What You Should Know About Isolation, And How To Prevent It

By Kevin Smith

IsolationEven the most private, introverted or reclusive among us need regular face-to-face connections. Whether it’s a one-on-one coffee with a longtime friend, a group book discussion or a morning at worship, regular interaction with other humans helps us learn to listen and empathize, put seemingly difficult issues in perspective and feel part of a larger community.

A recent article by BBC Future talks about how chronic, prolonged isolation warps the mind and alters our sense of reality: “Chronically lonely people have higher blood pressure, are more vulnerable to infection, and are also more likely to develop Alzheimer’s disease and dementia. Loneliness also interferes with a whole range of everyday functioning, such as sleep patterns, attention and logical and verbal reasoning.”

According to the AARP Foundation, older people may become isolated from their family and community because of injury or illness. They may lose the ability to drive and don’t have alternate means of getting from point A to B. Adult children who spend lots of time caring for an older parent or relative may begin to lose connections with their own support network. If a person’s health or mobility restrictions or caregiving duties escalate, it’s easy to become homebound (or feel stranded).

At Best of Care, we know how damaging isolation, and the loneliness that comes with it, can be to one’s physical health and mental well-being. We have seen first-hand how it can erode one’s sense of reality and connectedness, which in turn can exacerbate a pre-existing health issue.

Many of our homebound elderly clients interact with nearby family and friends on a regular basis through weekend outings and weekly visits. But many others aren’t so lucky: their families may live in another part of the country. Their long-time friends may have passed away, or are ill. Their spouses may have died.

In addition to the weekly visits we pay to their homes and the individualized support we provide, it’s our job to understand what kind of interaction each client thrives on. This knowledge helps us design care programs that help them stay connected to and engaged in the lives of others. From card and board games that stimulate thinking, to visits to the shopping center, library or physician, to discussion of current events or TV programs, to supporting a client’s specific interest or hobby, caregivers focus on stimulating dialog and positive sharing.


Assisted living’s only ‘assisted’ to a point: Read the fine print.

How to get your loved one the extra support they need

By Kevin Smith

Read the Fine PrintAssisted living can be a viable choice for seniors who aren’t able to do everything for themselves anymore yet do not require the clinical care that nursing homes provide. Over the past decade, many families have helped elderly loved ones move to the more structured environments that assisted living facilities provide.

What families often don’t realize (or haven’t read in their contract) is that assisted living facilities provide a finite scope of services to support residents’ daily needs. These include cleaning services, making a bed, meal service (dining or room service), mail delivery, etc. Some assisted living facilities do provide at extra cost assistance for daily living needs such as bathing, dressing, grooming, medication reminders, etc.

If you’re closely monitoring your situation (or that of a loved one) and have determined they require more support time than their assisted living contract provides, know that you do have choices.

First, has your loved one’s medical condition deteriorated significantly? Do they now require help to get out of bed or move with a walker or wheelchair? If the answer is yes, make an appointment with her/his physician to re-assess their needs and adjust their plan of care.

This is the time to evaluate whether your or a loved one’s current assisted living community has the supports (and quality controls) in place to meet their higher-level needs. It’s also a great time to have a heart-to-heart conversation with your senior. How do they perceive the services they’re receiving at the assisted living facility?

If more hours of hands-on support are required, you have the right to select who provides these services. Here in Massachusetts, many assisted living facilities contract with independent home care agencies to serve their residents. Separate from these agreements, many agencies also have independent private-pay contracts to serve clients in retirement communities and assisted living facilities.

Option 1

Are you satisfied with how the facility’s aides and/or nurses currently serve your loved one? Are you confident they’ll be able to provide the same quality with more hours? Are the aides employed by the facility able to provide additional service beyond their required tasks ? If you can answer ‘yes’ to these questions, you may consider paying the facility to provide an agreed-upon number of additional hours of personal health aide or clinical nursing staff time. 

Option 2

Are you uncertain about or do not have the level of care and quality that the assisted living facility’s aides and nurses are providing? You always have the option to choose a home care agency and pay them directly for services.

If you are considering Option 2, there are many quality licensed home health care agencies in Massachusetts to chose from, including ours.

