The Looming Crisis in California: A Shortage of Health Care Workers

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One of the biggest problems facing older adults in the United States is the growing shortage of professional caregivers. San Diego is feeling the pressure along with other cities across the nation. The demand for caregivers is increasing as the Baby Boomers need more services. Something needs to be done to ensure that the support they need is available to them.

Why are We Experiencing a Shortage of Professional Caregivers?

According to the Paraprofessional Healthcare Institute (PHI), the shortage is occurring due to an increase in demand from consumers, as well as turnover because of career changes or people leaving the workforce.

The Bureau of Labor Statistics (BLS) reported that 7.8 million direct care openings are projected from 2016 to 2026:

  • 4 million new jobs created due to growth in the industry
  • 6 million jobs that need to be filled due to employees leaving the labor force
  • 8 million jobs to fill due to employees making a career change to other industries

This $103 billion industry is facing a serious crisis as more people reach retirement age and require care in medical facilities and at home. The health care system is strained and working to keep seniors at home and out of the hospitals. Many of the people in need of care suffer from chronic health conditions and require ongoing assistance.

Finding a Solution

Recommendations have been released by the California Future Health Workforce Commission, to close this gap by 2030. Not only is it anticipated that we will have a shortage of professional in-home caregivers, but there will be additional need for nurse practitioners, primary care physicians, social workers, and physicians’ assistants.

On a positive note for workers, the increased demand for healthcare professionals with geriatric expertise means there is great career opportunity for people with the heart and skill set to work with older adults. Many people choose to have a lifelong career in professional caregiving, while others enter the workforce in this position, then use their valuable experience to move into nursing or other healthcare careers.

Home care agencies looking for qualified, desirable candidates are working harder than ever to attract and retain professional caregivers, competing with other care providers like residential care facilities, as well as employers in other service industries.

The shortage of professional caregivers is a serious issue, but there is hope on the horizon.

Kimberly Torrence, Director of Operations

Kimberly Torrence, Director of Operations

What is Windward Life Care doing to recruit and retain the best professional caregivers? We actively track local, state and national trends affecting recruiting and retention.  We have adjusted to labor force challenges without sacrificing our Home Care Aide skills and experience requirements. Retention of quality employees is one of our highest priorities because it benefits our clients, our company and the community we serve.  Our comprehensive orientation, ongoing training, and professional support from Aging Life Care Managers help our Home Care Aides to thrive in their role at Windward. This training and support, in addition to our competitive pay and outstanding benefits package, enables us to retain experienced caregivers. Understanding our employees’ needs and working with them to create the schedule they desire makes Windward a partner in their career and life satisfaction.  A strong indicator of our success in this area is the fact that our caregiver turnover rate is 28% less than the national average. We are proud to be the employer of choice for experienced and professional Home Care Aides in San Diego County. Contact us if you want to see how our Home Care Aides can enhance your life!

– Kimberly Torrence, Director of Operations

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Fair Senior Housing for All

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June is Pride Month, which is a great time to celebrate diversity and evaluate how we can better support equality for all older adults. We’d like to highlight an important topic: how discrimination affects the LGBTQ population living in senior living settings, and what needs to be done to fix this problem.

Problems in Senior Communities

It’s a tragedy that many LGBTQ older adults feel they must go “back in the closet” in senior living to avoid harassment/discrimination. Some LGBTQ older adults experience mistreatment from facility caregivers on a one-on-one level, and some facilities have cohabitation policies that discriminate against same-sex marriage and relationships. In addition to facing discrimination and mistreatment from facility staff, LGBTQ older adults may also find that other residents are exclusionary, or even abusive. As a result, older adults sometimes feel that their only option is to conceal their sexual orientation and/or gender identity so they can have a place to live and receive the care they need.

This situation can be difficult to face when a person has for decades of lived openly. It is a step in the wrong direction if seniors need to pretend to be siblings or “just friends.” In addition, LGBTQ older adults should not fear elder abuse in the form of emotional or physical harm from staff or other residents.

While these problems are common across the nation, some providers are looking for ways to accommodate all people. Many forward-thinking senior housing communities see the problem and are opening their doors to the LGBTQ community.

Legal Protections for LGBTQ Adults

If you or a loved one is being discriminated against in a senior housing setting, then it is important to know that legal protections are available. LGBTQ older adults need to be aware of their legal rights and tap into the resources and support that is offered. For example, a U.S. District Court recently ruled that senior housing landlords cannot discriminate based on sexual orientation.

