S. Gerber and Associates, Inc.: Providing long term care services in Houston, TX

Sid Gerber (shown here with one of his clients) is the founder of S. Gerber and Associates, Inc.. Sid has been in the field of geriatric care for over 20 years. After obtaining his masters degree in business administration from the University of Houston, he became a licensed nursing facility administrator, managing a 120-bed Alzheimer’s facility with 5 levels of care.  In 2000 decided to leave the field of nursing home care in order to develop a geriatric care management business.  Currently, Sid and his associates provide both care management and caregiving services.

Sid has a reputation for being sincere, responsive and competent. He comes highly recommended. “He’s like the older brother you can turn to when the chips are down,” one client said. “We know he’s busy,” another client said,  ” but when we speak he has a way of making you feel like you are his only client.”

“Throughout my career, I’ve always been an advocate for the elderly and their families,” Sid told us when we spoke with him recently. “Primarily I’ve helped adult children with their aging parents. Families began to look to me in order to find appropriate caregivers.”

Currently, Sid employs 12 caregivers, most of whom are CNAs. Sid’s special area of expertise is Alzheimer’s and other dementias and many of his clients are people with dementia.  “Caregiving is much more intense and demanding with people who have Alzheimer’s. Caregivers have to have specialized training.”

Sid used to train his caregivers in a classroom setting. He found that it was difficult to gather all of them together at the same time for trainings, which he provided himself through lectures and handouts.  Because that method of training was a time-consuming and sometimes frustrating process, Sid began to investigate using online training instead. He decided to use the e-learning available from Medifecta Healthcare Training.

“Online training made sense to me,” he said. “It’s a convenient and efficient way to train caregivers. My main concern was whether my caregivers had access to computers to do the training, but that turned out not to be a problem.  Actually, the caregivers have been very receptive to the online training.”

Sid likes Medifecta’s online training, which he describes as simple and straightforward to use. “The programs hit on all cylinders in terms of what’s most relevant to learn. I like being able to keep track of where everyone is with their training, and being able to print out the certificates so easily.”

For more information on S. Gerber and Associates, visit http://www.mylongtermcareservices.com/

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Tammy Bracken and Serenity Hospice Care

Tammy Bracken

Tammy Bracken has been Director of Public Relations for Serenity Hospice Care in Park Hills, Missouri for the past 7½ years. One of Tammy’s goals when she joined Serenity was to create a DVD library that could be used to educate family members, volunteers and staff at nearby nursing homes. “We’re getting there. Each year our library grows a little more.”

Serenity Hospice serves a big geographical area, providing end of life services to people in eight surrounding counties, in a largely rural area 60 miles southeast of St. Louis. The hospice began in 1989 through the volunteer efforts of a dedicated group of community members and clergy. “It was completely a volunteer effort at the beginning. It’s amazing what they accomplished. Our hospice is nonprofit, and nobody is refused services due to an inability to pay,” Tammy said.

From the start, Mineral Area College, a community college that serves the region, was a wholehearted supporter of the hospice. Serenity’s offices are still located on the college campus.

Tammy is enthusiastic about the value of education for family members, volunteers and staff. Alzheimer’s disease is one particular area where she sees a great need for more education. For years she has relied upon Medifecta’s two Alzheimer’s DVDs to educate both family members and nursing home staff.

“Considering how much we use those DVDs, it’s amazing that they still work!” she declared. “I just wish that the information on these DVDs was out there more widely, like on television. Alzheimer’s is one of those diseases that strikes the entire family. It’s like two deaths. First the person you know is gone, then there’s the physical death. If people could understand more about Alzheimer’s, it would be less stressful for them. People often just don’t understand the disease. For example, they really think that when the person is being uncooperative, they are doing it on purpose just to annoy them. Family members need to understand that these behaviors are a result of the disease. That’s why these DVDs are so great. They teach people such important information. We all need to understand Alzheimer’s better, because it’s certainly on the rise and with the baby boomers aging, it will just keep increasing,” she continued. “We see people in their late 60s and early 70s with Alzheimer’s, where we used to see them in their 70s and 80s.”

