Article by Matt Gannon, Communications Coordinator & Trainer with Oregon Care Home Consulting & Training.

She walks quietly downstairs with the dogs to start the coffee and let them outside so they can get their fill of the morning air and do what dogs do. She prepares breakfast for our three dogs, two cats, a guinea pig, and a bearded dragon. She dishes their bowls and whispers lovely things to each one, but not before administering insulin to our geriatric and diabetic cat.
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She runs out to the car to start the heater so she doesn't freeze on her way to work.

Now, it is time to prepare our kids' lunches for school, put fresh water in the pets' bowls, and put dog cartoons on TV so the dogs can finish their sleeping on the couch with full bellies in the living room next to the Christmas tree - while listening to Bluey, or some such show, before the rest of us wake. 

​She bundles up in her winter coat, grabs her coffee, and tells herself, "You got this, and you know why you are going to go and grind once again - you know why you are doing this. Deep breath....let's go." She goes out to the bitterly cold morning air and falling rain, and into the car. The house is still asleep, the sun has not yet risen, Christmas lights twinkle in the foggy rain from each home, and she's on her way.​

It's a short drive to the memory care community in our town, where there are elders who live out the remaining chapter of their lives. This is your mom, dad, grandma, grandpa, great-grandma, great-grandpa, neighbor, the people you always saw at church, who may have worked in your schools, built or maintained your streets and bridges, and who played a part in the community and society of your town.

People who lived full lives - who've raised children, grandchildren, and great-grandchildren, served their country and did it all the best way they knew how. And, now, in their later years, fate has delivered - dementia. This has landed them a residence and room at the memory care building and a seat at my wife's tables. These are our elders, and my wife, our children's mom, feeds them.

The time from the alarm waking her to pulling up to the parking lot is barely enough to prepare herself to answer the usual questions: who will show up today to work and who won't? Has that resident I love so much and who tells me she loves my food passed away since I was last there? What condition is my kitchen in and how far back will it set me to have to pick up the pieces of what someone else was supposed to do? Many unknowns, but one thing is known well -  the chances of walking into what "should be" is a rare and mostly non-existent occurrence. 

​No matter, people are depending on her, and the residents need to eat. She tells herself, "You can do this, and no matter what happens, they need me so they can eat, so here I am."​

Fighting back the emotions of facing the hard grind all over again, likely having to do it short-staffed (double the work), she stops for a moment and thinks of some of the brave, bleeding hearts who do work there, have worked there, and the good work and care they provide - her staff who she inspires with her unwavering standards and integrity to do the right thing always (and to wash their damn hands!), even when no one is watching because the residents deserve it. They look up to her and care about her and make it a point to let her know so, and she finds the strength to keep on going and do what needs to be done - she feeds our elders. ​

I worked as a dietary assistant, activities assistant, and certified nursing assistant in memory care for nearly a decade. I then worked as an administrator for memory care for some years. My private caregiving practice also led me to visit and serve my clients in many memory care communities across the Metropolitan area for over two decades. I know memory care and I know dementia care - it is my life's mission and passion to serve our elders who live with dementia.

The doors are locked, they can't get out, and people are losing who they are and what they have as they try to make any type of sense of their day-to-day life in memory care. To say the work can be hard is an understatement. It is not because of the residents who make it hard, they make it all worthwhile in fact. Rather, it is the lack of consistency and longevity of a quality team unit that gets in the way. It is certainly not for everyone. ​​

Taking care of yourself to better take care of others is talked about in this game, but put into action - training, mentoring, and support to see to it everyone can do this - this is not reality. So, instead, you have to save yourself to take care of yourself and you can only depend on yourself to do it, and lean on those who love you, to make sure your self-care is strong and true. And, wherever that leads you is the path you must be walking - even if it means your time in that particular place comes to an end at some point in the future.

When you care deeply about the work it can hurt deeply. It is not hard to care for the people, it is all of the rest of the crap that usually gets in the way. My wife has shown so much more than mere strength. She is a model of a giving heart of service, standing up for what is right, and holding people accountable - all of this to make sure the elders are fed.

