Home Care: A Handbook for Preventing Hospitalizations

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Patricia Dubroof:

Hi, welcome to Book Chat. It’s another great adventure, a nice afternoon. Speaking to you from Maryland, we are going to be visited by an author from Boston and our very own Steve Lorberbaum, who contributed to the book. The book is called Thriving at Home, A Handbook for Preventing Hospitalizations. And we’re just going to introduce ourselves while more people are coming on. So, I always like to just show this picture of my mom and dad, because what’s really important to us at Assisting Hands Home Care Potomac is family. And I learned the hard way all about caregiving because my dad had a major stroke and we all had to pitch in and then finally hire outside support and what that was like and how we figured it out. I wish I had known all the things that Steve taught me in the past couple of years about caregiving and caregiving options because we needed it then. So, I’m happy to say that they had a really loving relationship and my mom has survived my dad now by 14 years and is 93 years old and doing just fine. So, it’s quite an amazing world we live in.

Patricia Dubroof:

And now, let’s talk a little bit about David. He is originally from Minnesota, but he’s a Boston guy and that’s how I know him. So, I don’t know if I hear Minnesota in you at all anymore. He was inspired by caring for his grandmother and got involved in-home care through that passion. A lot of us come to this with very basic, intuitive knowledge and then realize this is a whole world of engagement here for our elders.

Patricia Dubroof:

I also want to introduce Steve Lorberbaum, who is the contributing author for this particular version. He’s going to talk more about his world, but he actually came from the attorney side of the field and I call him a recovering attorney. And he and his wife both faced very similar situations where they needed caregiving support and it was challenging to figure out. So, he decided to start Assisting Hands Home Care. We now have branched out to Fairfax, Virginia, as well. So, let’s do a little bit more intros from each of you. And I’m going to leave this up on the board for a little while so that people can go to the website or look at more about the book. So, Dave, welcome.

Dave Tasto:

Thank you. Happy to be here.

Patricia Dubroof:

And, just as a side note, can everybody make sure you mute until you want to ask a question? Because it does give us feedback and we are recording. So, if you don’t want your picture showing do the no-picture thing. All right, so Dave, tell us about your world and how you got involved, and how you got to writing this book. What was the passion behind that?

Dave Tasto:

Thanks. I think just a real brief touch on that experience with my grandmother and then I’ll get into the why the book because it ties to that. I was just touched by some caregivers that were caring for my grandmother during the hospice period. I actually had a chance to meet them. I went back to Minnesota and met them at my grandmother’s funeral. They told stories about going above and beyond and just doing so much for her at that time, which, for my mom, made a challenging time a little bit easier to manage. My mom was impressed by the caregivers that she actually had said to me at one point calling me from Minnesota and saying if she knew that there was help like this that existed, she could have kept Mom at home. Instead, though as dementia progressed, my grandmother did move into a community.

Dave Tasto:

But that ties a little bit into the reason for writing the book in that.. Well, first of all, many of us want to age in place like nine out of 10 Americans want to age in place or live retirement where they want to live. And that awareness that was missing from my mom about what she could have done for my grandmother to keep her at home was a piece of it. Just getting more of that visibility into what home care can do was a key piece. But, in a lot of our teams at Assisting Hands and Steve’s office and our office here are a lot of the same values and approaches.

Dave Tasto:

A lot of the things that we do can be and are being done by family members in the community these days, particularly after last year, when there’s a little bit more of a concern about the virus spreading in our neighborhoods and our communities. But, some of us family caregivers didn’t have the professional training that our caregivers do, in terms of infectious disease control and other types of things, or even manage, to get back to the topics of the book, how to keep home safer or how to manage certain chronic conditions at home.

