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At Home Nursing Care is sponsoring free event to to help family caregivers cope with caring for someone they love.  Owner/Founder Lauren Reynolds will serve as Emcee.  Reynolds understands the stress facing families as her own mother needed home care for 10 months before passing away of breast cancer at age 58.  [caption id="attachment_796" align="alignleft" width="150"] Reynolds and her mother at 58th birthday, months before her death[/caption] [caption id="attachment_684" align="alignright" width="150"] Our wonderful San Diego home care client with his caregiver.[/caption] Family caregivers are a critical link for those suffering from illness or a loss of independence, but with that responsibility comes stress and anxiety. To provide support for family caregivers,  the San Diego Caregiver Coalition invites you to a free event on April 5th in Rancho Bernardo. Called "Back to the Basics, Caregiving 101", this three hour morning seminar will give family caregivers information about basic steps to take when caring for someone else, including advise from an Elder Law Attorney and also a discussion about the myths of hospice. Speakers include Alejandra Ceja-Aguilar from the Southern Caregiver Resource Center, Attorney Richard Scott from the Elder Care Law Firm and Jennifer Marsh of Elizabeth Hopsice. Lauren Reynolds, owner/founder of At Home Nursing Care will provide opening remarks and will introduce San Diego Council Member Carl DeMaio. To register, simply call 1-800-827-4277 or go online at www.sharp.com. Download a flier here: Caregiver Coalition's Caregiving Conference-RB-Final If you are a family caregiver in need of support or a reputable agency to assist with your San Diego homecare needs, we invite you to give us a call at 760-634-8000.  We offer a no-cost, in home meeting with family caregivers to discuss your in home options.  Our Nursing Supervisor creates a plan that is unique to your loved one's needs and ensures your home care needs in San Diego are met. [caption id="attachment_1966" align="alignleft" width="150"] We are licensed and accredited.[/caption] At Home Nursing Care is a licensed and accredited provider of in home care, easing the burden on family caregivers.  Our home care services in San Diego and Los Angeles include helping with safety monitoring, companionship, bathing, dressing, meal preparation and more.  We are also licensed to provide in home nursing care, including medication management.  For more information, give us a call at 760-634-8000.  We invite family caregivers to visit our website, or email us at [email protected]  ...

More than 300 caregivers, employers and clients flew to Sacramento on February 21st to encourage lawmakers to pass thoughtful, reasonable laws regarding home care for the disabled and elderly. At the one day conference, members of the home care industry awarded Assembly Member Mariko Yamada (D-Davis) as Legislator of the Year for her efforts to introduce a cost-effective and reasonable bill that would regulate home care. Her bill stalled in the Assembly despite its goals to protect seniors, agencies and care workers rights from unscrupulous companies and the underground economy. Lobby Day was organized by the California Association for Health Services at Home in direct response to two bills that threaten to vastly increase the home health care cost. The first is SB411, proposed by Senator Price and co-sponsored by the SEIU, a union that represents service workers.  SB411 would regulate home care, which most responsible home care agency owners support.  The problem with SB411 is that it would cost the cash-strapped California $25 million and would impose excessive regulatory costs onto home care agencies. For example, under SB411, home care workers would need to be "certified" annually before they could perform non-medical in home care such as meal preparation, assistance with bathing, dressing and safety monitoring.  This is a higher standard of regulation than for workers who currently provide certified nursing assistant services.  Plus, at a cost of $165 per employee, per year, this certification would lead to a "tax" on the average home care business of $20,000 - $50,000 per year, an excessive fee to do business in California. While the concept of SB411 is good, the bill goes way to far and micromanages and overwhelms the home care owner.  In addition, it would require the names and places of employment of each caregiver be posted publicly online.  This would threaten caregiver privacy and make them easy targets of identity thieves. When Georgetta, a home care worker for more than 20 years, heard that her name and employer would be publicly posted online, she responded, "That's not safe,  I don't want my information available like that." Equally troubling is AB889, proposed by Tom Ammiano (D-San Francisco), that would end the personal care exemption for home care workers and would assume an employer is negligent if an employee files a worker's compensation claim.  This would reverse the efforts California has made to decrease the amount of fraud and waste in the worker's compensation system. It would also shorten worker's hours, remove the paid meal times worker's currently get with unpaid meal times and would increase the cost for seniors. This bill does the opposite of what it intends. Mr. Ammiano calls his bill the Domestic Worker's Bill of Rights, and he is promoting it along with the union the AFL-CIO.   Mr. Ammiano cites wage and hour abuses in the domestic service industry as the need for the regulations. Most responsible home care agencies agree that there are wage and hour abuses in domestic work, however those abuses tend to happen in private homes with workers who are not appropriately...

