Acting as our patients’ / parents’ advocates for home care

There is inherent tension dealing with a policy flawed by its quixotic attempts to distinguish between acute and long-term functional dependencies.

Specifically, they need to learn how to tell when needed services are not available because of Medicare regulations and when they are not available because an agency has a defensive policy that is designed to protect it from aggressive oversight.

Acting as our patients’ advocates for home care can be difficult because practices that meet patients’ needs and serve the public interest can exceed the intent of technical regulations.

Physicians providing care to frail patients who have difficulty leaving home or are not able to manage their own medical care at home should learn about the home health services and home care services that are available in their communities. Make sure all non-licensed care providers are certified and registered at

Several organizations, including the American Academy of Home Care Physicians, can help physicians deal with local home health care agencies. Physicians should identify home health agencies that have practice styles and perspectives that are complementary to their own and then build an interdisciplinary team slowly, patient by patient. Health systems can foster team building with more organizational support.

Why you should consider becoming a Senior Care Auditor

At a policy level, home care services need to be kept under the umbrella of prospective payment, so that the clinical nuances of each patient can be weighed when the consequences of home care are balanced against the consequences of acute hospitalization or long-term institutionalization. This change would prevent cost shifts based upon location of care.

It is our responsibility to take charge of the system and advocate for change that leads to a shared responsibility between physician, home care agency, and patient. Perhaps we should focus on bringing about a system we would want for ourselves, should we ever need it.

R. Miller MD


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What ancient Egyptians believed about Death

Ancient Egyptians believed that upon death they would be asked two questions and their answers would determine whether they could continue their journey in the afterlife.

The first question was, ‘Did you bring joy?’

The second was, ‘Did you find joy?

~Dr. Leo Buscaglia

Learn how to bring joy and excellence to caregiving.  Become an educated and certified informal, professional caregiver, or Senior Care Auditor with

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Two Aging in Place Careers for the 21st Century


As the elderly population numbers rise so has the desire to age in place.  For practical reasons of finances, and personal comfort and freedom, the trend for end of life residence has been to remain at home.  Nursing home numbers have been in steep decline for over a decade and that trend shows no sign of changing.

This new age trend toward permanent residence in one’s own familiar environment does require competent, proactive assistance to unfold as smoothly as possible over time.  Otherwise, either an expensive and/or dreadful assisted living facility is going to be one’s new address.

The older population is increasingly aware of the need for at home care. Their families are, too.  Some relatives step up others simply are not able to for whatever reason.  Both the oldster and the relatives are also aware of the dicey help they are likely to get from their loved one or the average home care agency. After all everyone has heard true stories of the child or care aide from hell, right?

So, if you like to work with frail adults and you need a career with long term possibilities and you do not have thousands of dollars to invest or the desire to get a 2 or 4+ year degree, and you do not want to be at the lowest end of the wage line, what are your options?  Consider these two, both of which open opportunities for you to work for yourself or for an agency in a matter of days or weeks for less money than you might imagine.

Personal care can be safe and enjoyable- if you know how to provide it!

Home Care / Senior Care / Elder Care / Long Term Care Careers for under $200

How to become a CPCA (Certified Personal Care Aide)

Certified Personal Care Aides (CPCA) are the most needed and requested service providers in the at home care industry.  Hundreds of studies of proven that care aides who have been properly educated enjoy their work more, get better quality positions and make more money.

Frail elders need assistance with the ADLs (Activities of Daily Living): cooking, bathing, dressing and grooming, etc.  If you are physically strong and do not mind helping people with their most intimate physical needs, becoming a Certified Personal Care Aide is a good choice.

How do I become a CPCA?  There are only a few Care Aide programs in the country. This online certification program for Personal Care Aides, only available at, is great for both informal family primary caregivers and professional personal care aides (after all, they do the same work).

Here’s why we say this to you…

CertifiedCare offers the only one that is accredited and  comprehensive PCA program that includes Alzheimer’s – Dementia and Special Needs education.  This program is only available online, has 4 modules and requires no other books or materials to complete at your own pace (no deadlines) – Certified Care gives you everything you need to get certified quickly and conveniently all in one package for under $200.

Become a real Certified Senior Care Auditor online at and earn credentials respected around the world.