Dave Tasto:

And, in talking to Steve through this, so much of our approaches were consistent. And, we thought that how do we tie together this point of the book about keeping people safe at home and out of the hospital. Again, if you recall last year, first of all, hospitals were a really challenging place to be last year. And even into this year with minimal visitations and so forth. So, having that help at home that can help provide a safe environment and help you manage through chronic conditions will hopefully provide those family caregivers much more confidence to do right by their loved one and keep their loved one healthy at home, out of a hospital.

Patricia Dubroof:

That’s great. Thanks, Dave. Steve, how did you come to Assisting Hands? What was your world?

Steve Lorberbaum:

I’m an engineer and a lawyer by training, probably why Dave and I get along is because he’s an engineer, as well. But, basically both my parents had cancers at various times up in New York and they needed aids and there was just so much we didn’t know. And had we known would have made our lives a lot easier and my parents’ lives a lot easier. They both died in the hospital, plugged into machines because no one mentioned hospice. Because oncologists are the warriors of medicine. So, they don’t ever admit defeat, so they don’t talk hospice. I don’t know what my parents would have chosen. Maybe this is what they would have chosen, but no one even broached the idea to us. And I felt like, God, this is something missing in the way in which we communicate with our families.

Steve Lorberbaum:

My father-in-law has dementia down in Florida for the last 10 years and actually is being taken care of by and Assisting Hands down there. And again, I could share with you stories about some of the caregivers that my sister-in-law had found prior to Kathy and I getting involved in-home care and sort of heading down the right path and you’d be shaking your head going, No, no one would do that. But yet they found untrained people who sounded good but didn’t know how to care for someone with dementia. So, that was sort of my impetus for starting Assisting Hands and retiring from the practice of law. And one of the things that really spoke to me about the book that Dave was working on is I would go meet with clients who were recently out of the hospital and they would have this bag of medicines that they used to take before they went into the hospital.

Steve Lorberbaum:

And another bag of medicines that they were taking now that they got out of the hospital. Well, no one did a medicine reconciliation. So, it turned out that, in one particular case, a client went back into the hospital before we got engaged because they were taking two blood pressure medications because the one that they gave him in the hospital was the same formulary but a different name than the one they were taking. So they didn’t know which, so they took two and ended up back in the hospital.

Steve Lorberbaum:

So to me, it just prompted this whole thought of how do you keep people safe? What are you going to do to make sure that people, when they go into the hospital, ask the right questions, know the right information, don’t just say, Okay? And then when they get back home to make sure, again, that they ask the right questions, they do the right things, that their homes are safe for them to be at home and to thrive and not end up back again. And Dave and I sort of talk, we share that philosophy, and this just became an obvious book to try to write to help people.

Patricia Dubroof:

Thank you, Steve. The book is divided into really accessible key points and I love it… The title of the first chapter is called Home is Where the Heart Is. So, that’s kind of what we all focus on is how best to keep folks at home and provide the care they need in the home. But what kind of conditions, Dave, might there be that would change that and have them go to a hospital? What kinds of things can we look at that might be happening down the road where we want to say, Oh, maybe we could prevent that from happening.

Dave Tasto:

Thank you. Home is where the heart is… I guess before the pandemic, home is your castle. Well, will these days, the castle has a moat around it, right? And there’s a resistance to having anybody come into your castle for all the right reasons. But, two analogies there, definitely home is where the heart is, but it’s safe and it’s your kind of comfort area. But on the home safety piece, though, keeping your home safe, you really want to focus on preventing falls because trips or falls are the number one reason why older adults go to the hospital. And many falls are preventable.

Dave Tasto:

So, there are things that we can do to keep our home safer. And won’t just think about looking for things on the floor, making sure that there are grab bars or things like that in the bathrooms or other access equipment in your home to keep it safer. An example I like to talk about in the kitchen is if we have to be reaching for cups and mugs or bowls and mugs in a cabinet up high where we’re a little bit off-balance, moving our center of gravity when we need an easier motion at home, why can’t we just place them upside down in the countertop? A much more easily accessible location, again, a simple fix for something that could cause us to get off balance and fall. So, a lot of little things that we can do in there, but basically it’s having the strength to balance, and identifying and removing the hazards in the home, are a big piece about preventing that first trip to the hospital.