What she teaches our children through the work she does is a lesson that is second to none in this world. We love her for it, we are proud of her, she is strong and brave and caring, and willing - all necessary traits the residents need in their support. She has these traits no doubt, and has exemplified this time and time again, day after day, seasons after season, year after year - she feeds our elders. ​

The day is done, and she arrives home to our menagerie, her family, who couldn't be happier to see her, knowing the work she's done, the differences she's made, the fatigue and sometimes heartache she feels, and the quality and taste of all she's put out in the work day to so many.

​How fortunate are we all, that she feeds our elders?​

Article by Alyssa Elting McGuire, founder of Oregon Care Home Consulting & Training.

In our recent weekly newsletter series on the topic of business ethics, we explored how integrity in the workplace is more than a personal virtue—it creates a ripple effect that shapes an entire organization, and even the entire adult care home field. See the previous articles below:
​1. What are Your Guiding Values?
2. The Ripple Effect of Integrity

Today, I want to dig deeper into the importance of integrity and experience in consulting, especially within the care home industry.

Lately, I’ve experienced an increase in referrals from prospective licensees looking to start a care home who felt stranded after working with someone else on their licensing process. These individuals stated they were care home consultants, but no matter how good their intentions, they provided incomplete or outdated guidance. We discovered one person was using modified copies of our forms from several years ago that we created for the benefit our clients, and that we regularly update to make sure they continue to meet licensing requirements. 

Unfortunately, the future care home providers who reached out to us after working with these other individuals were left with incorrect documents and information, stalled progress, and in all cases, had to withdraw their applications, sometimes multiple times, before seeking proper assistance. Not only were they out money, but time. 

Similarly, I’ve seen care homes that were deemed compliant by individuals touting themselves as care home inspectors, only to uncover serious deficiencies: unpermitted remodeling, non-ADA-compliant ramps, and bedroom windows too small to meet safety standards.

These oversights carry significant consequences, underscoring the irreplaceable value of both expertise and integrity in this line of work.

Integrity is invaluable, especially when lives and livelihoods depend on it. Our business is built on proven success stories over the past six years, backed by our core values: integrity, professionalism, equity, respect, passion of purpose, and ethical leadership.

Consulting is not just about filling out forms. If it were, my job would be much easier! What we do is about having a deep understanding of processes, applicable regulations, trust from the powers that be, and understanding how to successfully navigate it all for the benefit of our clients.

With 13 years of experience in adult foster care homes in Oregon and unique insights from our team—including a founder who worked as an adult foster home licensor and a co-owner with nearly 30 years of expertise as a building code specialist—we provide the guidance needed to avoid pitfalls and achieve success.
Surface-level knowledge isn’t enough to tackle the complexities of licensing and compliance. Success requires a detailed understanding of the system, the ability to troubleshoot issues, and a proactive approach to identifying challenges before they arise. This is the value of experience. 

Do we know it all? I’ll be the first to tell you the answer is “no" - we're not bookkeepers, marketing professionals, attorneys, or placement agents. That's why we specialize in what we do know, which is the licensing process, building code, AFH/ACH Rules, and compliance, and we recognize how this all plays a significant role in our clients' success. Most importantly, due to years of experience, we know where the roadblocks and pitfalls are located along the road and how to navigate the road successfully. We specialize in what we do and partner and contract with others who specialize in what they do to provide comprehensive support and services along the journey.

We don’t just provide services; we build partnerships. We walk alongside our clients, helping them avoid pitfalls and navigate detours. That’s the level of expertise and integrity you need in a consultant, and this is essential in the care home industry. 

Not all consultants are created equal, and this goes for any line of work. Many claim to understand licensing or compliance, but a little knowledge can be dangerous. Working with individuals who only see part of the complete picture often leads to more problems and expenses in the long run.

Here’s how to assess a consultant’s qualifications:

1. Relevant Experience: Do they have extensive, hands-on knowledge of the licensing process and/or the operational requirements of a care home?
2. Reputation: Are they well-regarded in the community? By licensing agencies? By community partners?
3. Legitimacy: Do they have a legitimate business? Is their business registered with the Secretary of State? Are they following applicable business-related requirements that they also expect you to follow?
4. Insurance and Contracts: Do they carry professional liability insurance and use clear service contracts?
5. Proven track record: Do they have history of success with other clients? Are you able to verify this information?