Home Care / Senior Care / Elder Care / Long Term Care Careers for under $300

How to become a CSCA (Certified Senior Care Auditor)

Harvard Study about Senior Care Auditing

Like oldsters but not so much the personal care work?  Consider becoming a CSCA.  CSCAs check on frail elders who are aging in place and observe their circumstances and general overall condition and make reports.  Typically, the elder, their relative or a loving friend pays for the visit.  At this time, the only way to become an accredited Certified Senior Care Auditor is through the CSCA program at Certified Care (  This program is only available online, has 5 modules and requires no other books or materials to complete – Certified Care gives you everything you need to get certified and registered quickly and conveniently for under $300.

Watch video on Elder Abuse

Believe it or not, caring for an elder is not like caring for a child and the same rules do not apply.  Hurting a frail elder physically or emotionally is very easy to do, and can land you in court or jail whether or not you meant the harm.  Learning how to properly care for a frail senior can be done in person at bricks and mortar schools for lots more money (bricks and mortar are pricey overhead).  Check your local area for that option. Or, if you have a smartphone or access to a computer you can take a full program online, study and test at your own pace, and get certified and registered automatically at for less than $300.

Another good and unique thing about ‘The Org’ is that consumers and agencies check their registry for credentials verification and to find better qualified care aides.

Get affordable, convenient, comprehensive Certified Care Aide and Senior Care Auditing certification at

Did you know that you can go from being a CPCA to being a CSCA easily? This is a good idea from the long term view.  Eventually, most PCAs just do not want the physical demands of ADL care, so they can become SCAs and continue to work with the population they love.

Providing care for those Aging in Place is truly a 21st Century career path with long term life to it. And, the best thing is you do not have to sign up for a lifetime of debt to get into it!

Find out more about Senior Care Auditing here

FAQs about Senior Care Auditing


About Becoming a Personal Care Aide in the USA

By Cathleen V. Carr, JD PhD


Posted in Aging at home, Caregiving Career, Caring for a Veteran, Certified, Certified Caregiver, Certified Caregiving, Elder Care, Elder Care Goods and Services, Professional Eldercare, Senior Care Auditing | Tagged , , , , , , , , , , | 1 Comment

Elephants, Caregivers, and Elder Care

Elephants and eldercare?  Caregivers and elephants?

Got your attention?

Elephants Making Heart Shape with Trunks — Image by © Dianna Sarto/Corbis

I thought I would write about the unseen, yet apparent, bond that often develops between living intelligent beings when they experience life over time, and the journey toward the otherside.  The awareness that ‘this side’ of death involves a complex cooperation between closely living beings such as in the caregiving relationship between the caregiver, the person who is the focus of care, and the other family members.  This is how the dynamic of caregiving seems to me to be; it is the need for one to allow themselves to give much care to another in need, and the corresponding allowing of that care to be accepted by both the care recipient and the recipients extended family of loved ones.  In truth, the act of giving care is a deep experience shared by all.

This bond of care can be shared by human caregivers and their cared for person, whether they be related by blood, friendship, love, marriage or the quid pro quo of a business relationship.

So, what do elephants and humans have in common?

Did you know that elephants are known to develop strong, intimate bonds between friends and family members? There have been reports of elephants forming lifelong friendships with eachother, and they mourn the death of their loved ones. Elephants have been known to linger near loved ones at end of life.   They have been observed grieving over spots where their friends and family members faded and eventually, died.  They have been spotted returning to death locations and gently using their mighty trunks to respectfully fondle remains of dearly departed friends or relatives.

You might say that is interesting elephant trivia, but what does that have to do with human caregivers?  Well, it all goes back to that unseen bond I mentioned earlier.

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I believe many people, even caregivers themselves, under appreciate the unseen bond between caregivers and their charge.  Also, I think many people, including caregivers, underestimate that people with whom we have more than casual contact often influence the behavior of the people with whom we are living or caring for so intimately.  Caregivers can free up family members to sort out who will lead into the future.  Caregivers can inadvertently facilitate the awareness in others of just how much a senior family member means to the group  and how their passing will forever change many things.  Caregivers effect the the lives of other humans with whom they share a home or this type of experience.

The importance of elderly matriarch elephants to elephant societies is legendary: They are the leaders of their herd and the “social glue” for maintaining group cohesion.  The evidence is overwhelming that higher animal species have the same emotions humans do. The only animal species that modify their behavior due to familial bonds to accommodate the needs of an aging member of the family are Cetaceans (whales) and Pachyderms (elephants). 

