Article by Alyssa Elting McGuire, MA, MPA
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Most hospitals and skilled nursing facilities adopted electronic medical records years ago. Now, larger community-based facilities, such as assisted living and residential care, are slowly adopting electronic health records; however, the adult care home industry has yet to jump on the electronic records bandwagon.

This lag in adoption is likely due to several factors. Adopting electronic records can be more challenging for adult care home providers without electronic record experience who may initially believe they lack the money, staffing, and infrastructure to implement this change. Fortunately, these potential barriers are not insurmountable.

As larger facilities migrate to electronic record-keeping, it is simply a matter of time before more and more providers in Oregon start implementing electronic record-keeping systems in their adult care homes.
One trailblazer in the area of electronic record use in adult care homes is Shannon Carskadon. Shannon owns and operates Silver Cloud Adult Family Homes in Forest Grove and has been in the business for 25 years. I recently had the opportunity to sit down with Shannon to talk about her experience transitioning to an electronic records system earlier this year.

The system Shannon uses is supported through Beaverton-based company Care Facility Management Systems, LLC, which works with individual adult care home providers to “cost-effectively transition their business operations from paper to electronic records.” Owners Gueipin Xi and Elaine Hartman bring over twenty years of experience providing technical support and security to health care clients.

Interview with provider Shannon Carskadon(Interview has been edited for brevity and clarity)

Have you used electronic records for your homes before?
I used Excel files, which I printed out for licensing, but I had no system set up.

What made you decide to transition to electronic records?
There were current issues [with the hard copy records]. At licensing inspections, the books would be torn apart and nothing got put back correctly. There was too much repetition and similar mistakes. There was a huge potential for medication errors.
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Elaine [with Care Facility Management Systems, LLC] called me and asked if I’d be interested in helping build this program for use in other adult foster homes. The company takes care of online security with a private network, and provides training and support to use the system. I was all for it.

Tell me about the process of transitioning your paper records to the electronic records? How long did it take?
​Gueipin and Elaine provided me with the hardware and software, set up, and training. They also provide the system security, and ongoing technical support for the electronic records system. The support is amazing. Often, providers are isolated. For me, it feels like a professional system with support and cohesion.

At first, it was about 10-15 hours of work at the first of the month. I first started with medications only [eMAR], and it took as long as it takes to enter medication orders. The eMAR is a no fail system. For example, with a PRN, caregivers have to write the result in the record, or they cannot close the entry. Also, I can easily track narcotics using the system.

There was a learning curve, but my caregivers picked it up quickly. We worked on it piece-by-piece until they were comfortable with each section.

Elaine then came to my home with a large scanner. I scanned all resident records into the system and they’re saved in a secure folder. All the [paper] records I have left are in two binders.

What are some other benefits of the system?
​I can send and receive [electronic] faxes to the doctor, and I can have legal representatives electronically sign documents.
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We also use the system to document resident activities and facility records, such as smoke detector testing. I can add reminders and tasks for staff. Caregivers log in with an individual login and see the reminders and tasks. I can run reports and look at tasks that were done. I can also see when caregivers read an email I sent.
My data is secure and consistently updated, and I can access the information securely and remotely. If we have a fire or earthquake, I can get into the system remotely and I don’t have to worry about losing records.

Tell me about your renewal inspection after you started using an electronic records system.
​It saved a lot of time. The inspection at my first home was in January (2019), and the renewal inspection of my second home was in March. I learned from the first inspection, and had everything ready to go for my second inspection. The licensor was in-and-out in two hours and got everything [the licensor] needed. I had no medication violations.

What advice do you have for other providers who are considering the transition to electronic records, but are concerned about either cost, the challenge of transitioning, licensing, or other issues?
​Take the time to learn the program. It’s especially beneficial for multiple homes. I can run compliance reports, and I can check on caregivers remotely and run audits to see who logged in, when, and what actions they took. The program is customized so it meets licensing requirements. If you do your due diligence, the system helps you be compliant.
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Finally, the cost is worth it. It’s less than ink and paper, and that doesn’t include the time saved. We’ve been thrilled with this. I can’t say enough positive about it.

About the Author

Alyssa is founder, principal consultant and training specialist with Oregon Care Home Consulting. She has spent the majority of her career providing program service delivery, regulatory leadership, training development, and program coordination and management in government and not-for-profit organizations. She is passionate about helping current and  future adult care home providers in Oregon successfully navigate the licensing process and provide quality care to seniors. ​

Article by Alyssa Elting McGuire, MA, MPA
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Today, March 8th, is International Women’s Day. March is Women’s History Month. Every day should be a day to celebrate the lives, strengths, and accomplishments of women.

