Tag Archives: seniors

5 Ways to Make Caregiving Less Stressful


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It can be stressful and lonely caring for an aging parent. The endless appointments, piles of laundry, agitated behaviors, meals on the table, pills to dispense, answering the same questions over and over, siblings that don’t help or worse yet criticize your every move. If you haven’t already, you need to create some strategies that will help ease the stress of caring for your aging parent or loved one.

Consider building these strategies in to your every day routine and tap in to them before you reach your tipping point.

Build a Care Team

You cannot do this alone. I don’t care how skilled you are or how much you love your mom or dad you will need help to care for them. It can be informal or formal in the way of paid help but you need to create a routine that includes help. That can be friends that drive mom to her hair appointment or a paid housekeeper to clean the toilets. You may need the assistance of a paid caregiver to help with bathing or meal preparation. I’ve yet to meet anyone that can care for an aging parent 24 hours a day 365 days out of the year without the help of  care team.

Resource: Lots of Helping Hands is an online service that can help you build and organize a care team. At the very least set up an account and start exploring the possibilities.

Surround Yourself with Peers

Find a support group or reach out to people you know who are in the same boat as you. I know it’s hard to reach out when you aren’t feeling like your best self but I have news for you other people in your shoes don’t care nor are they feeling great either so you have nothing to lose by reaching out to others. A good laugh or a good cry with someone that’s been there can go a long way in easing the stress. Caring for an aging parent can be a lonely place and no one understands that quite like another caregiver.

Resource: My favorite online support forum is at agingcare.com. You can find peers there any time day or night. I find the folks there to be supportive, non-judgmental and full of information that can help. Click here…

Create Moments of Respite

Typically we think of respite as a lengthy break of 24 hours or more but think of the impact simple moments of respite throughout your day could make. An activity for you alone that can provide you with a break from caregiving. Walk around the block, read a book, coffee break, hair cut, retail therapy, exploring art… Whatever brings meaning to you and provides you with a break from your caregiving duties; do it!

Let Go of Perfection

If you’re a perfectionist, please learn to let it go. A perfect day does not exist in the world of caring for an aging parent. Without a doubt, you will have moments of joy and happiness but there will always be laundry to do, appointments to make, things to worry about so understand this. There is no perfectionism in caregiving and you are going to drive yourself nuts if you remain on the hamster wheel of perfection, so get off of it.

Stop Being a Martyr

Being a martyr is not a healthy way to get your needs met. Suffering and expecting others to read your mind will not only set you up for resentment and anger but it will push away the people you should be depending on the most. Consider setting boundaries and putting yourself in the position of being empowered versus being victimized.  Find ways to set healthy boundaries; learn when to say yes and when to say no. A caregiver stuck in the cycle of being a martyr is destined to become stressed out.

Moving forward…

Checking back over this list do you see any strategies that may work for you? Can you pick one that you can weave in to your daily or weekly routine?

If you can’t imagine practicing these strategies on a day-to-day basis, consider posting them on your refrigerator and use them to hit your reset button…

Do you have a secret for dealing with stress? Questions about the above suggestions? You could help other caregivers by sharing your thoughts in the comment section.

Medicare; Physical and Occupational Therapy!


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This is a short and sweet post about accessing physical and occupational therapy under your aging parent’s Medicare benefit. Here’s a great resource that explains the Medicare benefit much better then I ever could. If your aging parent is struggling with cognition, getting dressed, getting in and out of a chair, they have fallen or are struggling with a transition to a senior living community, please find an occupational or physical therapist to help them. A little intervention early can make a BIG difference and go a long way in helping them maintain their independence!

In the Northern Colorado area, you can access Covell Care and Rehabilitation for help…

 

 

Transition to Senior Living Not Going Well? Don’t Give Up!


I wrote earlier this week about how difficult it can be adjusting to a senior living community and being the old new kid on the block. As a geriatric care manager, families often turn to me for help with this issue so I want to share with you the professional resources I turn to for help with my clients who are struggling with a transition.

