When a Trusted Helper Becomes a Caregiver

Steve Barlam: 0:00

The caregiver makes less money than they should be making. Now, JFS Care, we take pride in paying our caregivers more than traditional agencies because we are mission driven. We are a nonprofit organization, and our mission-it's so interesting. Our mission used to be, Barbara, all about creating better care experiences for our older clients, but we had gotten it wrong, you know. So our mission these days, and for the last four years at JFS Care, is all about how do we take better care of our caregivers? How do we honor them? How do we train them better? How do we create better jobs for them? Because we know that when we can do that really well, they're going to deliver really great care for our clients.

Barbara Hament: 1:02

Hello, and welcome to season four of Dementia Discussions. I would really like to take a moment to thank the guests who were on this past year, and to thank you, the listener. I really could not do this show without you. And over the past couple of years, some of you have called me, so I am encouraging more of you to pick up the phone and call me. I'm accessible, and I'm so eager to hear your story. I'm at 310-362-8232 or you can email me at dementiadiscussions.net. So again, thank you. I'm grateful for you, and so looking forward to another year of us being together. Hello, and welcome to Dementia Discussions, the podcast for and about caregivers. Today on the show, I am so thrilled to have Steve Barlum. Steve is the CEO of JFS Care, which is the caregiving, the private caregiving arm of Jewish Family Service Los Angeles, and the just past president of the Aging Life Care Association, which is the national organization that all of us care managers around the country belong to, and on top of all that is a colleague, mentor, and dear friend for decades. So, Steve, thank you for coming on the show. I so appreciate you. Oh, it

Steve Barlam: 2:45

is so nice to be here, Barbara. You know how much I enjoy speaking with you.

Barbara Hament: 2:50

Oh, absolutely. So, right back at you. So, I wanted to chat with you about a situation that we see so often, and I think it's totally relatable to a lot of families. It's a situation where the housekeeper, let's say, or the assistant becomes more than kind of morphs into the caregiver over time, and you know, kind of the pros and cons of that, right? How you know how that situation usually goes, and so I just wanted to kind of you know spell that out a little bit. And so I just saw a couple, and pretty typical, right? A couple with three adult children launched long ago out of the house. You know, a couple are out of Los Angeles, one's in LA. So a couple's been on their own, but they have this housekeeper, right? And she's been with them for years since the kids were little. So she's honest, trusted, part of the family, and right, yeah, and so you know, as the husband has been a little bit more forgetful, has had some trouble with his balance, tripped on the steps, wife is still driving. She shouldn't be. There's been some fender bend, you know, some scrapes on the car. So of course, you know, the caregiver over time has started to do more things. Right, started to come more days, more hours. Has been driving them to the grocery store, helping with shopping and now helping with cooking, so you know over time, right? Her her role has increased her her days and her hour. Yeah, you know it. Yeah, we

Steve Barlam: 4:53

see this all the time. We see this all the time. Yeah,

Barbara Hament: 4:57

all the time, right? So at. It's all good, all good, right? Things are going smoothly until the responsibilities are kind of more than the housekeeper can can. Let's see, what do I want to say? Trying to

Steve Barlam: 5:18

manage well or do well. It's out of their their lane, out of their scope of practice, out of skill sets. Yeah,

Barbara Hament: 5:30

out of their skill sets until this right. Until right the tasks are are too many, too much. Yeah, out of out of their scope of practice. Yeah, and. so oftentimes that's when families call us, right? That's when adult children call us. Yeah, they come into town or they start seeing that things are not as they always have been, or they're getting even like we've had a couple of situations where the adult children are getting a little worried, right? This trusted person is now like taking their parent to the bank. One of them, we had a situation where one was going to the meeting with the financial planner. So you know, suddenly, like adult son is saying, "Hmm, this doesn't seem right. So that's oftentimes when we get calls from adult children, who are yeah.

Steve Barlam: 6:26

I see it in two different ways, Barbara. There are those families who absolutely recognize something's going on right now and have a little concern and let us know, right? And say, you know, can you, you know, look at the situation and give us some feedback? And are there other alternatives and things like that? But then there are the other families who approach us and think this is really a great solution. That the housekeeper is in place, and this is great. And we sometimes walk into these situations and see, is it as great as you think? And you know, God bless the parent for trusting and being able to accept some care and some help from somebody else, because so often we walk into situations where that's not the case, and so I get it. For many families, it's a relief that there's somebody they trust that's available, that the parent is willing to accept some help from, and it's a great thing. You know, it works until I always say it works until it doesn't work.