It’s no secret that women make up the majority of caregivers for both seniors and children. It has been researched and written about for years. In families, of course, the care burden is primarily placed on the shoulders of female spouses and daughters. According to the Alzheimer’s Association, “Approximately two-thirds of caregivers are women…and one-third of dementia caregivers are daughters.”

If we look at the numbers for adult care homes, we can see there isn’t a significant difference between family and professional caregivers, in this regard. There are almost 1,600 adult care homes in Oregon, and based on a quick sampling of the State’s provider list, it is plain to see the majority are owned by women.
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I think we’re starting to see a slow paradigm shift where there is less expectation that caregiving is “women’s work,” and where more men are proudly taking on caregiving roles. Anecdotally, I’ve seen a significant increase in the number of men opening adult care homes over the past few years and being the primary caregivers, or working along side their female partners. This is a good thing.

​Even with this slow shift taking place, the majority of caregivers are still women. According to a 2018 Portland State University report on adult foster homes in Oregon, 88% of providers live in the adult care home, and a third had children under 17 living at home. From this, we can conclude that many women are both providing care for residents and their children. This is both a benefit and a challenge. It really is more of a benefit, though, if we consider these women would be caring for children, or having to find care for children, regardless of where they worked.

In this regard, one significant benefit of owning an adult care home is that parents can stay home with their children while working. The adult care home business provides women with the opportunity to be their own bosses yet also care for children or aging parents while working at home and making a solid income. What other business truly provides this opportunity for women?

So, on this International Women’s Day, let’s take the opportunity to recognize and appreciate the work of women around the world, and also here at home. Let’s continue to recognize the important work of adult care home providers and support those providers who are making an important contribution to both the older generations, and the next.

Article by Alyssa Elting McGuire, MA, MPA
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Several years ago, I read an alert in the local paper I had seen many times over. Miriam*, who was 87, had wandered from her adult care home the previous day. She had fairly advanced Alzheimer’s disease. Though her memory and judgement were both strongly affected, she was physically able to maneuver with little issue, as is often the case with individuals who have Alzheimer’s disease. My stomach sank, though, as I continued reading. Miriam was still missing.

I kept an eye out for updates, but unfortunately there was no positive outcome in this case. The news updated the story soon after local law enforcement found Miriam deceased, not far from her care home.

This story highlights an extreme outcome of wandering and elopement, as most cases end with the resident safely back at home. Still, this story reinforces the importance of not becoming complacent. This situation could have happened to any care home provider. It’s an unfortunate story that illustrates the importance of managing wandering and preventing elopement in adult care homes.

Wandering vs. Elopement
The terms wandering and elopement are often used interchangeably; however, they are not exactly the same. Wandering is pacing or aimless walking. This generally takes place inside the home or facility, though it can also take place outside. These are the individuals you see who pace up and down the hallway, seemingly without direction.

Elopement, on the other hand, is the unplanned exiting of the home or facility. It commonly includes “exit-seeking behavior.” This exit-seeking behavior and elopement from the home puts residents at great risk of harm.

According to the Alzheimer’s Association, 60% of people living with dementia will wander at least once.

Who is at Risk?
According to the Alzheimer’s Association, 60% of people living with dementia will wander at least once. Individuals who have some form of dementia are at greatest risk, especially individuals who are in the middle stage of Alzheimer’s disease. Additionally, residents with cognitive limitations who recently moved to your home are at increased risk. Those who have a history of wandering or exit-seeking behavior are at great risk.

Assessing for Elopement Risk
What can you do to recognize and reduce the risk of elopement? Your screening process is the first step. It is important to conduct a thorough screening to find out if your potential resident is at risk for elopement. During your screening interviews, ask if the individual has ever displayed exit-seeking behavior or wandered outside the home or facility. Additionally, if the individual is currently in a facility, review their narratives, care plan, and any incident reports to find out if there is a concern about wandering and/or elopement.

Also consider using an elopement risk assessment tool, either during screening or after the resident has moved to the care home when their condition has changed.
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It is important to understand, even if you’ve conducted a thorough screening, or the resident has no prior history of wandering or elopement, they could still elope from your home after admission.

Tips for Keeping Residents Safe
How do you keep residents with wandering or exit-seeking behaviors safe? Below are several tips and evidence-informed interventions for keeping residents safe. This is not an exhaustive list, as each resident’s needs and situation are unique, but it is a place to start.