My “go to” resources to help my clients struggling with a transition (drum roll please) are  Occupational Therapy and Counselling. By the way, both of these resources can be accessed under Medicare B with the cost of the co-payment so both are resources worth knowing about and exploring…

Occupational Therapy: I refer to an Occupational Therapist (OT) when I notice my client has some physical limitations that are interfering with their independence. Examples would be limited ability to use the phone, dress themselves or pour a glass of milk. I also refer to an OT when I suspect memory or cognition may be a factor in the transition. Perhaps your mom or dad are really struggling to reorient themselves to their new community.

An OT, can assess your aging parent and identify limitations and create a care plan to optimize functioning in those areas. They can also assist with adaptive equipment, room arrangement, cabinet organizing, orientation strategies and exercises designed to assist with increasing strength and mobility. The bottom line is an OT will create a care plan this is designed to maximize your aging parent’s independence. This can help with a new sense of well-being and confidence which naturally would make the transition a little easier!

Finding resources: ask the administrator of your senior living community, physician, local elder care network directory, yellow pages (if you can find one) or google: occupational therapist, Medicare B, outpatient, name of your city.

Counselor or Psychologist: I refer to a licensed clinical social worker (L.C.S.W) or psychologist (PhD) for counselling when my clients are exhibiting signs and symptoms that may be related to depression or intense anxiety about their move. I may even arrange this resource before the move if there is social history of mental illness, depression or difficulty with transitions. For some older adults and families, this can be a tough sell because of the stigmatization attached to mental health but trust me when I tell you it can make a world of difference for your aging parent to work with a counselor to help with this transition.

Finding resources: ask the administrator of your senior living community, family, friends, physician, local elder care network directory, yellow pages (if you can find one) or google: social worker, counselor or psychologist, Medicare B, name of your city.

Five Keys to Success

1) Physician’s order; both are Medicare B benefits and will require a physician to sign off and provide the order. Make an appointment for your mom or dad and attend that appointment!

2) Communication; don’t just ask the doctor for the order. Provide information that will lead them to understand the service is needed. i.e. “dad is having a difficult time getting dressed ” or “mom is tearful and isolating herself since the move”.

3) Positive spin; both are short-term disciplines so encourage your aging parent to be open to the help as it may just keep them in their apartment versus a nursing home (tough love).

4) Utilize both; you could certainly utilize both these disciplines at the same time. Two disciplines are better than one. The focus is very different so why not?

5) Flexibility; typically an OT can come to the senior living community but not always. You may have to arrange transportation to a counselor. Either way, flexibility will be needed.

Don’t hesitate to ask for help from either of these resources if your aging parent is struggling with their transition to a senior living apartment. A clarity session with me may help as well; during a clarity session we can strategize specific interventions for your aging parent and I can help you define which resources will be the best for you and your aging parent.

A little intervention early can make a BIG difference…

RELATED ARTICLES:

Aging Parents: Understand and Survive Their Transition!

Autonomy in the Retirement Community: Geriatric Care Manager’s Role

Aging with Autonomy in the Retirement Community

Can You be Old and Happy? It starts with your mid-life self…


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Can you be old and happy?

I asked this question of a group of seniors this week and, without hesitation, they answered a resounding YES!

No doubt, happiness is a challenge late in life when you’re faced with multiple losses one after another; loss of independence, spouse, friends, home, financial status, health, memory…..

The key to maintaining a sense of happiness as we age is certainly attitude and the ability to adjust to change. The good news is, there are attitudes that you can foster to ensure that you will remain happy as you grow old!

Five Keys to happiness and aging…

Acceptance: One thing that’s universal about aging is that your life will change in one way or the other. If we can’t accept these changes, we are destined to stay stuck in time and hold on to a world that really doesn’t exist any more.  On the other hand, by accepting changes we put ourselves in a position to adjust and reclaim our sense of self and well-being. A sense of self that is based on our values not values dictated by our families, society or the health care system.

Flexibility: Rigid thinking is the cousin to denial and puts us at risk of not accepting help when we need it. Without flexibility, we can become unhappy with the events of our lives and learn to see our world as all gloom and doom. Flexible attitudes put us in the position to “re-invent” ourselves as we age. You’re going to be put in a position time and time again where you’ll need to find common ground. Whether it’s with your family, your retirement facility or your van driver, you are going to need to foster a bit of patience and flexibility or you’ll be miserable trying to control the world around you.

