Rise in Popularity of at-home Caregivers; Dallas Nursing Homes in Decline

In recent years, there has been a significant shift occurring in the dynamics of long-term care for senior citizens. There are a few key differences between the senior citizens of today and the seniors of twenty to thirty years ago: today’s senior citizens are living longer, they have more income, they are more accustomed to modern creature comforts, and they increasingly prefer to “age in place,” a term that means they wish to remain at home with the assistance of a home healthcare provider rather than enter full-time nursing homes.

The US population continues to age rapidly, as indicated by projections delivered in October 2016 by the Population Reference Bureau stating, “[…] the number of Americans ages 65 and older is projected to more than double from 46 million today to over 98 million by 2060.” This rapid shift in the population demographics of our country means that today’s seniors represent a large slice of the US economy, and they are using this purchasing power to secure their best chance for future health and happiness, which they do not envision taking place in traditional nursing homes.

While nursing homes do remain a necessity for both older adults and younger adults who are very ill and thus require 24-hour medical care from nursing professionals, they now appear to be less than suitable for those who do not need such intensive care. According to a 2005 AARP study, nearly half of all nursing home residents had dementia, and more than half also spent most of their time in bed or in a wheelchair. For seniors who are more active and healthy, being sequestered away in these discouraging surroundings may spark depression, reduced movement, and premature decline.

When senior citizens merely require help with errands, cooking, light housekeeping, and managing medical appointments, the best long term care can usually be provided in their own homes. A home health care worker can visit them daily (or as needed), providing assistance in a wide range of areas. Naturally, given the option, the elderly almost always prefer to remain at home in comforting and familiar surroundings. Indeed, for many seniors, staying at home while being cared for by a home health care worker is the safest and most medically sound choice.

When aging adults cannot safely remain in their own homes due to a loss of mobility or onset of disease, but are not so ill that they require the familiar model of round-the-clock nursing care, assisted living facilities are an increasingly attractive option. Even so, for many aging adults who are experiencing symptoms from disease, a valid alternative to entering an assisted living center is to work with an at home medical caregiver. Dallas home health care specialist company, CareStaf, provides seniors in the greater Dallas area with medical home health care services in the comfort of their own home.

Those who require round-the-clock medical assistance can choose between moving to an assisted living facility or working with a skilled medical caregiver in the home. Assisted living facilities usually offer a continuum of care ranging from nearly hands-off  to nearly full-time nursing care, but one thing that remains constant is their dedication to providing their residents with a comforting second home.

It’s important to look for an assisted living facility that has been cleverly designed to look and feel more like long-term residences than hospital rooms, offering either private or shared rooms with many creature comforts. Some facilities will offer beneficial classes such as yoga, tai chi, art, music, dance, and meditation, and promote social interactions with clubs and regular outings into the surrounding community. In these comfortable surroundings, the elderly can either recuperate for the eventual return to their own private homes or permanently relocate, depending on their needs.

For those who are eventually able to return home, chances are good that they will still benefit from having a home health caregiver who is available to attend to their needs. Often, the adult children of the seniors in need of care wish to do everything on their own to care for their aging parents.

Home health care and assisted living facilities are options to help these seniors’ adult children care for their parents in familiar surroundings without putting their own busy lives and careers on hold for indefinite periods of time. Because of the grim mental images the term “nursing home” so often calls to mind, most families today are terrified at the thought of placing their beloved elders in such homes and they will do anything to find better options that are ideal for both themselves and their parents.

Many children will often go so far as to promise their parents that they will never place them in nursing homes. This is an easy promise to make when your parent is still relatively young, active and healthy. Naturally, no one who truly loves and cares about their parents wants to envision them wasting away in a nursing home. Furthermore, the end of life should be just as enjoyable and rewarding as the beginning of life. Getting older should not have to mean being sequestered away, lying in bed all day.

