Peeling Back Labels to Find People: Private Home Care Provider Gets It Right

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Throughout the history of mankind, human beings have displayed a rather uncanny knack for labeling other humans. However, one family-owned, New Hampshire based private home care provider, Live Free Home Health Care, makes it their company’s mission to peel back the labels that have been assigned to the seniors for whom they provide care, and find the fascinating, unique individuals who so greatly need them.

Too often in the world we live in, and especially in healthcare, people get assigned all kinds of labels. If you’ve ever worked at or visited a hospital or doctor’s office, it’s likely you’ve heard a living, breathing, human patient referred to as “the [insert diagnosis] in [insert room number].” Like healthcare, the aging services industry also has a less-than-perfect track record for assigning labels to clients. Labels for elderly clients can range from the positive to negative, such as cute, talkative, pleasant, and agreeable, to anxious, unsocial, combative, or difficult. Other common labels can be graver designations such as wanderer, hoarder, severely demented, non-ambulatory, and the list goes on. In some cases, labels are used as shortcuts to explain client needs. In other cases, labels are used as red flags for care providers so that they are aware of the situation they are entering. Too often, labels turn into a reason for caregivers to pigeonhole someone whom they’ve never really spent any time getting to know. Labels can cause caregivers to expect a bad situation and it becomes a self-fulfilling prophecy.

Live Free Home Health Care in New Hampton, New Hampshire is breaking the mold by training their team to look beyond labels that can prevent caregivers from learning the whole story about a client and his or her care needs, and their efforts are paying off.

Recently, Live Free was called to provide services to an elderly, multicultural couple in their eighties - a Swedish-born wife and a husband of Korean heritage, who had been receiving caregiving services from another home care company that labeled the couple as “difficult.” Although the husband and wife speak English, both also have very heavy accents. In their younger years, the two met in Europe and traveled the world together, eventually settling in the United States. They now live in an addition to a friend’s home that the husband, a retired architect, designed himself. The home care company categorized them as “difficult,” re-assigned new caregivers to them multiple times, and doubled their rates, citing the increases were needed due to the level of difficulty in providing services. They also complained that the husband constantly “meddled” in his wife’s care, before discharging the clients and referring them to Live Free.

“When we decided to work with this couple, we did a number of things differently that made a big difference in how we approached helping them,” says Lisa Clark, RN, Assistant Clinical Director for Live Free. For starters, Live Free made the extra effort to get to know the couple and the friends with whom they were living, as well as the back-story behind their friendship. The couple, who never had children of their own, live with Mr. and Mrs. Jong-Yoon Kim and their children. Mr. Kim, also of Korean heritage, is a forty-something Professor of Graphic Design at Plymouth University in New Hampshire, who met his elderly tenants in a very unlikely place - at a roadside rest stop ten years earlier.

“My wife and I were at a rest stop in New Hampshire and I saw an elderly man trying to use the vending machines, and his hands were shaking. I could see he was having trouble so I offered to help him. When he responded to me, he spoke in Korean. At that time, I didn’t think any other Koreans lived in New Hampshire (chuckles) so I was happy to hear him talk, and I started speaking Korean back,” says Kim. “One of the first things he asked me was if my wife was Korean, and if she could cook because he was dying to have some home-cooked Korean food.” The two exchanged phone numbers and Kim invited the elderly gentleman to come for dinner.

“At the time, my wife and I were in the process of moving into a new house, and I lost his number in the move so I couldn’t contact him. Four years later my phone rang and I recognized his voice immediately. He asked if the offer was still good for my wife to cook Korean food and I said yes. We had him over and our friendship began,” says Kim. During the course of their friendship, the elderly couple moved in and out of several assisted living facilities, at one point asking Kim to assist them with finding yet another facility. But every facility they toured they did not like, says Kim.

“I think they just did not fit in well to that regimented environment. They really wanted to live in a home of their own,” says Kim. After much discussion, the Kim family offered that the retired architect could design and hire someone to build an addition to the Kim home, where he and his wife could live with the help of a home care company. “I’ve never seen anyone so happy in my life,” says Kim. The addition turned out beautifully, but their experience with home care companies did not start out smoothly.

