Remember this isn’t about you and your experiences or beliefs. This is about the caregiver you’re there to help. Aside from an accurate diagnosis and medical treatment, nothing is as important as a trusted friend who will take the time to listen to fears and innermost thoughts. Don’t pass judgment by trying to change the caregiver’s grief, fear, anger, or guilt – you can’t feel them or understand them from her perspective and it’s unlikely you have the training to suggest how the caregiver should or shouldn’t feel.

A caregiver friend of mine recently said, “I’m not so much stunned about today as I am about the future. Oh my God. What he’s been through and what he’ll go through. One of the things that keeps me going is what you told me years ago about new treatments being available every day.” They are. Be a friend. Practice sharing hope.

For more information on Eldercare and a guide to the decisions eldercare givers face on a daily basis you can visit [http://eldercare911answers.com] for guidence from Judie Rappaport and Sue Beerman, Co-Authors of the best selling Eldercare911.

Many years ago, as a young woman with three small children, I attempted to supplement our income by selling health insurance. I failed. In six months I sold just two policies – one to my parents and one to my cousin, both farmers in central Kansas.

There were lots of reasons I didn’t succeed, but my primary mistake was thinking that when someone purchased insurance from me, they were doing me a personal favor. That’s the reason I didn’t push my then-healthy 60 year-old mother to add the prescription rider to her hospital income policy, which they could have had for just a few more dollars each month.

Ten years later, my mother was suffering with macular degeneration, osteoporosis, restless leg syndrome, heart disease, and severe hearing loss. And then my dad had a stroke, and she became his primary caregiver.

One of the ways she coped with the stress of the job was to go to her computer, disengage her emotional monitor and write to me about everything she was experiencing and exactly how she felt about it.

Five-and-half years following Dad’s first stroke she wrote, “I told your dad that if he gets down completely, I will have to sell some land and put him in a nursing home. It didn’t bother him at all. I’m sure he figures that he will commit suicide. I had your brother take his gun away.”

A few months later, Dad fell. He broke seven ribs and punctured a lung. Despite my mother’s determination and absolute commitment to keep him at home, she finally had no choice.

She wrote, “I’m very grateful that you’re coming home, although I don’t anticipate this trip will be any fun for you. Your dad is not going to be happy about being moved from the hospital into the nursing home, even though they offer excellent care there. As I told you, it’s very expensive, but I just can’t take care of him in the shape he’s in now. I don’t know what I’ll do if he doesn’t die or get better before the Medicare benefits run out. If he doesn’t recover enough for me to take him home, I’ll have to sell some land. If I do, I won’t tell him. As you know, the land has always been sacred to the men in our family.”

Dad died two weeks later.

I have often thought about the huge difference long-term care insurance benefits could have made during the final stages of my parents’ lives. Fortunately, they had continued to pay the premiums on the little policy I sold to them in 1984. Through the years it did exactly what the insurance company had promised it would do. Every time either of them stayed in the hospital, they received a check. That money paid for gas, food, hotels, and other unplanned expenses. It was a Godsend. Even so, it was a very small drop in a very large and leaky bucket.

My mother frequently said, “Your Golden Years start the day your youngest child graduates from high school, and they end the day your health goes to hell.”

Most of us will outlive our “Golden Years” and will need some form of long-term care. So when you see a now-healthy relative cross the street, or a friend duck around the aisle of the grocery store because they don’t want to talk to you about insurance, try not to take it personally.

Because if and when their “Golden Years” come to a screeching halt and you have helped them provide quality health care for their loved one without having to sacrifice everything they have worked their entire lives to accumulate, I guarantee you they will appreciate your persistence and welcome your phone calls.

I can’t tell you how many times my mother said, “I’m sure glad we have that hospital income policy.” How sad to remember at the time, I thought she was buying it just to help me.

The institution of the family is decisive in determining not only if a person has the capacity to love another individual but in the larger sense whether he is capable of loving his fellow men collectively. The whole of society rests on this foundation for stability, understanding and social peace.

Martin Luther King, Jr., 1965

Parenthood involves more than childrearing. It is the legal and physical custody of a child as child and parent grow together. Most parents successfully raise their children without consciously experiencing parenthood’s developmental phases. They enhance their coping skills, altruism and self-respect as they work through their own unresolved developmental issues. For example, being a parent activates both positive and negative memories of relationships with one’s own parents.

