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.

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. 
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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. 

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:  

• Federal Payroll & Income Taxes
  • Social Security and Medicare Taxes (FICA taxes)
  • Federal Unemployment Insurance Taxes (FUTA)
  • Federal Income Taxes
• State Payroll & Income Taxes
  • State Payroll Taxes
  • Transit taxes (Tri-County Metropolitan Transit District (TriMet) and Lane Transit District (LTD)
  • Employment Taxes (State Unemployment Insurance or SUTA):
  • Workers’ Benefit Fund Assessment (WBF)
  • Workers’ Compensation Insurance
• Local and City taxes
• Periodic Payroll Reporting
• W-2, W-3, 1099 and other annual reporting

​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. 

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:

• File a timely return;
• Make accurate reporting; and
• Pay the required tax amount by the due date. 

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:

• Maintains proper financial recordkeeping throughout the year;
• Maintains proper classification of taxable income and non-taxable income;
• Claims all available and qualifying business deductions;
• Files annual & quarterly tax returns in a timely manner; and
• Pays timely quarterly estimated payments.

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:

• Improved quality of work.
• Standardized financial reporting.
• Reduced owner work-related stress.
• Increased owner productivity and job satisfaction
• Potential long term cost reduction.

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.

​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 Alyssa Elting McGuire, MA, MPA

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:

• anxiety 
• isolation
• depression
• lack of energy
• fatigue
• insomnia

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:

• Allocate time for self-care
• Schedule breaks for both staff and yourself
• Don't over commit. Be okay with saying "no," and setting boundaries.
• Honor your personal needs
• For providers, trust your caregivers. You have well-trained caregivers. Trust them to take care of the residents while you're away.
• Pre-plan a time weekly (on say, Sunday evening) to review records and take care of what needs to be done
• Recognize the difference between what needs to be done now, and what can wait

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.

 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. ​

Article by Alyssa Elting McGuire, MA, MPA

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 that 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.
​
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.
​
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.
​
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. ​