However, as the years wear on and their parents begin to suffer from disease and the natural progression of aging, a huge number of these adult children will eventually find themselves unable to care for their parents alone at home. Sometimes, this may happen mere short months or years after such promises were made to keep the parent(s) out of a nursing facility. When they realize they cannot keep their promise, adult children usually feel guilty and helpless, no more wishing to confine their parents to nursing homes than their parents wish to be sent to them. Increasingly, families are determined to find suitable alternatives to nursing homes.

While even in recent years only the more affluent segments of the population could afford to keep their elderly family members at home with an in-home caregiver or place them in a comfortable assisted living facility, that too has begun to change. In October 2016, The Henry J. Kaiser Family Foundation reported that “four out of five states are expanding home care benefits through Medicaid and 16 states are even beginning to provide housing services with their Medicaid dollars.” Insurance coverage is expected to continue to change in an attempt to catch up with the mounting consumer demand for home-based health care and living facilities that will cater to the active lifestyle and social interaction that seniors require to continue living happy, healthy and fulfilled lives.

This news is so exciting, both for the aging population and for their children who are struggling to care for them. As more and more insurance coverage becomes available to spend on at home health caregivers, more and more of the elderly population will be able to live out their retirement and beyond in comfort, surrounded by family and familiarity. Studies clearly demonstrate that seniors, along with ill patients of all ages, who are able to remain solidly and actively a part of their families (as much as their illness allows) are happier and actually live longer than their counterparts who live out the end of their lives in depressing, dreary and dour nursing homes.

This clear trend in consumer demand has also impacted nursing homes as one might expect, with hospitals and other medicare-funded facilities deciding that they can keep these facilities profitable only by shifting their focus from providing only full-time nursing care toward also meeting the needs of those who require only minimal medical care on a daily basis. Seniors today, armed with decades of research into health and aging, are being guided to turn away from long-term nursing facilities and instead seriously considering that they should choose freedom, positive social interactions, and the opportunity to participate in rewarding hobbies and activities in their golden years.

This shift in focus has the potential to ensure that in the very near future, the elderly in our communities will have more options to choose from where they can remain engaged, happy, and vibrant for many years more while receiving the assistance they require medically. This would seem to indicate that the more we provide our seniors with happy twilight years, the longer they will remain healthy enough to fully enjoy them. The demand for alternatives to full-time nursing facilities is thus expected to be a permanent, self-perpetuating shift in how we care for our elderly rather than a brief surge in the popularity of alternative options.

At Home Healthcare Fraud: What it Looks Like and How to Avoid it

home healthcare fraud video clip shot

Whether you or your loved one requires medical at home healthcare services or non-medical home care assistance is an important distinction to be able to make. Choosing the right personal home care for someone you care deeply about is not a responsibility that should be taken lightly. After all, the home health care providers you choose will be working closely with your loved one and will be in and out of their private residence on a regular basis.

Because of the intimacy involved in home care, whether medical or non-medical, the process of selecting the right home healthcare company can make anyone feel nervous. The first question you should be able to answer is whether your situation calls for the skills of a medical home health care provider or if your needs can be met via the assistance of a non-medical personal care service.

What Is Personal Care Service?

Also referred to as non-medical home caregivers, a personal care service can provide you or your family member in need with a wide variety of care services, tasks, and everyday functions. A non-medical personal caregiver is appropriate when your situation calls for non-skilled assistance.

If your loved one needs help with some of his or her everyday tasks, but doesn’t require specific medical attention while at home, a non-medical healthcare personal assistant is more appropriate. Some of the services that fall under the non-medical home care umbrella include:

  • Help with bathing and grooming
  • Meal planning and preparation
  • Memory care
  • Reminders to take medication
  • Ambulation and mobility assistance
  • Help with walking and light exercise
  • Light housekeeping
  • Transportation services to: doctor appointments, restaurants, hair appointments, family gatherings, religious services, weddings, the cinema, plays (and other entertainment venues), and many other activities that are associated with daily living
  • Companionship
  • Assistance with homemaking responsibilities
  • Pet care
  • Socialization
  • Incontinence care
  • Running errands
  • Assistance with paying bills
  • Wellness program assistance

What is Medical Home Healthcare?