On February 21, 2011, hundreds of employees and owners of home care agencies will gather in Sacramento to lobby against harmful home care legislation that threaten to drastically increase the costs seniors pay for in home care. One bill, SB411, co-sponsored by the SEIU, the Service Employees International Union, and Senator Cullen Price,(D- Los Angeles) calls for licensing home care in California and also certification of home care aides. While reputable home care companies, who are members of the California Association for Health Services at Home, support licensing the growing home care industry, they oppose this bill unless two very harmful provisions are amended. First, in this home care services act, SB 411 will require that employers pay for training for their employees, and then pay an annual fee of up to $180 per employee. This is an exorbitant fee and it’s higher than any other fee we can think of imposed on companies in California.    This added expense to have an “annual” certification will cost the average home care agency an estimated $20,000 to $50,000 per year, an expense that will have to be passed onto consumers who already struggle to be able to afford care to stay in their homes. Secondly, the bill will require all home care aides to have their names and where they work posted publicly on a website, which invades their privacy and threatens their personal safety.  In addition, it provides a launching pad for identity thieves who will already be able to gather a great deal about the home care workers. One employee, Georgetta, a former nurse, said “that’s not safe; I don’t want anyone who goes online to know where I am working.” Home care agency owners and their employees instead want to support licensing, but to have home care workers names and employers not posted publicly. Also, it’s a waste of time and money to force companies to renew the certification of their employees “annually”.  A much better plan would be to have the certification revocable if there was any crime, similar to what happens with Certified Nursing Assistants and nurses. On top of those two harmful provisions, SB 411 would cost the state an estimated $25 million dollars, at a time when the state is cutting services and grappling with a massive budget deficit. A much lower cost option is AB 899.   The California Association for Health Services at Home is supporting AB 899 by Assemblywoman Mariko Yamada (D-Davis), chair of the Assembly Committee on Aging and Long Term Care.  It would license home care agencies and would not post employees names and placed of work online. As the elderly population is expected to double over the next 20 years, costs must be controlled or seniors will be forced to find care in the underground economy, or worse, they'll end up in nursing homes paid for by Medicaid.  We urge those who are concerned about these issues to contact their State Senator or Assembly member and urge no on SB 411, unless amended until it makes common and economic sense.  ...

Many people are wondering how a proposal to end a federal "exemption"for personal care attendants and home care aides will end up affecting the costs for clients and employment home health care laws for employers. In a presentation to home care employers, attorney John Gilliland tried to stress that while major changes may be in store, agencies will be able to adapt. "This wont put you out of business," he said, clients will still need help.   A sad, unintended consequence is that the higher costs associated with the changes will force some seniors into skilled nursing homes rather than aging in place at home. A proposal by the U.S. Labor Department would end an exemption that allows employers to not pay overtime to "companions" who provide care in someone's private home.   This exemption has allowed longer shifts, such as 12 hour shifts and "live-in", where the caregiver spends 24 hours in the home, but generally sleeps eight hours a night. The proposed change would also mandate that caregivers be paid minimum wage, something that's already law in California. Gilliland said that there are 17 states across the country which have already eliminated the exemption and companies and clients have adjusted. For live in care, he said, clients will be given a choice:  Do they want continuity of care with one caregiver for most of the week at a higher rate, or do they want costs lowered by having multiple caregivers in the home working less than 40 hours total? Archana Acharya, an attorney with Murphy Law Group in Los Angeles, said of the proposed changes, "It's a grey area right now." Hypothetically, in California, here is how the rule change for live in care may play out. Right now families are charged a basic rate for 16 hours of work, provided the caregiver gets 8 hours of sleep, five of those hours uninterrupted. The average rate in San Diego County is $200 - 240 per day for that service. Under the new plan, if a family wants more continuity of care, for a 24 hour "live-in" shift, they could expect to pay a regular rate for the first 8 hours, time and a half for the second eight hours, and double time for the last four hours, adding up to sixteen hours per day of work.  Eight hours of sleep time could be deducted from the employee's pay and the client's costs, if the employee actually got 8 hours of sleep.  The costs to the client would likely be as much as $300 a day. Another requirement of the proposed rule change is that records must be kept of any interruption of sleep time.   Employees would have to keep a time sheet noting any reason for waking up overnight.  In California, if an employee gets less than five hours of uninterrupted sleep, they must be paid for all 24 hours.    It's at that point that the costs would skyrocket for clients, and it would probably be less expensive to move into a nursing facility.  Worst case, the client would...

