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Article by Matt Gannon  Life is fundamentally about relationships and our connections to others. Humans operate to gain and maintain control (in varying degrees) within relationships: to ourselves, with others, to our environment, spiritually, and to our place in the larger world around us. This is like a balancing act we operate throughout our lives. We ascribe meaning and purpose to the different relationships. Many relationships will shift and change over time, while others remain relatively the same. Within our relationships we have choices and we maintain control of our time, effort, participation level and, the interests being served - all of which shape who we are, our characters, and our identities.  The Dementia Experience Dementia is progressive. Over time dementia demands a different type of communication to find and keep positive connections in relationships. Dementia creates a loss. For the people living with dementia, there is a progressive loss in abilities and independence. When we attempt to understand the dementia experience, what can become more understood is how a person living with dementia is losing a sense of control in their lives. One thing I have come to know well in my time of caring for people living with dementia is how life for them tends to become less about content and detail - and more about feelings. I also know people living with dementia do not lose their ability to feel, understand and recognize the emotion they are having when feeling it. They may not be able to understand and express fully why they are feeling what they are, but the feeling itself is familiar. Emotional memories are very deep-rooted memories and are still often more accessible and familiar (especially when utilizing the senses). The emotional experiences of a person living with dementia can be broken down into two categories: positive & negative. They may be feeling one way or another, or a combination of both at times, but how they are feeling and what they are feeling matters when it comes to providing care. Over time dementia demands a different type of communication to find and keep positive connections in relationships. What is Person-Centered Language? When providing person-centered care and communicating with a person living with dementia, it is important to do all we can as providers so the person ultimately feels more of a sense of control - this becomes our goal in each moment. It starts with an acknowledgment and validation to the moment you share, and to what emotion you sense is being felt. This can be done by communicating with feelings, both verbally and non-verbally. What is person-centered language and why is it important when caring for people who are living with dementia? It is about respecting the individual in our care approach at all times. Once we know the person we are caring for, we can plan and deliver care to them based on our knowledge of who they are as a unique person who also happens to be living with dementia. As you read the phrases below, ask yourself how does it feel to switch from one phase to another? I have a dementia resident.......
 When we move to using person-centered terms, our approach, attitude, tone, body language, and empathy can change. It will benefit both us and the person living with dementia because what we do and say can have a significant effect on how they are feeling. If we carry the right mindset, the right attitude, and the right outlook then we are ready in our right care approach. Less is often more when choosing the words we say as we communicate to a person living with dementia. Show more, talk less is generally a good formula. We pursue short, brief, and repeated words and sentences as many times as necessary. We strive to create words together that become familiar between us and familiar to whatever activity we may be doing within our routines, we can identify the words and use them repeatedly as they become mutually understood. We can look to use words the person living with dementia tends to use or respond best to, or phrases that mean something to them. It is up to us to learn what those important words and phrases are, and when we do, to share those words with anyone else who provides care to that person. When we move to using person-centered terms, our approach, attitude, tone, body language, and empathy can change. Insert positively-charged words into statements, such as “ah, that’s a good thing, that’s a good one isn’t it, I like that, I love that, that feels good, doesn’t that feel good? that looks good, and thank you”. A positive way of communication can be to offer suggestions over telling or directing what one needs to do. When assisting a person in any way, from pushing their chair in for them to buckling their seat belt, or helping to get a jacket sleeve on, it is important to seek their sense of satisfaction or approval before moving on to the next thing/task. This can be done by simply asking, “Ok then? Are you happy with that? Does that feel good? Is that a good one?” Or even doing the thumbs-up gesture and awaiting their response before moving on, as this communicates respect and how you see them and care enough to ensure they are satisfied with what you’ve done to assist, before another task or agenda takes over. This is person-centered language.  Why is this important? How much or how little we know about a person we are caring for makes a big difference. A person living with dementia is still the “person” they have always been and in many ways will continue to be. But they are also changing and different in some ways now. What they need from us the most is to SEE them for who they are and to know what makes them unique. By doing this we are reaching the center of a person and can care for them in a way that charts their personal care course - providing a feeling of control, not taking more away. Person-centered language is part of how we communicate to people living with dementia who depend on us to understand, and to be able to connect in the most respectful ways possible. Respect matters in all of our relationships, but for the person who is living with progressive dementia that is affecting their brain, we must ensure our approach and the language of our care is received in the way our residents living with dementia require - to have the strongest relationships we possibly can. What they need from us the most is to SEE them for who they are and to know what makes them unique. By doing this we are reaching the center of a person...