When you or your loved one will need assistance on a regular basis that requires the skills of a trained medical professional, the kind of care that will best meet your needs falls under the umbrella of medical home healthcare.

Oftentimes, clients who are receiving medical home health care services are transitioning from a hospital stay back to the comfort of their own home. When family members are not equipped to provide the skilled medical attention required to keep your loved one healthy and comfortable, that’s when you should seek out skilled support workers to help continue the excellent care you or your loved one received from doctors and nurses in the hospital.

Naturally, almost everyone who is living with a chronic or terminal illness prefers to live at home surrounded by their family members and the comfort that comes with familiarity. It has also been shown that those patients recovering from acute-care like surgery, illness and childbirth heal faster when they are surrounded by loving friends and family members.

Skilled medical home health care services typically include the following:

  • Wound care
  • Administration of IV medications
  • Ventilator monitoring
  • End of life care
  • Hospice services
  • Medication monitoring – checking for side effects and effectiveness of dose changes
  • Medical testing – bloodwork, blood sugar level checks
  • Monitoring of vital signs – clinical measurement of heart rate, temperature and respiration (breathing) rate. Although blood pressure is not technically considered a vital sign, it is also often measured along with vital signs.
  • Medication injections
  • Physical therapy services
  • Pain management
  • Formal health status monitoring

Once you have determined whether your loved one will require unskilled non-medical home care (also often referred to as personal care assistance) or medical home health care, you must carefully screen the home care specialists in your geographical area to ensure that your loved one will receive the highest standard of care possible.

How to Choose the Right Home Health Care Company

As there are currently a plethora of home health care agencies across the country, you definitely will not be short on choices when it comes to selecting a home healthcare provider for yourself or a family member or loved one. However, because of the high number of companies from which you will be able to choose, effectively narrowing down your choices can easily become an overwhelming task.

Additionally, the recent increase in reports of home health care fraud are alarming to anyone who is in the market for a top-of-the-line home health care provider. Not only do you have to worry about licensing, certification, insurance, availability, training and whether or not there’s a waiting list, but now you have to do a thorough background check and investigation to make sure you aren’t going to be the next home health care fraud victim.

What Does Home Health Care Fraud Look Like?

Stories abound centering around unfortunate families who have put their trust in what they thought was a trustworthy and respectable home health care company, only to be targeted, defrauded and humiliated. It’s important that the public becomes more aware of the potential to be scammed by what is ultimately a fake or unscrupulous home health care company. With awareness, you will be able to avoid becoming the next victim.

One common example of home health fraud schemes plays out like this: an elderly or chronically/terminally ill person is visited at home by people claiming to be employees of the patient’s home health care team. While one of the scammers creates a diversion, the other makes quick work of stealing anything of value from the unsuspecting victim. Things like cash, credit cards, jewelry, and other valuables have been reported missing in situations like this one.

Is Health Care Fraud a Victimless Crime?

The story above demonstrates quite well that health care fraud is definitely not a victimless crime. Other examples of health care fraud are not limited to the home health care sector of the health care industry, and include:

  • Billing patients or insurance companies for services that were never provided
  • “Padded” insurance claims that include actual services that were rendered along with additional or extra services that were never provided
  • “Upcoding” – charging patients or insurance carriers for services and or procedures that are much more expensive than the services that were really provided.
  • Patient diagnosis code inflation – falsely reporting a patient as having a much more serious diagnosis than they actually have
  • Misleading a patient to believe that he or she requires a specific treatment or level of care in order to receive more money – in some cases leading a patient to believe that the treatment or level of care recommended will be covered by insurance or Medicare when in fact, the treatments were never covered by insurance and will be the sole financial responsibility of the patient
  • “Unbundling” – breaking down what was one procedure or treatment into each individual step of the procedure and billing each step individually, causing a spike in the cost
  • Charging a patient substantial co-pays for treatment or services that have already been paid in full – this behavior is commonly seen in the home health care industry when unwitting seniors are receiving home care that is being paid for or financed by a family member.
  • Accepting patient referral kickbacks

Any of the above examples of health care fraud can be discovered within many different specialty areas of the health care industry, including home health care and personal care assistance companies. In order for any of these fraudulent acts or scams to take place means that important and private medical information and records often become skewed with false and/or nonexistent diagnoses.