People who successfully master these challenges achieve new levels of psychological and emotional maturity along with their children.

Carolyn Newberger, professor of psychology at Harvard University, described how parenthood moves from egoistic to integrative phases:

Phase 1: Egoistic
Parents are self-focused and see their children as extensions of themselves.

Phase 2: Conventional
Perspectives shift from self-centeredness to childrearing practices drawn from traditions, experts and age-related norms.

Phase 3: Individualistic
Children are viewed as unique individuals.

Phase 4: Integrative
Parents learn and mature with their children in their families, communities and society.

Most parents intuitively meet their challenges. Many need help learning how to grow with their children. Some need education and clinical treatment to function competently. A comparatively small percentage but critically large number is unable to function competently. Typically these are adolescents and dependent adults.

We Need a Paradigm Shift

The family is the most fragile of all human institutions, yet it is the bedrock of civilization. Its strength lies in the cohesion and loyalty of the parent-child relationship from which the larger world of kin, community and nation evolves. Our moral stature and our social organization flow from parenthood. It is the source of the work ethic as well as our human capital. Self-assertive social and integrative cultural values are blended in the crucible of parenthood.

Families produce future generations. They protect members against ill health, old age, unemployment and other hazards. Especially in the United States, family relationships are strained by the tension between self-assertive social values and integrative cultural values. Is a child a parent’s private property? Or is a parent a child’s temporary legal and physical custodian?

Both the extreme political left and the right espouse self-assertive values that regard children as private property. The far left stresses the freedom of parents to do as they wish. The far right stresses the privacy of the family. Both extremes assert that parenthood is outside the public domain. Both avoid holding parents responsible for their children’s behavior. To do so is “parent blaming,” they say.

These extreme self-assertive views need to be balanced by integrative values. But the act of balancing them creates friction between competing personal interests as well as between “the world as it is” and “the world as it ought to be.” Like the encircling polarities of the Chinese yin/yang symbol, the world that is and the world that ought to be are intertwined.

The World That Is

Self-assertive capitalism regards the family as a unit for generating money that will be spent on goods and services. It creates winners and losers and undermines reciprocity, altruism and mutual obligation… vital ingredients for the common good. Ironically, self-assertive capitalism weakens the civil society without which the marketplace itself cannot survive.

All wealthy nations, including the United States, are welfare states… that is, they are primarily capitalist states with large, selective doses of socialism. In Wealth & Welfare States: Is America a Laggard or Leader?, Irwin Garfinkel, Lee Rainwater and Timothy Smeeding point out that by its nature, capitalism produces too much economic insecurity. The objective of state welfare institutions is, therefore, to reduce economic insecurity.

Certain institutions families, congregations, service clubs, athletic groups, parent-teacher associations and social organizations offset self-assertive capitalism. They hold our society together, but they are under pressure.

Families have become money machines that generate income to pay off debts. Work schedules are more important than family schedules. Undisciplined consumption is encouraged. Television pumps out images that oppose cultural integrative values. The desire for status is so strong that children attempt to display their worthiness through material things others want or envy. Low-income families struggle to provide these items so their children can achieve some degree of status in school. In contrast, if children are involved in extracurricular, family or community-oriented activities, they don’t need to consume to achieve status.

If we were a true materialistic society, we would value making, using and keeping material things for functional and aesthetic purposes. We would value and enjoy natural and manufactured goods. Instead we are a consumer society in which commodities are sold and discarded. Our economy depends upon planned obsolescence, a throw away orientation.

Unfortunately, promoting consumption of disposable commodities carries over into human relationships. People are viewed as means to an end. They are only consumers of goods and services. Producers and service providers have no commitment beyond satisfying the needs and pleasures of consumers.

This attitude leaks out to color all kinds of relationships. It’s most obvious in the temporary “hook-up” sexual affairs seen today, but it also permeates family relationships. Cohabitation avoids the legal obligations of marriage. Marriage is seen as disposable when one partner no longer meets the other’s needs. Children can be designed through technical procedures and gestated by surrogates. They can be adopted if an individual has enough money to pay others to obtain them. Children have become commodities.