“Most people with late stage Alzheimer’s are in nursing homes. We work with over 20 nursing homes and give in-services to nursing home staff members,” she noted. “Nursing home staff are not always trained in how to relate to people with late stage Alzheimer’s so these DVDs are very helpful. The information is presented in a way that is clear and easy to utilize. I think the descriptions of what happens in the brain are helpful, and the specific situations that are shown in the programs are helpful, too. Once staff members learn from the DVDs, they feel more confident about providing care. It gives them a whole different outlook,” she said. “And that’s true for family members, too. They learn that the person is not trying to upset them on purpose. It helps family members to rethink how they interact, and it gives them a sense of peace. ”

—Gaea Yudron, Medifecta Healthcare Training





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Direct Care Workers: The Emergence of a New Profession

Registered nurses are a vital component in our health care model. Direct care workers who provide care to elders and disabled people are also crucial to our health care system. But there are significant differences in the two occupational categories and those differences may shed light on recognition of direct care workers and their role in health care.

Nursing is an accepted part of the health care system. There are Boards of Nursing in each state. Curriculum standards and scope of practice are well established for nurses. To become RNs, students must pass a national licensing exam after completing a 2-year ADN degree or 4-year B.S. degree.

It wasn’t always that way. In the mid 1800s, nurses received little or no formal training. They got their training on the job, just as many direct care workers do today. By the late 1800s, nursing gained more legitimacy as an emerging profession. This was largely because of the influence of the English nurse Florence Nightingale and the American nurse Clara Barton. Nurses began to receive formal training in 2-year training courses provided by hospitals. There were as yet no commonly accepted professional standards, so the quality and content of courses varied considerably. Graduates were qualified to work in the homes of the sick. (For the first 50 years of nursing in America, nursing was provided mainly in the home setting.)

Now that nursing is so widely accepted, it may seem surprising to remember that as a profession it went through stages in which its value was not recognized, its scope of practice was not developed and standardized training and examination was not expected.

Direct care workers today face many of the challenges that the nursing profession did. Although personal and home care aides are in the top fastest-growing occupations in the country, direct care workers are not widely recognized or included as part of the health care system. It’s almost as if they are invisible, even though they are in high demand.

“It has only been in the last 10 years that direct care workers have been required to have any training,” said Marion Karpinski RN. “One of the reasons I founded Medifecta Healthcare Training and developed the 40-hour Personal Care Attendant Training Program was to provide standardized training for direct care workers in the home setting.”

Training Varies Widely
Training regulations for direct care workers vary widely from state to state; many states still have no training requirements. Some states require less than 10 hours of training. Wyoming for example requires a minimum of 8 hours of training for homemakers. Illinois requires 8 hours of training for home services workers, but provides a long list of topics to be covered. A pending bill in California would require 5 hours of training for home care aides.

Some states require more hours of training. For example, Massachusetts requires 40 hours of training for homemakers and 60 hours for personal care workers. Arkansas requires a minimum of 40 hours for personal care aides. Florida, New Mexico and Wisconsin all require 40 hours of training.

“Some states require 75 or more hours of training for in-home care providers,” said Ms. Karpinski, who has reviewed many states’ training requirements. “Do we really need a CNA level of training for in-home care providers or are we just creating another obstacle to meeting the huge demand for care providers for our elders and disabled? I believe that a well-organized 40-hour training program in care and communication skills is sufficient to prepare care providers with the skills and confidence they need to provide quality home care. Let’s make training accessible and available to more people in order to have enough qualified care providers in our communities,” said Ms. Karpinski.

States may require a specific number of hours of training, but leave topics unspecified. Or they may specify training topics, but not indicate how much time should be spent on each topic. These broad variations and omissions regarding training are not only confusing; they represent increased danger to the health and safety of elders and the direct care workers who care for them.

Job Titles for Direct Care Workers Vary, Too
Job titles for various types of direct care workers vary from state to state. Homemaker companion, home health aide, personal care aide and unlicensed assistive personnel are some of the titles used for these workers. Imagine what it would be like if nurses were known by different job titles in each state, or if their scope of practice or training varied widely from state to state. That is the current situation with direct care workers.

A Hodge Podge of Agency Licensing
Unlike the standardized licensing required for many types of health care organizations, there is no standardized licensing for agencies that employ direct care workers to provide nonmedical care. Laws requiring background checks for agency owners also vary widely. In many states, you can open a private duty agency with only a business license.

Angil Tarach-Ritchey RN, a geriatric care manager who owns a Visiting Angels nonmedical care agency in Michigan, favors licensing. As she recently commented, “Anyone in the state of Michigan can open a private duty home care agency for $20 or $30 and a business license. You don’t need to have any formal education, experience or training. You can hire anyone to provide care, and not be required to train them or even background check them, because there are NO regulations,” said Tarach-Richey.