Today At Home Care Solution, along with the City of Encinitas, the Encinitas Senior Center and 75 family members and friends wished Loren a happy 100th Birthday. [caption id="attachment_118" align="alignright" width="300" caption="Loren celebrates 100 years"][/caption] The 100 year old retired veteran and his 97 year old wife celebrated with a luncheon and party at the Encinitas Senior Center, where they have been volunteers and members for over 30 years. Overwhelmed by all the attention, Loren responded to how he managed to live to 100, "I didn't drink, smoke, tell dirty jokes or go with the girls who did." In response, his wife of 71 years told the crowd, "That's not true, or you would not have married me." [caption id="attachment_120" align="aligncenter" width="162" caption="The happy couple - Loren and his wife, Edna"][/caption] Mayor Jerome Stocks presented a proclamation from the City of Encinitas to Loren in honor of his reaching the century milestone. [caption id="attachment_119" align="alignleft" width="240" caption="Loren is King for the Day with Encinitas Mayor Jerome Stocks"][/caption] The Mayor commented that Loren and his wife had lived in Encinitas for 60 years.  They bought an ocean front lot in Cardiff back in the early 1940's, paying a whopping $700 dollars for the now multimillion dollar property. (They sold it and moved into central Encinitas years later.) Loren commented that he wished he'd bought a few of those lots, if he only knew.  But he says, $700 was a lot back then! At Home Care Solution was happy to provide cake for the celebration, baked by Chef Maria Santana. [caption id="attachment_123" align="alignright" width="150" caption="The Birthday Cake"][/caption] Our employee, Aida, says she's so happy to know the couple.  Happy Birthday Loren! [caption id="attachment_121" align="alignleft" width="210" caption="Loren and Aida, At Home Care Solution Employee"][/caption] ...

A recent USA Today article states that there is an increase in seniors living over the age of 90.  According to author Haya El Nasser “The number of people living to age 90 and beyond has tripled in the past three decades to almost 2 million and is likely to quadruple by 2050”. Seniors who live longer generally have some sort of disability or need help at some level of living. Sandy Markwood, CEO of the National Association of Area Agencies on Aging, indicates that the focus needs to be on being able to help these seniors live at home as long as possible as nursing home cost could rise to average $72,000 a year. Long Term Care at any level, in the home, assisted living or nursing home can add a tremendous cost to seniors and their families. Government Programs Only Pay For About 16% Of Long Term Care Government programs such as Medicare, Medicaid and the Veterans Administration will cover the cost of long-term care under certain conditions. Medicare will cover rehabilitation from a hospital stay or limited care at home if there is a skilled (medical) need. The Veterans Administration will cover the cost of nursing home care indefinitely if the veteran is at least 70% service-connected disabled. The VA will also cover other forms of home-based or community-based care if there is a medical need. Medicaid will cover both medical and non-medical related long-term care but in order to qualify for Medicaid a person has to have less than $2,000 in assets and income that is insufficient to pay the cost of care. Funding Long Term Care with your Life Insurance Policy Drawing cash from life insurance or changing a life insurance policy should only be done after reviewing with an expert advisor.  Loss of the policy and death benefit could prove to be a detriment.  If, however you have accumulated cash in a life insurance policy and no longer need the coverage you may consider using the cash for long term care or purchasing a LTC rider to your current policy. New insurance products are being developed to cover both life insurance and long term care insurance. ElderLawAnswers reports: “A new law makes the purchase of products that combine annuities or insurance policies with long-term care insurance more attractive. These "hybrid" products are gaining in popularity due to a law that went into effect January 1, 2010, making distributions from life insurance and annuities tax-free when used to pay for long-term care. The same law also allows owners of annuities or life insurance policies to exchange their old policies for insurance for long-term care or hybrid policies without being taxed.” Combination sales which include life insurance, annuities and traditional long-term care coverage are becoming popular with insurance companies and may prove a method of financing long term care.  Investigate closely, however to find what exactly will be covered.  Some policies do not cover home care costs or complete costs of nursing homes. Long Term Care Insurance Funding for All Long Term Care Needs The first long-term care...