Barbara Hament: 7:51

Right, and sometimes it's even the assistant or the housekeeper who reaches out to the family to say, right, reaches out to the adult children to say, you know, your mom is falling, or your mom needs more help in the shower. Like another case, the assistant felt uncomfortable. Okay, his job also had morphed over the years, and he was uncomfortable showering the person he was taking care, you know, he was now taking care of, and so that's when he reached out to the daughter-in-law and said, "I think I'm kind of beyond my, you know, I don't feel comfortable with this anymore. So, very

Steve Barlam: 8:34

right, you know, it's not change is never easy, and we tend to only make a change when we're forced to make a change, and so there's sort of the red flags that we need to be aware of and to be thoughtful in order to be able to introduce a change at the right time. It's all about timing, right? So when a housekeeper is involved, let's say, and then starts to maybe cook some meals or do some shopping or do other household-related tasks, but just a little more expansive, I have no problem with that, and it's actually a lovely thing, right?

Barbara Hament: 9:23

Absolutely. Only

Steve Barlam: 9:24

gets in the way when somebody is asked to do something that they don't have the training, the experience, the knowledge to be able to do a really good job at. And oftentimes, people are wanting to do the right thing, they want to be nice. They care about caring for that person, and so they may agree to do things even if they're not the right person to do it. And so we always need to be thinking about: Is this the right person to be doing? The specific tasks that are being asked that are needed of them to ensure that the parent's needs that the parent isn't put at risk in any fashion, right?

Barbara Hament: 10:13

Oh yeah, absolutely right.

Steve Barlam: 10:16

You know, some of those things you absolutely nailed, like bathing or toileting or transferring somebody safely. So somebody with the greatest intent, even without putting the person at risk, the older person at risk, could be putting themselves at risk if they don't know how to transfer someone from you know sitting to a wheelchair properly, they could throw out their back. They could hurt themselves, and if that happens, then the family, the client, could be liable for all kinds of things. You know, especially if there aren't insurances in place, workers' comp, other liability insurance in place, so it's really important to make sure that the right people with the right experience and training are in place, just to ensure peace of mind for everybody involved.

Barbara Hament: 11:18

Yeah, absolutely, absolutely. Yeah, safety and peace of mind. So somewhere along the line, someone recognizes whether it's the family or whether it's the you know the housekeeper or the assistant. Someone recognizes that a change is needed,

Steve Barlam: 11:35

right?

Barbara Hament: 11:36

Yeah, and and reaches out, hopefully to someone like you, someone like me, where so we can, you know, assess the situation and and make some changes, bring in some help.

Steve Barlam: 11:50

So there's really a few different roads that people can go down, different pathways that people, and when people need care in the home, I would say there's probably three traditional models, and then I'd love to talk to you about something new that we're doing. That's a variation on the theme of one of those models.

Barbara Hament: 12:13

Right. Yes.

Steve Barlam: 12:14

One one of the routes is that people can hire somebody privately. Right. You hear about from your neighbor, from a relative. Oh, I know of a caregiver who is working for a friend or working for a relative or a whatever sort of a trusted source, and you can hire somebody privately, and that's generally the lowest cost to the family, and the only words of advice around that model. So that's at one end of the spectrum of hiring privately, is that you want to make sure that you treat that person fairly and legally within the state laws, the labor laws where you're living. I know for in California, it's really hard to use somebody privately and treat them either paying them under the table, which is not legal, or treating them as an independent contractor in California. It's hard. to pull that off legally, and you just want to make sure you have an employment agreement, you have insurances in place, and that you're treating the person as an employee. That's the words of advice. Okay, so one way is that. Then another model out there is a registry model, and a registry model is similar to housekeeper agencies, nanny agencies, how they're traditionally run, in which there is an organization that does all the recruitment and screening of the individual, and provides you with someone, and then they become your employee. And the issue in that some of those agencies say you can treat them as an employee or as a contractor, but be cautious and get good advice either from an attorney or your accountant. Whether you can really do that legally, you know that's just something to be cautious. That's the second lowest cost route to go of using a registry where you're the employer, but you get an organization that can help you find viable candidates who do the screening, recruitment, and provide you with, and you pay them a fee to do that,

Barbara Hament: 14:58

like a finder's fee, a

Steve Barlam: 14:59

finder. It could be a lump sum, or it could be a small monthly rate. It's different agencies work different ways, different registries.

