Home Health Care agencies can basically be broken down into two different models, the registry model and the employee based model. Both types can offer the services of nurses (RN’s, LPN’s), home health aides (HHA’s)/certified nurses aides (CNA’s), companions and other services such as physical therapy (PT) and occupational therapy (OT) The question for many consumers, what is the difference and which type is right for them.

Nurses registries have been around since the civil war. In this model, an agency does all of the background work, such as interviews, criminal background checks, reference checks and any other checks they feel necessary. Once a candidate has been approved, the registry will refer them to the person in need. The caregiver is considered an independent contractor by the agency and not supervised directly by the agency. This is also called the consumer directed model as the consumer is the person in charge.

With the employee based model, the agency does a similar type of screening, however, instead of referring the caregiver to the consumer, the agency employs them.

Each model has its’ pros and cons.

Pros of the registry model include

• Cost of the service is generally lower than agency model.
• Caregivers usually earn more, which tend to attract a higher quality of caregiver.
• Consumer is in total control. They decide what gets done, when it gets done and how it gets done. They decide if the caregiver stay on the job or needs to be replaced.

Cons of the registry model include:

• Person is not supervised by agency nurse.
• Caregiver is not covered by WC insurance.
• Family may be the employer and need to take out payroll taxes.

Pros of the agency model include:

• Caregivers are covered by workers comp and bonded by the agency.
• Caregivers are supervised by agency nurse.
• Agency is alway the employer and deducts all appropriate taxes.

Cons of the agency model include:

• Cost tends to be higher.
• Caregivers do not earn as much as those on the registry side.
• Agency has control over when and where caregiver performs their duty. Agency can pull a caregiver if they need that person for a different case.

You will find supporters for both sides. It is up to you to decide which type of business is right for you.

To learn more about nurses registries, go to www.privatecare.org

To learn more about employee based agencies, go to

Retired Supreme Court justice Sandra Day O’Connor’s husband has found love from another resident at his assisted living facility in Phoenix Arizona. O’Connor left her position on the Supreme court in 2005 to take care of her husband, who is suffering from Alzheimer’s disease.

This is obviously a woman who cares very much for her husband, and yet she is not upset about his new arrangement. Different people react differently to situations such as this. O’Connor is a very intelligent woman and probably has a great understanding of what this disease does to people. It is probably difficult for her to see her husband with another woman, but at the same time she is probably just happy to see him in such an improved state of mind.

It does bring up several questions:

1) Is it OK for Alzheimers patients to do things that are normally not acceptable?

2) Is this really infidelity?

3) Is this something that should be encouraged for Alzheimer’s patients?

Are reviews the best way to judge home health care and assisted living? This is a question we have been hearing since we bagan caregrade.  We obviously feel very strongly in the power of honest reviews. A person using reviews has a great advantage over a person who is selecting a service without the same information. Reviews allow people to experience what others find good and bad with a particular business. Armed with this information, you should then ask appropriate and pointed questions to the businesses you are investigating. Reviews by themselves should not be the only criteria used to form an opinion.

People often ask us how to tell if a review is honest or not. It is very hard to know for sure, however we have taken steps to try and limit false reviews. On top of that, our professional reviews are done by certified geriatric care managers that  consumers can feel confident with. The combination of professional and user reviews makes for a powerful source of information. A wise shopper can then take that information and apply it to their other search tools and come up with a choice they can feel confident with. The information age we now live in creating an unparalleled opportunity for people to make decisions not based on hype and advertising money, but on honest, true information. Consumers are now in the drivers seat.

A Care Manager’s View of Home Care

CareGrade.com did an interview with professional care manager Liz Salston, LSW to find out what a professional care manager looks for in a home care agency.

CG -What do you, as a care manager, look for in a home care agency?

LS - I look for an agency that offers a comprehensive service, not just companionship. I want the client to be able to have medication assistance and hands on care from a home health aide should they need it. I also look for supervision from an RN.

Other things I look for include having consistency in terms of coverage, and a good relationship with the care manager, which includes feed back and quick responses to phone calls. Lastly, I want to see that an agency does a good job of screening the home and the client’s needs in order to help make the right match with a caregiver.

