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24-Hour Care Vs. 24-Hour Monitoring

24-Hour Care vs. 24-Hour Monitoring

Home Care Difference sign

Is there a difference between 24-Hour Care and 24-Hour Monitoring?  Oh there’s a difference alright.

What’s the difference?

Here’s a question:  Is this person providing attentive care to the road or MONITORING the road?

Monitoring vs caring

Do you want Mom or Dad to receive 24-Hour CARE or 24-Hour MONITORING?

It’s the same question you could ask about your next hired driver.  Would you like the driver to be CAREFULLY DRIVING, or MONITORING THE ROAD?

If you’ve visited a facility on a tour, you still may have no idea what your loved one’s experience could be like.  After all, the facility was built to impress you ON THE TOUR!  Facilities were not built to impress you with their care!  Care doesn’t sell!

The elaborate marble floored entryway. Designed to take your breath away.

You know what sells?  Marble floors.  Grand entryways.  Stylish upgrades.  All of this works for facilities because upgrades sell!  Sexy sells and CARE is NOT sexy!  What’s sexy?  Movie theaters are sexy!  Grand pianos are sexy!

During a tour?  They turn off the bed alarms. When there is a tour, they’ve ‘secured’ their troubled care recipients.  They have tucked their poor wandering seniors somewhere away from the tour.  More of the professionally dressed staff are in the building on a tour day.

These would be appropriate facility labels on the call alarms.

They have given out some tranquil meds.  They are eradicating otherwise ever-present odors on a tour day.  Hospital smells aren’t sexy.  Cookies are sexy!  They are baking cookies during the tour so it smells like home for the tour.  Sexy sells!  Cookies sell.

You know what’s really sexy to Mom and Dad?  Staying At Home!  For the discerning adult child looking into care for their beloved Mom or Dad?  A solution to keep Mom or Dad safely at home?  That’s sexy!  Okay, maybe it’s not sexy..but it sure is a comfort.

Senior Home Care Facilities. We love and hate them.

You thought those fresh baked cookie tricks were just for real estate agents?  Oh no.  The real estate agents learned it from the auto dealerships.  The facilities aren’t the only places strategic about appearances.

Here’s a story about ‘selling’ and strategic appearances:

My late great best man Jerry Flaherty was a car salesman for a few years post-college.  Along his years in used auto-sales he learned some critical tricks of the trade that may have you re-evaluating your next used car purchase.

Auto Dealerships are as big as senior rehab facilities.  They are also expensive to run and they too have ENORMOUS sales quotas.  To reach their sales quotas? Salesmen will go to any length imaginable.

At their disposal, used car salesmen have a fleet of AUTO DETAILERS! (as a comparison to this article-think of the marble floors in a facility entry way).

The Auto Dealer Lot. Lots of magic and snake oil.

Those dirty torn up clunkers that get traded in to the auto dealers get worked over and polished to a fine shammy.  It’s the same kind of grandeos upgrades facility designers are going for.

After all, isn’t the magic in the shining details?  It sure is if you want to sell a hunk of garbage to some unfortunate hopeful car buyer.  It sure is when you want to wow someone.  Todays facilities are doing the same thing.

Maybe there’s a hair salon (yet another high dollar money grab for the facility)  There’s an old timey ice cream parlor (normally an unmanned station-mainly there for looks).  There’s a familiar grandfather clock.  A big old  fireplace.  All of these items designed to represent the actual comfort Mom or Dad can enjoy in their own home.

The auto dealerships pride themselves on turning a clunker into someones shiny dream car.  Jerry told once about a particular car that was traded in.  Almost entirely full of garbage.  Some unkempt 20 year old kid was getting his dream car. Trading in his college clunker for the pennies.  The auto dealers could make more money off of the used car than the new car!  The process starts with auto detailers scrubbing the car clean.  The auto detail team then coats the clunker with enough wax to bring the faded paint back to a shiny new car look.

Christian Talk Radio.

To further entice buyers (think grand piano in the entry way) The salesmen tune all the radio stations to conservative christian talk radio type channels.  Nobody wants to buy a college kids car,  but everyone wants to own a car that their Grandma just got done driving.  So, car dealers disguise automobiles to look the part.