Barbara Hament: 15:09

Would you say that care.com falls into one of those two?

Steve Barlam: 15:14

That a care.com is more of a registry model, yeah, and that is an option, and they do some recruitment for you, and they feed you candidates, and it is more of a commodity kind of service. It's

Barbara Hament: 15:34

right, so they're not doing any screening. You you have to do all the screening,

Steve Barlam: 15:39

and then they have services that can help with payroll and things like that that you pay for additional. Got it. Okay. The last is an agency model, and an agency model is where the agency acts as the employer of the caregiver. You don't have to pay the caregiver directly. No money ever goes from the client or the family to the caregiver themselves. It avoids any of that awkwardness and you know of having money go back and forth between a client and the provider. The agency handles all of that. The agency is responsible for taking out the appropriate employer deductions. They're responsible for having the bonding and the insurance, the workers' comp insurance and liability and malpractice insurance. They're also doing the screening, the oversight, the training of the caregiver, and there's it costs more because of the cost of all that, right?

Barbara Hament: 16:53

Right. And some agencies, I don't know if JFS does this, but do you guys handle like if a family is so fortunate to have long-term care insurance, is that something you guys?

Steve Barlam: 17:04

Yes, we work with long-term care insurances all the time.

Barbara Hament: 17:09

So you provide the information that is needed for reimbursement.

Steve Barlam: 17:13

Exactly, and we assist filling out the forms so that way things run as smoothly as possible. So if people happen to have long-term care insurance policies, they tend to want to work with an agency versus a registry or a private individual. Although things are changing in the long-term care insurance industry, so again, the three models is hiring someone on your own, doing your own recruitment, your own screening, and handling all the employment pieces to that.

Barbara Hament: 17:51

And when you say, just sorry, just to go back one second, when you said it's not legal to pay them under the table, so you're saying if you're, which everyone does, right? You're paying a person, let's say by check or giving them cash every week or whatever, every couple of weeks, once a month. So, since they are not, since you're not taking out payroll deductions, they are not, or since they're not a w2 employee,

Steve Barlam: 18:21

right?

Barbara Hament: 18:21

That is not legal here in California. Is that what you're

Steve Barlam: 18:25

saying? Yes. You really, if you are telling the person what to do, if you're directing their activity, if you're setting their rate, and if you're setting the hours that are worked. You are the employer. You are not a contractor. If you said you can come in any time you want, you can do what you want, and I'm not going to provide you with any oversight. You just do what you think is right, which very few caregivers could meet that you know criteria, so families can get themselves into trouble because an employee may say,"Yeah, I'm fine with that. Pay me under the table. Great, I love that. Yes, yes, yes. That's what I'd actually prefer. And then after the fact, if they become disgruntled or unhappy, they can apply for unemployment, and then that's a red flag, and it can trigger other organizations to say, "Wait a second, you're not entitled to unemployment because there's no record that anyone had ever contributed towards unemployment as an employer, and then we've seen families where there are fines that could be 50,000 100,000 back taxes, overtime pay, people get sued, and. There are large sums that could really hit a family hard. So we we always want you know we're an organization, an agency that does thing in the most kosher way. We want to you know do things very cleanly, and so we obey all labor laws. As an agency, we are required to take out all deductions, and while it's a little bit more per hour, it reduces the liability and creates more peace of mind that someone else is the responsible party, and if somebody is going to sue, they're going to sue their employer. They're not going to sue the client. So right,

Barbara Hament: 20:49

right,

Steve Barlam: 20:50

sort of assume that responsibility.