CG - What problems do you most often encounter?

LS - I have had some issues with the professionalism of agencies when communicating information about their clients. On a broader scale, making good matches between the client and caregiver is a big problem. Agencies often fall short when taking all of the facts about a client in to account. They need to look at more than just the physical condition and consider things such as the client’s interests, quirks and personality. They also need to consider the caregiver’s needs. For example, an agency should be careful not to send a person with allergies into a house with pets they are allergic to.

Response time when filling cases, especially for call outs and emergency fill-ins tends to be another problem. An agency should be staffed well enough that it does not have gaps in coverage.

CG - What questions should a family ask when speaking with an agency and trying to make a choice?

LS - People searching for care should ask the agency…

What happens if it is not a good match?

How quickly can you make a change if it is needed?

Do you have enough coverage if a person calls out?

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CG - How long does it usually take to get service started?

LS - A good agency should be able to get a new case started within 48 hours. Sometimes they have to start with a temp until they can secure more permanent placement.

CG - What are the most difficult cases to fill?

LS – I find cases that are short term, less than two weeks, can be a challenge to get filled. It takes just as much work and costs the agency just as much to staff one of these cases as it does for a long term case. The agencies are just not as motivated. What they fail to recognize is that is that short term placements often result in long term cases over time. Agencies need to take this possibility into account.

Other cases I find hard to get staffed are when there is a racial bias. Unfortunately it is out there. I attempt to teach my clients and their families’ lessons in tolerance and acceptance when engaging home care services. Clients need to understand that the majority of workers in this field come from minority groups and that their priority should be the quality of care provided. Personal biases need to be put aside and relationship building will occur over time if given a chance.

Liz Salston is a social worker with 22 years of experience in the field of services for older adults. She has served as Director of Recreation and Social Services at the Martin and Edith Stein Assisted Living Residence and as a social worker at the Central New Jersey Jewish Home for the Aged in Somerset. She has run several socialization and respite groups at the Jewish Family Service of Southern Middlesex County and has worked as a social worker in HUD senior housing.

Liz holds dual Bachelor of Arts degrees in Sociology and Judaic Studies, a Master of Social Work, as well as a Master of Arts in Contemporary Jewish History.

She is a licensed social worker in the state of New Jersey, a member of the National Association of Professional Geriatric Care Managers, Inc., and the National Association of Social Workers.

You may reach Liz at www.salstoneldercare.com (732) 238-1775

A Professional Care Managers View

CareGrade.com did an interview with professional care manager Liz Salston, LSW to find out what a professional care manager looks for in assisted living facilities.

CG - What do you, as a care manager, look for in an assisted living facility?

LS - The first thing I look for is to see if it is truly a homey environment. This is not an institution these people are moving into, it is a new home. While being homey is important, the facility must also be well run and have a kind staff. I look for a place that all employees, from housekeeping all the way up to the director, will drop whatever they are doing to help a resident with whatever their needs are

Other things I look for include

An environment that is protective for people who are memory impaired. I like to see that the higher functioning people are able to come out and socialize with the rest of the resident, as long as there is staff supervision.

The facility has nursing supervision 24 hours per day

Transportation to doctors and outside recreation is provided.

There is an affordable tier system of care level.

The survey.

Lastly, I like a facility that either has a separate skilled section of its own or a relationship with a skilled facility. I want to know that if a person requires the skilled care for a short term stay, that they will be transitioned back to their home in the assisted living facility once they are better.

CG - What problems do you most often encounter?

LS - I really don’t see many problems with the facilities I use.

CG - What questions should a family ask when speaking with an agency and trying to make a choice?

LS - Will staff engage their parents?

Will they push the residents to go to activities or encourage them to participate?

Do the residents each get lifeline pendants in case of emergency?

How does staff help settle a person into their new surrounding?

Is their any type of support group separate from resident council?

CG - How long does it usually take for a person to move into a facility?

LS - If there is no waiting list, a person should be able to move in within a week. It definitely saves time and speeds everything up when a family works with a good care manager. We have already done all the homework and know what facilities would be best for each individual.