The language the salesman use is just as polished as the cars.  Every car they sell “just came in off a trade”.  That gives the sleazy salesman 100 directions to go to spin a yarn about the previous owner and the”cherry conditioned vehicle” the kid just dropped off.

The former clunker car with 3 coats of wax?  They drive it down a nearby dusty road.  This way, when the salesman tell their story about the dear little lady who traded the car in, they can use their hands to wipe away the dusty layer-revealing the shiniest car you’ve ever seen!(particularly shiny by contrast now to the fresh dust).

The facilities can’t really give your parents the comforts of home.  But with their high prices they can take your parents home!  With their marble floors, grand pianos, movie theaters-their comfortable faux fire places? They can fake it!

They can and do fake it.  But there is a reality for those in the know:

24-Hour Monitoring is NO substitute for 24-Hour Care.

In my hospice management years I worked with an excellent & efficient department manager.  When someone tried to sugar coat something she would always use a phrase her Father used.

Ahhh.. The polished turd.

“You can’t polish a turd”.  As it turns out…a turd is a turd.

When it comes to Facilities, we are often being sold a polished turd.

The fact that facilities can advertise what they are providing AS:  24-Hour Care? is pure insanity.   There is an absolute mountain of difference between 24-Hour Care & 24-Hour MONITORING.  Monitoring is ALL A FACILITY CAN DO!

Yes, the building has lights on 24-Hours a day.  Yes, somewhere in that building there is a caregiver or two.  BUT…there are 100+ people competing for care from that ONE PERSON!!

Remember the children’s story about the woman who had so many children she didn’t know what to do?  As it turns out, this is a great metaphor for care providers in a facility.  There’s too many diapers to change.  Too many mouths to feed.

There was a facility caregiver who felt like the old lady who lived in a shoe. She had so many residents…she didn’t know what to do.

Here’s a fair Final question: Why aren’t facility tours conducted at 2AM?  That’s the time I’m most concerned about my loved one.  What’s the facility like at that hour?  I urge anyone reading this to go and see for themselves.  Here’s some things I have personally seen at that hour.

#1. The Wanderers.  There is very little actual sleep and rest to be had in a facility after hours.  If you are hard of hearing you are in luck.  If you have a sleep mask?  You are in luck.  If you want you want to lock your door?  Turn off the blinding florescent hospital lights from the hallway?  You are not in luck.  If not, you’ll too be hard pressed to rest in a facility.  The poor wanderers often end up in your loved ones room.  Like a lot of the residents, ‘The wanderers” have found themselves upside-down on a sleep cycle.

Every facility has confused seniors walking around at night. Most of the time they are looking for a familiar face. Or thanks to meds, their days and nights are confused.

All thru the night at a facility there are LOUD alarms.  Consider The Wanderers, the noisy televisions blaring all night, the blinding facility lighting.  The wanderers can’t sleep at night, so they try to sleep during the day.  At night, the wanderers have already had their sleep.  So they wander.  They are exhausted, but they don’t sleep.  Nobody does.

Facility staff we have interviewed will shamefully admit that the easiest person to watch is the over medicated person.

Don’t forget what The Wanderers become.  When a Wanderer has wandered too often where they aren’t wanted, the facility will adjust their sleeping meds.

#2. DRUG INDUCED SLEEP ZOMBIES.  Wanderers become drug induced sleep zombies.  Beware.  They are out there.  And they are coming in. With hardly a clue to where they are.  Those poor over medicated seniors desperate for a good nights sleep are the new ‘walking dead’.  Half asleep drugged out elderly zombies.  They are disoriented, confused and again, medded-up.  “where did all these people in robes come from?”  We aren’t sure, and they have no idea where they are either.

After hour evenings at a facility are prime time for outside cleaning crews to clean the entire building.

#3. The Janitorial staff.  These poor people have been asked to ‘sterilize’ a place that is never actually capable of being sterilized.  Cleaning crews are commonly asked to provide their services at places like this after hours.  The general hum of a floor waxer or a vacuum as it turns out…helps drown out the sounds of all those bed alarms going off.


Why do abandoned nursing stations seem so spooky?








#4. A whole lot of NOBODY.  The deafening and confusing silence of abandoned, empty nurses stations.  Yes, 2:00AM at a facility is a regular “The Shining”.