Patricia Dubroof:

And that’s one of the things that we provide with Assisting Hands Home Care is a little safety assessment of the house. So that feeds right into the whole way we do business. It’s so important. So, let’s talk a little bit more about the challenges that get people to the hospital. So, there’s a trip, there are other things, too. Do you want to talk a little bit about that?

Dave Tasto:

I think once you’ve been to the hospital, and it’s okay to go to the hospital… There are challenges associated with going, but often, hospitals can provide the best care available when needed. So, don’t necessarily discourage going to the hospital when it’s needed. A key piece, though, around knowing when it’s needed is to understand your condition at home, particularly for those who might have a chronic condition. And there are four chronic conditions that drive us to the hospital, but four, in particular, increase your chances of going back to the hospital. And, I would just say that the statistics are that one in five Medicare patients goes back to the hospital within just 30 days. So, it’s a real statistic in that once you do go to the hospital, you’re very likely to go back. So, managing aspects of your health is very important, and having those smooth transitions home, I think, is critical.

Patricia Dubroof:

I know that one of the things people think about home care just being in the home, but, actually, home care providers like ours can actually go with you to the hospital. They can meet you at the hospital if you’re feeling like you need that extra support. And a lot of times in the hospital, at least pre COVID, that was really helpful, especially for families who are out of town, who can’t get to mom or dad in the hospital. So, they know somebody who knows their loved one is going to be by their bedside.

Steve Lorberbaum:

It’s really true –

Patricia Dubroof:

Steve, you want to talk about that a little bit?

Steve Lorberbaum:

I was going to say that really, it’s a function of a home is, the way I define it is wherever a person is at the moment, living. And it could be a rehab, it could be assisted living, it could be independent living, an apartment building. We’ve served clients in hotels. So, it’s not just a location, and generally, we think of home as the place that someone is that they want to be. But, home care happens in lots of places to help bolster and support people. A lot of times now, especially with COVID, medical professionals are allowed into an assisted living community or rehab facility and family members aren’t. So, we have often become the eyes and ears for family members to know what’s going on, how are their loved ones being treated because they don’t feel that they can get enough information from the rehab facility because they’re short-staffed, they’re doing everything they can, but they’re not returning calls promptly.

Steve Lorberbaum:

So, it really is a function of where are they home at the moment. But, for the most part, is the people that gravitate towards home care want to stay at home. It’s where they feel their anchor is, it’s where they feel their connections are. And, everybody has to determine when, if any, is the right time to move to another type of living situation. Almost every condition that Dave mentioned in the book can be addressed at home safely, for as long as someone desires to be at home. It really just comes into making sure that the house is set up properly, that there are safety supports and that they have the appropriate level of home care, whether it be from family caregivers or private caregivers or a combination of both.

Patricia Dubroof:

So, let’s switch gears a little bit. We’ve talked a lot about why you would need a home care provider. How do you make that choice? How does a family go through the process? What should they expect from Assisting Hands and your tips on what they should avoid? Dave, you want to start in a generic way?

Dave Tasto:

I’ll start in the generic and I think Steve could probably fill in a lot of details, as well. I would recommend if your desire’s to age in place or live your retirement in your home, to reach out to firms that you’re going to want to establish a relationship with before you’re in a crisis. Ask the questions that you want. You’re better able to objectively assess which firm is a good match for you. And there could be some legal needs or financial needs, but also care needs at home. I think reaching out, asking the right questions, and Steve could probably fill in on some of the questions to ask, but definitely build those relationships before you’re in the middle of a crisis, I would suggest

Patricia Dubroof:

Sounds like a good plan. Steve, what would you like to add?