On January 1, 2012, it will become a crime in California for an auto repair shop to "fake" repair of an airbag.  The law, called SB 869 and Sponsored by Senator Leland Yee (D-San Francisco), grew out of a problem exposed by At Home Care Solution Founder Lauren Reynolds back in 2008. As a consumer advocate in 2008, Lauren confronted auto repair shop owner Arnold Parra about air bags he had supposedly repaired in a used truck.   Lauren asked to speak to him about the airbags, but instead, Parra took off running. He had good reason to try to get away. "He has blood on his hands," said attorney Julie Haus. She represented the Ellsworth family, whose 18 year old son, Bobby, died in a car crash involving that very truck.  Bobby was a passenger in the truck being driven by his friend, Waylon Blocker.  Waylon fell asleep and crashed. The airbags should've deployed, but they were missing.  All that was in the steering wheel was paper. Waylon's family had purchased the truck from Arnold Parra.  Parra paid $3000 for it at an auction of totalled vehicles.  He made some repairs and sold it to Waylon's parents for $8000.  But Parra didn't repair the air bags.  He tossed some paper in the steering wheel and then glued it shut. (He always maintained he only did some bumper repair on the truck and never touched the air bags). The Ellsworth family won a $15 million verdict against Parra, but they never were paid a dime and Parra was not convicted of any crime because there were no airbag replacement laws about faking airbag repairs. Lauren presented her San Diego airbag repair investigation to Senator Leland Yee, who cited her investigation as one of 3 cases in the U.S. where fatal crashes involved fake air bag repairs.  As a result, Senator Lee sponsored a bill to make faking the repairs a crime.   Lauren welcomes the news that as of January 1st that bill becomes law.  It means that from that point forward,  someone who behaves like Arnold Parra will be doing something not just unethical, but illegal. Original February 28, 2008 story Family awarded millions in "fake" air bag case  ...

On December 15th, The Department of Labor announced a new proposed rule that could dramatically change how seniors and those with disabilities access home care.  The proposal would eliminate a long standing federal labor code exception that allows home care agencies and private families to avoid paying overtime and minimum wage to live-in caregivers.    (In California and many other states, minimum wage is already mandated by state law and paid, but the overtime exemption still exists.  Most reputable agencies in California already pay higher than minimum wage for hourly home care workers.) The overtime exemption dates back to 1974 and it was intended for domestic employees who “provide companionship services for individuals who (because of age or infirmity) are unable to care for themselves…” The idea was to allow a family or individual to hire a “caregiver” and set a wage for live-in, allowing the family to avoid excessive regulations regarding mandatory breaks, paperwork, etc.   Over the last three decades, the exemption has also been used by third party employers, such as home care agencies, to put caregivers in the home for so called “live-in” shifts.   The caregiver is typically paid for 16 hours of work per day and is given 8 hours of rest. The caregivers take meal breaks in the home and have access to restrooms, a phone, tv, and rest as needed.  However, regular labor codes, such as providing a 15 minute break every five hours of work, are not applicable. The Labor Department cited a large growth in the home care industry and a growing number of workers employed as caregivers as a reason to re-examine the live-in overtime exemption. Under the rules proposed December 15th, home care agencies and registries would no longer be able to use the exemption for live-in workers.   It’s not yet clear if that would mean live-in caregivers would have to be paid minimum wage the first 8 hours, time and a half the second four hours, then double time the next four hours.  If that is true, the cost to seniors and their families would go up by roughly 50 percent per day.   The result could be that families would turn to the underground economy for care and would perhaps hire unscrupulous individuals who are not vetted, trained, or supervised. Under the proposed new rules, Individuals and families could still use the exemption if they hired privately, however, that use would be narrowed.  For example, they could not hire a “professional” caregiver, or someone who provides care as a vocation.   They’d be able to use the exemption only if they hired a family member, friend, or someone who doesn’t ordinarily earn income from caregiving. The proposed rule clarifies that only incidental housework could be performed by the live-in caregiver.  Tasks such as cleaning dishes or doing a load of laundry would be okay.  Vacuuming would not be okay. Other incidental tasks to be allowed would include bathing, dressing, grooming, toileting, driving to appointments, feeding, etc. It’s also not clear what affect this would have on nannies or babysitters,...