Aside from the fact that falsifying medical records is a crime, the effect on patients goes far beyond the financial difficulties that most will inevitably soon face. When medical records become tainted with inaccuracies and erroneous diagnoses, patients are often not immediately aware that any fraudulent behavior has taken place. This can lead to patients being further misdiagnosed by other (honest and legitimate) medical and health care professionals because of the false information that has now become part of their permanent medical records.

An example: A psychiatrist or other mental health professional who participates in fraudulent billing practices may falsify or elevate his patients’ diagnoses (see upcoding above), in order to receive payments for treatment that was never administered. Doctors who participate in health care fraud of this type manipulate the medical records of real people, many of whom they have never even met.

These people will then be saddled with false mental health diagnoses, such as bipolar disorder, suicidal ideation, psychosis, homicidal thoughts, and other disorders that present a significant social stigma. Additionally, future medical professionals who view these patients’ medical records will trust the falsified information and thus, may go on to provide further treatment that is unnecessary and inappropriate.

At times, health care fraud can even result in putting patients at risk physically. There have been health care fraud incidents wherein well respected medical specialists have performed medically unnecessary surgery on patients (to further pad their own wallets) – putting the patients’ health and even their lives at risk.

How to Avoid Becoming a Victim of Health Care Fraud

Awareness is the first step in prevention of fraud in home health care and any sub-specialty area of medical care. Protecting yourself against health care scam artists is not likely something you thought you’d ever have to do. As a society, we are accustomed to putting our trust and faith into the doctors, nurses and other medical professionals who treat us.

As unfortunate as it is, it is necessary to take proactive steps so that you are not the next health care fraud victim. These steps will not only help ensure that your health care experience is legitimate and accurate, but they will also help lower your overall healthcare costs.

  • Avoid disclosing any of your personal identifying information to anyone claiming to be a health care professional over the phone or online.
  • Do not invite any self-proclaimed, unsolicited “medical professionals” into your home, especially if you are alone.
  • Closely review all of your medical records on a regular schedule. If you discover any discrepancies, immediately report the errors to the National Health Care Anti-Fraud Association (NHCAA) as well as your insurance company, if you have one.
  • Get familiar with the details of any and all of your existing health care problems. Become your own advocate and do not accept a diagnosis that you feel is inaccurate. In addition, carefully review all medical paperwork that you receive from any health care provider – especially billing documents. Are you being charged for the right treatments? Are the listed dates of treatment correct?
  • Be wary of any home health care provider, personal assistance company or other medical professional who offers you free treatment. In general, free health care services are part of a larger health care fraud scheme and you will likely end up with significant amounts of medical debt in the future.

As you are investigating and interviewing potential home health care and/or personal assistance companies to provide care for either yourself or a loved one, make sure that the company you ultimately select is:

  • Appropriately licensed and certified according to state and local requirements where you live
  • Fully insured, covering both their liability as well as the liability of their employees
  • Specific and descriptive regarding all services that they will be providing you or your loved one with. Be sure to get a clear list of all of these services in writing. Vague or unclear answers should send up a red flag and send you running in the other direction.
  • Upfront about their hours of availability – home health care services are often needed at all hours of the day and night. Those home health care agencies who are not available to serve 24/7 probably aren’t at the top of their industry.
  • Able to provide medical service for treatment as necessary. Even if you or your loved one doesn’t currently require medical home health care services, it’s very possible that this need may arise in the future.
  • Fully trained and adept at using any and all medical equipment that will be used in the treatment that you or your loved one will receive.

