Hiring Privately - updated notes

If you are looking for home care for your loved one, whether through an agency, personal referrals, or especially through advertisements including free on-line ads, you should be sure to:

A. Verify that the caregiver you are considering is Florida licensed. Here is the link to the Florida database - check it out. http://ww2.doh.state.fl.us/irm00praes/PRASLIST.ASP

--> You should do this regardless of the source, whether a friend, an

Safety 'Chair Rails'

One client had an interesting idea for a chair rail.  Rather than putting up decorative trim, the client had a more functional rail made, which was used on long stretches of wall around the house.

In this case, the rail was used along the living room and in hall areas.  Standing back, it looks like a substantial piece of woodworked trim, but up close it's much more functional.  It serves as a sturdy hand-rail or banister, and also as wall protection against bumps by the wheelchair or walker.

The idea was taken from the bumper rails used in some nursing homes and many hospitals, and is fairly simple to install.  This rail was made from just 2-by-4's and smooth...

Helpful Furniture

Sometimes the right furniture makes all the difference.     

Caregivers may have clients who gradually have come to need a hospital bed or lift chair.  However they might get some resistance to the idea, as people like their own familiar things.  Clients can also be understandably....

Rehab Facilities - National Rankings

The US News and World Report has issued its listing of top rehabilitation hospitals.  The following rehab hospitals are in the top tier in the national rankings.  According to the survey, they have the highest reputations among the physicians polled. 

o   Rehabilitation Institute of Chicago   Chicago, IL
o   Kessler Institute for Rehabilitation  West Orange, NJ
o   University of Washington Medical Center  Seattle, WA
o   Spaulding Rehabilitation Hospital   Boston, MA

Nursing Home 'Honor Roll' listing

US News & World Report has issued an updated list of 'best nursing homes' based on government rankings. A few were designated as 'honor roll' facilities, meaning they received top scores in each ranking category over the past year.  Theses are listed below. The honor roll selection is based on scoring, meaning the list is just a starting point for selection.

Disaster Preparedness

Here in Florida we are concerned about hurricanes, but most parts of the country have their own natural disaster threats.  The county where I live has an excellent Hurricane Guide on line with safety advice and preparedness checklists that might be helpful wherever you happen to be.

Among other items, the guide recommends that you know in advance where your nearest emergency shelters are located.  If you have a 'special needs' person...

The Caregiver's Notebook

Imagine this.  A well credentialed caregiver shows up at a new client and is briefed at length by the previous caregiver, who is leaving. This new caregiver listens to everything without making any notes at all on this complex case. She is there, her first day, without the thought of keeping a notebook!   I actually recommend....

Expiration Dates

When taking on any new home care case, don't forget to check expiration dates on all food as well as, of course, medicine.  This point was also mentioned briefly in the earlier Disaster Preparedness post, however the discovery of some very old cans of food in an elderly client's cupboards suggest that this is worth highlighting.

Nursing Home Selection Notes

There are certainly plenty of guides and checklists published on the internet and elsewhere for selecting a nursing home. Medicare has an on-line pamphlet, and also a checklist.  Here are some of my own notes:

1. As I have suggested previously, check out the government websites of nursing homes, and specifically the '5 Star ranking' score of the ones you are considering. As you narrow down your choices you may want to look into the factors behind the rankings.  As an example, I see my son's employer received only a mediocre ranking. That nursing home.....

CNA Continuing Education

As we know, CNA's have continuing education (CE) requirements similar to those of other licensed professionals.

Self-employed CNA's sometimes have challenges in meeting this requirement, but they also have some interesting opportunities. There is no....

Men With Hammers

A famous writer supposedly said, "to a man with a hammer, everything looks like a nail."

That saying may be appropriate in the elder care field. The challenge for clients and their families is to understand the best course of action or treatment, instead of just the best choice services that are being offered by an individual or agency.

Sometimes the best care for the client involves several different approaches or disciplines. Perhaps it includes a combination of appropriate therapies, medicines, and counseling. Some providers may have good short-term solutions, but do not have the tools or experience needed to

CNA Report Card

So often, impressions of caregiver performance are subjective. As with any medical provider, a home caregiver's bedside manner is important. Just as with others providing treatment and care, however, we must not forget that actual, measured results do count.

As a caregiver, you should be aware of whether the client has improved or not under your care, even if the change has been gradual. This is not something you get from......

Stretching your LTC claim dollars

I sometimes work for clients who have Long Term Care insurance policies. Often, these policies have dollar limits to payouts, rather than specific time limits.

One of my clients, a couple, did some research into this, and found that their policy covered care by state-licensed individuals - meaning CNA's like myself.....

Saw Horses and Quality of Care

The Wisconsin technical colleges have a series of 80 training videos online (Lessons 1 - 80) that can be useful for caregivers. The series is geared towards training aides in hospitals and the like, but the techniques and precautions apply to home care as well. 
These are classroom-type lessons, so the style might be a bit tedious for casual viewers. Even so....

