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



Are you The Chosen One?

By Stephen Smith, CEO, Best of Care Inc.

The Chosen One

Within every family, there’s The Chosen One. I’m not talking about the first-born son. Or mama’s favorite. Or daddy’s little girl. Or the brainiac. Or the troublemaker.

The Chosen One is the sibling who has a gift that’s taken for granted until a crisis happens. That’s when The Chosen One’s calm demeanor, practical mindset and warm heart shine in her or his service to others.

The Chosen One in our family? My sister Debbie, whose straight-talking, wise-cracking yet gentle approach helped her thrive as part-time professional caregiver here at Best of Care, while working full-time in a management position at a regional hospital.

In 2005, our mother was diagnosed with breast and lymph node cancer. As a home care agency owner, I knew that to remain in her home through her illness, mom would require a very high level of support.

We all helped. As her legal proxy, I helped Mom pay the bills and manage her affairs. Our sister Patty, a nurse at Brigham and Women’s Hospital, was her healthcare proxy, taking her to frequent visits to the doctor and for cancer treatments.

Debbie took on the lion’s share of Mom’s day-to-day care. Her professional healthcare experience had taught her to also be a competent family caregiver.

But juggling two demanding jobs with Mom became overwhelming. After much thought, Debbie made the difficult decision to resign from both and take care of mom full-time. She also took on the caregiving role for mom’s brother (our uncle) full-time.

Debbie’s relationship with Mom during her decline was loud, sometimes profane and often comical. But through it all, Mom knew and accepted that Debbie was the one best suited to be at her side.

Mom passed away in 2007. With a heavy heart and newfound time on her hands, Debbie decided that instead of going back to her hospital position, she wanted to shift her career from hospital manager to professional home caregiver.

That’s how our family’s Chosen One became one of the most in-demand caregivers that I’ve ever hired.

Debbie’s clients love what we love about her: Her no-nonsense approach. Her warmth and humor. Jokes Debbie, “The ladies I help in their homes love me. Why? They’re hard of hearing. And I’ve always been LOUD!”

Debbie also helps bring our homebound male clients “out of their shells” with gentle assertion, coaxing them to do what’s needed to maintain their personal health and well-being. As a social person herself, she actively listens to client’s stories of their lives and families. And for those who must get their medications and food on time, she’s punctual as a clock.

It’s a fact, and not surprising, that the vast majority of our Chosen Ones are women. If they have siblings located in other states, they may the only one near enough to provide care to mom and dad. Like my sister Debbie, they may willingly choose to be their parent’s caregiver. Like Debbie, they’re often putting their own careers at risk and their own families’ lives on hold to fulfill this commitment.

So Debbie’s work, both when Mom was alive and now as a professional caregiver at Best of Care, is a blessing for our family.

The home aides we hire also possess “The Debbie Factor”. Our training programs help new hires embrace their talent for empathy, humor and caring…while ensuring that their clients are safe, and that they receive the health and personal care services that are essential for them to remain in their homes.

Of course, not everyone has the aptitude, attitude and desire to be a Chosen One. The Chosen One can easily become resentful in her role, especially if her siblings don’t carry their weight.

Regardless of whether you’re The Chosen One, or The Chosen One’s brother or sister, you don’t have to go it alone. Support is out there. More than 300,000 home care agencies with more than 1.4 million employees now serve those who don’t have the time, skills or emotional fortitude to intensely care for their loved ones.

From the services of a home aide who spends a few hours per day to do cooking and laundry, to 24/7 nursing care support, our country’s Chosen Ones (family members and professional caregivers alike) are supporting our elders in their homes while giving their families peace of mind.

Inspired by the growing societal need to provide affordable, quality care for elders, Stephen Smith founded Best of Care Inc. in 1981, which is now recognized as one of Massachusetts most respected private home care companies. Today, Best of Care’s 200+ employees deliver home care to more than 75 towns and cities to the Greater Boston area, the South Shore, Southern Massachusetts and Cape Cod. The agency has an A+ rating with the Better Business Bureau.


What are the ingredients of a ‘Best Family Business’?
by Stephen Smith

The agency I founded in 1981 was based on a concept — caring for seniors in their own homes as an alternative to nursing care — that was, quite frankly, not very well understood at the time.

I learned that building a viable home care business meant being flexible, offering services that might range from simply doing errands to full service 24/7 nursing care.

As a finalist for the 2014 Family Business Association Awards in Massachusetts, Kevin and I recently were honored to participate in an interview with the Radio Entrepreneurs Network on how we built our business, the principles we live by, and the advice we give to any family member who is caring for an elderly loved one.

Give our interview a watch and a listen. And as always, we welcome your feedback!


Quality in Home Care: Three Keys for Success

nurse_talking_man   By Kevin Smith, President & Chief Operating Officer, Best of Care, Inc.

In any service business, your company’s reputation is only as good as your customers’ experiences. Here at Best  of  Care, our reputation depends on the dedication and expertise of our caregiver team.

These are the most important elements in our approach for providing quality home health care.

Punctuality and attention to detail.
Mr. X gets his bath at 9 a.m. Mrs. Y must have her insulin at 8 a.m. If these services happen late, it’s not only the client who suffers: Their families, who have careers and lives of their own, would need to re-prioritize their day to attend to mom or dad.

That’s totally unacceptable.

Our home care clients and their families rely on us to adhere to schedules and instructions focused on their specific health and daily living needs. Our caregivers understand the importance of showing up prepared, and showing up on time. They are dedicated, reliable, and responsible for taking care of a loved one.

Observation and communication.
Our nursing and administrative staff closely monitor how we care for clients in their homes. They’re in constant touch with clients and their families, case managers and caregivers. Our team of registered nurses conducts a supervisory evaluation with each of our home caregivers to determine how our clients are doing, how they’re interacting with the caregiver, any feedback the family is providing and what additional support the client may need. We base salary increases, caseload considerations and potential client-caregiver matches on feedback from our supervisors. They allow us to better predict the compatibility of clients and caregivers, reinforcing our concierge approach.

Training, education and advancement.
Home caregiving is physically and emotionally demanding, but also rewarding. Our home health aides work with clients with varying conditions, diagnoses, and mental and/or physical illnesses. They work with clients of all different ethnic and socioeconomic backgrounds. This type of experience is vital to anyone who wants to pursue an advanced degree in healthcare and another level in their career.

To better equip our home care aides, Best of Care offers regular staff education and training. By delivering safe, efficient care to homebound clients, they become respected members of the family’s caregiver team, which in turn enhances their job security and work opportunities.

Many of our home health aides are actively working towards their RN or LPN licensure or are going to a college to become a physician’s assistant. We actively encourage our team to pursue these additional credentials, which supports both their career goals and our clients’ needs.

Whether you’re looking to begin a career in home care, take your nursing degree into a home care setting or accelerate your career, you’ll find opportunities in the home care market. Interested in supporting Best of Care’s clients in Greater Boston, Southeastern Massachusetts or Cape Cod? Give me a call or send me an email!