In Shattered: Modern Motherhood and the Illusion of Equality, Rebecca Asher describes how women who set off on a footing of equality with their partners are betrayed by them when babies arrive. Mothers become “foundation parents” and de facto “household drudges,” condemned to professional sidelining and part-time jobs because fathers fail to pull their weight. Mothers feel victimized, fathers feel guilty. The pair that started out on an equal-opportunity journey through life ends up sniping at each other, or scoring weary points. Many split up.
Internationally, the commodification of children is blatantly obvious. Worldwide, 1.2 million children are abducted, bought and sold each year. Every day children as young as nine are abducted or taken under false pretenses from their villages by human traffickers. These girls and boys are promised good jobs and good pay but they end up working in brothels, mines and sweatshops. For example, more than 200,000 Nepalese girls are believed to be victims of this international trade.

In the United States, the commodification of children is less obvious, but here are some examples:

• A Texas Senator proposed a bill that would permit a $500 payment to each woman who places a child for adoption rather than have an abortion. The intention was to provide an incentive to avoid abortion and make an adoption plan. Such a proposal implies that a value can be set on a newborn baby $500 in this case. It ignores the costs of pregnancy, pre-natal care, childbirth and any complications thereof.

• Rebecca Taylor tried to sell her 5-month-old boy for $10,000. Taylor never bonded with the child and needed the money to get another apartment. She was charged with offering the sale of a child.

• Through Fertility Choices Worldwide the cost of hiring a surrogate mother to produce a baby can range from $103,000 to $165,000, although she receives a fraction of the cost.

Challenges for Parents

Parenthood is an economic burden for too many parents. In the United States, our society expects parents to rear their children without adequate resources. The lack of childcare, health care and effective education saps the rewards of parenthood and is detrimental to our society. Parents are distracted by:

• The decline of committed, sacrificial relationships that results in weak family bonds;
• Viewing children as extensions of themselves rather than as life companions;
• Pleasing children rather than expecting them to contribute to family wellbeing;
• Guilt for being imperfect parents; and
• Stress that makes employment away from home attractive and that strains parental relationships.

Efforts to integrate childrearing and employment demonstrate the consequences of delegating parenting functions. After sixty years, the Israeli kibbutzim modified the care of babies and toddlers in separate children’s houses because of its negative effects on parent-child relationships and on adult outcomes. The inability of Kibbutz-raised children to engage in intimate personal relationships was traced to early environments lacking cohesion and continuity because of transient, superficial interactions with caregivers. Virtually all kibbutz babies now receive maternal care at home during their first year of life as their mothers gradually return to the workplace. In the United States, it will take years to assess the long-term effects of today’s delegated childcare of babies and toddlers on child development and adult outcomes.

The World That Ought To Be

Commercial marketing uses world as it ought to be symbols. Slogans such as Be all that you can be, Reach out and touch someone, and Own a piece of the rock focus on appealing cultural values.

John Maynard Keynes concluded in the 1930s that unchecked “animal spirits” emotions, human impulses, enthusiasms and misperceptions drive the economy into booms and busts in a market system that fails to govern itself. On the other hand, tempered by government and safely channeled into healthy capitalism, these same animal spirits can be a source of entrepreneurial energy and benefit everyone.

Most modern social and environmental problems like ill health, lack of community, violence, drugs, obesity, mental illness, long working hours and large prison populations are more likely to occur in a society with large gaps between classes. Addressing inequality in our society would benefit everyone, the well-off as well as the poor.

Our young people’s social, economic, health and educational problems require integrative community and social efforts that include racial and cultural diversity. Still our service systems often view children and youth separately from their families and communities. Programs for different categories of problems treat children as freestanding units and focus on school, peer, social class, racial, neighborhood and societal factors rather than on their homes.
These problems could be minimized if our society recognized that parenthood is a career with economic and social value and that it is our society’s foundation. This would shift the balance from self-centered consumerism to a friendlier and more integrative society.

Because competent parents are essential for our society’s survival, minimum legal standards should be set for determining a person’s readiness to assume these responsibilities.