The care home industry is serious business with significant responsibilities. The value of integrity cannot be overstated. It ensures that every document, inspection, and decision is backed by expertise, professionalism, and genuine care for your success.
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Partnering with a consultant, and other professionals, who combine expertise with integrity ensures you’ll receive accurate, reliable information that prioritizes both the safety and well-being of those in your care and your success.

When you’re ready to invest in your care home’s future, choose professionals who can support you on your journey, and who stand on their principles. Because in this business, integrity isn’t just a value, it’s the foundation on which to build a successful business. 

Article by guest author Alexis Baker, MT-BC, CDP, owner of Bridgetown Music Therapy

As a music therapist, one of the questions I am asked all the time is “What exactly is music therapy?”
 
The formal definition of music therapy as defined by the American Music Therapy Association is:

“The clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.” (AMTA, 2019)
 
This definition can be broken into two parts:

1. It involves the use of evidence-based music interventions designed to accomplish specific goals based on the needs of an individual or group.
2. All of this happens within a therapeutic relationship, and that person is a credentialed professional music therapist.

 
To break these parts down further, evidence-based interventions are simply music-oriented experiences or activities such as singing, playing an instrument, moving to music, and songwriting, all of which have been studied and shown to be effective in promoting health and improving quality of life.
 
Next, music therapy is always goal oriented. The focus is using music to achieve specific, measurable goals and objectives. A few examples of general goal areas include improving communication abilities, increasing range of motion, reducing stress/anxiety, and promoting social connection. The music therapy process involves assessment, treatment planning, implementation, documentation, and evaluation.
 
Finally, music therapy is based on a therapeutic relationship which implies there’s an established relational bond involving rapport and consistency. This person is a professional board-certified music therapist. As a side note: According to the Certification Board for Music Therapists, there are currently only 10,000 board-certified music therapists in the U.S.
 
Music therapists go through rigorous training to enter the field as a certified and highly-trained professional. They complete a specialized bachelor’s degree in music therapy which is like a double major. Coursework covers a wide variety of areas including music theory, ear training, music history, psychology and human behavior, human anatomy, and therapeutic applications. Music therapists are required to be competent on four instruments: guitar, piano, voice, and percussion. Training also includes 1,200 clinical training hours. Following completion of all coursework and hours, they must take and pass a national board exam to earn the credentials MT-BC (Music Therapist-Board Certified). Recertification is every five years which requires the completion of 100 CMTE (Continuing Music Therapy Education) credits.
 
Music therapists can work with any age, all the way from babies in the womb or preemies in the neonatal intensive care unit (NICU) to older adults and end of life/hospice. Music therapists work in many kinds of settings including adult day programs, childcare programs, long term care, hospitals, schools, rehabilitative facilities, community health centers, hospice care, and private practice. Music therapists serve a wide variety of populations in these settings including but not limited to people with developmental disabilities, physical disabilities, mental health conditions, issues associated with aging, dementia and various other diagnoses, disabilities, or diseases. 

It’s exciting to hear about what music therapy is, but many people struggle to recognize it as a clearly defined practice. They see anything music-related and want to call it ‘music therapy.’ It’s true, music can function therapeutically in a myriad of ways, but the formal practice of music therapy is specific and limited, so let’s talk about what music therapy is not.

To put it simply, music therapy is not music education or music entertainment. It can involve aspects of education and entertainment. It can even sometimes look like education and entertainment, but music therapy is different from these two fields.

Music education is the structured teaching and learning of music theory, practice, and appreciation. It involves more than just learning to play instruments or sing—it encompasses a wide array of skills and knowledge, including reading music, understanding rhythm, harmony, and composition, and exploring music history. Music education fosters creativity and cultural understanding by introducing students to a variety of musical genres and traditions from around the world.
 
At its core, music education helps develop essential cognitive and motor skills. Studies have shown that learning music enhances memory, improves problem-solving abilities, and sharpens attention to detail. It also boosts emotional intelligence by providing an outlet for self-expression and understanding the emotions conveyed through music.
 