Steve Lorberbaum:

I agree with that because a lot of times we get a call and someone’s in crisis. Someone’s in the hospital and now they’re about to discharge and they just got the word that they’re discharging tomorrow. And now, husband, wife, son, or daughter is frantically calling around because they realized that Mom can’t go home by herself. And it’s very stressful for the family. And it’s better if, as people age, they just gather information. There’s a lot of choices out there. There are adult day programs, there are a variety of home care companies. There are private caregivers. Just to gather information, talk to a couple of people so that you have that sort of an envelope for the Defcon 5 that, when it happens, you rip open the envelope and you’re ahead of the game. You’ve got some people to call and ask questions.

Steve Lorberbaum:

When people say to me, Well, how do I know if I should use you all or another company or hire privates? That’s probably an hour-long talk in and of itself, which I’m happy to have with anybody. But by and large, you want to make sure that the company you work with meshes with your ideas for what you think is appropriate care. And that they’re fair, honest, and reasonable with you. Anybody that says they can do anything is a company I would probably run away from because there’s a lot of things that Dave and I and Patricia would tell you is just not realistic. It may be an aspirational, nice hope but the reality of the world in where home care operates and where you can find appropriate caregivers is a different world than what you may want. So, it’s important to have somebody that pushes back to you and says, yes, this is what we can do and this is what we really can’t do.

Steve Lorberbaum:

You can make the choice, and maybe it isn’t our company, but you want somebody that’s going, to be honest with you about what is capable of being provided. And I would focus on continuity of care. I’d want to make sure you wanted to work with a company that said they try to get one or as few caregivers in there as possible. I know there are companies that every day, a different caregiver shows up. Well, that’s not ideal if you want to establish a relationship of honesty, integrity, and trust. Which is what, I think, both Dave and I really focus on. Our aides show up and they’re strangers in a home and it takes a while to build trust. And for them to know a loved one, and for the loved one to get to know them. No one magically just knows how to do it all in a home because everybody’s different.

Steve Lorberbaum:

Some people want somebody that’s an Energizer bunny that just starts running and doesn’t stop all day long. Other people and we’ve had clients say, I don’t want her to touch a thing or do a thing unless I ask them to, and there’s a chair in the other room I want them to sit it and I don’t want them to come out of that room unless I ask them to. Now, it’s extreme, but we’ve had it. So, you’ve got to learn what your clients want so that you can deliver it properly. So again, ask questions, be honest about your needs, get an understanding. And if someone says yes to everything, probably run away.

Patricia Dubroof:

I know we could talk about this subject for a long time. I think what’s really important for families to understand when they’re listening to this video is just that the options are out there and they’re very accessible. And then there are also people who can help you assess those options like case managers or care managers who can put together a whole package for you and do some of the legwork. We get clients that call all the time that say, I’m just overwhelmed by this process. So, that’s another resource. One of the things I noticed, and maybe there’s another edition coming out we can hear more, but this one really focuses on preventing hospital stays, but it doesn’t add in the mental health piece and May is Mental Health Month. So, I thought I would just remind all of you listening that we also very much work with folks with dementia and Alzheimer’s, and other cognitive challenges. Do you want to speak to that a little bit, Dave?

Dave Tasto:

Particularly for folks with neurological conditions like Alzheimer’s dementia or Parkinson’s, trips to the hospital can be challenging because of the Steve mentioned, the meds lists, and stuff that gets changed around. Well, the hospitals take over all of the medications and having an understanding of, bringing the med list and be prepared. And these are all things that our teams can help support, as Steve mentioned, or I think you might’ve mentioned. Our aides can go to the hospital and bring this med list and explain the situations for our clients so that if there is a need to go to the hospital, it’s a smooth transition. Or taking notes at primary care and making sure that those notes are effectively communicated out to family or other healthcare providers are critical. But no, we definitely can help and support folks with neurological conditions.

