Serving the home health, home care and hospice industry since 1999.

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by Tim Rowan

There was quite a collection of brain power in Redondo Beach, L.A. this week when Honor hosted its first annual "Sage" conference.

Dr. Bill Thomas is a global leader in the effort to challenge ageism. Founder of the "Eden Alternative" and the "Green House Project," Dr. Thomas' three decades of work culminated with a four-year journey across North America, when he engaged elders in conversations in 140 communities about what concerns them the most.

Yoky Matsuoka, Ph.D., is a Google VP who has been a university professor and co-founder of "Nest." She received the MacArthur Award, was named one of the "Brilliant Ten" by Popular Science magazine and recognized as one of the "Top 10 Women to Watch" in 2010 by Barbie. (Yes, Mattel’s Barbie has an award to honor successful women.) Dr. Matsuoka has over 300 issued or pending global patents.

What do older people want to be called?

The discussion at Honor's meeting turned to the language of aging. Surveys are revealing which descriptors to dump, which to use, and which might be coming next.

"The only people who want to be called 'Senior' are high school freshmen and sophomores."

"Elderly," "geriatric," and "senior citizen" are out."

An NPR survey found preferences for "older adults," "agers," and "Boomers" (but not Baby Boomers).

On the fringe, some politically correct suggestions included:

  • "person over 65"
  • "perennial"
  • "oldster"
  • "age-venturer"
  • "longeviteer"
  • "sager"

The list of speakers and panelists goes on and on. Better to quote them their most memorable statement than to call up each one's bio. Attendees were mostly personal care home care agency owners. They heard research and opinions like the following from these two and from other aging specialists from the motion picture industry, the Alzheimer's Association, medical school professors, and an Anaheim city councilman who is also a home care agency owner.

  • "The most human thing about humans is a grandmother holding a baby while the mother goes out to find food."
  • "The great irony is that aging hasn't changed. Some people have always lived to 80-100 years of age. What is different today is that many more do so."
  • "The best work with elders takes place when we stop doing things for them and start doing things with them."
  • "In our culture, we attach stigma to things that are normal: facial wrinkles, changing hair color, not being able to run the 50-yard dash as fast as when you were a sophomore. These are normal, not things to fret over."
  • "Aging in place does not necessarily mean dying in the home where you raised your children. What elders want is to live on their own terms, where they want to live and how they want to live. Autonomy, dignity, and choice. Well-meaning adult sons and daughter can deliver a crushing blow by imposing their own choice on where their parents live."
  • "It is almost impossible to be a human elder when you are alone. Aging is an intensely social phenomenon. Sometimes making human connections is the best medicine we have to offer."
  • "Loneliness is as damaging to longevity as smoking 15 cigarettes per day."
  • About dementia: "If you want to reduce your risk, exercise." If someone wants to live at home with dementia, focus on helping the caregiving spouse. "The burden of supportive services must be spread as widely as possible."
  • Asked whether the name "home care" is still valid if the goal is living where they want rather than staying in their family home, Dr. Thomas thought for a moment and said, "When we change our mission to helping people live where they want and how they want, when we change the focus of what we do, then we will be worthy of a new, better name."

Yoky Matsuoka came to this country from Japan to become a professional tennis player. When injuries interfered, she discovered a love of technology. Over the years, she found that one thing can interfere with one's best-laid plans there as well: human behavior.

A brilliant robot for healthcare worked find in institutions but the Wi-Fi-enabled machine failed in home care. "I forgot my Wi-Fi password." "I don't know where I left my phone." Etc. So she pivoted to a thermostat managed by artificial intelligence to save energy. It did not. In fact, it wasted energy.

"We would set the cooling system at 72 and very gradually raise it to 76 throughout the day," she said. "The elders in the trial would walk past the thermostat and freak out. '76! Oh, no!' And they would manually crank it down to 68. We abandoned that AI product."

She also had advice for inventors and entrepreneurs. "It is hard for a giant like Google to innovate. They set a direction and need to focus on selling what they have, not immediately replacing it with something a little better. The ideal situation is for small startups to do the innovating and then be acquired by a giant."

She frowned and added, "You just have to hope they didn't acquire you in order to kill your idea so it wouldn't compete with theirs. That is often how it works."

About the Workforce Shortage

Swallow hard and read on. Among all the excellent panel discussions, the details of staffing were the hardest to hear. Moderator Andrea Cohen, Co-Founder and CEO of HouseWorks, and panelists Shannon Sedgwick, Senior Economist with the L.A. County Economic Development Corporation, Jessica Ku Kim, Senior Director of Workforce Development at the same County department, and Jenna Hauss, Director of Strategic Initiatives and Community-Based Services for ONEgeneration, a non-profit that puts seniors and infants together for mutual benefit, laid out the facts for all to hear, whether they wanted to or not.

  • Median home care turnover rate in 2018 was 82 percent, a 15 percent increase from 2017.
  • Median pay for care workers is $11.12 per hour.
  • 20 percent report they have interviewed at Amazon.
  • Latest forecasts estimate 7.8 million caregiver job openings by 2026. 1.4 million of those will be created by growth and aging; 3.6 million by people leaving a job and, of those, 2.8 million leave for jobs outside of home care.
  • Home care is a "local industry," meaning the demand is a factor of population, not of the health of the economy.
  • Innovations in staff recruiting and retention include:
    • nursing students may work as intern caregivers for college credit
    • persons with criminal records are often safely employed and anxious to work
    • a senior living facility opened its own nursing school. It's turnover rate is currently between 9% and 13% and it is helped by 4,000 volunteers, many of them elders themselves

One last piece of wisdom emerged from these discussions that every home care owner needs to hear and take to heart. Scholarly research into staff retention has found that low-wage, low-skilled caregivers stay with an employer for three reasons. In order of importance:

  1. Respect
  2. Hours
  3. Hourly pay rate

Owners surprised to hear results essentially upside-down from their own assumptions questioned survey findings but were assured that the research is valid that found a higher departure rate by care workers who are not treated like professionals and who do not hear frequent expressions of gratitude and admiration, even if they are paid more.



©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.