Readiness for Parenthood

In most states, minors over sixteen can obtain a marriage license with the consent of parents or guardians. Kansas and Massachusetts specify twelve for females and fourteen for males. New Hampshire specifies thirteen for females and fourteen for males. If there is no parent or guardian, or if the guardian is an agency or department, consent can be given by a court. Marriage and military service can be regarded as acts of emancipation from minority status.
In contrast, most European nations make eighteen the minimum age for marriage. In Malta, people may marry from the age of sixteen, although paradoxically the age of consent for sexual intercourse is eighteen. In Turkey, the legal age for marriage is seventeen for girls and boys. In Ireland, a court can authorize the marriage of minors less than eighteen under certain conditions.

Decision-making that leads to adolescent parenthood can be flawed and is an appropriate concern for public policy. In reality, immaturity renders a minor incapable of truly informed consent about marriage or becoming a parent. State laws governing marriage age and emancipation need to be updated to conform with the physical and psychological realities of adolescent development.

In spite of the rhetoric against adolescent pregnancies, our society does little to prepare parents for their new responsibilities. Dependent adult and young adolescent childbirths from unplanned and planned pregnancies are generally considered inevitable. These vulnerable parents, it is assumed, will somehow learn to handle parental responsibilities after the children are born.

Most of the literature about adolescent pregnancy and parenthood doesn’t distinguish between minor and legally adult adolescents. Late adolescent 18 to 21-year-olds are usually considered adults.

Giving birth to a baby doesn’t produce an adult brain or eliminate adolescent developmental issues. John Mitchell, a developmental psychologist, calls attention to romanticized notions that can hide elementary facts:

Romanticizing adolescence blinds us to the adolescent’s capacity for life-diminishing choices. Romantics refuse to tally the teen suicides, runaways, juvenile sex trade, prisoners, broken mothers, damaged infants, and abusive fathers. In order to mature, the natural talent of youth must be aimed and trained.

Many adolescents are wishful thinkers who lack a future orientation because of their sense of invulnerability and their attraction to risk. They are easily swayed by the belief “it can’t happen to me.” This flavor underlies the attitude “I don’t care about that now” despite knowing that cigarettes, drugs, noise and steroids produce diseases, addiction and hearing loss while shortening lifespans. Babies and young children must be protected from these characteristics.

Adolescents who become pregnant have difficulty envisioning alternatives and reasoning through the consequences of childbirth. I had the following conversation with a fifteen-year-old white girl from a middle-class family:

Doctor: I’m told that the test results show that you are pregnant.
Patient: My boyfriend and I knew it because the condom broke.
Doctor: What do you plan to do?
Patient: I’m going to have my baby and keep it. My boyfriend will drop out of school to support us.
Doctor: Do you think that you are old enough to raise a child?
Patient: No. I certainly wouldn’t try to get pregnant.
Doctor: Then how is it that you plan to raise this baby?
Patient: Oh, it was an accident. Besides, I don’t like school, and I can get money to live on. I know a lot of kids who are doing it.

Adolescents who become pregnant are unprepared for the decision-making and responsibilities involved in parenthood. Mature adolescents recognize that they are not ready for parenthood and terminate their pregnancies or make an adoption plan.

Does the Biological Right to Procreate Extend to Persons of Any Age?

The progress of our society has been based on the rule of law, the tangible repository of our cultural values. We are able to transact business with checks and credit cards rather than cash because of the trust we have in the enforcement of our laws. Yet we are still reluctant to legislate standards for competent parenthood. The prime example is our failure to deal with the crisis of adolescent childbirth.

In the United States, there is a strong emphasis on reproductive freedom. The U.S. Supreme Court described the right to procreate as a basic liberty in 1942 in Skinner v. Oklahoma. This has been interpreted as establishing the right to procreate. The political right might oppose the termination of any pregnancy and urge girls on to childbirth. The political left might hold that minor adolescents have the right to procreate when physically able to do so.
GirlMom.com describes itself as a “politically progressive, left-aligned, pro-choice, feminist” website that supports young mothers in their struggle for reproductive freedom and social support. It holds that adolescents are socially conditioned to believe they are irresponsible. This creates a self-fulfilling prophecy in which adolescent parents believe they can’t parent well and therefore don’t. For GirlMom.com adolescent parenthood is not a crisis; the crisis is that adolescent parents do not receive enough public support.