CG - What are the most difficult people to find assisted living for?

LS - Individuals with behavior problems and psychiatric conditions or people who are agitated tend to be the most difficult to find the appropriate accommodations. Another group are those that have problems making the adjustment to a new place to live.

Liz Salston is a social worker with 22 years of experience in the field of services for older adults. She has served as Director of Recreation and Social Services at the Martin and Edith Stein Assisted Living Residence and as a social worker at the Central New Jersey Jewish Home for the Aged in Somerset. She has run several socialization and respite groups at the Jewish Family Service of Southern Middlesex County and has worked as a social worker in HUD senior housing.

Liz holds dual Bachelor of Arts degrees in Sociology and Judaic Studies, a Master of Social Work, as well as a Master of Arts in Contemporary Jewish History.

She is a licensed social worker in the state of New Jersey, a member of the National Association of Professional Geriatric Care Managers, Inc., and the National Association of Social Workers.

You may reach Liz at www.salstoneldercare.com (732) 238-1775

CareGrade.com did an interview with professional care manager Mark Zilberman, LCSW to find out what a professional care manager looks for in assisted living facilities.

CG What do you, as a care manager, look for in an assisted living facility?

MK I like to see what my immediate reaction to the place is. How are the aesthetics? Is the place comfortable? Do I feel good there?

Then I look to see what services are offered, in particular, what is included in the base fee. One of the biggest problems I encounter when trying to compare one place against the other is figuring out what is included and what is extra. Some places seem like they cost more, but when you really compare apples to apples, you see that they are offering a lot more services in the base price. Other places are more ala carte.

I also check to see what happens when a person runs out of money. Is the facility set up to work with them when that happens? Some facilities are accepting Medicaid, but sadly most places do not.

When possible, I check to see what other people say about the facility. I look for input from people who have had actual experience. A service like CareGrade can be helpful with something like that.

I also look to see what staff they have available. Do they have a social worker and nurse? What days and hours are they available? Does a doctor come in to see patients and how often do they come? Do they have transportation available?

As a care manager, I also look for facilities that work with me and include me in the patient care process. I like to form an alliance and work with them to help bring about the best results.

CG What problems do you most often encounter?

MK The biggest complaint I hear about from people is assisted living facilities is the food.

CG How long does it usually take for a person to move into a facility?

MK That depends on a lot of factors. If a person needs to pack up their belongings, sell their home, fill out the paperwork, get financing settled and a host of other circumstances it can take a several weeks or longer. People who work with care managers such as myself tend to move in much faster, as I am experienced in helping them with all of the things they need to do. It goes much faster and easier when a professional is there to help.

CG What are the most difficult people to find assisted living for?

MK I think that one of the more challenging things is when a person is borderline between a nursing home and assisted living. I try and work with the facility to see what the best place for the person would be.

Mark Zilberman, LCSW, has been working in geriatric care management for almost seven years. He brings diverse experience to the field, having worked and studied in the specializations of substance abuse, mental health, developmental disabilities, and homelessness. As Founder of NorthStar Care and Guidance, he and his organization are called upon to manage a spectrum of issues for families. Zilberman was previously affiliated with SeniorBridge, Inc., Beth Israel Medical Center, and The Floating Hospital.

He received his MSW from SUNY at Stony Brook. A licensed clinical social worker in NY and NJ, Zilberman holds credentials in substance abuse counseling from both states. Mark is a member of the National Association of Geriatric Care Management.

You may reach Zilberman at www.NorthStarCare.net, 888-288-6152

A care managers view of home care

CareGrade.com did an interview with professional care manager Mark Zilberman, LCSW to find out what a professional care manager looks for in a home care agency.

CG What do you, as a care manager, look for in a home care agency?

MZ As a care manager, the main thing I look for is service. The caregivers don’t seem to be very different from one agency to another except that certain registries pay better and can attract a slightly higher caliber of person. What does differ is the service I receive. I look for an agency that will work with me, be responsive to my requests and questions. I also look for how well an agency handles problems when they occur. Can they fill in with replacements quickly and can they solve the problems when they come up?

CG What problems do you most often encounter?