Patricia Dubroof:

That’s great. So, what’s next for this book for you? What was the goal of getting this written? So many people want to write a book, but you actually did it, so Bravo.

Dave Tasto:

Thank you. I just want folks to have the information at hand to keep their loved ones healthy. And so the more folks that we can get it out to and help them… In-home care, private duty home care, we can’t help everyone. Not everybody has the means to work with us. And often, in between our shifts, family caregivers are helping out. So, the better we work with family caregivers and prepare them, the better off all of our loved ones are going to be. So, just increasing visibility awareness is going to hopefully result in better health outcomes for our loved ones.

Patricia Dubroof:

That’s very generous. And the last part of the book, in your appendix, you actually go through what are the signs of COPD, heart failure, diabetes, stroke. And we’ve been launching these little mini videos for the Chamber of Commerce here, and we specifically worked on safety, stroke, and heart attack. So we’re right with you, Dave. We love what you did and that you put it on paper. And then, Steve, your contribution in Chapter Nine about serving Montgomery County in particular, we feel like we have really, really special families here. First, we’re very international. And, we get a lot of questions that other organizations of the same ilk may not get. And Steve, do you want to talk a little bit about why it’s so special in Montgomery County?

Steve Lorberbaum:

Sure. So, Montgomery County is, besides this being a great place to live, we have a wide arrange of people, both clients, and caregivers. So, we really have a very multicultural area and it gives us an opportunity and a challenge, right? So, it’s an opportunity to learn more about other people’s cultures. Most of our caregivers come from West and East Africa. I had one in today and we were discussing jollof rice and fish wrapped in grape leaves or banana leaves. And those are things that you’re not going to have in Idaho that we get to talk about here. The challenge then becomes that our caregivers don’t know how to make meatloaf, but they can make a mean fish wrapped in banana leaves. So, bridging that cultural gap is often an interesting challenge for us to make sure that we provide the best care to our clients, but also give them an opportunity, if they’re interested, in learning more about the cultures that our aides all come from.

Steve Lorberbaum:

And, it’s fun. I love learning. I actually had to go do a COVID test this morning with a caregiver in a parking lot because she was going on shift and needed a rapid test. And, while we were waiting for the test, we were talking about various dishes that she likes and things that she likes to make for clients if they’re willing. And it’s just fun. I mean, to me, I’d like her to come to my house and cook dinner.

Patricia Dubroof:

Should do an international dinner.

Steve Lorberbaum:

It would be good. We did have a picnic pre-COVID, where we had Latin American food for our Latinos and Latinas caregivers. We had West African food and then we had burgers, dogs, and ribs. So, we really covered the gamut for everybody. And I would tell you, we took a test and I think everyone preferred African food to American food.

Patricia Dubroof:

It was just really well done.

Steve Lorberbaum:

It was, it was good.

Patricia Dubroof:

That’s really good. So, I’m going to ask our visitors, if they have any questions. Do you have anything you’d like to ask particularly of our experts in the field here? And you can either raise your hand or unmute and ask your question, it’s fine. Or if you want me to ask it… Irene, did you have a question? You looked like you were jumping in. Unmute, sweetie. Unmute.

Steve Lorberbaum:

She’ll get there.

Irene:

Here we go. There we go. Actually, a lot of things going on, but from what Steve just said, both my father and my mother had Alzheimer’s, and actually we were blessed that Patricia did some art therapy work with my mom while she had Alzheimer’s. But, what you were saying about the West African population, I luckily got my mom into a home about a mile from my house. So, I visited her almost every day for a number of years before she died. And I was so struck by the caregivers in the assisted living, and they were from West Africa. And I remember saying, You all are so tender and you really care about my mother. And they said, Well, in our culture, there is no Medicare. There is no Social Security. So, we grow up knowing that part of our responsibility as we are middle-aged and a little older is to take care of the older generation. I was so touched by how their culture approached the whole concept of working with older people.