Pre and Post-Operative Care in the Home

Many millions of Americans undergo major surgery each year. However, many of us are still woefully under-informed about the recovery process. The truth is, preparing for and recovering from a major surgery involves much more than fasting for 6 – 8 hours beforehand. Even a simple surgery like a hip replacement can require a long, painful recovery period – often longer than patients initially imagine.

Usually, for a portion of this recovery time, patients are likely to require help with wound care, simple movement, and self-care like toileting, bathing, and eating. Indeed, things a patient has taken for granted, such as sitting up or turning over, can be impossible without physical support.

Now for the good news: if you know you will be having a surgical procedure, you have time to prepare your home and arrange support for your recovery. Every surgery is a unique situation, certainly, but most of the time this vital preparation will make the recovery process much more manageable.



Preparing Your Home

If your home has stairs, you will benefit from moving things you will need to access during your recovery to the main level. Ask your surgeon if you will need a hospital bed during your recovery, and if so, prepare a space for the bed near an outlet with a surge protector.

If you will be using a walker or a wheelchair, take time to make sure the path from the bed to the bathroom is clear—at the minimum. Ideally, you will have wheelchair or walker access to all the main-level parts of the house. This will be helpful when you are cleared to begin moving around your home.


Ask your surgeon or physician about any assistance devices you will require during recovery. Now is the time to order a handheld shower head, shower chair, toilet chair, and any other items you will need.

Arranging for In-Home Care


Now that you have prepared your home for your recovery, CareStaf of Dallas wants to support you as you heal. Our team of compassionate, skilled nurses are available to take care of you in the comfort of your own home until you are once again able to care for yourself.

If your family is able to support you during the day, or only at night, our nurses can be available when your family members are not, even if that’s just while they are asleep. However, if you require assistance 24 hours per day, we also provide round-the-clock services.


Our medical home health care nurses can assist you with wound care and provide physical support as well as preparing meals and even helping you eat if you are unable to sit up and feed yourself. A full list of services provided by our medical home health care staff is available here.

About CareStaf of Dallas


CareStaf of Dallas has been family-owned-and-operated since 1996. We are committed to quality patient care, which is why we have a full-time clinical RN director. When one of our nurses is caring for you in your home, they are also being supported by our RN director at all times, ensuring that you are receiving accurate, evidence-based care.


We are here to help you heal.

Please contact us about your upcoming surgery. We will be happy to answer any questions you may have and help you decide which level of care will be right for you.

How to Choose the Best Personal Assistance Service in Dallas

Some of the most common questions we hear when we talk to families are, “What are we supposed to be looking for? How do we know we’re choosing the very best personal assistance service in Dallas for our family member?”

We understand how difficult it is to assess something so complicated. There are many factors that must be considered, and every situation is as unique as the people involved.


Personal assistance services are designed to help individuals with disabilities accomplish tasks that he or she would not have been able to accomplish independently, as if he or she were not disabled. These services are usually the key factor in disabled individuals being able to remain in the home of their choosing rather than them being forced to move into an assisted living or other care facility.


Because it is vitally important that people be allowed to remain in their own homes for as long as possible, choosing the best personal assistance service in Dallas could be the most positive thing one can do for their disabled family member.

Each person who requires personal assistance services will have unique needs and requests to bridge the gap between their capabilities and their life’s requirements. One person might need help with mobility and transportation, and another might struggle with a degenerative cognitive impairment. The services required will always be as unique and complex as the people they assist. For this reason, there isn’t a quick description of the “right” or “best” way to offer personal assistance service.

There are, however, a few key things to look for when you’re trying to find the best personal assistance service in Dallas.

1. Choose Someone Compatible
Make sure that the personal assistance service you choose offers compatibility assessments. Whomever they send will be spending a lot of one-on-one time with your loved one. A positive outlook, gentle demeanor, good sense of humor, excellent hygiene — within reason, the traits you and your loved one value highly should be present in your assistance provider. A harmonious relationship between the assistance provider and your loved one is something you should never have to compromise on. At CareStaf of Dallas, we have seen firsthand how vital it is to match the care provider’s personality with the client’s. This focus on compatibility is our specialty.