Best of Care is a proud member of a professional home care association that can help you find an agency in Massachusetts: The Massachusetts Home Care Aide Council (hcacouncil.org).

Searching for a home care agency across New England to serve your or a loved one in assisted living or in their retirement community? An online match system, iNeedHomecareNow.com, lists more than 100 agencies in Massachusetts.


Podcast Interview with Radio Entrepreneurs

Boston, MA, March 26, 2015 – Listen to the podcast of Kevin Smith from Best of Care discussing the home care industry in Massachusetts with Host Jeffrey Davis from Radio Entrepreneurs.

Podcast Interview with Radio Entrepreneurs


A New Level of Boston Proud: Homecare Coordination, Winter 2015

By Kevin Smith

Local news reporter set up to broadcast live from Quincy Center T Quincy, Mass., February 20, 2015: 50-mile-an hour wind gusts. Eight foot snow banks. Greater Boston is on track to experience the second-coldest February on record. Between Quincy and Raynham, we’ve received 90 inches of snow in 21 days. As I write this from Best of Care’s Quincy office, I’m staring out at the snow-buried tracks of our still-inert MBTA rail station. I see backup buses attempting to deal with lines of tired commuters. I worry about our elderly clients in their homes. And I worry about the safety of our home care staff, many of whom depend on the region’s public transportation system.

The nightmare of snow-snarled Boston hasn’t diminished our home caregivers’ dedication. When weather allows a safe commute (and often when it doesn’t), they rise many hours earlier than normal to get to clients’ homes on time.

Thanks to the efforts of the Home Care Aide Council of Massachusetts and other home care industry advocates, our caregiving staff is now exempt from the severe weather travel ban that was previously hampering our efforts to get to homebound clients.

Even when our administrative offices are closed, Best of Care’s administrative team continues working from their homes to monitor our clients and coordinate services. The processes and technologies that we’ve set up for any severe weather event are helping us ensure that over 1,000 clients and the 250+ home care aides and nurses that serve them remain safe even as the snow and ice piles higher.

Our web-based scheduling software can be accessed at any time by our administrative staff.  Our aides use smartphones, iPads, and tablets to let us know if they can safely make it to their destination. Clients’ status and employees’ availability are tracked and recorded in real time. Everyone is connected and accountable. Everyone is expected to monitor their email for status updates or service requests.

If, despite their best efforts severe weather or transportation delays prevent a home caregiver from arriving safely to a client’s home, or a client needs support outside business hours, they call our answering service. Each call feeds to an application on our on-call supervisor’s device, allowing them to adjust staff assignments or address emergencies.

Every morning at 8:06 a.m., I receive an email from the answering service with a detailed summary of all calls we’ve received overnight, which we review with the on-call supervisor. Using web-based software, we run daily reports outlining each client’s level of risk, high to low. If a client’s regular caregiver is unable to reach them, and an alternate caregiver is also snowbound, we reach out to family members or the client’s support network to come up with a plan. Depending on the level of care our client requires, we call upon our Elder Services program contacts, or on local fire-rescue-ambulance services for support in transporting the client to a location where they can receive daily living assistance or medical support until roads are again safe.

We pay close attention to homebound clients whose medical conditions demand around-the-clock attention. Before every storm, we connect with our 24/7 caregivers to advise them to bring extra food and clothing to the client’s home in the event they’re not able to leave after their shift ends. We also contact the next-shift caregiver with the same cautions. We call the client’s family or support network to discuss how their loved one will be transported and where they will go if there’s a power or water outage. During Boston’s first snowstorm of 2015, a diabetic client’s home lost power. Because roads were nearly impassible, we called the local fire department to transport him to a local medical facility.

Through our region’s weather ordeals, we are working hard to protect our clients’ health and well-being and our workers’ safety. And that’s Boston Proud in action.

About the Author

Kevin Smith is President and COO of Best of Care Inc., which provides home health care services to North Shore, Greater Boston, South Shore and Cape Cod communities.


Aging and Vision: Tips to Preserve Our Sight

By Kevin Smith

Aging and Vision

As part of the individualized care plan Best of Care develops for each client, we pay close attention to those with low vision or vision-related medical conditions. A big factor in how we provide in-home care is understanding and supporting each client’s specific needs related to their level of vision. Here is a summary of the most common eye conditions you or a loved one should know about and look for.