There’s a new GARGANTUAN assisted living facility in our territory in Dublin, Ohio.  It’s grandeur accoutrements are second to none.  Complete with an old-timey movie theater (which is playing movies ENDLESSLY) to a normally empty theater.

Some senior care facilities these days share the costs of 20-90,000 sq. ft. spaces.

A walk down these ghost town hallways at 2am is not unlike what the experience is like on a non-tour day at 2pm.  Empty store fronts.  The occasional very confused senior walking with their walker seemingly lost in time and space.

If you need staff, hit your emergency call button. If they don’t reply, look for them in the smoking lounge.

Where on earth are the facility staff at 2am?  Look in the break rooms.  This is where they should house the receiving end of the emergency call buttons (if they actually wanted them to be answered)  But no, this is the graveyard shift workers sanctuary retreat area.  Free from the Wanderers.  There’s Late night television to watch.  Snacks.  Ipads.  Coffee.  Vaping vapers vaping.  It’s a regular who’s-who of the caregiving underworld.

There’s no way to care for 14 people at once.

The good news?  There’s a better way.

In order to build our Home Care team in Columbus, Ohio we have interviewed THOUSANDS of applicants since 2003.  Half or more of them have had facility experience.  We ask all of them about their experiences.  Turns out they report 40% or more of their time at a facility is spent doing paperwork.  Facility staff we have interviewed report staffing ratios of 1 caregiver to 14 care recipients.

If I were a caregiver in a facility I would want to know (as many staff have shared honestly with me:) How can I keep my boss happy?

I can either A: Provide Underwhelming Care to 14 residents or B: Provide excellent care to 2 and maybe 3 residents and ignore eleven residents entirely?

The math itself prohibits quality care.  How horrifying is that multiple choice reality that many of our staff were forced to make?  At best, there’s no correct answer.  Is it a trick question?  I wish.

What the answer to that question does provide is a reality that care recipients in a facility receive less than one hour of actual hands-on care PPPD: Per-Person-Per-Day.  Facility residents are in fact: Not cared for 90% of the time.  They are MONITORED.

Another little GEM about facility staff.  Our care has provided supplemental care for area facilities for 15 years.  When families require more hands on care than the facility can provide?  We are called.  The family will call us.  The facility will call us.  They know they can receive one-on-one care if they BRING IT THEMSELVES. Click the link to learn about where your loved one’s facility dollars go:

The squeaky wheel gets the oil

We get asked every week to be the ‘squeaky wheel’ at the facility. When our clients have to stay at the facility? WE make sure they get great care.

When families call with this request; we are happy to assist.  When one of our current clients have a surgery, they are always told they need to recover in a rehab (no longer does recovery take place in a hospital)

I always recommend to ANY family who must go into a facility that they send a loved one to ADVOCATE for their loved one 24-Hours a day.  Since providing 24-Hour care is an almost impossible task for any family, our team are happy to do the overnights.  We will also take the baton for any remainder of the care balance in order to put together 24-Hour coverage for our treasured clients.  In even the ‘nicest’ facilities we have served in: Having a constant advocate is the only way to ensure that your loved one will receive proper care.

Money in facilities

Search our blogs for a breakdown of where your facility dollars go. *hint: care is not cost #1, #2, or #3.

Home Care or a combination of home care and family assistance is the only way your loved one can receive ACTUAL 24-Hour Care at a facility.  We have had clients receive 28-Hours of care for their loved ones each day.  The family members who ask for this know that bathings or toiletting is more safely done when 2 caregivers are present.  In this style of care a safe lift is performed with 2 strong caregivers to ensure proper cleaning and safe transfers.  Visit this link to learn more:

What’s the math on that?  We are providing 110% of care for our Home Care Care Recipients vs. 10% or less of the day allotment of one-on-one care your loved one receives at a facility.

In short?  There’s an AMAZING difference between 24-Hour Care and 24-Hour MONITORING.  Know the differences for your loved one.

Ben with husband of senior care recipient.

Ben Smith is The Founder, President and C.C.I.C. (Chief Caregiver in Charge) at Always There Home Care.  His ongoing mission is to provide the greatest care imaginable for those fortunate enough to desire care for their senior loved ones in Columbus, Ohio.

Call us today to schedule a meeting over the phone or in person with Ben. Call our 24-Hour Home Care Hotline: (614) HOME-CARE 466-3227.

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