Hiring Privately

By engaging a private caregiver, you can often get a highly qualified professional at affordable rates. With the latest developments in licensing, insurance, and on-line resources, you might consider using a licensed CNA.

When considering a CNA, ask for the caregiver's license number, and check it out with your state's Department of Health, either on-line or by phone.

Licensing. Exams for CNA's have become standardized across many states. State licensing also includes law enforcement checks, with FBI checks....

Finding that "Throat to Choke"

A recent post by an elder care adviser: "Important point:With an agency- you have someone with money to sue if need be!"

Seconded by the franchise owner(?) of a new home health care agency: "you have an agency to sue when you hire an agency (I call it a "throat to choke")".

In case we don't get the point, they are both saying you had better arrange for your home health care worker through an agency, and not deal directly with the caregiver. After all, throttling is banned in most places, and suing for money only works if there is some to be found. And home care agencies have insurance policies. Therefore, their logic goes,....

Agencies, Nurse Registries, Companions

Florida has three kinds of licensed or registered home care companies.

- Nurse Registries (recruiters)

- Home companions (sitters and non-health)

- Home care agencies

Only the last group is technically a home care agency, but all.....


DNR, "do not resuscitate". As some politicians have put it, this subject is above my pay grade. Or is it?

As aides or family members, we are advocates for the client, and for the best care possible. I am naturally suspicious of DNR's because ...

CNA? or HHA?

Certified Nursing Assistant or Home Health Aide? Which is more appropriate? It depends.

When I worked in home care in a different state, I was trained and certified as a Home Health Aide. Since I was not 'assisting nurses' but rather providing private care, a CNA designation seemed less relevant.

Florida, where I live, recognizes that there are HHA's in the workforce, but it does not test or license them. Florida only requires that some appropriate but unregulated training be given, by agencies themselves, for HHA's that they place.

CNA licensing, however, includes coursework and hands-on training that generally includes an internship in a nursing home, a law enforcement background check, and a state licensing exam....

Nursing Home "Honor Roll"

US News & World Report's honor roll of nursing homes.

Trust Your Nose

If it doesn't smell right, it probably isn't.


When visiting care facilities, including acute care hospitals, nursing homes, rehab units and even assisted living homes, trust your sense of smell as you check out conditions. A sanitary place will smell sanitary. Odors won't be covered up with...

Hand washing

Please excuse me if I seem upset about this.

We've all see the headlines like "Inadequate hospital hand hygiene is spreading MRSA."

CNA's in most states are even tested on hand washing. Hospitals are increasing enforcement of the procedures. Is it working? Or do we still see situations where the staff wash their hands when they enter the room, put on the latex gloves, then.....

Bedsores - Prevention Summary

There are a number of things that can be done for prevention of sores:
  • Help the person shift frequently, at least every couple of hours.  If the person can't move at all.....

Bedsore prevention - lotions

I recommend using the best cleansers and lotions you can get. These are often only available at medical supply stores or from online medical suppliers, and are usually expensive. I believe in being frugal, but this is one area where you don't want to save pennies.

Even if your client or loved one is in a long-term care facility, you will still want to look into this. There is a good chance that even acute care hospitals....

NIH's Wound (bedsore) Treatment Chart

This chart from the NIH's website is just a reminder that the treatment of bedsores is not "do it yourself." Wound care is complex, and important.

See your physician or Wound Care Nurse.

When Bedsores are Discovered

First, I should say that my experience is with prevention, and you should discuss any treatment with a doctor.

Second, wound care is complex. The proper treatment, including ointments and cleaning materials, will depend on whether the sore is infected or not and whether it is wet or dry. Get expert medical treatment.

Bedsores are serious.

Bedsores are very serious, especially if they develop into open wounds. They don't heal easily, and can get...

Bedsore prevention - high-end beds

In my earlier post Bedsore Prevention Part 1, I mentioned the importance of a good bed, and I used Hill-Rom as an example. The main reason beds like these are so helpful for preventing bedsores is that they can be set to gently roll your patient from side to side at regular intervals. The timing, speed, and amount of the roll can be preset, and can be set to be more gentle than...

Trust but Verify

This is a delicate subject.

How often have heard that the staff in a particular rehab or long-term care facility is caring and loving, and that everything is so nice and clean? Everyone smiles and hugs, and the linen and gowns are fresh. These are good signs.

It's wonderful to find a place like that, especially if it also provides genuine rehabilitation services. I've found that you need to actually check under the covers, though, before you get too carried away by good impressions.

Few family members will want to actually check on the work that's being performed. Much too often, supervisors don't thoroughly check, either. Creases in the skin can hide small problems that soon become big ones.

Bedsore prevention - intro to beds

The best cure for bedsores is prevention. Preventing sores takes a great deal of effort, but it is always worth it. There is one piece of equipment that can help.

For clients who can't move themselves in the bed, make sure that when they are hospitalized or in long-term care they have a prescription for the...