For learners of any age, music education often starts with basic concepts like rhythm and melody and gradually progresses to more advanced topics such as composition and performance. In academic settings, it is commonly taught through choir, band, or orchestra programs, allowing students to collaborate and learn teamwork.
 
Beyond the classroom, music education is accessible through private lessons, community programs, and online courses, making it available to people of all ages. Whether someone aspires to become a professional musician or simply wants to enjoy the personal and social benefits of music, education in music nurtures a lifelong appreciation for this art form while enhancing overall personal development.
 
Music education plays a vital role in shaping well-rounded individuals, enriching both their academic and emotional lives.

Music entertainment, on the other hand, is more of a receptive experience. It’s enjoying music for the value of being entertained.
 
Music entertainment is the broad field of performances, events, and productions centered around music as a source of enjoyment for audiences. It encompasses everything from live concerts, festivals, and DJ sets to recorded music, streaming services, and music videos. Whether experienced in person or through media platforms, music entertainment is a universal form of enjoyment that transcends language and cultural barriers.
 
At the heart of music entertainment is the connection between artists and audiences. Musicians and performers create experiences through their music that can evoke emotions, tell stories, or simply provide a fun atmosphere. These performances might be intimate acoustic sets or massive stadium concerts, where production elements such as lighting, sound effects, and visuals further enhance the experience.
 
In today’s digital age, music entertainment has expanded beyond live events to include various digital formats. Streaming platforms like Spotify and YouTube allow people to access vast libraries of music from artists worldwide, while social media enables fans to interact with their favorite musicians directly. Music videos, television shows, and films that feature or are centered around music have become key parts of the entertainment industry.
 
Ultimately, music entertainment is about creating memorable, emotional, and engaging experiences. It serves as a means of relaxation, celebration, and connection, providing joy and excitement for individuals and communities alike. From the casual listener to the devoted fan, music entertainment touches lives by bringing people together through the power of sound.

We are now aware there’s music therapy, music education, and music entertainment. All of these are important, and each serves various purposes. But what if something doesn’t fit the definition of formal music therapy? Or it’s not quite pure music entertainment, or it doesn’t fall under ‘music education’? There is one more term to introduce you to: ‘music engagement’.
 
Engagement is somewhat of a buzzword recently. Music engagement doesn’t have a formal definition, but it does offer a helpful description for things other than pure music therapy, entertainment, and education. Music engagement can incorporate elements of all three of the above. Music engagement is participating in music-based activities for the benefit of participating in music-based activities.
 
As a board-certified music therapist, I’m a huge supporter of music therapy services; however, having been in the field for the past 10+ years, I know that music therapy services can often be expensive and inaccessible. There just aren’t enough music therapists to serve all needs everywhere, especially within senior care. It can also be cost-prohibitive or difficult to access geographically. For example, what about rural areas? This presents several problems for which I wanted to find a solution.
 
I created our virtual music engagement program for many reasons. At the center of it all is my passion and mission in life to use music to make a difference in older adults living with dementia.

Second, this program was created in response to Covid. It started out as an alternative when the pandemic was limiting activities. It can still function in this way. Beyond Covid, however:

• it’s a cost-effective solution to life enrichment through music
• it’s a turn-key activity for busy care home providers and staff
• it’s accessible 24/7 with lots of variety to choose from
• it’s a high-quality alternative when other options simply don’t fit the budget or are inaccessible.

 
Finally, I created it as a music engagement program, for individuals and groups to ENGAGE with music for the purpose and benefits of engaging with music!

For more information about Bridgetown Music Therapy and our virtual music engagement program for care homes, click here.

What I love most is the satisfaction I get when I see a resident move in to our home, settle in, and blend in with other residents and begin to regain some of their strength back. I love the joy and contentment I see in the faces of residents' families when they know their family member is well taken care of.

​Also, I am a father of two girls, ages 5 and 8 years old, and I love sports - especially soccer and basketball. 

Orchard Adult Care Home: A Serene Place to Call home
Where Seniors and Adults with Disabilities Receive the Care and Respect they Deserve
Phone: 503-618-1133
[email protected] 

Article by guest author Valli Brunken, MBA, BSN, RN, owner of Nightingale Consulting.