Barbara Hament: 20:53

Yeah, that risk exactly, exactly. And there are other. I mean, there's there are many benefits, of course going through an agency. If a caregiver leaves on an extended trip, right, goes abroad for several weeks to see their family. If they're out sick suddenly, we're not

Steve Barlam: 21:13

working with an agency. Then all of a sudden, you're stuck. Like, what am I going to do? Do I have to take off work and take care of my mother while the caregiver is out sick or while I'm scurrying about to try to find a replacement? So working with an agency, you have a backup pool. I would say I have been doing home care for so many years now, and it is, you know, we always find the backup,

Barbara Hament: 21:45

right?

Steve Barlam: 21:46

You know, we don't leave people in the lurch, so that's part of what people are paying for-that backup support, exactly,

Barbara Hament: 21:55

right. And so that's a great thing, you know, that's a great thing. There's so many benefits, but I would say here in LA, the cost of care is so high.

Steve Barlam: 22:07

Yeah. So

Barbara Hament: 22:07

most families can do this for a year, two years, three years, and then really as needs mount and hours get longer, and suddenly you're looking at daytime care, nighttime care.

Steve Barlam: 22:24

Yeah, the

Barbara Hament: 22:25

costs over time are prohibitive.

Steve Barlam: 22:28

Yes, right, Steve. We've said that over the last probably three years. I've been, you know, hitting my head against the wall. You know, just saying the model, the traditional model, doesn't work for a lot of people, especially as they need more full-time care. Full-time care has gotten so expensive because there was a change in the law, maybe 15 years ago. There was an exemption to labor laws that allowed for a living exemption. So, if somebody was staying in your home, you could avoid overtime paying somebody overtime hours if you're requiring them to be on the premises in the state of California, you have to pay somebody for every single hour they work. So, if somebody needs 20-four hour care and you have one worker, according to the state of California, if they are required to be on the premises, the first nine hours that they're there, they get paid regular time, and then the next 15 hours they have to be paid a time and a half. So you can imagine how the cost just skyrockets. In the past, there was an exemption, so live-in care was affordable. Live-in care in the day used to be 200 304 to $400 You know,

Barbara Hament: 24:17

right a day

Steve Barlam: 24:17

was more manageable compared to. to what it is today, which is double, triple that.

Barbara Hament: 24:26

Yeah, about$1,000 a day.

Steve Barlam: 24:29

Yes, you do it legally through an agency. Now, we created a few years ago, as I was saying, a colleague and I put our heads together, and we started to explore and look at models across the country. And we were saying this isn't working for so many people who need full-time care. So we uncovered that there was a model out there that is a hybrid registry model. It's similar to a care.com but white gloved, and not so much more than care.com It is a service, and it's only for living. It's a service that saves families over $100,000 a year compared to agency rates, and it affords us to be able to pay caregivers significantly more than they make in a traditional agency.

Barbara Hament: 25:35

Oh, I'm glad you brought that up. Right, so let's just talk about that. Going back to the you know our our usual models. That huge discrepancy between what a family is paying. So let's say you are paying hourly and overtime. Let's say 12 hour shift. You're still paying a lot of money in California. Yet the caregiver because the

Steve Barlam: 26:00

because of all the overhead, the worker with all these other things that an agency has to do-the training, the oversight, the recruitment-the caregiver makes less money than they should be making. Now, JFS Care, we take pride in paying our caregivers more than traditional agencies, because we are mission driven, we are a nonprofit organization, and our mission-it's so interesting. Our mission used to be, Barbara, all about creating better care experiences for our older clients, but we had gotten it wrong, you know. So our mission these days, and for the last four years at JFS Care, is all about how do we take better care of our caregivers? How do we honor them? How do we train them better? How do we create better jobs for them? Because we know that when we can do that really well, they're going to deliver really great care for our clients. That's the byproduct. So our mission has shifted, and we really were thinking as we created this new model called Care Family for live-in this hybrid model that saves families over 100,000 compared to traditional agencies. Caregivers get paid more. The cost is less for the end user. They get better care, but it's only for live-in. It's only for those needing 24/7 and the way in which we do it, it is a hybrid registry. So we do the recruitment, we do the screening, but we offer such a white glove service in terms of handholding and helping families to get a service, not a service agreement, an employment agreement together with an attorney. We connect people with a payroll service that makes it so easy to pay the caregiver, keep track of everything, and we help families get the insurance in place through their existing homeowners or renters insurance because it's required in the state of California that that be offered and at an affordable rate. So we can pull this all together, and even with our involvement in our costs-we're still saving people over 100,000 a year for full-time care.