MZ The biggest problem I find is that the aide who is sent to a case is not well matched to the client in need of care. When an agency makes a good match, the cases work out much better. Unfortunately, many agencies are very busy and do not have a huge selection of people to try and make the perfect match. They do their best but have to work with who they have available at that particular time. Often, the need for a home attendant is initiated during a crisis. Therefore, the agencies must act quickly.

CG What differences do you see between agencies?

MZ The main distinction I find is agency or registry. The agency employs workers directly while the registry uses independent contractors who work for the client. I tend to lean towards the agency model. I find that there can be advantages with registries, such as lower costs, but the family needs to understand potential problems. I explain how they work and let the family decide which way they want to go.

CG What questions should a family ask when speaking with an agency and trying to make a choice?

MZ Families should ask about after hours coverage, how quickly does the agency get back to them, do they offer medication management, how often is billing done and what the costs are to name just a few.

CG How long does it usually take to get service started?

MZ I have found that is usually takes just a few days to get service started. Companies that use my assessment as a professional care manager are able to get the case started faster than companies who need to do their own.

CG What are the most difficult cases to fill?

MZ Filling a case for a person who smokes tends to be harder to staff. Many caregivers just do not want to sit in a smoky room all day. Cases involving mental illness and behavioral issues can also be a challenge.

CG What role would a care manager play if a family is looking for an agency?

MZ Family’s will probably get better service working with a care manager that has relationships with an agency or agencies. There’s a familiarity with staff that can really help. Obviously, an agency or registry has a greater need to serve a care manager as that CM can be or is a conduit to many other cases.

Mark Zilberman, LCSW, has been working in geriatric care management for almost six years. He brings diverse experience to the field, having worked and studied in the specializations of substance abuse, mental health, developmental disabilities, and homelessness. As Founder of NorthStar Care and Guidance, he and his organization are called upon to manage a spectrum of issues for families. Zilberman was previously affiliated with SeniorBridge, Inc., Beth Israel Medical Center, and The Floating Hospital.
He received his MSW from SUNY at Stony Brook. A licensed clinical social worker in NY and NJ, Zilberman holds credentials in substance abuse counseling from both states. Mark is a member of the National Association of Geriatric Care Management.

You may reach Zilberman at www.NorthStarCare.net, 888-288-6152

Here are some great reasons to eat right.

A recent study found that seniors who went one week without enough protein began showing signs of muscle deterioration. The answer is to eat a balanced diet which inludes protein (not a high protein diet) along with exercise. Strenght training is the best type of exercise for maintaing muslce development.

Another study found that eating cruciferous vegetables such as broccoli, cabbage and cauliflower can help reduce your brains aging. Women who ate more vegetables particularly the ones mentioned above had memory scores equial to women a few years younger.

Eat right to help age well. That is the answer.

CareGrade relies on the views of professional geriatric care managers to provide their professional reviews. This allows individuals looking for information about senior service providers  to get a professional’s perspective. We will be providing interviews with the county’s finest care managers to find out what they look for in home health care agencies, assisted living facilities, elder lawyers, hospices, and more. Read our up coming interview with Mark Zilberman.

Summer is a popular travel time for everyone. For seniors, there are both great opportunites as well as potential hazzards. Getting away to the beach or mountains is great in the summer. Spending time with family is another high point of summer travel. Seniors need to take extra precautions due to the heat and poor air qulity. Here are a few tips

• Make sure hotels have good air conditioning
• Have the car’s air conditioning  serviced prior to car travel.
• Seniors often have a need to urinate more frequently and therefore avoid consuming enough fluid while traveling. The combination of high heat and low fluid volume can quickly bring on dehydration. Drink plenty of fluids at all times.
• Don’t be overly active outdoors if the heat is excessive or air quality is poor.

There are some great summer travel sites to check out:

As kids get out of college for the summer, the rooms and classes open up for seniors. Visiting colleges accross the country can be a rewarding and affordable way to travel visit http://www.seniorsummerschool.com/

Elder Hostel provides hostels specifically for seniors. They have fun trips and packages for the over 55 crowd. Visit http://www.elderhostel.org/