Kristin Luker, a professor of sociology at the University of California-Berkeley, points out that adolescents have raised healthy children throughout human history. She overlooks the fact that the average onset of menstruation has dropped from sixteen to twelve years of age. She holds that when good prenatal care and nutrition are available, the adolescent years are the best time to have babies from a physical point of view. Luker believes that “the jury is still out on whether or not adolescents make ‘bad’ parents.”

Sara Ruddick, professor emeritus at New School University, hopes that the youngest mothers will have the resources to which all mothers are entitled. These viewpoints reflect a widely held belief that parenthood, as with procreation, is a right rather than a privilege.

These views conflict with the moral and legal principle that a child is not the property of the genetic parent. From the moral point of view, parenthood is not a right awarded by procreation. As adoptive parents well know, it is earned by nurturing a child. From the legal point of view, genetic parents hold legal and physical custodian rights that are defined and can be revoked under child neglect and abuse laws. People who require legal and physical custodians themselves cannot be the legal and physical custodians of other persons… and newborn babies are other persons.

The Double Standard

Franklin Zimring, professor of law at the University of California-Berkeley, points out how accepting low-income adolescent parenthood while encouraging middle-class adolescents to terminate pregnancies or create adoption plans reveals a double standard. Ageism, sexism and racism are all contributing factors as pointed out previously in this book.

Most adolescents who become pregnant realize that it is unwise to enter parenthood. But this wisdom often is not reinforced by their families, professionals or society. To deprive adolescents of informed consent the most important part of which is to ensure that they fully understand the responsibilities and consequences of parenthood is an abrogation of parental and professional obligations. It violates the responsibility of professionals to do no harm.

Title XX of the Public Health Service Act specifies necessary services for Adolescent Family Life Demonstration Projects. These include adoption counseling and referral services; education on the responsibilities of sexuality and parenting; and counseling for immediate and extended family members. This model should be available to all pregnant adolescents and their families as proposed in the next chapter.

It has been known for many years that pets’ interactions with senior citizens can help bring joy into their lives that may have been missing. As we age, lots of things change; some of those things aren’t necessarily for the better. Many senior citizens can find themselves alone. Our bodies can become more restrictive of movement and use. Our minds can suffer, as well, from dementia and the inability to recall names, numbers, and even some of our fondest memories. Being able to experience the love of a relationship with an animal can help ease the pain and sorrows of those times.

An animal companion, even for a short while as many programs offer to nursing homes, can be a tremendous boost to a person’s morale and spirits. The unconditional love supplied by a cat, dog, or other living animal can work wonders for an aging person’s mental state and overall health condition, supplementing what a physician can only do with pills and physical therapies.

As well as providing love and companionship for seniors living in elder care facilities, animal programs have also been proven successful at jails and juvenile justice centers. The idea is for the program to be rewarding to both human and animal. The animals should receive love and attention in return for their unconditional love and time given to others.

Pets and At-Risk Kids
Living accommodations provided to at-risk kids and those who have gotten in trouble with the law near Detroit, Michigan can find respite in helping dogs learn the basics of obedience. Thanks to Macomb County’s animal shelter and a nonprofit organization, known as Teacher’s Pet, dogs and kids get the opportunity to interact, hopefully contributing something to each other. Those responsible for guiding the efforts of the program state that they have seen a noticeable change in the attitude of the kids involved.

Prison Dogs
One program called Safe Harbor originated in 2004 in Kansas. The volunteers obtain unwanted dogs from high-kill shelters in the Midwest region and take them to the Lansing Correctional Facility. The group has trained approximately 100 inmates to care for and foster the dogs. Many times, these dogs need to learn socialization skills, as well as the basic obedience commands. The interaction between prisoners and dogs has contributed greatly to both. Training the dogs gives the prisoners something useful to do and can bring them a huge sense of accomplishment and pride. The dogs get the love and attention they need to re-focus on the ability to live in a home.

Senior Citizens/Mature Pets
Senior citizens and older, mature pets can especially enjoy a beneficial cohabitation. Younger cats and dogs may have a little more energy and require a deeper commitment of physical engagement than an elderly person might be able to provide. When discussing animals needing new homes, the majority of the time older animals get left out, as kittens and puppies seem to be the preferred adoption choice. A wonderful solution for these older animals is to allow them to be placed with senior citizens. It can provide an extremely beneficial relationship for both parties.

Similarly, programs are available in some areas that encourage pet owners to take their four-legged companions visiting in hospitals, especially cancer or pediatric wards, and children’s shelters.