I get this question quite a bit and there are several options for the LPN who is owner/operator of an AFCH.

1. Let the LPN license lapse and not renew (focusing only on the owner/operator role of their AFCH). This is not my recommendation but is certainly an option. Please note that as an unlicensed person the former LPN could provide the same clinical care that the unlicensed personnel does, but no Nursing tasks can be performed without delegation by an RN.
2. Continue as an owner/operator and work “on the side” as an LPN in a setting where you can continue to gain practice hours for nursing license renewal and where you can be directly supervised by an RN.
   
   
3. Enter into an LPN-to-RN bridge program to become an RN. In these programs, you can receive an Associates Degree in Nursing (ADN) which will then allow you all the privileges of an RN (including performing your own AFCH nursing delegations to unlicensed staff).  This can then be a stepping stone to pursuing the Bachelor of Science in Nursing (BSN). This is the step that I most often recommend. It is available in most community colleges and some online programs.  It typically takes 18 -24 months to complete.  If you are doing it to provide a higher level of care or for supervising your staff and residents, it’s possible it could be considered a business expense and deducted from taxes (consult your tax accountant to be sure). 

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​Ultimately, I strongly recommend getting the BSN eventually because many settings are requiring it and you never know what you’re going to want to do down the road.  It’s always best, in my view, to give yourself as many options as possible for maximum flexibility in your nursing practice.

Here is a short list of some local programs in Oregon that offer LPN–to–RN Bridge Programs (these are not all-inclusive):

• Mt. Hood Community College
• Clackamas Community College 
• Chemeketa Community College 

I was born in Romania, as are many providers, and that is where I earned my nursing degree. Shortly after, I escaped the Communists by migrating to Belgium for about a decade. I went back to school in Belgium and France and got two master’s degrees, one in geriatrics and nursing home administration, and another in business administration. I speak Romanian, French, and English. 

I came to the United States in 1995, and in 1996 I fell into working in an adult care home by accident – a friend begged me to work in his house so he could go on vacation. I agreed and quickly I discovered it feeds my soul. Because Romania is a culture of multi-generational living where we care for our elders, my background made it feel like a natural fit. I love helping people when they most need it, and I found the relationships that would form with the elders very meaningful. Six months later, I opened my first adult care home. I now have three classification 3 homes, and there is nothing else I’d rather be doing. ​

Updated and reposted from March 2019.

You’re thinking of opening your own adult care home for seniors and individuals with disabilities. Congratulations! This is an exciting decision. Maybe you’ve worked as a caregiver for several years in an adult care home, assisted living facility, nursing facility, or as an in-home caregiver. Perhaps you've worked as a nurse and would like to take it to the next level and be your own boss.

You’ve now decided you’d like to take the next step and become an adult care home provider with your name listed on the license. You most likely feel passionate about caring for seniors and individuals living with disabilities. This is great, though this is not a decision to be made lightly. Owning your own adult care home business and being a caregiver for someone else are two very different experiences with their own unique challenges and benefits. 

When I started my own business in 2018, I had a vague idea of the level of commitment it would take, but in retrospect, I really had no idea. I consistently work more than I've ever worked before in my life. I haven't taken a true vacation in four years, and I regularly work 12-14 hours per day and work at least six days per week. Like most small business owners, I work a lot, but I also recognize I have the luxury of having some down time because I'm not caring for others. I've heard this same feedback from new providers, as well. They didn't realize how much time owning their own business would take, especially a business where you're providing 24/7 care to other people. ​

​Frankly, running a small business is not for everyone. Sometimes the best advice I can give someone is to consider a different path. Often, providers mention they spend a lot of time on business management, rather than solely direct caregiving. If you simply love being a caregiver, you might want to consider remaining a caregiver and working for someone else, but working in a capacity with more responsibility, rather than owning your own business. If you have management and leadership skills, you're highly organized, have strong ethics, and you're business-minded while also passionate about high-quality care, then owing a care home business might be the right move for you. It's an added benefit to have prior experience running a small business.