Steve Lorberbaum:

That is true. It is interesting. Many of the cultures where our caregivers come from a culture of caring, come from a situation where they have multi-generational living Look, home care is a relatively new phenomenon in other parts of the world because, here, people are so mobile that… My parents were in New York, my wife’s parents are in Florida, we’re here. In other countries, people don’t stray that far from where they were born. So, the expectation is they will take care of their loved ones here because people are all over the place and so busy and both husband and wife, children are working, it requires us to have the capability to have professional caregivers. And those people that do it, they don’t do it because it’s easy, because it’s not. They do it because they have a passion for it because they want to help people. And they’re really trying with their best heart to do the best. I’m not going to tell you they’re always perfect, because they’re not. But it comes from a passion for caring because it’s not an easy job.

Irene:

Well, just one other thing. And, and I hear you and I feel like I lived it with my mom. We were in a very difficult situation. When you said the home is where your heart is, my mother just really didn’t want to leave her home but had severe Alzheimer’s. And, she also didn’t want caregivers to come in. I mean, she would not open the door and it was really a quite complicated situation. So, I felt we really… She never got over wanting to go home. And, so it was a very complicated situation. I don’t know how you would necessarily deal with that. I felt like it was always an issue.

Steve Lorberbaum:

You know, it is interesting. And it’s hard. We have clients now who are home. So my wife was visiting my father-in-law down in Florida and he looked there and said, When are we going home?” And she said, dad, you are home. This is your house. You live here, you’ve lived here for 50 years. He’s like “Really.”

Irene:

Hmmm.

Steve Lorberbaum:

And he said to her, I have CRS. We’re “What’s CRS? He goes, “I can’t remember shit.” And, at least he has a great sense of humor about it.

Patricia Dubroof:

They can’t remember that acronym. So, they like to tell that joke, but they get screwed up because they can’t remember.

Steve Lorberbaum:

But, I thought it was great. Right now, we’re helping transition somebody to assisted living and it’s going only okay. Because every day, the wife wants to go home, wants her husband. And it does take time. And even when you’re in the home, it’s hard to get somebody to do accept care. A lot of times, we’ve had people where the caregiver shows up and just checks in every couple hours, but doesn’t crowd somebody, gives them space so that they are alone, they are at home, but there’s somebody there maybe in another room or in the basement who says, Hey, you ready for lunch? There are ways. But, it’s a challenge with Alzheimer’s and dementia.

Patricia Dubroof:

Well, we’re getting to the end of our half-hour of Book Chat. Another fascinating educational opportunity to learn about things that we really didn’t know about before. And, I’d like to invite you all to join us at the four monthly events that we offer. And we do have a change for Diana Takashi. She won’t be until July. She’s going to be traveling in June. So, we’re going to switch two people and I’ll update that soon. But our next What’s Your Plan? Where Steve actually runs the interview, is with Janet Griffiths, who is a speech pathologist and a wonderful supporter of all things stroke-related.

Patricia Dubroof:

And then we’re having our Yoga for Self Care Death Cafe, which is an open discussion about death and dying. And, of course, at the end of the month, Book Chat, and it will be with Lauren Kingsland and her book, The Healing Journey. She’s a textile artist who creates fascinating art relating to healing at Georgetown’s Lombardi Cancer Clinic. So, that’s going to be really exciting. I really appreciate Dave coming along today and making this book, creating this book, making it possible for us to give it to our families and caregivers around this area. Steve, thanks for taking the time to fill in the pieces of what’s so important about Montgomery County’s caregiving with Assisting Hands, and thank you guests for being here. So, without any further ado, I say, thank you and goodbye.

If you would like to schedule an appointment to discuss your Alzheimer’s and Dementia care needs or to set up a free in-home evaluation with one of our nurses, call us today in MD at (301) 363-2580. We are located in Bethesda, MD, (301) 363-2580, and Reston, VA, (703) 556-8983.