Purpose: There’s a tendency to isolate from society, as we age, and feel we have nothing to contribute. This can lead to a lack of meaning in our lives, which can lead to depression.  Cultivate a curiosity about the world around you, find meaning in every day life and stay engaged with the world around you.  Make no mistake about it, older adults still have plenty to give and there are life lessons to be taught. Finding meaningful activity and projects that bring us purpose and foster happiness will give us a reason to “get up” and get dressed each day!

Gratitude: Fostering an attitude of gratitude is universally healthy regardless of your age but it becomes particularity important as we age. It’s easy to become down heartened when your life becomes less and less about who you are and more about your disabilities and doctor appointments. By fostering an attitude of gratitude, we will start seeing that our glass is half full versus half empty. You can start fostering this right now by listing 5 things you’re grateful for…

Courage: You’ve probably heard the saying “old age ain’t for sissies” and let me tell you it’s the truth. It takes a huge amount of courage to face the bad news, hold your head high and find the dignity to carry on. The emotional strength it takes to push through the fear and sadness can be critical in forming a sense of happiness late in live. Expressing your fear can lead to a shift in understanding and foster the courage you need to push on and find a new happiness for today.

I was so inspired by the seniors I was with this week as we discussed happiness and aging. Their openness and insight touched my heart and inspired me to cultivate my own attitudes about happiness and aging….

How about you? Do you think about your own happiness and aging? Do you find the above attributes important? Do you have your own ideas about the keys to happiness and aging?

Leave a comment…. I’d love to hear from you!

Aging Parents: Open Your Prison Cell and Be Free


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There are times I’m working with a client and just for fun I throw out the topic of forgiveness. I may say something to the effect of “have you ever considered forgiving your mother for what she’s put you through?” or “perhaps you could consider forgiving your brother for not being here to help you”.

The response varies from silence to a look of utter disgust, as if I’d just confessed to being a mass murder…

Then I qualify what I’ve said in terms of the suffering I see in a person’s eyes, the pain they express or the chaos that’s swirling around and the choices that have to be made about the care an aging parent needs to receive. Holding on to resentment towards an aging parent while at the same time trying to help them puts both of you at varying degrees of risk.  So consider letting go of it for your sake and for your aging parents’ sake but ultimately know this…

Forgiveness is not something you do for your aging parent or toxic sibling; forgiveness is something you do for yourself.

One of my favorite books on forgiveness is “Forgiveness is a Choice” by Robert D. Enright, Phd and in it is one of my favorite quotes on forgiveness…

 “Unforgiveness, bitterness, resentment, and anger are like the four walls of a prison cell. Forgiveness is the key that opens the door and lets you out of the cell”

Consider releasing yourself from you prison of anger and resentment towards your aging parent and free yourself of the toxic dynamics that tie you down.

The choice is ultimately yours…

Physical Therapist, Occupational Therapist and the Geriatric Care Manager


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A physical and occupational therapist can assist with mobility or activities of daily living but often they find their clients need assistance with life care planning and the “big picture” of their lives. It’s not uncommon for therapist (by default) to take on the role of geriatric care manager. This can become uncomfortable when you’re acting outside the scope of physical or occupational therapy. A referral to a geriatric care manager and ongoing collaboration can take the stress and worry out of therapy sessions and put the focus back on the clinical  experience.

Collaboration between physical therapists, occupational therapists and geriatric care managers can be critical when an elderly client is struggling to reach their goals and maintain their independence: depression, anxiety, poor family support, unmet critical needs, long-distance families, poor problem solving skills are just a few indicators that a referral to a geriatric care manager may be in order. As a therapist this conversation can be uncomfortable so therefore the referral doesn’t get made and everyone continues to struggle.

Overcoming Barriers to the Referral

While the therapist sees the value in working with a geriatric care manger (no doubt it makes their life a little easier) but how do you get the aging client and family to take a leap of faith and say yes to the referral?

Without a doubt the number one barrier for physical and occupational therapist in referring to a geriatric care manager is the perception that it is “too expensive”. Since a fee for service geriatric care manager is not paid for by insurance or Medicare the perception for a lot of people is that they can’t afford the service and expertise of a geriatric care manager.