• Care plan around wandering. Recognize and document when a resident is most likely to be at risk, and what possibly triggers wandering or elopement. Increase the level of observation.
• Meet the needs of the resident. If a resident is confused about where he or she is and insists he or she needs to “go home,” or “go to work,” use non-pharmacological interventions to address his or her underlying feelings and needs.
• Keep residents active during the day. Provide person-centered activities.
• Install door alarms all exterior doors of the home. Make sure to keep them turned on at all times.
• Consider using an ID bracelet, such as the Alzheimer’s Association Medic Alert + Safe Return® bracelet.
• Ask the resident’s legal representative to contact your local sheriff’s office or police precinct to find out if they have a registry for individuals at risk, like the Washington County Sheriff’s Office Help Me Home Program.
• Make changes in the home environment. Paint exterior doors a similar color as the wall, or put a dark rug in front of doors. Also consider putting a “stop,” or “do not enter” sign on doors.
• Provide a space for residents to wander safely inside. If a resident wants to walk outside, plan for a caregiver to go with him or her.
• Involve the resident’s family and/or legal representative to problem-solve around concerning, exit-seeking behavior.

Sometimes you can do everything within your power to keep residents safe, and things will still happen. It is important, then, to recognize the point at which an adult care home may no longer be the safest placement for a resident with exit-seeking behavior.

Fortunately, what happened to Miriam is a rare outcome in situations when a resident elopes from the home. In most cases, with awareness, prevention, and intervention, you can keep residents who wander safe.

*name and details have been changed

I was recently sitting in a class on the topic of website marketing offered through the Small Business Development Center, and I started thinking to myself, “why do so many adult care home businesses not have websites?” I’ll be the first to admit I’m no marketing expert, but I can say I recognize the value of a small business having an online presence.

Why, as an adult care home provider, should you invest the time and money into having a website or an alternative web presence for your adult care home business? I’d like to give you seven reasons why you need an online presence that showcases you and your adult care home.
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• It’s part of your overall marketing plan. This is your passion, but it is also your business. You need a marketing plan, and you can’t ignore the fact is a major marketing tool these days.
• Families are looking online for housing options for their loved ones. A business website probably won’t come up first on search engines, but you can make your presence known by using services such as Laria Care Finder where people can find detailed information about your home
• It lends you some credibility. In this day-and-age, if nobody can find your business online, they can become a bit skeptical about your business. This is also true if they visit your website, and it’s obvious you haven’t updated it since 2005.
• You have control over the content. You can post beautiful pictures of the inside and outside of your home, and offer any details that might be of interest to people looking to move to your adult care home.
• It gives people a personal connection to you, as a caregiver. Post photos of yourself and give information about your approach to providing care, and why you chose to go into this business.
• It gives you a forum to post client testimonials. Let people know about the great care you provide by posting client and family testimonials (while always keeping confidentiality in mind).
• Make it easy for people to find you. You want to make it as easy as possible for people to find information about your care home and your contact information.

When I was a young college student, my professional goal was to ultimately become an executive director of a non-profit organization, or reach a higher-level position in government. I also wanted to make a good income. Yes, I realized as I got older it was a bit idealistic and naive to think I’d make a lot of money working in the public sector. Over the years, though, what I have learned about myself is that money and prestige are not the main motivating factors in my life. I eventually recognized my original goal was not actually about position or money, but about being in a position with enough authority to make a real difference.
What is your personal definition of success? Is having a high-level position and a high income important, or is having a family and helping others your definition of success? Should we define a successful person as a well-rounded person?
Here are several suggestions to help you find your own success.