There is no question health care spending is a critical issue.   Approximately 17 % of our gross domestic product is related to expenditures in health care, an amount that's seen a steady rise. Health care reform was proposed as a solution to the rising costs, but Steve Espinoza of the Hospital Association of San Diego and Imperial County warns the road ahead is clouded with fog and haze. Take Accountable Care Organizations for example.  Espinoza explains them this way, "It's like a unicorn, everyone knows what it is, but no one has ever seen one." What is Health Care Reform? The Health care reform is a 10 year process, with a watershed year being 2014, assuming the constitutional challenges are met and an individual mandate to buy insurance or face a penalty survives. Accountable Care Organizations are one part of the plan.  Put simply, ACO's are a way to reduce costs, by reducing unnecessary tests or procedures.  Those in the organization would share the cost savings and the potential risks of getting less reimbursement for undesirable outcomes.  Another major goal is to reduce hospital readmission rates within a 30 day period for the same diagnosis. Espinoza likens the idea to a TV Manufacturer, say Sony for example.  Sony uses lots of different vendors for the parts...

Caregivers often don’t recognize when they are in over their heads until they reach a breaking point.  Short-term the caregiver can handle it. Long-term, help is often needed. A typical pattern with an overloaded caregiver may unfold as follows: 1 to 18 months - the caregiver is confident, has everything under control and is coping well. Other friends and family are lending support. 20 to 36 months - the caregiver may be taking medication to sleep and control mood swings. Outside help dwindles away and except for trips to the store or doctor, the caregiver has severed most social contacts. The caregiver feels alone and helpless. 38 to 50 months - Besides needing tranquilizers or antidepressants, the caregiver's physical health is beginning to deteriorate. Lack of focus and sheer fatigue cloud judgment and the caregiver is often unable to make rational decisions or ask for help. It is often at this stage that family or friends intercede and find other solutions for care. This may include respite care, hiring home health aides or putting the disabled loved one in a facility. Without intervention, the caregiver may become a candidate for long term care as well. At Home Care Solution provides nurse case management, social worker case management, and high quality certified nursing assistants, home health aides and caregivers to assist when families become overwhelmed.  We provide care on an hourly basis and we specialize in high quality and affordable live-in care for 24 hour peace of mind. With the holiday season upon us, caregivers feel even more stress -- with planning, shopping and participating in holiday activities. This is a perfect time for family and friends to step up and provide some respite time and caregiving help.  Whether it is provided personally or arranged as a gift of services to be provided by a professional respite company or home care provider, it is a welcome gift. An article in “Today’s Caregiver” states: “Nearly one in four caregivers of people with Alzheimer’s disease and other dementias provide 40 hours a week or more of care. Seventy-one percent sustain this commitment for more than a year, and 32 percent do so for five years or more. One of the best gifts you can give someone caring for Alzheimer’s is something that provides a bit of respite and relieves the caregivers stress. The Gift of time: Cost-effective and truly meaningful gifts are self-made coupons for cleaning the house, preparing a meal, moving lawn/shoveling driveway, respite times that allow the caregiver time off to focus on what he/she needs.” It is also important to note that hiring professional care provider services can provide valuable ongoing support to an overloaded caregiver. A financial planner, care funding specialist or a reverse mortgage specialist may find the funds to pay for professional help to keep a loved one at home. A care manager can guide the family and the caregiver through the maze of long term care issues. The care manager has been there many times -- the family is experiencing it for the first time. An elder law...