I contend that the average person can’t afford not to hire a geriatric care manager. With the average cost of a consult being under $200 and a clarity session being as little as $65, the benefits gained such as improved communication and quality of life far outweigh the money you stand to lose because of poor planning, miscommunication and lack of knowledge about available resources.

Ways a Geriatric Care Manager Can Help a Therapist Help Their Client Reach Their Goals

Service Coordination - often times physical and occupational therapist are able to identify unmet needs but are unable to assist in locating and coordinating the appropriate services. A geriatric care manager is able to collaborate with the therapy team by providing service coordination and reporting back any additional concerns and updates.

Transitions – a physical or occupational therapist may be the professional that indicates a need for additional care or a move to assisted living. The geriatric care manager can provide the client with resources and education to assure that the best individual solution is identified. They can also assist with the actual move and transition to a new home.

Additional Screens – while physical and occupational therapist focus on the physical it’s not uncommon for the emotional to get in the way of reaching therapy goals. A geriatric care manager is able to provide additional mental health screens such as a geriatric depression screen or quality of life assessment and additional mental health screens such as a geriatric depression screen or quality of life assessment and report the results to the physician and the rest of the clinical team.

Medical Management – facilitate communication between doctor, client, family and other health care providers to assure that everyone is on the same page and working towards compatible goals.  A GCM can also monitor adherence to medical orders and instruction: strategize interventions if necessary and recommend appropriate resources.

Family Meetings – let’s face it, it’s becoming more and more common for family dynamics and friction to interfere with the goals of therapies. A family that is not engaged with the process can easily side track your client and create challenges in reaching goals. A family meeting with a geriatric care manager can clarify the issues and create consensus in moving forward.

Ongoing Monitoring – physical and occupational therapist have insurance and Medicare guidelines they must meet in order to receive reimbursement. For therapist, this means they sometimes have to discharge a person from their case load even though they have concerns about their care and well-being.  A fee-for-service geriatric care manager can be that safety net that provides ongoing monitoring and the ability to refer back to the therapist as needed.

When the therapist and geriatric care manager work together for their clients, they offer a holistic and comprehensive approach that is unique in the world of health care.  A comprehensive approach ensures that the goal of maximizing an older adult’s independence and quality of life are met and clients are satisfied with the care they are receiving and the life they are leading. The leadership and client focus that the GCM brings can empower the entire team, including the client, to work towards care plan goals and maximizing potential.

If you are a physical or occupational therapist exploring ways to refer your clients to a geriatric care manager or integrate geriatric care management into your therapy company, I’d love to hear from you.

LuAnn Smith, email: luannsmith100@gmail.com or phone: (970) 223-5656

Your feedback is always appreciated!

Home for the Holidays and Aging Parents


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For many of us, “home for the holidays” can be that time of the year we notice something isn’t quite right with our aging parent or family member. Sometimes the signs are obvious; other times they’re not. Here are some red flag warnings that may indicate that your aging parent or family member is at risk and in need of some help.  

  • Clutter and odors in a home that was always neat and clean
  • Outside of home in disarray, uncut grass, need of repairs
  • Weight loss or weight gain
  • Poor grooming by a person that once was meticulous
  • Refusing to go with friends and family on social outings or to doctor appointments
  • Avoiding all conversations related to “how they are doing”
  • Intense mood swings, anger and anxiety
  • Excessive drinking, smoking or eating
  • Unpaid bills, maxed out credit cards, piles of unopened mail, sweepstakes entries
  • Neighbors and friends pulling you aside to voice concerns
  • Unexplained dents in their car
  • Difficulty getting in and out of the chair
  • Bruises or limping that may be the result of a fall
  • Pets uncared for, cat box hasn’t been scooped, matted dog fur, under or overweight pet
  • No food in the house or junk food containers from a person that normally would cook

What next?

In extreme cases; no food, no utilities, delusional or combative parent, severe urine and feces odor, filth in the house, neighbors reporting bizarre at risk behavior. Behaviors and signs that your aging parent is at risk of self-neglect; your best bet, in a short-term long distance visit, is to contact the local Adult Protective Services. They don’t have a “magic answer” but they can start by assessing and attempting to get services in place.

