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Sunday, October 31, 2010

Amazing Will to Live - Update 10/31/2010

"Amy" is still plugging along. Until this past week she hadn't been eating enough to keep a fly healthy but she is now starting to eat more at meals. [She has never been a big eater and doesn't have much in the way of "reserves", meaning fat.] She has been walking, joking with her caregivers and is recognizing the staff again. Is she out of the woods? Probably not. But she is a daily miracle!

Tuesday, October 26, 2010

Amazing Will to Live - Update 10/26/2010

Amy is still with us, fighting every day to live... almost literally! Her poor caregivers deserve combat pay!

Sunday, October 17, 2010

The Amazing Will To Live

I have a client, I will call her Amy, who has the most amazing will to live. By rights she should have died the Friday before last. Her oxygen saturation was dismal without the O2 being turned up all the way, her kidneys were shutting down and she had an infection. The doctors didn't think she would live through the night but she's still here, fighting every minute to regain strength so that she can continue living.

This is a person with severe dementia, severe osteoporosis and is pushing 90 years old. How did she get to this point?

About a year ago, Amy fell and basically shattered her hip, actually the top part of her femur. The surgeon put in a metal plate and dozens of screws to hold her bone together so it could heal. Because of her dementia, we were unable to keep Amy from walking too early. If she had to use the bathroom she could not understand why she couldn't just walk the few feet to the toilet even though a caregiver was at her elbow to help her into her wheelchair. People with dementia are not able to understand cause and effect anymore. The facility staff did the best they could but she broke the plate and a few screws early on. The amazing thing was that she wasn't having any pain. The doctor decided to just leave it and see it it would still heal.

About six weeks ago, Amy started having pain... a lot of pain. We don't really know why but it could have been that there had been scar tissue holding everything in place and it either got torn loose or might have been just reabsorbed into her body. Amy was sent to the hospital where she spent a couple nights while the doctors tried to decided what to do. The doctors ultimately decided to send her back to the facility where she lives with "palative care." Palative Care means that they are managing pain. It became obvious pretty quickly that this was not a viable option for Amy. Either she couldn't understand why she couldn't move about without a lot of pain or she had to be sedated so much that she was in a stupor.

I talked with the administrator and the director of nursing at the facility, who agreed with me that this was no way for Amy to live the rest of her life. I called the family (who live a long way away) and discussed the situation with them. We came to the agreement that it would be better to take the risk of surgery rather than "sentence" Amy to the current situation. I called the surgeon who had done the original surgery. We discussed options and I decided on the option that wouldn't "fix" her hip but would take the pain away and still allow her a certain amount of mobility. Amy had been using a wheelchair a lot after the first surgery so she wouldn't miss not being able to walk very much. Again, I ran this option past the family, who also agreed. I also talked with Amy about this. Even though she has severe dementia I felt that she could let me know whether she was in agreement or if the thought of surgery was frightening or repellant to her. She fully agreed to have the surgery. She didn't like being in pain and wanted to do what was needed to stop the pain.

The doctor scheduled the surgery for a Thursday and instructed me to have Amy at the hospital by a certain time on Wednesday. Amy was in a good mood and was able to give consent [unofficial but still important] to the doctor after the doctor explained the procedure again. Amy made it through the surgery without a problem. Unfortunately, on Friday the problems started. Amy's kidneys started shutting down and she got an infection on top of needing all the oxygen they could pump into her. The doctors didn't think Amy would live through Friday night but she was still "kicking" on Saturday. Sunday the doctor notified me that Amy needed a blood transfusion. I talked with the family and told the doctor that yes, we wanted Amy to have the blood. [We figured that if she was fighting the least we could do is give her the tools to fight with.] By Tuesday the doctor said she could return to the facility under "comfort care." [Meaning= death is imminent] Well, today is Sunday and she is still with us. Her kidneys have started working again and she is over the infection. She still needs oxygen but that is minor. She is getting up for some meals. She's having trouble keeping food down [probably a leftover from the anasthesia] but she is obviously fighting to live.

Some people might have disagreed about having surgery arguing that someone with such severe dementia has no quality of life left. If you could see her, you would know what determination and quality of life is all about. Amy is one amazing woman and I am honored to know her and be allowed to serve as her Power of Attorney. Life is Precious... no matter what age.

Sunday, October 3, 2010

Starting a Business Like Bridge Builders, Ltd.

What I love about this business is the day-to-day diversity of demands. Each of my clients is their own soap opera, as I suppose each one of our lives is. The difference between my "active" clients [clients who currently need assistance] and the world at large is that my clients cannot manage their lives without assistance. Sometimes they are willing to listen to advice and sometimes they will do things that I know will have unpleasant consequences. It is not my job to tell my clients what to do. It is my job to give my clients the available options, along with the consequences, good and bad, of each option and let my clients make their own decision. It is easy to tell someone what to do. It is far more challenging to respect a person's right to make a bad decision. My job then is to try to be a "safety net" for my client so that the consequences are not as serious as they might have been. I love the challenge.

I "boot strapped" my business. I learned through my journey of developing a business that banks, angel investors, etc., are not interested in bankrolling a social service business. In this business Angel Investors are in the form of friends and family [if they have money to loan]. The bank wants to secure everything you own against a loan for operating money and, in my opinion, are to be avoided.

I started with a somewhat vague business concept of helping the elderly and disabled and have honed it by trial and error through the years. It hasn't been easy but it is the most rewarding venture I have ever experienced. There will always be good times and bad, great cash flow and trickle cash flow, clients I love and clients I could be happier without. There will be the never ending battle to capture receivables [getting the unpaid invoices paid].

If you are afraid of risk, work for someone else.

When my [then] business partner and I started the business, our goal was to "bridge" the gaps between services available for the elderly and disabled. We did not want to duplicate services that were already available. Many people were skeptical when we opened our doors. I finally got someone to explain the skepticism. "Old-timers" could recount numerous businesses that would start up to assist the elderly and disabled, doing a good job. Then, they would disappear leaving all of the people they were helping without any support. It's great having a strong desire to help others, but if you cannot run an efficient business, you will end up closing up the shop.

I have received calls from people saying they want to start a similar business in their area. While talking to them I learn that they expect customers to come flocking them them when they open their doors and that they will build the business for 10-years, then sell it off making a nice, tidy financial profit. WRONG! #1 - Marketing this type of business takes a lot of networking and demonstrating successes. You don't get handed credibility on a platter and credentials only get you so far. #2 - It takes many years to develop a reputation within a community. I am coming to the end of my 8th year and this year we have been hearing that our good reputation extends far beyond the area we serve. It takes about 10 years to develop a reputation as an expert in a particular field. #3 - We are talking about people here, not hardware or some other commodity. You cannot just sell your client contracts to someone else and move on. When my business partner left, I witnessed the concern our clients experienced. Our clients were very worried about whether the business would survive my business partner leaving. I've even noticed how worried some of my clients can get when one of my employees leaves the business. These vulnerable adults depend on us for their quality of life and sometimes for their very lives. Please don't let them down!

If you are not in this business for the long haul, please don't start it. Ten years may seem like a long time when you're starting a business but the time flies amazingly quickly. Of course, you will want to start thinking about how you will phase out of the business as you get closer to retirement. There are ways to do it so that it doesn't traumatize your clients.

Still want to get started? Call your local Small Business Development Council and get a [free] business advisor assigned to you. I didn't start using a business advisor until year four. I would have avoided many problems if I had a business advisor from the beginning.