Currently, 27 states require licensure for private duty agencies. Licensure bills are pending in Hawaii, California, Michigan and Arizona.

What Does the Future Hold?
Will direct care workers be acknowledged and included within the healthcare system as a profession? Can we find, train and retain enough direct care workers to fill the critical and growing need? How can we provide a living wage and benefits to direct care workers, making that high-demand work more attractive to job seekers? Can we look forward to nationally recognized training standards for various levels of direct care workers? Will licensure be required for home care agencies in all states? These are only a few of the questions that remain unanswered.

Gaea Yudron, Medifecta Healthcare Training

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The Direct Care Alliance develops a credential for personal care and support professionals

DCA Executive Director Leonila Vega, Esq.

The Direct Care Alliance (DCA) is a national organization representing workers that care for elderly and disabled people in long term care facilities and private homes. DCA recently developed a credential designed to assess the competence of direct care workers.

Direct care work is the fastest-growing occupation in the United States. Currently about 3 million direct care workers provide home care. Depending upon the locale, direct care workers may be called home care aides, personal care attendants, personal assistants or nursing assistants.

Not only do job titles vary from state to state, training requirements do, too. As an article in the New York Times pointed out, “… this is a field that resists standardization. Training and certification requirements for home care aides remain a hodgepodge. Thirty-five states regulate home care agencies and set varying requirements for their workers… But 15 have no regulations for agencies. And very few states regulate individual caregivers at all.”

States with no licensing requirements are now wrestling with development of licensing standards and are investigating what kind of training requirements are necessary for direct care workers. Meanwhile, many families are faced with establishing the honesty and competence of direct care workers for themselves.

According to the Direct Care Alliance, “With no national credentialing or training requirements for personal assistance, elders, people with disabilities and their families have no reliable way to assess the knowledge of those they hire; agency employers must devise their own assessment procedures; state policy makers have no national standard to depend upon; and workers in this field have no way to demonstrate their professionalism and skill.”

Direct care workers can qualify for the DCA’s Personal Care and Support Credential after passing a competency-based test that contains 50 multiple-choice questions on topics like bathing and lifting techniques, ethics and safety. The test also evaluates care providers’ “situational judgment”– how effectively aides respond to problems, emergencies and needs.

“These workers have a lot of knowledge and skills, but they don’t have a way to prove it,” said Helen Hanson, professional development manager at the alliance. “The credential is a way to show employers and prospective employers their professionalism.”

To learn more about the Direct Care Alliance’s credential and its overall mission, visit www.directcarealliance.org
—Gaea Yudron, Medifecta Healthcare Training

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Fall Prevention: Incorporating Exercise and Tai Chi

Falls represent a significant threat to the well-being and life expectancy of elders. “When an older adult falls, it can begin a cascade of events affecting quality of life, including a loss of independence, reduced mobility, and even earlier admission to a nursing home,” said Lynn Beattie, vice president of Injury Prevention with the National Council On Aging. “An injurious fall can also affect caregivers, family members and even entire communities. But the good news is that falls are largely preventable.”

Exercise helps to maintain muscle strength, flexibility, balance and endurance and is a very important aspect of fall prevention. Muscle weakness, especially in the legs, is a key risk for falls.  The National Institute of Health recommends simple exercises aimed at improving balance and lower body strength. They include:

1. Standing on one foot: Raise one leg slowly while holding onto a  sturdy chair for support. Hold for up to 10 seconds, then repeat with other leg.

2. Walking heel to toe: With arms extended out at shoulder height, walk by placing the heel of one foot in front of the toes of the other foot. The feet should nearly touch. Repeat for 20 steps.

3. Balance walk: Extending the arms out at shoulder height, walk in a straight line with one foot in front of the other. As you walk, lift   your back leg and pause for a second before moving forward.  Repeat for 20 steps.

4. Back leg raises: Stand behind a sturdy chair and hold it for support. Slowly lift one leg straight back without bending your knee or pointing your toes. Try not to lean forward. The leg you are standing on should be slightly bent. Hold for one second. Repeat 10-15 times.

5. Side leg raises: Stand behind a sturdy chair with feet slightly apart, holding the chair for balance. Slowly lift one leg out to the side. Keep your back straight and your toes facing forward. The leg you are standing on should be slightly bent. Repeat 10-15 times.