Where should you turn for the legal support and advocacy that is needed? SAGE is a national non-profit organization that advocates for LGBTQ older adults. They have a “National LGBT Housing Initiative” designed to tackle the problems LGBTQ seniors are facing when looking for housing options. The goal is to improve and expand senior living options for older adults, giving them a safe place to live without fear of discrimination or harassment. Elder law attorneys experienced in working with senior housing issues are another good resource.

Windward Life Care is here to help you find the right services and support in San Diego County. A member of the San Diego Equality Business Association, Windward is committed to providing compassionate and inclusive services for older and disabled adults in our community.

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Navigating Hospital Discharges with an Aging Life Care Manager

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Windward Life Care’s professional Aging Life Care Managers provide an array of services that benefit clients and their families. One particularly important function is assisting clients and their support systems in managing medical conditions and related problems. This includes helping clients and their families navigate through often stressful and confusing hospital visits, whether the visits are routine or urgent. Care managers like Windward’s Terry Ehlke, RN, BSN, CMC, serve as the client’s primary advocate to facilitate the entire process. Terry took some time out of her busy schedule to answer questions about some of the essential services a care manager provides at such critical moments in a client’s care.

Terry Ehlke, RN
Clinical Services Manager
Windward Life Care

How can Aging Life Care Managers help when an older or disabled adult is hospitalized?

Care managers function as patient advocates, making sure the client is cared for properly during hospitalization all the way through discharge. Care managers work closely with the client and hospital team to ensure everyone understands the history and special needs of the client, any unnecessary trips back are avoided (such as for tests that can be handled during the current visit), the client is safely discharged, and adequate discharge instructions are provided to the client and caregiver. A care manager can also step in with any appeals to pause or slow down the discharge process if need be. Often clients don’t realize they can say “no,” so they just go along. The ultimate goal is for clients to experience the safest and most effective and efficient hospital stay possible.

What are the risks when the hospital says it’s time for a patient to be discharged?

Unfortunately, the discharge process can often be too fast and disorganized. Without any standard of care for hospital discharge in place, every hospital does their own thing. Hospital staff are under great time pressure and can rely on “cookie cutter” discharge plans that don’t account for the client’s unique circumstances. The very real situation at the client’s home is often overlooked, so failures stemming from not considering certain bigger-picture issues are common. Elderly clients especially are very medically fragile. In addition, communication and referral delays can lead to unsafe situations at home and treatment delays. Instructions to the patient regarding follow-up care, if even provided, can be rushed and inadequate. This is particularly dangerous in the case of a new diagnosis for diabetes or congestive heart failure. There is a significant risk that problems that could have been easily prevented through a better discharge process will lead to readmission.

Why is preventing readmission such a big deal?

I recently read a study that revealed up to 27% of rehospitalizations were preventable. While it’s true that many readmissions are simply not avoidable, medical issues that are not resolved prior to discharge or failures in the transition to home can often result in an otherwise unnecessary return to the hospital or emergency department. Readmission has a huge impact on the client’s quality of life and safety. Each hospital visit poses that much more exposure to potentially lethal complications (medication errors, hospital-acquired infections, blood clots, etc.) while putting added stress on the client who is once again away from the comforts of home in an unfamiliar environment. Worsening cognition, including delirium, can result from being in the hospital environment. Ultimately, readmission delays recovery, possibly introducing new complications.

Who is most at risk for recurring hospitalizations/readmission?

There are myriad factors that increase the risk of repeat hospitalizations. These include taking certain medications, such as antibiotics, glucocorticoids, anticoagulants, narcotics, antipsychotics, and antidepressants to name a few, as well as certain chronic health conditions, like advanced chronic obstructive pulmonary disease, diabetes, heart disease, stroke, cancer, and depression, among many others. Prior recent hospitalizations and premature discharges also increase risk, as does low health literacy, a limited social network, and low socioeconomic status.

A key advantage of working with a care manager is that we have detailed knowledge of a client’s daily life, health, diet, medication regimen, and other circumstances that can impact his or her health and well-being when it comes to hospital readmission.

Medications can be confusing and the risks of taking them incorrectly are high. What can families do to help reduce errors and complications in this area upon hospital discharge?