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Article by Matt Gannon In honor of National Caregiver Day on February 19th, we wanted to highlight the work of our amazing adult foster care home providers in Oregon. Matt Gannon spent some time talking with provider Noel Ngure, RN with Living Springs Homes in Portland. Please read below to learn more about Noel.  How long have you worked in the adult care home business? I’ve been a licensed care home owner since the Spring of 2020. In 2004, I relocated to this country after having been a a high school teacher for 12 years. I started working humbly as a CNA, went to LVN school in 2007, doubling efforts since I was in my bachelor's class at that time. I graduated in 2008 with bachelor's degree in human services with a major in management. In 2009, I started my master's degree journey and graduating in 2011 with my Masters in Education: Curriculum and Instruction. My passion of offering competent, uncompromised care continued pushing me. In 2014, I started my RN classes, and by grace, we are here today successfully. What do you love most about the work you do? The results. In 2017 I was found with Invasive Ductular Carcinoma. The care I received from my family was amazing. My RN daughter quit work to take care of me. When one day I said I'd never repay her, she replied, "Mum , Pass it on." Those are powerful words do drive us to performance. When I take care of a family member living with dementia and observe her every day, seeing the positive progress, the strength and persistent beauty despite the situation, that encourages me. When I work with a client and see them improve, change and progress with near-normal life, it makes me smile and move forward. I love the difference I am making in the lives of the people I touch in this career. The impact made is immense, and this gives me strength. I love the difference I am making in the lives of the people I touch in this career. The impact made is immense, and this gives me strength. What do you believe makes someone’s work successful? Consistency and continuity of care make someone's work successful. We are consistent in what we do and this allows better communication between our team players. Communication is key, or else we would have a big mess. Caregivers take time to talk to each other, passing over clear and concise communication. This is not about competition, it's about bringing our strength to the table and doing what each of us does best for productive results. This leads to competent care, which is encompassed by integrity. Accountability is key, every one of us has to take responsibility of what we do or what we miss. A positive attitude for both the licensee and the caretakers is very important, and we have to support each other for best results. We licensees need to allow our staff to bring their strengths to table, allow them to positively utilize their skills without focusing on weaknesses. This is not a competitive business, it's about offering competent care.
Anything else you’d like us to know about you? We are a Christian home, we practice our Christian values and have a table for prayer every morning for everyone to come to if they choose. I am hopeful in the years to come we will have more homes, caregivers, and more people reached through the care we can give.
By Guest Author Yohannes Zewudie with Yohannes Tax & Accounting  The Oregon Department of Human Services identifies adult foster care home licensees as independent business owners. Owners, who are responsible for Adult Foster Home (AFH) businesses are usually expected to wear so many hats to discharge their responsibilities and achieve their company’s vision. Trust and relationships created with owner(s), customers, employees, government (federal & state) agencies and the society determine the success of businesses. Small businesses, including adult foster homes, deserve the opportunity to be successful in their line of business. Regardless of the business size, accounting as a profession plays a significant role in creating a conducive environment for success. It is with this in mind that I argue small businesses should consider having an accountant if not a certified public accountant (CPA) to achieve their ultimate goal. Here are seven ways an accountant will benefit your adult care home business: 1. Effective and Efficient Business Management Businesses need historical, current and projected financial information to make the right decision in their business. Without complete and accurate financial recordkeeping and reporting, a small business owner cannot say for sure the true profitability of his/her business. Small businesses that tend to measure their profitability and success based on available cash flow or bank balance are only looking at one criterion. Business owners who rely on incomplete or wrong information usually make decisions that impact their business negatively. Accounting, as a support function to owners, is tasked with recording business financial data, analyzing them and generating timely and reliable financial reports to show the true picture of business status and profitability. It is for this reason that small businesses need accountant who can assist them in running and evaluating their business. 2. Peace of Mind In the ever increasing federal and state regulatory environment, small businesses are required to comply with various tax laws and regulations. Among other, businesses including AFHs have to report:
Many AFHs are not well-equipped to meet these and other regulatory and compliance requirements. Having an accountant who properly handles these mandatory compliance requirements gives AFH owners peace of mind for them to focus on other important business matters. Having an accountant who properly handles these mandatory compliance requirements gives AFH owners peace of mind for them to focus on other important business matters. 3. Ease of Annual Business and Personal Income Tax Reporting The United State Internal Revenue Service (IRS) and the State of Oregon expect taxpayers to:
Small businesses and their owners face challenges in compiling the necessary business records during tax season. Without a good recordkeeping and tracking method, it is daunting for small businesses to fully meet the tax reporting requirement. Lack of proper accounting system could result in understated business income and/or deductions that may result in higher taxes, interest and penalties. If the owner or business deliberately attempt to evade taxes or willfully fails to file or pay taxes, they could be subjected to criminal tax fraud cases. AFH owners can ease the stress associated to tax return filing by hiring an accountant who:
4. Utilize Available Business and Financing Opportunities More than large and medium businesses, small businesses tend to miss out on available business and financing opportunities due to lack of information or poor financial recordkeeping. The missed opportunity to utilize the Small Business Administration Paycheck Protection Program (PPP) is a very good example. Significant number of small businesses failed to utilize federally available PPP. An accountant comes handy to assist small businesses to have the necessary records and enable them seize these available business and financing opportunities. 5. Quality of Life AFH owners assume so many duties and responsibilities (manager, receptionist, purchaser, accountant, janitor and many others) in a single day to be successful. Since AFH owners are not expected to be knowledgeable or proficient in every task, they might have to work more than 12 hours a day to accomplish all these tasks. These business burdens make the owners unhappy and inefficient. The opportunity cost of spending too much time at work may also negatively impact their health, family dynamics and other social life. An accountant can shoulder one burden and perform the accounting-related duties in the right way. Delegating the accounting tasks to the right professional would result in the following:
6. Financial Consultation Based on available company financial data and their business environment, a certified public accountant can provide knowledge-based financial consultation to AFH businesses. These consultations could have a significant impact on tax savings and business growth. 7. Representation in Federal and State Audits In case of federal or state audits, a CPA can represent an AFH to handle their audit. Unlike an accountant, which is limited to the return prepared by him/her, a CPA can represent any business in federal or state audits. "While all CPAs are accountants, not all accountants are CPAs”. A CPA is an accountant that passed the rigorous testing and strict licensing requirement to practice in the state. CPAs are expected to abide by the code of ethics and must update themselves by taking the required continuing educations every year. A CPA is an accountant that passed the rigorous testing and strict licensing requirement to practice in the state. CPAs are expected to abide by the code of ethics and must update themselves by taking the required continuing educations every year. The benefits listed above are not an exhaustive list as to why adult foster care homes need an accountant, if not a CPA. It is always advisable for small businesses to reach out to professionals and seek advice on how they can achieve their ultimate business goals.
Article by Tracey Diani  The world as we’ve known it has come to a complete halt. Schools are closed, businesses have shut their doors, farms are losing their crops, and millions of people are adapting to a new way of life that very few ever imagined would happen in their lifetime. COVID-19 has wreaked havoc on cities, states, and countries around the world. As we all adjust to new ways of life, some things are still very much the same. The need still exists for people to receive care. There are specific challenges for caregivers who are tasked with providing intimate care and assistance with activities of daily living, yet this time, our seniors greatly rely on top-tier caregivers who are essential workers. Invaluable methods of adjusting include teleconferences and video screenings, which have become extremely vital pieces to the placement puzzle as we search for the ideal placement for patients. As a lifelong optimist, I cannot help but accentuate the silver lining I see in the near and distant future for us all. An adult foster home provider is now able to conduct the screenings and assessments over the phone and in live video calls. It’s small adjustments such as these that are opening our minds to new ways of running adult foster homes. This option means owners and operators can schedule multiple screening appointments and gather much-needed information from home. Providers can make multiple calls to all the necessary parties involved together with all the information they need to make an informed decision regarding admission of new residents. I want to share five ways to integrate new admission policies and options in your home during the pandemic:
Keep in mind, policies and procedures around wearing masks, social distancing, going out in public are changing weekly if not daily. Please be sure to call the institution that you are working with, whether it’s a hospital, post acute rehabilitation center, nursing home or assisted living facility, please check with them to see what their policies are and help them to keep them in place. I see a glimmer of hope as humanity comes together during times of crisis. I encourage all of us to take a moment to reflect on the good things we have in our lives, and some positive changes. We can use new options to effectively screen and admit residents. We can adjust to our new normal and make it through this together.