Barbara Hament: 28:47

So, would you say the family would have to have maybe an involved adult child who kind of spearheads all this?

Steve Barlam: 28:57

It could be an adult child. It could be a fiduciary. It could be a professional that's involved. It could be a friend who's willing to step up to the plate. But given the fact that so many of our clients have dementia, right? It really couldn't be managed self-managed by somebody who has whose thought process might be compromised and not be able to manage, because it does take a person to confirm once a week when they see it coming over their email. The caregiver worked these hours. Do you confirm that took place? It needs the confirmation from a third party, a family member, or a friend or professional to do that, and in doing so, then the checks can be issued to the caregiver.

Barbara Hament: 29:55

So we started out talking about the housekeeper. Let's say. The housekeeper decides to live. Like, have you ever had a case where the actual housekeeper becomes the the family goes through bringing them on? You know, as a actual w2 right? We're talking about a w2 employee.

Steve Barlam: 30:15

Yeah, and normally there's a place for the housekeeper, but it's generally when somebody really requires full-time care, we try to figure out how do we augment what the housekeeper is doing with getting, and it might be somebody coming in three times a week, four times a week as a caregiver for six, seven hours to do bathing, to do other activities to make sure you know, or might be daily for four hours a day or six hours a day to augment what the housekeeper who might be living in is doing, but to make sure that there's somebody who has the right training, experience, know-how. because it's not just the task, but it's also being able to identify when things are heading south. You want somebody who has experience, who sees when somebody's legs are getting swollen, to seize that and to be able to either tell the family, or to tell the doctor, or to tell the care manager, if there's one involved, that something has changed. So it's not just doing being knowledgeable about giving a bath, and it's having the experience of sort of paying attention to the changes, being able to document things and communicate things appropriately, and that's where it's great to have, you know, a more trained caregiver in place.

Barbara Hament: 31:55

Oh, absolutely! Like you're saying, a CNA, absolutely, who's trained to see that maybe the urine is getting cloudier, darker. You know, a person's not drinking as much as before, or eating as much, or losing weight, or you know, whatever. Right, right. Legs are getting swollen. Whatever it is, and I would say, you know, the it enables like when you hire help, and as hard as it is to make that big change. However, you do it, it enables the daughter to be the daughter again. It enables the housekeeper to go back to housekeeping tasks. It enables a person to assume their original role, right?

Steve Barlam: 32:39

And I remind folks all the time because they will say, "My mom will never accept help from an outside source. Right? They only want the care from the housekeeper or from me, husband, family, or exactly. Yeah. What I remind them, especially if there is a housekeeper, as I said right at the beginning of the podcast, it's a really good thing that they have the capacity to have formed the relationship with the housekeeper. There are some people who have such a difficult time with any relationship, and so we oftentimes will reinforce that with our clients and say you are a strong person. We know it's not easy to accept somebody new. You have done it in the past. You have surprised all of us that you never wanted to accept help from anyone. And look, you accept accepted it from this person. We want to introduce somebody else who is coming in as a friend of the housekeeper or a friend of the family to make it as easy for the person to accept. So we build upon if that person has that capacity to was in the past able to develop that as well,

Barbara Hament: 34:06

right? That trust and that connection, absolutely, yeah.

Steve Barlam: 34:10

And it's all about the relationship, right? You don't want somebody coming in and steamrolling, or you know.

Barbara Hament: 34:20

Oh, that's another. That's exactly right. So then the trick becomes, you know, how not to threaten the the person who's already there. Not how how to bring them in as a team member, right, and not threaten the role of the housekeeper or even the daughter. Like sometimes we're taking away tasks that you know the purpose of the daughter or the spouse. So how how do we do that?

Steve Barlam: 34:48

Sometimes we'll fill out a worksheet with folks and figure out what are all the tasks that need to be done. What are the tasks that the housekeeper would like to be doing? What are the tasks? That the daughter wants to be doing. What are the tasks that the husband wants to be doing, and what's left? And those are the things that the caregiver can output, and that's and also help highlight what can the caregiver do that's their, you know, that's their strength that they're really good at, and it might be with bathing, it might be with toileting, it might be with meal preparation, it might be with social engagement, it might be companionship. There are so many different components to good care that we just try to figure out. Everybody has their role, as you said, Barbara. Right, the family, the housekeeper, and it's really just figuring that out. There's lots of moving parts, and that's the beauty of your involvement as a care manager to be able to eyeball the situation and help families with that.