Nursing Home Rating System

Here is a link to the government ratings of individual nursing homes: HHS.gov (http://www.medicare.gov/NHCompare/Include/DataSection/Questions/ProximitySearch.asp)   They rate each of more than 10,000 nursing homes on a scale of one-star to five-stars, based on inspections and various measurements.
Much Above Avg. 5 out of 5 stars
Above Avg. 4 out of 5 stars
Average 3 out of 5 stars
Below Avg. 2 out of 5 stars
Much Below 1 out of 5 stars
If you click the nursing home name, and then select the categories, there are some comments. Here is an example, for a place with a "One Star" rating:

Roll pillows as foot bolsters

These pillows make good bolsters for the feet. Not under the ankle, but between the client's foot and the bed's footboard. The foot should be propped up to a normal position, at close to a right angle. Not straight out and unsupported for lengths of time.

You also need those pillows when using Craftmatic or hospital type beds, because the client may slide down when you don't realize it. You don't want their feet wedged against anything hard at the foot of the bed.

Disaster Preparedness for Diabetics

We don't want to wait until a natural disaster is at our doorstep to think about getting ourselves prepared. Here in Florida hurricanes are a worry, but almost every part of the country has its own natural disaster threats.

As caregivers we have special concerns and responsibilities, especially when we are caring for those with special needs. Diabetics are an example.

There are many articles and checklists available online these days. Here is a link to a helpful example of a checklist for diabetics. In Florida, aside from having a secure residence not vulnerable to flooding, we have to assume that we could be without power for a week or longer, and that we might not have access to medicine, food, or other supplies.

Air conditioning ducts

Air conditioning and heating ducts are easy to overlook.  When you are establishing a clean, safe environment for your clients, these should be professionally cleaned.

You might be surprised at the accumulation.

Natural alternatives

We all know that honey has many health benefits. I always use honey in tea instead of sugar.

A physician speaking at a recent conference here described the benefits of honey as a skin lotion. He pointed out that honey never needs refrigeration, and for a reason....

Safety Tip - EMS and Fire Department

If your client is confined to a wheel chair, or even just uses a walker, see your local Fire Department and EMS, and let them know. The emergency workers will appreciate it, and they may stop by and introduce themselves to your client.

This is especially important if your client lives in a condo or apartment. If there is a fire or other need to evacuate, they will know to check and will make a special effort to make sure your client is safe.

Air Ambulance

I have traveled twice on trips by air ambulance. One was a lengthy trip that required a short refueling stop along the way.

Small Lear jets were used, and along with the pilot and co-pilot there was an RN and a respiratory therapist. These very competent people were arranged by the air carrier as part of the flight.

The jets looked like private aircraft from the outside, but inside were...

Concierge Advocate Service

Here we are talking about the concierge medical service companies that have been featured in magazines and newspapers.

These are not the concierge physicians or practices. These are high-end service companies that provide advice and open doors for their clients, but do not provide actual medical care.

When you have a special need they will pull whatever strings.....

HBO Alzheimer's Project series, On-Line

HBO's series of shows about Alzheimer's is available for on-line viewing. The five-part series is on the Alzheimer's Association web page:


My apologies for the graphic picture.

"Most MRSA infections occur in hospitals or other health care settings, such as nursing homes and dialysis centers."

This upsets me because it is entirely avoidable. It spreads so easily when proper standards are not maintained that some facilities seem to accept MRSA as a fact of life.  Unfortunately, this also means....

CDC on Handwashing

The following is a presentation prepared by the CDC:

  • Infections are a serious problem in healthcare facilities.
  • Every year, an estimated 2 million patients get a hospital-related infection. 90,000 die from their infection.

Northwestern Memorial, Chicago

If you happen to go to Northwestern Memorial in Chicago as a visitor or with your client, I recommend asking for a tour. Many of the features are very interesting, but easy to miss.

For example, in all the patient areas, even in the corridors, the ceiling lights are placed so that a patient will never be looking directly into them. They said that the lobby and check-in area were designed to be like...

Range of Motion Exercise

Don't forget to ask the doctor or physical therapist for the "range of motion" exercises that they prescribe for your client. Take your client through the routines, and keep to the schedule that the professional recommends.

Some home health care agencies prohibit "massage therapy" by aides, as part of their general policy. While there are reasons for having that type of policy, you should not...

Foot massage?

When is the last time your client had a really good foot massage? They will appreciate regular massage.

I learned from the Art Riggs instructional DVD's, but there are also free foot massage instruction videos available online.

Foot Massage Techniques for the Elderly -- powered by ExpertVillage.com

Dress Code

If you are working for a hospital, the dress code is fairly simple. It's whatever you're told.

With private care, there is certainly more flexibility. Some agencies try to set some standards, but that doesn't necessarily work.

My private clients often don't want people to think that they need a caregiver, though, and definitely don't want to be seen in public with one....

First name basis?

A useful guideline for addressing elderly clients is to assume that:
1. they were professionals or business owners before retirement, and
2. you were working for them back then.

Besides, workplaces were more formal years ago, and your client may have been quite accustomed to "Mr." or "Mrs."

Some service providers say that they always ask in advance for permission to use first names. Clients will almost always say it's ok, of course, out of politeness. Better to wait until the client suggests it first, if he or she cares to.