Establish communication with doctors, neighbors, friends and family members. You start this conversation by stating that you are worried. Out of respect, you don’t have to be real specific but voice concerns and ask the doctor, neighbor, friends or family to call you if they see anything out of the ordinary.  It is critical that they all have your phone number (or email) and you have theirs.

Resource round-up. Now would be the time to locate resources in your aging parent’s community that may be able to help you now and in the future. It might be a home health agency, nursing home, area council on aging or a geriatric care manager depending on your aging loved one’s specific need and location. There’s an aging network in place; tap in to it! Also, consider what your informal resources are such as neighbors, churches, friends and local family.

At the initial stage of long distance care giving, I can’t emphasize enough the importance of setting realistic expectations for yourself and your aging family members. What you may feel is helpful; they may feel is intrusive and controlling.  Their solution to their aging challenges may be less than adequate and keep you up late at night with worry. The best solution won’t be created in a couple of days. The key is to find middle ground and take tiny steps forward.  Understand that in many ways your hands are tied. Do the best you can with each phone call and every visit. That’s all you can ask of yourself…

RELATED POST YOU MAY FIND HELPFUL

Aging Parents: Understand and Survive their Transitions

Growing Old: It’s not just About Taking the Right Pill at the Right Time!

Aging Parents: Fast Forward 30 Years

Empathy: The Key to Forgiving our Aging Parents!


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Empathy is the capacity to understand and respond in an emotional way to the unique experiences of another person, in our case an aging parent. The moment of being able to imagine what another person is going through. I encourage you to learn to use empathy as a tool for forgiving your aging parents and continue to use it again and again. I would even go so far as to say without empathy there is no forgiving an aging parent.

Empathy leads us to forgive an aging parent by enlarging our perspective of them and their lives. Before they were our parents, they were children: suffered losses, fought wars, experienced traumas or perhaps even long-term abuse. These experiences led them to be the people they are today and the parents that raised us. When we understand their stories we feel empathy for their experiences and have a better understanding of the people they are.

Personal Story

My dad lost his dad at the age of 12 in a tragic car accident. It was a beautiful day in June of 1950, in rural Indiana. My grandpa delivered fuel for Farm Bureau and on his last trip of the day he picked up his young family, my grandma, aunt, uncle and my dad, to take them with him for a ride in the country. Sadly they were all involved in an accident when a man ran a stop sign and hit them. The impact of the wreck pushed the truck in to a tree, which made it difficult to get them out. My grandpa was dead, my aunt gravely injured, my grandma was unconscious. My dad and my uncle had to climb out of the truck over their family’s bodies to strangers that were waiting to help them.

I had always known about my family’s accident but it wasn’t until I read a copy of the newspaper article describing it  that I really understood the impact. Reading the newspaper article and seeing their names in print, filled me with sadness and brought me to my knees; I cried and cried. For the first time, I was able to imagine what my dad had experienced and I felt compassion for what he had gone through as a 12-year-old boy.  The walls around my heart started to soften and I understood how this moment defined him for the rest of his life. I felt empathy for him and his experience.

My empathy for my dad’s experience is something I try to hold in my heart now that he struggles in his aging process. I can’t lie; I don’t always succeed. I get mad at his choices, I want to scream sometimes, other times I just want to walk away but I try to hold that 12-year-old boy in my heart and feel empathy for the old man he has become; it’s in that moment that I forgive…

 

 

 

Give the Gift of Forgiveness this Holiday Season


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Forgiveness is a choice we make and forgiving an aging parent can set us free of the anger and bitterness that ties us down. The bitterness you feel walking through that door towards your aging parent; knowing you will not be appreciated. The anger you feel when you don’t hear “thank you” for the hot meal or ride to the doctor’s office. I understand if you are struggling with the choice of forgiving an aging parent; the constant and repeated offenses they continue to heap upon you create feelings that may make it impossible to put the gift of forgiveness under their Christmas tree. But I want you to consider this…

Give the gift of forgiveness to yourself

Forgiveness, when thought of as a gift we give the offender, may feel impossible.  A gift given to someone who may or may not deserve the compassion, benevolence and love that comes with it.  But I can guarantee that the one person that does deserve the gift of forgiveness is you. Forgiveness is tough complicated work  with layer after layer of family grievances, issues and emotions. Add on the fact that the person you have grievances towards now depends on you in their old age; it can make this time of the year difficult at best.