All pet caregivers need to remember that animals need to be properly cared for. They need to be kept warm in the winter months and cool in summer months. Proper food, water, and shelter are required for their comfort and well-being.

Streamlining expenses and refining services dominate current technology trends.
For the past few years, senior living software has been steadily increasing in functionality and spreading into all areas of operations.But economic conditions have forced a shift in focus from software bells and whistles to the much-needed basics-how operators can use software platforms to perform specific functions and streamline expenses while maintaining the highest levels of quality care to residents.

And while there is still value in software integration-using one all-encompassing operational system that addresses a range of tasks-leading software suppliers are heeding provider feedback and offering solutions that tackle individual challenges.

Niche Needs

Software suppliers that are leaders in specific niches and those that have separate modules within their comprehensive packages have an advantage right now, says Tom Patten, president and CEO of PALs Software, based in Duluth, Minnesota.

Most of the calls Patten fields now are from current and prospective customers who need help with basic regulatory or service delivery challenges. Examples include maintaining error-free medication management services, providing compliance alerts for nurses, or documenting services more efficiently. Smart operators know that “profitability and regulatory compliance go hand in hand,” Patten adds.

Of course, this trend doesn’t mean providers are no longer interested in purchasing comprehensive software packages; however, those investments are more likely to occur in a better economy. As a result, the more efficiently a supplier serves providers now may influence future business, when those companies are ready to upgrade, Patten says. Providers should look to software companies with product packages that require less upfront investment, such as monthly subscription charges versus buying the software package outright. Internet hosting prices have also gone down, which can contribute to software-related cost savings.

Overall, providers have been steadily refining their current software needs, says Robert Mann, co-owner of Wichita, Kansas-based INTRAcare. This is working to streamline expenses and maintain quality care services; however, many providers know a down economy is not the time to slash marketing. It’s important to invest in marketing, particularly in tight economic times when some competitors may not be as visible in the market. Lately, Mann says, sales and marketing modules have been the most popular among operators.

“They come to us with high hopes of putting in a fully integrated operational management package, but their biggest needs are solutions to help them fill their buildings,” Mann says. “We can offer that individually and then they can step up later” with other functions. Software suppliers must be flexible, he adds, especially now. And providers should demand that kind of service.

Essential Benchmarking Tools

Much has been made of how software can help providers identify their lowest performing communities for improvement. In this rough economy, though, such benchmarking functions also help identify an ailing property or group of properties. Equipped with comprehensive data, a company could decide to sell those properties instead of investing in a strategy that would prevent foreclosure or receivership, Mann says. In those situations, software portability becomes an additional plus. A company can ask the software supplier if that residence can be packaged into a freestanding customer account so its operational data can be easily transferred in a sale.

Other areas software can help tackle, particularly in tight economic times, include distinguishing your company among its closest market competitors and increasing resident retention and move-ins, says Elizabeth Wheatley, corporate director of clinical services for Newton, Massachusetts-based Five Star Senior Living, which relies on A.L. Wizard software to support operations at more than 200 communities.

Wheatley says meeting these goals starts with the time employees save by using the software to efficiently conduct, track, and analyze resident assessments. The data collected and entered for each resident generates a customized service plan which ensures not only that the resident receives the care he or she needs, but also helps manage staff so that care is provided efficiently. The program also tracks and trends resident improvements and declines in various areas, providing valuable data that can be shared with residents and families.

“We’ve gotten a lot of positive feedback from nurses who are resident service managers,” Wheatley says. “They say it’s made their life easier and they like the ability to customize service plans. The executive directors are also happy. It generates automatic reports and they know what their staffing needs will be.”

While clinical care software has been able to perform these functions for some time, lately more providers are seeing them as a way to weather the downturn, says Jim Wills, CEO and president of A.L. Wizard, based in San Diego. The software developer began targeting the resident assessment space about a decade ago, while many others have since built out their packages from marketing or accounting niches.

Pivotal Partnerships

Another major trend is not in software capabilities or turnkey solutions, but rather in how suppliers interface with providers. “There’s no more developing programs and handing them off to customers; there has to be a partnership,” says Rita Burgett, president of Move-N Software, based in Bedford, Texas.