Barbara Hament: 36:04

Right, not threaten anyone's role. Exactly.

Steve Barlam: 36:08

Yeah.

Barbara Hament: 36:08

Yeah. So you said care family. It's a national model.

Steve Barlam: 36:13

Care family was started in Los Angeles, and we are actually serving clients in San Diego, in Orange County, and we're just starting to serve in the Ventura and Santa Barbara counties. So we're in Southern California, and it's really taking off. That people are seeing that there's an alternative because it really allows family members to have more control over who comes into your home, and if you think about it, when you have full-time care, 20-four-hour care, if you have two different shifts coming in and out, and having six or seven people who come in and out throughout the week for somebody who has has some kind of cognitive decline. How disorienting that is! It's more chaotic. Whereas if you could create a model depending on the care needs, clearly of just two people, a four day a week and a three day a week, like how wonderful is that for the person,

Barbara Hament: 37:24

right? And

Steve Barlam: 37:25

especially if they're getting paid fairly, like they're gonna stay, and they're not. You know, the turnaround is practically eliminated to do better pay customer. customized approach in matching, and then families just feel more in control because they're interviewing, they're selecting, they're creating sort of what is the salary they have, the agreement. It's more intimate the relationship between the caregiver and the family or the client, and that just works a lot better in these situations.

Barbara Hament: 38:10

So, does it have to be a rate that includes the overtime? How does how do you figure out the rate

Steve Barlam: 38:17

exactly? So, our executive director, who's a gentleman named Matt Turing, generally meets with every single client. They set up a Zoom meeting with any financial people, family members, anyone involved to really go through the proposal. It's a written proposal, and it spells out exactly what the costs are and what is for what, and what it all adds up to, and again, the total is a lot less than the traditional. But there are different components. There's the salary to the caregiver, the small component that goes to care family, a small component that goes to the payroll system, you know, system, the cost for the attorney to set up the initial agreement. Like there's these little pieces to it, but it's all taken into account, and it helps the family. We had the

tag line: 39:19

the right care, the right way, because it helps families do it correctly. Because so many people are putting themselves at risk doing it under the table, and I hate that.

Barbara Hament: 39:32

Right,

Steve Barlam: 39:32

I understand why they're doing it. So we want to create sort of an in-between model that says you can do it correctly. It costs you a little bit more, but not a lot more. Right, you can keep it, no, right, and you're doing it all legally. So

Barbara Hament: 39:51

it makes sense.

Steve Barlam: 39:52

Yeah,

Barbara Hament: 39:54

yeah, it makes much more sense and more sustainable over time.

Steve Barlam: 39:58

Yes, right, exactly. Exactly,

Barbara Hament: 40:00

more affordable over time. So,

Steve Barlam: 40:04

you know, our goal-we are really looking at this stage of ways to touch more clients. We genuinely believe that we have a great model out there, both with Care Family as well as our traditional model, the other thing that we're doing a little bit more uniquely at JFS Care in our traditional model is that we're doing smaller hours. So we have clients who use us for two hours a day. Now,

Barbara Hament: 40:39

how do you do that? That's so hard to do as an agency. I would imagine.

Steve Barlam: 40:46

So we charge a little bit more per hour, but it's a lot more cost effective for families as opposed to if there was a four hour or a six hour minimum, which many agencies have, and there are lots of agencies these days that are saying we only want eight hours a day, and we get a lot of referrals from those organizations because we have a solid pool of just about 400 caregivers who are our employees that we want them to be working, and so some of them might be working 30 hours a week, and they just want a few hours, a few days a week to fill up their schedules, and so it works for us. It's a win-win, and since not many agencies are doing the minimal hours. We'll do that, and those hourly rates, instead of being in the low 40s, they might be closer to the high 40s or low 50s. But it's just for one or two hours. We'll do

Barbara Hament: 41:57

it. You know what? That's a great idea, especially for families who are just starting to bring in help, because most people don't feel like they need whether they do or not don't feel like they need eight hour an eight hour shift. Right? What are they going to do with the person? They're just going to sit around. They don't want to see a caregiver on their phone. They don't have enough to do around the house. They just need them for this task or that task. You know, I just need them for a little of this, a little of that, not for an eight-hour shift. So yes, bringing someone in.