Give the gift of forgiveness to yourself

Make the choice to start the next year out as your year to turn towards compassion and love. Whatever motivates you to start your journey in forgiveness it is your gift to give to yourself. It doesn’t have to be a big confessional type of thing, it doesn’t have to look or feel a certain way but it does have to start with you making the decision to let go of the anger and bitterness you feel in your heart. Forgiveness will set you free and there is no better time than now to get started on your journey…

Related BLOG Post!

Aging Parents: Forgiveness is a Choice

Aging Parents: What is Forgiveness

Top Five Reasons to Forgive your Aging Parents

Waiting for an Apology? Reflect on This…

Forgiveness: Discover your Aging Parent’s Story

Forgiveness: Get Clear on Your Pain

If you were physically, verbally or sexually abused as a child you may want to consider seeing a psychologist or counselor to assist you with your forgiveness journey. The articles in this blog are consider information only and not meant to replace mental health or spiritual counseling.

Aging Parents: Let’s Talk Home Health Care Agencies!


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There are two different types of home health care agencies that I want you to be familiar with: Medical and Non-Medical. Depending on your location, you may or may not have a lot of options but basically the following information will educate you about what to expect and help you with your elder care planning…

Non-Medical Home Health Care; these agencies can provide assistance with chores, errands, light house cleaning, cooking, transportation, bathing, hygiene, dressing, ambulation and companionship. Their employees are probably not going to be certified nursing assistants but are most likely to be personal care assistants that have been trained by the agency.

My experience has been that the majority of agencies take their training seriously and they monitor their employees to ensure that quality service is being provided. You will not find physical therapist, occupational therapist, registered nurses or social workers in the non-medical home health agency.

Cost: The cost of non-medical services in Northern Colorado varies depending on need but a good ball park figure is approximately $20 an hour. If you purchase service 24 hours a day that cost can be as low as $14 – $15 an hour. This service is paid for privately unless you qualify for some type of home based community service through your county aging programs. Contact your local area council on aging for guidance on this. Don’t assume that you don’t qualify; ASK!

Medical Home Health Care; You’ll find registered nurses, physical therapist, occupational therapist, social workers and certified nursing assistants at the medical home health agency.  The medical home health agency is driven by the Medicare dollar. The care provided under the Medicare A benefit is limited and a person must meet the requirement of being “home bound” in order to receive this service through your Medicare A benefit. This is a short term benefit and is typically a short term solution to a long term problem…

Cost: This service is covered under your Medicare A benefit on a limited basis. There will probably be a co-insurance that you will be responsible for. If you have Medicare supplemental insurance, they should pay the co-insurance and the agency should bill them.

Keep these points in mind

  • Medical Home Health is driven by Medicare dollars and regulated by the Federal Government. Therefore, they are limited in scope and what they can do for you. They can only provide services related to the skilled need.
  • In some areas such as Northern Colorado, some agencies provide both medical and non-medical home care which can be confusing as they have the businesses structured independently to meet government requirements (back to above point).
  • Worried about your aging parent at home but they haven’t had a hospitalization, don’t appear to need therapy or a nurse to manage medical treatment? Call a non-medical home health agency.
  • Is your aging parent in the hospital waiting for discharge? Start asking the discharge planner about getting a referral to a medical home health agency and ask about the specifics in terms of coverage and what the clinical team is recommending in terms of follow-up care.
  • You may need both non-medical and medical home health care at some point. The non-medical to assist with day to day living needs and the medical to assist with medical needs as well as physical and occupational therapy.
  • In Larimer County, Colorado there are over 30 home health agencies and more coming in to the market every day. In Blackford County, Indiana, I found 3 home health agencies. Not all regions have the same resources and practices. Always start your search locally.

I hope in some small way you find this information helpful and you feel a little better  equipped to make decisions about home health care agencies.

If you continue to find yourself confused about home health agencies and you’re not sure which fork in the road to take, a clarity session may be helpful so you can ask questions and receive advice about your individual situation …