The client and/or family caregiver must be clear on all medication instructions. Families and caregivers need to determine who will set up and manage the medications, as the client may not be the best person to do this for him- or herself. All medications, including pre- and post-hospital meds and over-the-counter meds, should be reconciled. Be sure to update and consult with the primary care physician as soon as possible following a hospital discharge. Due to the complexity of managing the administration of multiple medications at multiple times of day, enlisting the services of a home health nurse may be the best option. Pharmacists can also be an invaluable resource.

What are some of the issues where multiple healthcare providers are involved?

There are often many providers involved after a discharge. Inadequate hand-offs and communication problems between them are major impediments to a smooth transition to home. Home health providers, including nurses and therapists, may get incomplete information from the discharge planner’s referral. Equipment is ordered (or maybe not) and does not arrive on time. Home care aides are often not provided with basic information prior to working with a new client. There’s the potential for no one to follow up on hospital lab results after discharge if the discharge papers didn’t indicate any were pending. Pharmacies are also known to transcribe orders incorrectly, or not know some medications were discontinued or changed at the hospital, and then they don’t fill them correctly or at all.

Do doctors ever talk to each other about their shared patients?

Hospital doctors, or hospitalists, do not talk to primary care doctors as a general rule. This often comes as a surprise to our older clients who were used to a different system for most of their lives. Doctors may share computer records, but those are sometimes incomplete. Up to 50% of patients do not see their primary MD following a hospital stay, though this is essential to the success of ongoing care and is usually included in the “to do” list in discharge instructions. The hospital discharge planner typically does not make this appointment for the client. Referrals are mostly made to specialists, but if the client does not follow up to make an appointment, the specialist may never see the client.

What steps does a care manager take to ensure a smooth transition to home when a client is leaving the hospital?

This is often the time when we first get involved with a new client because the family or involved professional realizes they need an advocate. The Aging Life Care Manager conducts a full assessment that starts with a review of the discharge instructions. Particular attention is paid to any signs that require medical attention, medication changes, any restrictions on physical activity and diet, and any treatments that are needed. The care manager also follows up with the primary care physician and specialty providers while making sure the client and family have a complete understanding of all of the above and consults with them regarding possible needs for home healthcare assistance.

The care manager also discusses with the client and family meal preparation, physical and social activities, transportation needs, financial resources, and client preferences, because a care plan that does not align with the client’s preferences cannot be effective.

The care manager then develops a customized care plan based on this thorough and holistic assessment of the client. The plan addresses both immediate needs and long-term care goals, and it clearly identifies who is responsible for each service. The care manager communicates the completed plan with the client, family, caregivers, and other professionals who may be involved in the client’s care. The care manager then supervises the plan’s implementation.

 

Terry Ehlke recently presented on the topic of hospital discharge planning best practices at the San Diego Regional Home Care Council Spring Symposium in May 2019. Terry was recently promoted to the position of RN Clinical Services Manager at Windward Life Care and is available for assessments and consultation.

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Windward Life Care Celebrates 15 Years of Meeting Evolving Needs of San Diego’s Aging and Disabled Adults

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San Diego, CA – May 15, 2019 – This month Windward Life Care® reached a milestone, celebrating 15 years of business. Since 2004, Windward Life Care has grown to be one of San Diego County’s premier aging services firms, evolving alongside the rapidly transforming elder care landscape. Starting out with a handful of employees, Windward now employs over 150 office and caregiving staff, following its 2017 acquisition of Lifeline Care, and has served over 2,000 older and disabled adults.

The story of the company began 37 years ago in 1982 when Windward Life Care founder, Norman Hannay, MPS, CMC, first learned about the “integrated model of care” while working with geriatric care management expert B.J. Curry Spitler. In the integrated model, geriatric care managers directly supervise in-home caregivers to create optimal client outcomes. Hannay sought to expand the integrated model of care throughout the county and formed his own company in May 2004, first known as Elder Care Guides. To reflect changes within the geriatric care management profession, the name was changed to Windward Life Care in 2016. Today, Hannay continues to serve as president of the company, which employs a team of social workers, registered nurses, certified care managers, and professional caregivers who work together to care for older and disabled adults throughout the county.

“Norman and I are proud to work with so many people who are as passionate as we are about caring for older and disabled people. I enjoy my daily interactions with our dedicated team of Aging Life Care Managers® and home care aides, who continually strive to be the most compassionate and effective advocates they can be for our clients,” stated Susan Valoff, LCSW, C-ASWCM, current vice president and part owner, with over 20 years of geriatric care expertise. “It brings me great pride to celebrate 15 years in business with our devoted employees, valued clients, and trusted business partners.”