As we move into our 40s and 50′s, we often develop presbyopia (farsightedness) that often requires reading glasses to do close-up work. We may need more light to read, or have problems with glare from bright light. We can also experience significant dry eye, which can affect vision.

While these conditions are a normal part of aging, it’s also important to know what symptoms and conditions must be evaluated and treated immediately. According to the American Optometric Association, if you see any of these symptoms or changes in your eyesight, see your eye doctor right away.

Fluctuating vision may be a sign of diabetes or high blood pressure (hypertension) that can damage the tiny blood vessels in the retina and put you at risk of permanent eye damage.

While bothersome spots and floaters in the line of vision are often shadows of particles floating in your inner eye fluid, pay attention to them. If the floaters become more frequent, and are accompanied by bright flashes of light, these symptoms may signify a pending retinal detachment which can lead to serious vision loss or blindness.

Loss of side (peripheral) vision may be a sign of glaucoma, which occurs when the optic nerve is damaged and no longer transmits all visual images to the brain. To catch this condition early, it’s important to have yearly eye exams that include a glaucoma test.

If straight lines appear distorted or wavy or there appears to be a blind spot or empty area in the center of your vision, you may have the signs of age-related macular degeneration (AMD). The disease affects the macula, the part of your retina that is responsible for central vision where the eye’s acuity is sharpest. The disease causes a blind spot that’s right in the middle of your field of vision. If not treated early, consistently and aggressively, it can lead to blindness.

If you or your homebound loved one has had diabetes for a long time, you may be at risk of developing diabetic retinopathy, the result of progressive damage to the tiny blood vessels that nourish the retina. These blood vessels can leak blood and other fluids that cause swelling of retinal tissue and clouding of vision. The condition usually affects both eyes. The longer a person has diabetes, the more likely they will develop diabetic retinopathy, which can cause blindness.

If your vision has gradually become cloudier over time, or you don’t perceive contrast or colors like you used to, or you have a higher sensitivity to glare, you may have developed cataracts, which are cloudy or opaque areas in the normally clear lens of the eye. For many, cataract surgery, which replaces the natural lens of the eye with a new lens, often helps patients regain their visual acuity.

For clients who no longer see well enough to drive, our home aides pick up groceries or take clients to errands or appointments. Our licensed home care nurses can regularly administer prescription eye medications and eye drops. Just as important, we are able to connect our clients to medical and rehabilitation professionals who can perform essential regular eye checkups and tests, diagnose vision problems before they become crises, and sometimes even restore a higher level of vision through treatment.


Live, Retiring on Cape Cod, Senior Services

Cape Cod Chamber of Commerce

For more than 30 years, Best of Care has supported families who want their loved ones to be well cared for in their own homes, but don’t have the time or expertise to do it all themselves.  Our family-owned and operated home health care agency provides quality home care to residents of Cape Cod, Martha’s Vineyard, and the South Shore.

From help with cleaning and cooking, to assistance with daily living activities like bathing and dressing, to nursing care and rehabilitation services, to support for those with moderate, severe or chronic medical conditions, our concierge approach to your loved one’s unique needs may include any or all of our services.

Cape Cod Chamber of Commerce, www.whycapecod.org


How Home Care Helps Us Cherish Time With Mom

By Barbara Smith

Mary and Her Daughters

This is a story about how home care has helped our mother, Mary Kelleher, live the life she wants while allowing me and my siblings to focus on what’s important to her…and our family.

Mary will turn 87 on December 27. Her four daughters – my three sisters and me – will celebrate Mom’s birthday as part of our annual holiday tradition. She’s a small, feisty, active and fiercely independent woman who is proud of her Irish heritage. She is our role model, our beacon.

Mom still lives in the home where she raised us. Widowed in her late 30′s when my dad died in 1966, she took a food services job at our local school. Rising to become food services manager, she became all the students’ mom! Mom never remarried, and worked extremely hard to support her family. She made sure that we all received college educations and pursued careers.