Especially in tough times, it’s critical that the software supplier is going to be there to ensure providers’ needs are really met, she adds. Important questions to ask prior to investing in any kind of software package include:

o What is the software company’s process for product development?

o Does it use focus groups and talk to customers about their needs and how to make software user-friendly?

o What is the process the company uses to make product changes and upgrades?

o How long has the company retained the same programmers?

o Is tech support handled in house?

The leading senior living software suppliers all bring their customers on board as they hone their products. For example, Move-N sends screen-shot tests to caregivers and asks for feedback. Burgett says this allows the company to make strategic changes. “We develop as the market changes,” she explains. “Our only plan for development is when a customer tells us they need something.”

INTRAcare also uses customer feedback as a main source during its product development stage, a strategy that has benefited Wichita, Kansas-based Legend Senior Living. Based on the provider’s input, INTRAcare was able to provide an operations management software solution that could interface with the provider’s payroll/accounts payable program, says Matthew Thornton, vice president of operations.

Five Star Senior Living considered developing a homegrown solution for its resident care needs, but opted for A.L. Wizard because it was more cost-effective and its products were built using provider input, Wheatley says. She also liked that Five Star was able to run pilot tests before making a purchase.

New Devices, Capabilities

PDAs, iPhones, and other handhelds have become an integral part of corporate and mainstream culture. The most exciting development for Burgett is that she can access not just the Internet but the contents of her entire computer, including all files and applications, through technology from her cell phone provider. Indeed, recently she recalls checking her accounting program on her cell phone at the beach.

“Whereas before we had to develop programs and include the technology that goes with them, now we’re finding that we have to be compatible with the technology that is out there,” Burgett says. “It totally changes the way that we have to do our strategic planning for the future.”

Handhelds can make service delivery more efficient, not just for executives and managers to check data in real time wherever they are, but also for caregivers who could pull up service plan task lists and check off each task as it is completed right in a resident’s room, Burgett suggests. She predicts that advanced applications, including mobile technology, might even become a must for attracting top young talent. Plus, families already are demanding online access to up-to-date information on loved ones, although HIPAA restrictions and security concerns may slow some of those capacities.

“It’s something that’s coming; it has to,” she predicts.

It may be coming, but it may not be quickly, some software suppliers say. One reason is a question of whether staff, who may even be learning English as a second language, will be intimidated by handheld devices, Wills says. Another question is whether handhelds make the care experience more clinical, and that debate extends to marketing, says Mann.

INTRAcare offers tools to integrate with Microsoft Outlook, making it easy for sales staff to access lead-based info on PDAs. Still, Mann wonders, will too much dependence on handheld devices in the presence of seniors and their families impersonalize the sales process? And overall, he asks, is this technology practical with respect to how senior living operates?

“I think when an operator has mastered the basics of tracking all leads and follow up, performing move-ins real time, doing assessments on regular intervals, and capturing all potential revenue, then these types of tools can make a difference in further streamlining their operations,” Mann says.

However, this year, economic strains and uncertainty again clearly are at the top of the list for providers. Purchasing handheld devices for multiple staff is expensive, and because of their size and portability, they are easily damaged or lost, Thornton says.

Kiosk Care

A more likely alternative for onsite service- delivery documentation is kiosk-like terminals outside rooms where caregivers can document delivered services in almost real time, Thornton prognosticates. These would be more affordable and also better meet legal standards for documentation, he says.

Ultimately, what Thornton finds most exciting is not handheld technology but the possibility of integrated-and portable- document imaging and data storage. “If we can input accounts payable documents and save images, that would be an enormous savings for a company this size,” he says.

Medication records that have one point of entry that flows seamlessly from the doctor’s prescription to the pharmacy to the caregiver who administers the dose is Wheatley’s “next dream.”

That goal may not be so far away if the current administration continues to spearhead a national electronic medical records system, Wills says. “There’s no reason why we, at an assisted living care management level, can’t integrate better with products that have health records capabilities,” he says. “We just need to build a platform that will make it easier to integrate with products like that.”

Whatever is around the corner, even if providers are not spending much now, software companies should not sit idle if they want to remain on the leading edge, says Wills, who says his company plans to make a major announcement soon regarding its newest software modifications. The economy will inevitably return to health, he adds, and providers will again want the latest and greatest.