• Set SMART goals for yourself. Setting goals, along with perseverance, are the keys to success, however you choose to define that success. Recognize success won’t land in your lap; you have to pursue it using your SMART goals as a guide. Set financial, relational, career, and other goals for yourself. How do you see your life in one, five, or 10 years from now? Also, start saving early for retirement!
• Believe in yourself and your abilities. I realize this sounds completely cliche, but it’s really important. Often highly-proficient people suffer from what is called “imposter syndrome.” This is where knowledgeable and skilled people feel they are faking their knowledge and skills, when in fact, they are highly-competent. Embrace what you’re good at, and do it well.
• Take calculated risks. I’ve always been risk-averse, but I realized nothing great will happen without taking some risk. Starting my own business was a calculated risk I was willing to take. Just like in the stock market, the greater the risk, the greater the potential reward. Consider the possibilities and the outcomes of the risk, and make a choice with which you’re comfortable.
• Follow your passion. Don’t take a job simply because it pays well. You’ll be miserable, and money won’t make up for a job you dread going to every day. Find a job that pays the bills but is also something you truly enjoy.
• Network. I never recognized the importance of networking when I was younger, but as I’ve advanced in my career, I’ve realized networking is vital. Join trade organizations and attend related conferences. Connect with others, not for what you can get out of the relationship, but to work together with people who support your vision and have similar passions and interests.
• Help others and give back. Volunteer for a cause that is important to you. Mentor struggling students, help at the local food bank, visit home-bound seniors, or join the board of directors of a local non-profit. Much happiness comes from helping others.
• Have a good attitude. A lot of businesses would rather hire someone with a good attitude and train them for a particular position, than hire a qualified person with a poor attitude. Choose to have a positive mental attitude.
• See yourself as a lifelong learner. Learning can be formal, such as a college degree, but most of our learning is informal. Find areas in which you would like to improve, and either take additional classes, teach yourself online, read a book on the subject, or find a mentor who is willing to take you under their wing. Never stop learning.

So, you’re thinking of opening your own adult care home for seniors and persons 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.
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 elderly and disabled individuals. This is great; however, this is not a decision to be made lightly. Owning your own adult care home business and being a caregiver for another provider are two very different experiences with their own unique challenges.
Now is the critical time to reflect on your motivation and passion for becoming an adult care home provider, while also considering the realities of this role. Now is the time for a frank discussion. I’d like to talk about seven reasons to open your own adult care home, and three reasons to consider another career path.
Let’s start with the reasons not to open your own adult care home. 

1. ​All you see are dollar signs. Sure, you’re hoping to make money, as this is a business; however, people who go into this field mainly for the money quickly burn out, or realize the money isn’t worth it. When starting out, you might go months without income while you’re working through the licensing process. Sure, private pay residents pay a pretty penny, but you also have to factor in the cost of your lease or mortgage, insurance, food for a large household, and the cost to hire and keep good caregivers. If all goes well, you’ll make a decent living, but there are definitely easier ways to make money.
2. This will be your side business. The state requires you, as the licensee, to be involved in the business. Frankly speaking, everything falls on your shoulders. You shouldn’t expect to simply hire a resident manager and take a hands-off approach to your adult foster home business. 
3. You take issue with government regulation. This field is highly regulated. Let me say that again. This field is highly regulated. Did I mention this is a highly-regulated field? To put this into perspective, the Oregon Adult Foster Home Administrative Rules are over 150 pages long. Not only do you have state regulations, but there are both federal and local regulations you must follow as a small business and an adult care home. To top things off, state licensors will show up to your home unannounced, and you might have periodic visits from APS and a long-term care ombudsman.

Okay, I admit that was a bit intense, but in my time working in adult care homes in both a protective services and regulatory capacity, I’ve seen it all. My purpose is not to scare you away from this business, but to make sure you’re going into the business with your eyes open and for the right reasons.
Now let me give you the reasons you should consider opening your own adult care home business.

1. You are in a good place, financially. You have enough to buy or lease a home and make payments for several months without any income, plus you have the required two months worth of reserves.
2. You have the patience of a saint. Both your residents and their families will test your patience, at one point, or another. You just see this as part of doing what you love.
3. You’re ready to take complete responsibility. You’re willing to be responsible for anything that happens in the home, even if it was not your fault. As a licensee, you will be responsible for what your caregivers do. Hire good caregivers, treat them well, and pay them well.
4. You believe complete privacy as overrated. You’re okay with living where you work, and working where you live. Frankly, you’re excited about living in a multi-generational household. You enjoy talking with older individuals and hearing about their amazing life stories, and you’re looking forward to having several more grandparents.
5. You’re an organizational wizard. The Oregon Adult Foster Home Administrative Rules require you to document practically everything. Are you organized enough to keep resident records, facility records, personnel records, and business/financial records straight, in addition to meeting the care needs of residents?
6. This is your passion and your calling. You know this is what you’re meant to do. Working with older and/or disabled individuals brings you immense joy and fulfillment. You feel called to do this work, and you’re committed to helping seniors live in a safe, home-like environment where you help them remain as independent and engaged as possible. You want to provide top-notch care.
7. You’re ready to commit yourself 100% to the business, and everything that entails.

Now is the perfect opportunity to really reflect on your skills, passions, interests, personality, and lifestyle before you make the leap into becoming an adult care home provider. It can be a challenging, yet highly rewarding career, especially if you go into the business for the right reasons. As the old adage goes, choose a job you love, and you never have to work a day in your life.