When she retired in her early 60′s, Mom didn’t break stride. Monday mornings, she volunteers at our local hospital’s front desk, meeting visitors and patients and working on the computer. She coordinates membership activities at her town’s historical society. She keeps up with her friends. She attends Mass every Sunday, then spends the rest of the morning with her brother, sister and brother-in-law talking, laughing and watching movies at home.

Six years ago, Mom fell and broke her hip. Mary After she came out of the hospital and rehab, we began balancing our work and other obligations with making sure she didn’t over-exert in doing things around the house. We installed home devices to help her get around safely.

But like any family, we worried. And we were becoming exhausted. My husband Steve (founder of Best of Care) and my son Kevin, who is growing the business as President and COO, began talking with Mom about having a home aide visit her once or twice a week.

Mom was initially dubious. We had to help her feel comfortable with the idea of a homemaker/companion. Robin, one of Best of Care’s longtime home aides, began visiting Mom on Tuesdays and Thursdays. Robin now does Mom’s laundry, helps with cooking and light housework, and does errands. Robin and Mom have bonded through the TV programs they both love and the community news they share. Now, Mom can’t imagine a week without Robin’s visits.

With Robin’s support, the Mary Kelleher we respect and adore is able to retain her autonomy and maintain her full life in the home that’s been her rock for more than five decades.  And that means the world to us.

Barbara Smith knows what it takes to support families through quality home care. Barbara’s husband, Stephen Smith, founded Best of Care, Inc. 30 years ago; Kevin Smith, one of Barbara’s two children, is now Best of Care’s President and COO. Today, Best of Care’s trained and experienced home care professionals provide an extensive array of personal care services, homemakers and companions, hospice care, private nursing, nursing care management and specialty services from Massachusetts’ North Shore to Greater Boston to the South Shore and Cape Cod.


Three Strategies to Ease Your Parents into Home Care

By Faye Sanders
Human Resources Director and Scheduling Coordinator, Best of Care Inc.

Client and NurseAt least half of the family members who call Best of Care to inquire about our services for an older loved one begin their call like this: “My parent doesn’t know that I am calling you. They really need help with daily activities in their home, but when I bring up a home care service they just flat out refuse.” This is something we hear EVERY day.

As we age, one of our greatest fears is losing our independence and autonomy to do as we please without assistance. We want to keep on taking care of our personal needs without support. We want to continue preparing our own meals, maintaining our homes and doing errands alone, all without risk.

Our parents – who have dedicated their lives to caring for children, grandchildren and neighbors – frequently have a difficult time with the concept that they now require support themselves.

Here are three ways that we help families gently ease home care into their older loved ones’ lives.

1. Begin with a friendly visit. For older family members who are uncertain if home care is the right move for them, one of our care coordinators and a home care aide will visit their home to chat, talk about the services and assess their needs.

If the family wishes, we will send a nurse out to evaluate how safe their loved one’s home is. Even if we do not provide nursing services, we can recommend devices and equipment, e.g., lifeline bracelets or necklaces; showering benches and seats, grab bars, mats – all important supports that can reduce the risk of falls.

2. Start out small. Even if your parent or relative requires a higher level of support, we will often begin with basic services, such as meal preparation, light housekeeping and errands once or twice a week. This helps your loved one get to know and trust the home care aide. One of our clients began with two one-hour visits per week. Her home care aide is now with her in her home Monday through Friday, 8 a.m. to 4 p.m. After this client was hospitalized, she asked her aide to also visit her at the rehabilitation facility. So, the home care aide becomes not only a helper but also a companion and a friend.

3. Develop trust gradually. Many who resist home care don’t like the idea of a stranger regularly coming into their home.

Ask if there’s a thorough background check system, which Best of Care conducts for prospective employees on federal, state, county and driving record levels. Our hiring and screening process is extensive and our home care staff is highly supervised. Home care aides have binders where they jot daily notes for nurses and family members; a supervisor visits clients’ homes quarterly.

At the beginning, we try to determine our clients’ personality. Do they take initiative? Are they timid? Do they take charge, or must they be guided through their day? Then we match each client to a caregiver who understands and works with that client’s specific traits.  An aide may come in for a few visits with your loved one to see if there is a ‘fit’. If they get along, great; if not, we will offer a different aide based on your loved one’s preferences. Once trust and a bond has been established, we can tailor our program to what your loved one’s actual needs are.