Whales have been seen to buoy up an ailing member of the pod (an extended family) to keep it from sinking. Elephants have the closest family ties of all animals, the eldest surviving female, the matriarch of a herd, might be the great, great, great grandmother to the youngest; and the others in varying relationships, are mothers, grandmothers, children, sisters, aunts and cousins.  While the older always take care of and shelter the younger they also shelter and accommodate the oldest. 

When the matriarch is dying of old age, and the herd is in an area where food and water are abundant, the rest of the herd will stay with her, comfort her with their trunks, caressing her, talking to her, vocalizing over her, never leaving her side. If in an area where resources are more scarce, while some are foraging, there will always be a group around her comforting her and expressing their love.  

The herd will remain with her body, mourning, for several days, and even years later will still return to fondle her bones with their trunks. Eventually one of the matriarch’s daughters will be chosen as the new leader to follow.  While humans are not so decidedly matriarchal, human families do, even if it is unspoken, accept a new leader in the family and carry on with living.  What’s more, there is an entire industry humans have developed for grave maintenance,  and graveside visiting is even as a family ritual for many people.  I wonder if eons ago we humans learned how to grieve and pay respects from elephants?

It could be argued that the elephants have some humans beat in this regard of devoted elder care.  Nevertheless, this is why I believe caregivers, whether by blood,  love or commerce, have much in common with elephants.  They are (usually) lovingly care for their elder until the end. I find that kind of loyalty and devotion to be not enough acknowledged, let alone heralded.

So, to all you caregivers, hats off and thank you for paying it forward.  May you be blessed with compassionate care when your time comes.

And keep in mind…

Caregiving is an long term responsibility.  If you are interested in being the best elder care provider consider getting un upgraded education and career credentials.  From caregiving 101- day 1 through transitions, from dying and death and afterwards, there is much to know.  Click here for more information and a very special update.

Author: Dr. Cathleen V Carr

Get affordable comprehensive quality care education and credentials here

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Home Care of Elderly: How to Reduce Risk of lawsuit

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Are you a Primary Caregiver for a loved one or client?  Did you know that caregivers can be sued for misfeasance as well as malfeasance.  That means you don’t even have to intend to hurt someone to get sued!  What are you doing for your professional development as a primary caregiver to help improve the odds that you will not catch a elder abuse charge or personal liability suit?  Do you even know where/how you are vulnerable?

The shift towards accountable care models has increased complexity for home care providers -especially Independant Care Aides.  Agency care providers are not much better off, because agency care education is still skimpy, if it exists at all, beyond basic orientation.

Learn key performance outcomes that truly reflect quality outcomes and will guide you thru clear paths to improvement, immediate results, and reduced liability.  It does not take long to get all the info you need to work with confidence, less stress, and happier clients/loved ones.

It is easy to get this self education responsibility out of the way – even from your own couch at home.  How?  Register at for distance eLearning online certification and credentials registry.  You can do the work even from your smart phone!

For almost 10 years has set the standard for modern home caregiving.  What are you waiting for?  Save up, get family-friends-clients to help with the money- and get started ASAP!  Reduce abuse and protect yourself from lawsuits.

Read more about CertifiedCare caregiving credentials 

Need a career in LTC that is not so touchy feely?  Become a Certified Senior Care Auditor!   Get quick FAQs about Senior Care Auditing as a career for those who like to work with the elderly

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Hiring? How to Check a Caregiver’s References

Whether hiring for a loved one (or two) at home or hiring a new employee for a small or large corporate agency, it is important to know who you are really getting.

First time hiring or replacing of caregivers can provoke anxiety, and rightfully so.  This person will be in a home and intimately involved with a vulnerable person.  Financial accounts and computers can be accessed.  Worse still, physical or emotional abuse can take place and much harm done before it is caught and stopped.

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Caregivers should have broad spectrum education prior to hire.  They should know about professional boundaries and how to communicate with family members and their clients.  They should know how to be prepared for any emergency.  They should know how to keep the days from being too boring and lifeless.  Of course, check a certified Personal Care Aide registry to find that out.  But, even if they can demonstrate that they know those things, how can you know what they are really like on the job?  In addition to asking for caregiving credentials and certifications, you must also ask for –and check- references.