Article by Alyssa Elting McGuire, MA, MPA  Originally posted 6/10/19. Updated 2/16/20. One of the more common questions I’ve been asked, both when I was with licensing, and now as an independent consultant is, “How do I find residents?” My advice has always been to start thinking about your strategy to market your adult foster home from the very start of the process, and use a multi-pronged approach to getting your business noticed. To better assist my clients now, I continuing to seek out beneficial resources and partnerships that will allow them to most effectively get the word out about their vacancies to the right people. That is key. To the right people. You want to go where people are looking for the care you provide. Don’t simply cast the marketing net wide, but instead be deliberate and strategic in your approach. There are a several avenues for finding potential residents, both private pay and Medicaid consumers. The list below is not comprehensive, but is a start. The options listed below provide similar services, yet are targeted to different audiences. Just like your stock options, you want to diversify. I’d like to tell you a bit more about each option. Placement agencies: These agencies receive a fee from the adult foster home provider for successful placement. Generally the fee is between 75 – 100% of the resident’s payment for the first month. Their target market is individuals and families looking for placement in a long-term care facility, including adult foster homes. A good resource to connect with a referral agent is the Oregon Senior Referral Agency Association(OSRAA), which also has a page to post your vacancies. Posting Websites: The target market for vacancy websites is individuals and families looking for placement in an adult foster home. Laria Care Finder is a local business that allows you to post detailed information about your home, about yourself as a provider, and about your vacancies. You can also add your business to the Alzheimer’s Association Community Resource Finder. Discharge planners, care managers, and social workers: Get to know discharge planners, care managers, and social workers at your local hospitals and skilled nursing facilities. Contact the facilities to introduce yourself and let them know what level of care your provide. State diversion/transition program: The State has a program specifically to move Medicaid consumers from nursing facilities to community-based facilities, such as adult foster homes. You can locate the local diversion/transition (D/T) programs by contacting your local licensing authority (LLA), also know as your local licensing office. As you can see, there is no single avenue to find residents. What it takes is a solid, strategic plan, and being both proactive and persistent. Put yourself out there and develop professional relationships with others so they both know and trust you, and the care you provide.
Guest article by Michelle Walch michellewalch.com  Adult foster care home work is a 24-hour, seven day-per-week job. Care home staff not only help with resident meals, errands, bathing and medical tasks, but these staff also give very much of themselves physically and emotionally. Many find the work rewarding, but it can be physically and emotionally challenging. That said, it is important to manage your own well-being so you can provide the best care. What is Burnout? “Burnout” occurs when someone is physically, mentally, and emotionally overwhelmed, according to Healthline. The rate of burnout is 53.3% for caregivers, and the rate of severe burnout is 27.1%, according to a Japanese study. When you live where you work, you never really have a place to take a break. You are always on duty. Many caregivers don't reach out for help and don't take a break from their work. As a result, exhaustion takes its toll. What are the Signs/Symptoms? Be aware of the burnout warning signs:
It is important to know the difference between burnout and depression. Depression is a disorder of your state of mind. Burnout is a reaction to severe stress in your environment. The World Health Organization (WHO) calls it occupational burnout to describe work-related stress. This is different from the medical condition of depression. An article in Psychology Today has a compassion fatigue questionnaire (similar to burnout) and suggestions on self- care if you scored high on the questionnaire. When you live and work in the home, how do you build a break into your schedule? Planning and Prevention Alyssa Elting McGuire, of Oregon Care Home Consulting, recommends planning to prevent burnout. "Self-care is like being in an airplane when the oxygen mask comes down. You give yourself oxygen before you give it to someone you are caring for. When you take care of yourself, you can then take care of others." A care provider in Washington County, Oregon, offered suggestions to prevent burnout:
For providers, trust your caregivers. You have well-trained caregivers. Trust them to take care of the residents while you're away. Why Self-Care is Important for Caregivers  You love your job, and give it your all, but to keep performing well, recognize when you need a break or help. When you are stressed out, it may negatively affect your ability to take care of others. But there are things you can do to take care of yourself. Reach out for support and get the help you need. How do you plan for, and prevent burnout? Like this article? Share with someone you know who would find this useful.