Variations of these movements are contained within tai chi, a system of exercises developed centuries ago in China. Many studies have been done in the past 10 years on the value of tai chi for preventing falls. In one study conducted at Emory University under the direction of Dr. Stephen Wolfe, special tai chi movements designed for seniors reduced the risk of multiple falls by 47.5%. The study concluded: “Our data suggests that tai chi can influence older individuals’ functioning and well-being significantly and provides some appreciation why this exercise form has been practiced by older Chinese for more than three centuries.”

Tai Chi involves low-impact activity with an emphasis on slow, repetitive movements. Many elderly Chinese people practice tai chi as a daily exercise routine. In Chinese sections of large cities like San Francisco or Honolulu, groups of older Chinese people can be seen doing tai chi together in the park.

Tai Chi continues to gain widespread attention as a gentle, effective fall prevention tool. The Center for Disease Control (CDC) recommended tai chi as a key component of community-based fall prevention programs in a report published in 2008. In 2010, a panel of experts from the British and American Geriatrics Societies published new fall prevention guidelines, recommending tai chi as a beneficial physical therapy for older adults. The California Department of Public Health recently began organizing a statewide tai chi program to reduce fall risk among older Californians.

Other fall prevention news

According to the Center for Disease Control (CDC), physicians have reported that they do not have adequate knowledge about fall prevention. Responding to this problem, CDC is developing a Falls Pocket Guide based on American Geriatrics Society guidelines. The guide and accompanying support materials will help physicians incorporate fall risk assessment and individualized fall interventions into their clinical practice.

In Southern California a consortium composed of the University of Southern California, the federal Veteran’s Administration, the University of California Los Angeles and California State University Fullerton have joined forces to develop and evaluate model fall prevention programs that could be replicated at reasonable cost in community settings such as senior centers.

Visit www.medifecta.com for information on Medifecta’s fall prevention DVD and suggested books.

— by Gaea Yudron

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Medifecta Healthcare Training Attends Annual Conference of National Private Duty Association

Home health care services are one of the fastest growing sectors in the U.S. economy. Even during the economic downturn that started in 2008, the private duty industry continued to grow significantly, fueled by the needs of a rapidly increasing elder population.

Kevin Smith, Chapter Liaison, National Private Duty Association

As Kevin Smith, chapter liaison for the National Private Duty Association noted, “Private duty and home care are much better known than they were even a few years ago. There’s a surge of companies opening in response to the aging population. People see that it’s a viable industry to get involved in. There’s a lot of growth and competition. Also, there’s much more focus on legislative and regulatory issues. Of course, we monitor that information on state and federal levels.”

Private duty is an emerging industry and regulations on private duty agencies and workers vary widely from state to state. Smith believes that the National Private Duty Association plays an important role as industry standards are developed. “I think that NPDA is in a great position to help form industry standards and guidelines and to recognize best practices. From what I see, our members want to do the best they can. They certainly want to assure that caregivers are trained appropriately.”

NPDA currently has 25 state chapters representing 23 states –Pennsylvania and California have two chapters each.

In 2009 Medifecta’s president Marion Karpinski RN was a featured speaker at the NPDA conference. This year Marion and senior program specialist Jo Walch attended the conference to share information about Medifecta’s educational resources.

NPDA members were happy to have the opportunity to meet Marion, who develops, directs and narrates all of Medifecta’s DVDs. Marion enjoyed the opportunity to connect, too. “It was great to meet people I’ve never met before from the private duty field,” Marion said. “The atmosphere was really upbeat. I noticed how much camaraderie there was among NPDA members.”

She continued, “It was so motivating to hear people’s comments about the quality of our work. They would stop by and thank us for what we do. They were really appreciative.  And they were truly interested in training too. They wanted quality training, and it was not just about meeting state regulations. NPDA really seems to be in the forefront of the industry.”

Many conference attendees have gotten to know Jo Walch because she is their program representative and they connect with her by phone. Jo is a real people-person and her comments on the conference reflect that. “When I met some of the attendees,” she said, “it was like meeting family. The energy at the conference was exciting. I met a lot of people, both new to our company as well as long standing customers. It was great to connect with them.”

“I thought the conference was very successful,” said NPDA’s Kevin Smith. “We added some new elements this year. We had a pre-conference section for people who’ve been in business for a number of years. We offered some coaching on how to make your business grow, and what to take into consideration when you want to exit your business. We also had a peer-to-peer discussion that was new this year, and people loved it. They let us know that they want more opportunities to do that. ”

For more information on NPDA visit

—by Gaea Yudron

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Joyce Beedle of Alzheimer’s Consulting Service

Author and consultant Joyce Beedle RN, BSN is one of the pioneers of compassionate Alzheimer’s care.  Her experience in the field provides a living example of how much change has occurred in Alzheimer’s care in the past 30 years.