By using these gradual steps, we are giving older loved ones the time to assess their ‘new normal’ of in-home care and, little by little, accept the level of services that can keep them healthy and happy. That’s safety, comfort and well-being for older family members, and peace of mind for their children.


Preparing Elderly Parents Returning from Hospital

Screen Shot 2014-12-01 at 2.53.50 PM

Best of Care’s President and COO had a feature article in December 2014 Health and Wealth magazine called: Preparing for Elderly Parents to Return from the Hospital. Here is what they had to say: “We’d like to thank you for your participation in the fall edition of Health & Wealth magazine. Not only did you write an excellent article, you positioned yourself as an industry expert, increased your company’s visibility, and engaged your customers . . . It will also be featured on our Health & Wealth Facebook page.”


One Slip Can Change a Life: Preventing Falls by the Elderly in the Home


What started as a normal day for one family ended with a serious scare when an elderly aunt who was 96 years old blacked out and fell in the bathroom at an assisted living facility. She was rushed to a nearby hospital in pain and with bruises. Her legal guardian, a niece, drove over 100 miles to meet her, and came almost every day for many weeks. The aunt had cuts all over her arms, which required daily dressing changes. She needed around the clock care, something that wasn’t necessary before the fall. After a few days, she was moved to a rehab nursing home with 24/7 therapeutic support. The aunt will not return to the life she was living just a few weeks prior.

This story is very common across the United States. One in three people over the age of 65 will fall at least once a year, and falls are the leading cause of injuries for this demographic. The emergency room treats an older adult for a fall every 14 seconds. Even if the first fall is not serious, older people become fearful of another fall. This can lead to their limiting their activity, which can also lead to depression. However, with the right knowledge and precautions, we can help prevent our elders’ falls.

Falls often happen due to multiple factors. They can be caused by the person’s home environment or their physical condition. If the elderly person takes medication, their attention or balance may be compromised. More than half of falls among the elderly happen due to slipping, tripping or stumbling inside their home. The biggest problem areas are the bathroom and stairs.

Many falls can be prevented with a few simple modifications to a person’s home or lifestyle. Removing loose throw rugs (or taping down the edges), removing cords from areas where people walk, adding sturdy hand bars by the toilet and shower, adding anti-slip tile and proper lighting can all help keep older people on steady footing in their homes.

Here are other measures that family members can take to help prevent their loved ones from falling:

Falls Among the Elderly

  • Because the aging process affects sight and hearing, make sure your loved one meets regularly with an eye doctor. Eyeglasses and hearing aid prescriptions should be updated regularly to allow your loved one to see both up-close and distance, and to hear others clearly.
  • Monitor alcohol consumption and limit your elders’ intake as much as possible. If they are taking medications that have dangerous side effects when combined with alcohol, make sure they are not consuming any alcohol at all!
  • Less than 40% of older Americans exercise, resulting in an elevated risk of falling. Taking a Tai Chi or yoga class, walking, dancing, or similar activities are all healthy options. Physical therapists can teach patients how to exercise safely to improve muscle strength, balance, and go through daily movements without straining themselves.
  • Investing in a pair of shoes with good traction and low, rubber heels can be a big help in making a senior feel more confident and secure.
  • Taking multiple medications can result in drug interactions that can cause dizziness, loss of equilibrium, and falls. Elders and their families should talk to their doctors about any potential side effects and interactions between medications. Remember to let the doctor know about any over the counter medications that the elderly person may also take, such as pain relief or sleep aids.
  • Canes and walkers are helpful, but only if used correctly. When buying a cane, get one that is properly fitted (not too tall or too short) and work with a therapist to learn the proper techniques for using it.

While falls are not usually fatal, they can be very harmful for seniors. Typical outcomes can be broken bones or serious bruising. If it’s serious enough, a fall can prevent a loved one from having normal life. The outcome from trauma like this puts stress on family members who must become caregivers.

Prevention is key for older relatives when it comes to falling to keep a loved one safe and in their home for years to come. Family members who retain a home care agency to help their loved one manage tasks around the house gain a sense of security that their loved one is being kept safe when they can’t be there.

Tags: fall preventionfallshome carehomecare