The home care and health care landscapes have transformed since 2004, particularly with the advent of California’s Home Care Organization licensure in 2016. New technologies have become a big factor in how in-home care providers coordinate their efforts and communicate with families. Geriatric care managers are now known as Aging Life Care Professionals®. But, for the most part, the challenges of aging remain the same: families are still spread out over long distances; dementia still poses tremendous challenges to those who live with the symptoms as well as those caring for them, and clients and families continue to need help navigating the complex health care and long-term care systems.

More and more U.S. families are learning the benefits of working with an Aging Life Care Professional who can help long-distance family caregivers have peace of mind and assist older or disabled adults with practical support in the location where they want to live. As members of the Aging Life Care Association, Windward Life Care’s care managers specialize in dementia care, complex family situations, mental health issues, and helping clients age well with a sense of purpose and quality of life.

“Fostering the growth of Windward Life Care has enabled us to serve many more clients and families throughout the county, allowing many people to reach their goal of aging in place in their own homes,” said Hannay. “We remain dedicated to helping our clients age well, honoring their individual goals, and supporting loved ones and involved professionals in making decisions that enhance the client’s quality of life.”

Windward Life Care continues to evolve as a local leader in elder care. The company plans to open a licensed home health agency to serve more medically complex clients and is embracing new technologies that elevate the quality of personalized care services.

Contact Info:

Julie Moore, Director of Business Development

[email protected]

619-450-4300

2045 1st Avenue, San Diego CA 92101

 

About Windward Life Care

Windward Life Care is San Diego County’s premier aging services firm providing Aging Life Care™ Management and expert in-home care. Windward’s clinical staff are members of the Aging Life Care Association® and are experts in the eight Aging Life Care knowledge areas: health & disability; financial; housing; family; local resources; advocacy; legal; and crisis intervention. Windward’s discerning recruitment and rigorous training sets it apart from other home care providers. Each individual client has a personalized plan for aging well. The interdisciplinary professional team at Windward is comprised of leaders in the Aging Life Care Association, including registered nurses and master’s level social workers. Their areas of expertise include dementia care, complex family situations, mental health issues, and helping clients age well with a sense of purpose and quality of life. The company’s office is located at 2045 1st Avenue San Diego, CA 92101. Connect with the company on social: facebook.com/WindwardLifeCare; twitter.com/WindwardLC; or on LinkedIn/Windward Life Care.

AGING LIFE CARE™ is a trademark of the Aging Life Care Association®. Only ALCA Members are authorized to use this term to identify their services. AGING LIFE CARE PROFESSIONAL® is a trademark of the Aging Life Care Association. It is an indication of membership in ALCA, and only ALCA Members are authorized to use this term.

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Specialized Mental Health Care for Older Adults

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Windward Life Care consultant, Dr. Hossein Samadi, is a geropsychiatrist, a physician trained to work with older adults and their unique mental health needs. As part of our commitment to caring for the whole person, we have arranged for Dr. Samadi to see Windward Life Care clients who can benefit from psychiatric care at our office on a monthly basis. This allows our clients quick access to quality mental health services in a comfortable and familiar setting. We asked Dr. Samadi a few questions recently about mental health and older adults.

Dr. Hossein Samadi

Q: What mental health diagnoses do you see most commonly in your older patients?
A: This can be broken down into three categories: mood disorders, cognitive disorders, and psychotic disorders. Among the mood disorders, the most common are depression, anxiety and bipolar disorder. The cognitive disorders vary by cause: Alzheimer’s disease; vascular dementia; frontal-temporal dementia; and others. Finally, though more rare in presentation, the psychotic disorders include schizophrenia, delusional disorder and dementia-related psychosis.

Q: What keeps older adults from accessing mental health treatment and services?
A: Several things, foremost being stigma, both on the part of the individual and society at large. Other factors include denial of illness, lack of access to competent providers, and direct and indirect costs of care.

Q: Are there misconceptions about older adults and mental health?
A; Yes. The most common misconception is that older adults necessarily have neurocognitive impairment or can’t make decisions independently. Other misconceptions include that older adults bounce back quickly from life stressors such as the death of loved ones or that they don’t experience financial difficulties.