Joyce says that her involvement with Alzheimer’s care began “by accident” during the 80s when she was working in hospital settings. During this period, doctors sent people with dementia to the hospital in order to give their family caregivers a break. Usually MDs used another medical diagnosis and the patient’s dementia was never mentioned. Working in that setting, Joyce had to learn how to deal with people who were confused, unable to understand nurses’ requests and sometimes resistant to medical procedures. As time passed, it became obvious to her co-workers that Joyce had a knack for figuring out creative solutions while relating to these patients.

When the hospital where she worked advertised for a nurse to staff a new Alzheimer’s drug investigation project, Joyce’s co-workers urged her to apply. “You’re so good at working with Alzheimer’s patients,” they said. Joyce actually remembers saying, “What’s Alzheimer’s?” She was not aware of the term and did not connect it with the confused patients she was good at dealing with.

It’s not that surprising that even nurses like Joyce were unaware of Alzheimer’s disease in the 80s, because there was little public awareness of the disease at that time. As David Troxel, well-known for pioneering the Best Friends approach to Alzheimer’s care, said in a recent interview, “Back in 1986 … I recall going to a dinner party and sharing where I worked and people around the table said, “Alzheimer’s disease. What’s that?”…There were very few services, little public awareness and their physicians were dismissive.”

Hired as a staff member of the hospital’s new drug investigation project, Joyce immersed herself in the emerging field of Alzheimer’s care. “That job gave me tremendous exposure to people with Alzheimer’s and to the dilemmas of family caregivers, who were so anxious to learn new ways to relate to the person with Alzheimer’s,” she said. “Family caregivers were my best teachers.” In the 70s and 80s, Beedle said, the priorities in Alzheimer’s care were “a clean bottom, a full belly and clean sheets.”  Restraints were frequently used.

Joyce’s care methods were quite different. Her approach to Alzheimer’s care has always been warmly personal and customized to each patient. Joyce believes that it’s important to relate to people who have Alzheimer’s as unique and valuable human beings. “No matter what you do, you want to make sure you take care of someone’s heart, their self esteem, so that they feel really good about themselves,” she said.

Joyce started Alzheimer’s Consulting Service in 1985. Currently, a great deal of her work is with Alzheimer’s care homes and memory care centers. At those facilities she teaches positive communication tools and care strategies to large classes of staff and family members.

“My main focus is generating ideas in care situations where the caregiver says ‘I’ve tried everything and nothing works,’ “Joyce said.

“If Alzheimer’s care is done as one size fits all it will not be successful,” she continued. “It will just be something forced on an unhappy, resistant person. Any aspect of daily life can become a battle because the person with dementia doesn’t have the brain capacity to understand, so that’s why I say my main work is generating ideas about how we can enjoy each other while I am helping you. My motto is “let’s enjoy being together.”

“Finding solutions to resistance means understanding the individual’s life experience and their emotions in that moment,” Joyce notes. She teaches staff and family members the importance of factoring in elements of the patient’s life experience in order to personalize effective care solutions.

Medifecta had the privilege of including interviews with Joyce in our early to mid stage and mid to late stage Alzheimer’s DVDs, which are our most requested programs. In these interviews, Joyce shares valuable information about the core principles of effective Alzheimer’s care and describes some of the highly effective methods she utilizes in her person-centered care.

Medifecta also carries The Carebook: A Workbook for Caregiver Peace of Mind, a publication that Joyce developed. The Carebook provides a convenient way to collect important patient care information in one location. Sections on food preferences, daily routines, self-care abilities and other personal information helps caregivers understand the person’s life history and needs. Other sections cover medications, emergency help and more.

Joyce was inspired to develop The Carebook: A Workbook for Caregiver Peace of Mind in response to a particular family’s situation. In that family, the husband was caring for his wife. But one day he had to go to the hospital for treatment after suffering a fall that left him unconscious. He had never written down any instructions on how to care for his wife because he knew all that information by heart. The couple’s daughter did her best to care for her mother with no information, but finally she called Joyce for help. When the husband recovered sufficiently, he and Joyce wrote the needed care information in a three ring binder. This experience ignited the idea for The Carebook, a tool that has helped hundreds of families and caregivers.

— by Gaea Yudron

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