Michelle Walch is a health and wellness copywriter based in Canby, Oregon. Visit her website. Article by Alyssa Elting McGuire, MA, MPA  November is National Caregiver Appreciation Month. In honor of the work adult care home providers and staff do day-in and day-out, I would like to take time to recognize and appreciate the work they do by telling their stories. Recently, I interviewed provider Vicky Barbu and her business partner and daughter Adriana Gavozdea about their experiences moving to America and starting their adult foster home in Tigard. They shared their stories of how they came to work in the adult care home field and provided their ideas on what makes adult care home providers, and other staff, successful. Interviews have been edited for clarity and brevity. Interview with Adriana Gavozdea How long have you worked in the adult foster/care home business? I’ve worked in this business for eight years, since I moved here from Romania. My mom owned the adult foster home for eight years prior. I came here to start a new life, and I actually started this job two days after I landed. My mom trained me at her level because someday when she wants to retire, I can take over the home. We work together, and we’re a team. What do you love most about the work you do? I love that I make a difference, honestly. For example, when a resident can’t brush their teeth and you help them, it makes their day better. Recently, a client who wasn’t doing well was having trouble putting on her sandals. She asked me to do if for her, but instead I coached her and watched her closely, and she did it by herself. She was so happy at the end and thanked me so much. That’s my joy. What do you believe makes someone’s work successful? Compassion, and you have to be built for this. What I mean by that, is I’ve met people in this industry who didn’t have passion and they were miserable. You have to love what you do and help other people. If you do it for the money, you may succeed financially, but at the end of the day you’ll be so burned out, it won’t matter. You have to like to help people. Anything else you’d like us to know about you? I think we’re amazing! My mom and I were doing other things back in Romania. I never worked in healthcare before. She was an accountant and I was CEO, and we ended up in America, starting a new life from scratch. You land here and have to start all over. My mom arrived at age 45 and I arrived here when I was 30. Since we have other skills, there is always another option, but we want to do this. We’re not stuck in this job, but we like this work. We got used to being at home, being home with you kids, be at home for meals. We are so family oriented. In Romania, you take care of the seniors, so we are used to being in the home with the older generations. In Romania, after I gave birth to my daughter, I went back to work. My grandmother took care of my daughter until she was four, and my grandmother was at my house all the time. It’s a cultural thing. You have to love what you do and help other people. Interview with Vicky Barbu How long have you worked in the adult foster/care home business? I opened my home in 2007, and before that, I was working as a caregiver in another adult foster home. We came to the U.S. in April of 2002, and I started as a caregiver in June. I was a bookkeeper in Romania for manufacturing, and I was also a foster mother. I came to America when I was 45. It’s hard to go back to school with new culture and language. When I arrived, I could understand English, but it was hard for me to talk. I learned to speak English well with residents while working. What do you love most about the work you do? When you are helping residents. When residents really need help and you can give them the help they need, you get to see how happy they are and how well they are feeling. This makes you proud and think, “I did something good today.” What do you believe makes someone successful? I am trying to do my job the best I can do. It is very hard work, and especially working with people with disease processes. Sure, it sometimes makes you crazy, but you have to have patience and try to understand the residents’ needs, that it’s not their personality, but it’s the disease. They don’t necessarily want to do what they’re doing. In this work, you need to have a lot of patience. It’s important to show residents you care about them. Much of the time, we know them very well, so we should try to be their voice (e.g. to medical staff and others). With every resident, you’re learning something new. Use that new information to learn and help the next residents. I learn a lot with every resident. You have to be open to learn new things. You don’t have to know everything. Open your mind and pay attention, and then you will learn. Anything else you’d like us to know about you? I am trying to make everything very smooth for my business behind the scenes. I know what I have to follow, so I’m trying to follow rules and make it run smoothly. My advice is make residents happy and follow the rules, and things will work well. My advice is make residents happy and follow the rules, and things will work well.  About the Author Alyssa is the founder and consulting & training director for Oregon Care Home Consulting & Training. Email Alyssa |
About Oregon Care Home ConsultingOregon Care Home Consulting & Training is the compass that helps current and future APD adult foster care home licensees successfully navigate the licensing process and have a successful adult foster care home business. ORCHC provides coaching, consultation, training, and ongoing support. This ultimately saves time, reduces stress, and improves compliance, which allows AFH/ACH licensees to focus more time on providing excellent care to seniors and individuals with disabilities.
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Disclaimer: Oregon Care Home Consulting LLC is not affiliated with the State of Oregon or Multnomah County Adult Care Home Program (ACHP). We are not State licensors, therefore we are unable to require compliance or guarantee your adult care home is in full compliance with current state and/or federal requirements. State and/or County licensors make the final determination of compliance. Additionally, we are unable to offer legal or medical advice, and no guidance provided by Oregon Care Home Consulting LLC should be construed as legal or medical advice. Always consult an attorney or doctor, when necessary.
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Disclaimer: Oregon Care Home Consulting LLC is not affiliated with the State of Oregon or Multnomah County Adult Care Home Program (ACHP). We are not State licensors, therefore we are unable to require compliance or guarantee your adult care home is in full compliance with current state and/or federal requirements. State and/or County licensors make the final determination of compliance. Additionally, we are unable to offer legal or medical advice, and no guidance provided by Oregon Care Home Consulting LLC should be construed as legal or medical advice. Always consult an attorney or doctor, when necessary.
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