2. Choose an Established Agency


This is not the type of position for which you can place an ad on Craigslist, and it isn’t like choosing a child’s babysitter for the afternoon. The personal assistance provider you trust with your family member’s safety must be trained, experienced, insured, and free of a criminal or drug history. The best way to make sure that all of these criteria are continuously met is to choose an established agency that keeps these high standards for their staff.


At CareStaf, all of our employees are subjected to rigorous background checks. We do not hire anyone with a criminal history. We also routinely screen each of our employees for drug use, and we and our employees are fully insured. This gives all parties peace of mind.


3. Choose an Agency with Medical Staff on Call


If your loved one should have a medical need at 2 a.m. when their personal assistance provider is the only one there at the home, does the provider have a built-in medical support network?

At CareStaf, the answer is yes. We believe that because we are taking responsibility for the collaborative care of our patients and clients, we must meet the best standard of care we possibly can. That’s why we have a Registered Nurse on staff 24/7. We offer both medical and non-medical care at home, and our RN serves both communities.

Home Health Care for ALS

When someone is diagnosed with amyotrophic lateral sclerosis (ALS), it is normally very frightening. ALS causes nerve cells to waste away and die, so that they no longer send signals to and from the surrounding muscle tissue. This leads to muscle stiffness (spasticity), twitching, and eventual weakening of voluntary muscles. The muscles affected are needed for breathing, swallowing, and speaking. Additionally, there are usually accompanying cognitive symptoms, with about half of affected individuals experiencing some form of change in their thinking and behavior.

Sadly, the course of ALS is rapid and aggressive. Often, people diagnosed with ALS only have a year or two left with their families. Because of this, many families want to care for their loved ones at home, and there is good news on that front: home health care for the ALS patient is manageable, and is almost always covered by insurance (but please, let us sort through the insurance paperwork for you).

At CareStaf of Dallas, we want to help you achieve your goal of having as many good days with your loved one as possible. We know every smile, every hug, and every conversation is precious. Keeping your family together at home can provide great comfort and stability for the affected family member as their ALS progresses.

Having an experienced home health care worker by your side as you care for your loved one will enable you to relax and rest during your valuable time together. The learning curve for home care can be quite steep, and the physical demands can become strenuous. We know, from having cared for our own loved ones, that having skilled, qualified help can make all the difference in the home care experience.

CareStaf of Dallas will match your loved one with the home health care provider who has the personality and pace that matches their own. We want to help cultivate warmth and cheer in your home and maximize healthy communication between our patients and our providers. These relationships can become friendships over the years, and as we’ve seen time and again, carefully matching personalities from the start can be that friendship’s foundation.

We pride ourselves on offering exceptionally compassionate care. Our home care providers will help your loved one eat when swallowing becomes challenging, help them stay as mobile as possible for as long as possible, assist with baths and dressing – but our skilled caregivers also help take care of your home, not just your family member. If you need help with light housework, errands, caring for a pet, church attendance, or other duties, let us help you. We want to bridge the gaps for you so that you are free to focus on your family.

Of course, our staff is highly qualified and fully trained. Each member of our staff has at least one year’s experience, but most have many more. Our supervising RN will be available to your family at any time of day or night should you encounter any unexpected complications. You will never have to face ALS alone; let us help shoulder your burden as you as you give your loved one the gift of at-home care.


Grief, Compassion, and Fatigue Tips

Understanding the different stages of grief are essential in managing your health as a nurse or caregiver. In a couple of recent articles in American Nurse Today, they describe these stages of grief and what to look for. Additionally, in a different article regarding compassion and fatigue, American Nurse Today discusses ways to recognize and better manage mental and physical health that comes with being a nurse or caregiver. Click on this link for the article on The Nature of Grief Click on this article on Compassion and Fatigue.

We are always trying to come up with topics to help you improve and better manage your career in healthcare. Please let us know if you have any suggestions on healthcare topics we can address to assist you in the future.