Always do a little research before you sign a contract with a home care or home health agency or hire an independent Home Health or Personal Care Aide. Sure, you can check the Better Business Bureau, but sometimes competitors’ plant complaints, so be careful of relying solely on that information. It is better to confirm interview claims of job experience by checking  prior hire references.

Ask for 2-3 references — and be sure to actually talk with the person referenced.  Get references from past employers – not family members or friends.  Now, what do you do If a care provider is new the business and does not have 2-3 past employers?  All you can reasonable do is trust your gut, focus on criminal background checks,  personal care aide education/certification credentials, and get a nanny cam- and use it.

So, how do you ‘check a reference’?

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Call an agency during business hours ( but not call during lunchtime) or a private client during the week between 7 and 9 pm, unless during the day makes sense. Ask the caregiver, who should know.  Otherwise, call on the weekends between 10 am and 8 pm. Identify yourself and clearly state up front that you are calling for a reference check on a person you are considering hiring for a job as a caregiver.  Clarify if the job you are hiring for is to provide for child care or elder care, and whether the care recipient has special needs.

Use these questions to check a caregiver reference, along with any of your own that are germane to the care experience:

  • How did you find the care aide before you hired them?
  • How long was the care aide or agency employed by you and when?
  • What were the circumstances which required the hire?
  • How well did the care aide fit the requirements?
  • What did you think of the quality of care provided? (Not how nice or sweet they were!)
  • Were there transportation challenges or other reliability problems?
  • For an agency, ask if they continuity of care was satisfactory or was there always different people assigned?
  • Did you have a good experience? Why or why not?
  • What kind of problems did you have, if any? Were they quickly and easily resolved?
  • Would you hire the person again?
  • Would you recommend them to your best friend or a relative?
  • Why did the job end?

If you follow these simple steps you can rest more assured that you will make a good choice in care provider.

Most people will understand why you need to check a reference.  Do not ignore the red flag if references are not provided or if you cannot reach a prior client after several attempts.

Good luck and happy hiring!

By Cathleen V. Carr

Need an affordable, convenient, quality caregiver certification program for yourself or an employee?  Online caregiver certification


Posted in Advocacy, Aging at home, Caregiving Career, Certified, Certified Caregiver, Certified Caregiving, Elder Care, Elder Care Goods and Services, Home and Health Care Agency, Nursing Home & Assisted Living, Professional Eldercare, Senior Care Auditing | Tagged , , , , , , | Leave a comment

FINAL RULE: Skilled Nursing Facility 30-Day All Cause Readmission Measure (SNFRM)

In the Fiscal Year (FY) 2016 SNF Prospective Payment System (PPS) final rule, CMS adopted the SNFRM as the first measure for the Skilled Nursing Facility Value Based Purchasing (SNF VBP) Program. The measure is defined as the risk-standardized rate of all-cause, unplanned hospital readmissions of Medicare beneficiaries within 30 days of discharge from their prior hospitalization. Hospital readmissions are identified through Medicare hospital claims (not SNF claims) so no readmission data is collected from SNFs and there are no additional reporting requirements for the measure.

Readmissions to a hospital within the 30-day window are counted regardless of whether the beneficiary is readmitted directly from the SNF for after discharge from the SNF as long as the beneficiary was admitted to the SNF within 1 day of discharge from a hospital stay.

The measure excludes planned readmissions because they do not indicate poor quality of care.

The measure is risk-adjusted based on patient demographics, principal diagnosis from the prior hospitalization, comorbidities, and other health status variables that affect probability of readmission. In calculating the readmission measure, unplanned readmissions are identified using a modified version of the CMS planned readmissions algorithm.

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Other exclusions include patients who were hospitalized for medical treatment of cancer, do not have Medicare Part A coverage for the full 30-day window, and do not have Part A coverage for the 12 months preceding the prior hospital discharge. Additional exclusions include SNF stays with:

  • An intervening post-acute care admission within the 30-day window,
  • Patient discharge from the SNF against medical advice,
  • Principal diagnosis in prior hospitalization was for rehabilitation, fitting of prosthetics, or adjustment of devices,
  • Prior hospitalization for pregnancy, and
  • Other reasons documented in the measure’s technical specifications.

For more information on the SNF VBP Program, visit the CMS webpage at:

For questions about the SNF VBP Program, contact:


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