“The first company we hired would actually say things like – we don’t know what to do,” says Kim, when speaking about how the staff would react to the wife, who has dementia. “They had a plan for how they did things and when that didn’t work, they looked to us for advice, and called us constantly. I have a job, and we have two children to care for and the whole thing was taking over our lives. I even had to cancel a speaking engagement at a professional conference. We were looking to them for help and to be the experts,” Kim adds.

When Live Free entered the picture, through a series of interviews with the Kim family, the elderly couple, and the couple’s primary care physician, Clark was able to paint a very complete picture of their lives, and devised a comprehensive plan for educating the clients, the friends, and the staff providing care. Clark listened to what the Kim family and the husband were describing about the wife, mainly that the behaviors she was exhibiting were not consistent with her personality. She determined, through her interactions with the couple, that the wife was frustrated because her attempts at non-verbal communication – like pushing food away because she was full – were not being acknowledged or understood.

Clark also educated the family that any kind of change in living environment can be very difficult for people with dementia to process and adjust to, and that some “difficult” behaviors could result. In addition, the wife and husband were people who had previously enjoyed being very active and unconfined, traveling the world and enjoying the outdoors.

“These people were educated, worldly, free spirits in their younger lives and they were not accustomed to a sedentary lifestyle,” says Clark. The wife’s restlessness was also being characterized as difficult by the prior caregiving company. “Of course she was restless. She wanted to be doing things because she’s been an actively engaged person all of her life. Sitting and watching television was not an option for her.”

Live Free also began regular nursing visits with the couple, and based on those visits, began making regular contact with the clients’ primary care physician. Clark had a suspicion that a medication could be causing some of the behaviors that were not consistent with the wife’s personality. As it turns out, this was a very big factor influencing the wife’s behavior, and when remedied by the physician, made the biggest difference. The medication was changed and many of the behaviors disappeared.

“It’s never just one thing going on,” says Clark, “Humans are complicated beings and every single person has a unique set of circumstances and needs. I could have two people the same age with the exact same diagnoses, and their individual lifestyles, goals and care plans are totally different. At Live Free, we take the time to individualize our services for people.”

“The physician was so receptive to our nurse calling to explain the nuances of the situation with his patient because we were able to give him more information than he could get on his own through office visits, and that led to a medication adjustment that improved the quality of life for this client and everyone who loves her,” says Clark.

“When the service you provide is care for people, standard templates do not apply. Working with human beings requires us to dig deeper instead of following protocol to the point of becoming robotic about what we do,” notes former home care agency owner and aging services thought leader, Merrily Orsini, MSSW. “Sure, there need to be policies, procedures, and regulations for aging services providers to operate, but there also needs to be an understanding that permeates the culture of aging services that with individuals comes individuality in circumstance and care. Reducing someone to one label is disruptive and short-sighted. It just doesn’t help anyone – the client or the care provider,” Orsini adds.

“At Live Free, we’re not interested in looking at labels. We’re more interested in peeling those labels back to see the unique person underneath. That’s how we truly discover what a client needs and how we move beyond the label that someone else might have put on them,” Clark adds.

Unfortunately, what labels are designed to do is stick, and sometimes they’re not so easy to remove. This story has so many great examples of people pulling off the label to reveal the person – the older gentleman taking too long at a vending machine who became a cherished family friend through a shared language and background; the “difficult” woman with dementia who underneath her “behaviors” was a world-traveler and life enthusiast; and the home care company who chose to see its clients as the complex, multidimensional human beings they are and will always be.

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About Live Free Home Health Care:
Serving the Lakes Region and Central New Hampshire, Live Free Home Health Care, LLC is dedicated to providing top quality care in the comfort of home, wherever home may be. Family owned and operated, Live Free Home Health Care offers a wide range of services, from companion care and assistance with activities of daily living to skilled nursing. All care is supervised and updated by a registered nurse, who is specially trained to watch for new or changing health issues. Whether the need is for short or long term care, Live Free Home Health Care works with each client’s physician to provide a continuum of care unparalleled with other agencies, and the compassionate staff promises to treat each client respectfully and like a cherished family member. Live Free Home Health Care also offers medical alert systems to provide extra peace of mind should an emergency care need arise.

For further information, contact (603) 217-0149 or visit

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Jason Harvey
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