Q: Is suicide a concern for older adults?
A; Unfortunately, yes. Suicide risk actually increases with age for both men and women after the age of 40. Risk factors include: prior suicide attempts, access to lethal means, male/single/non-religious demographic, feelings of hopelessness and recent interpersonal loss.

Q: What about family caregivers? What thoughts do you have about their mental health?
A: Caregiver burnout is a real problem and will only grow with the aging population. The first priority needs to be taking care of the caregiver, as their physical and mental health is often overlooked in favor of the needs of the patient.

Q: What advice do you have for older adults who want to maintain good mental health?
A: Get back to basics: maintain a balanced diet, exercise, socialize, and never stop learning. If a problem arises, seek professional help sooner rather than later.

At Windward Life Care, we are committed to helping you find the right resources to meet your needs. If you are looking for more information about healthcare for mental or physical concerns, talk to us to locate the best providers for your situation. We’re here to help!

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Reflections on Windward’s 15 Year Anniversary

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The story of the company now known as Windward Life Care really began over 37 years ago in 1982 when geriatric expert B.J. Curry Spitler started one of the first care management companies, Age Concerns, here in San Diego. Age Concerns had an “integrated model” of care in which geriatric care managers directly supervised in-home caregivers to create great client outcomes. Amy Abrams and I worked together at Age Concerns, along with Susan (Soest) Valoff, and were trained in the model of care that Dr. Spitler developed.

Susan Valoff, Norman Hannay, Amy Abrams

Later, when Age Concerns was sold in 2003, Amy and I felt we could continue the lessons learned from Dr. Spitler and extend the care management/home care integrated model in San Diego. We formed our company in 2004 which was first known as Elder Care Guides. Susan joined our team in 2009, later becoming a partner in the business. In 2016 we changed the name to Windward Life Care. We started our business with a handful of employees in 2004 and now employ over 150 office and caregiving staff. We are proud to have on our team so many people who are passionate about caring for older and disabled people.

Much has changed since 2004 and much remains the same. The home care and health care landscapes has gone through many changes, including the advent of Home Care Organization licensure in California in 2016. New technologies are a big factor in how we navigate out in the world and communicate with families. Geriatric care managers are now known as Aging Life Care Professionals. But, for the most part, the challenges of aging remain the same: families are still spread out over long distances; dementia still poses tremendous challenges to those who live with the symptoms as well as those caring for them; and clients and families continue to need help navigating the complex health care and long-term care systems.

Fostering the growth of Windward Life Care has meant we have been able to extend our reach to many more clients and families in San Diego County, allowing many people to reach their goal of aging in  place in their own homes. We remain dedicated to helping our clients age well, honoring their individual goals, and supporting loved ones and involved professionals in making decisions that enhance the client’s quality of life. We appreciate the chance to work with you. — Norman Hannay, MPS, CMC, President

The early years of bringing the vision of Elder Care Guides to life were so exciting. Norman and I knew we could deliver care management services in a distinctly professional and personalized way, if we could get our message in front of the right people. And I’ll never forget the first time the phone rang with our first opportunity to be of service. The client was a frail older gentleman living alone with dementia, whose only family lived thousands of miles away and was growing concerned about his safety, repeated episodes of wandering, and encounters with law enforcement. I felt a deep honor that his health system case manager had entrusted us with her referral, and that his family entrusted us with his care. We built a support system that centered around his personal habits and preferences, matched him with just the right companion, and slowly gained his trust, while ensuring that an appropriate safety net was in place. Elder Care Guides was built on the social work principles of starting where your client is and focusing on their strengths rather than their deficits, and it all came together for that client, who continued to live life on his own terms throughout the progression of his disease. Our reputation as a company that could – and would – handle the most challenging and delicate of situations grew from there, and I’m happy to see that it continues today.  ~  Amy Abrams, MSW, MPH

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A brief history of Windward Life Care:
May 12, 2004 – opened for business in La Jolla and hired the first employee, Amy Abrams, MSW/MPH
January 2008 – office moved to Liberty Station in Pt. Loma
March 2009 – Susan (Soest) Valoff joined the team as Director of Clinical Services
March 2013 – Office moved to 1st Avenue in Banker’s Hill
March 2014 – Acquired Senior Care Management
April 2016 – Changed company name to Windward Life Care
June 2016 – Obtained California Home Care Organization license
August 2017 – Acquired Lifeline Care at Home
August 2018 – Opened North County recruiting office

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