Steve Barlam: 42:31

So we will do those little shifts. Now it's a challenge to do it in a consistent way. So if you want same caregiver to come just once a week for two hours, we can't guarantee that because once that person who we found the job for two hours finds more full time, sometimes they are available, and we have set that up. It's remarkable to me that we have been able to achieve a certain amount of consistency, but we just can't promise it.

Barbara Hament: 43:05

Sure, if

Steve Barlam: 43:06

families want that consistent on a regular, generally more hours will help you to guarantee that. That makes sense. You know that, and

Barbara Hament: 43:17

usually, wouldn't you say usually as a person gets used to a certain, you know, having having a caregiver around, like they're more apt to increase the hours just over time naturally, kind of grows

Steve Barlam: 43:30

organicity.

Barbara Hament: 43:31

Yeah,

Steve Barlam: 43:32

exactly. And so it's all about the relationship, and you know, if you've never had care? It's hard to even conceive. Like, what would that be like? And it's awkward and it's strange. And so, we try to make it as easy as possible for families and for our clients to get the care they need and do it in a way that matches who they are.

Barbara Hament: 43:59

And we do talk about that-that it is uncomfortable to have someone you know that you don't know in your house, and it is an invasion of privacy. But over time, you get used to it, and you even look forward. I mean, imagine looking forward to a person coming.

Steve Barlam: 44:16

I would say that that is a majority of the time. I'd say 90% of our clients look forward to their caregivers coming. There might be less than 10% who, you know, there could be resistant for one reason or another, but they absolutely require the care, and we do our best with, you know, a smile on our face. Yeah, I love this work. You know, I have to say it's really rewarding to be able to make a difference in people's lives. I just hate that it has to cost as much as it does, and so we continue to be thinking about innovative ways to cover services. I'm grateful that there. Programs through the VA. There are programs through social service agencies like our parent organization, Jewish Family Service. There are programs through the state like MSSP that offers ways to have case management provided, as well as them being able to use in-home supportive service, which is a public benefit home care model, so you know there's a new program.

Barbara Hament: 45:32

Have you heard of that new program through Medicare, the Guide program?

Steve Barlam: 45:36

Yes, the Guide program is a fabulous one, and we're investigating and engaging with some local hospitals right now to be part of that. Actually, we were approved through UCLA and through Cedars provider. Yeah, so we're heading in the right direction. It's moving a little slower than I would like, but that's the nature of who I am. One more, yeah. I think that we will get there.

Barbara Hament: 46:09

Agreed. Agreed. We are heading in the right direction, trying to make care more affordable to more people. Yeah.

Steve Barlam: 46:18

Yes, and those who can afford, we want to offer the very best care that we can, right?

Barbara Hament: 46:24

Of course, absolutely. Yes, Steve. Thank you for coming on the show. So appreciate you.

Steve Barlam: 46:31

Oh, such a pleasure to have this kind of conversation. You're so easy to talk with, Barbara.

Barbara Hament: 46:37

Oh, well, I appreciate you, and I look forward to having you come back. If you have any other innovative programs through JFS Care, through JFSLA, you know, please come on back and let's talk about them.

Steve Barlam: 46:51

Thank you. Thank you for joining us today

Barbara Hament: 46:57

on another episode of Dementia Discussions. If you're a caregiver or know someone who's a caregiver that would like to be a guest on the show, please call me at 310-362-8232 or go to dementiadiscussions.net forward slash contact and let me know. I would love to have you. Remember that you can follow Dementia Discussions on Apple Podcasts, Spotify, Google Podcasts, and many more. If you listen on Apple Podcasts, it would mean a lot if you would leave me a review. For any other information about this podcast, please visit me at dementiadiscussions.net, and please share this podcast with someone you know if you think it may help. Thanks again for listening, and I'll see you here again next time on Dementia Discussions.