Happenings...

I apologize for so much time passing between blogs. Between the Thanksgiving holiday, which was complicated by a freak snowstorm, first-of-the-month billings and an exciting event that also required a flurry of time-consuming activity. I just haven't gotten anything written.

My exciting news, though, is that I have been nominated for the Small Business Association's Small Business Person of the Year Award. I am so excited! Of course, these things are never just handed out without some work on the nominee's part. I spent a good portion of last weekend, Monday, Tuesday and Wednesday getting a packet of information together. It had to be at the Seattle SBA office by Friday, December 10th. Evidently, 35 people statewide have been nominated. I was told that I will find out if I've won in early March 2011. If I win for Washington State, I will be invited to the SBA national celebration in Washington, DC in May. Just being nominated is a huge honor!

Building Bridge Builders, Ltd. into a viable business has been the hardest job I have ever had and it has been worth every minute. The services that we provide are so needed and there will be an increasing demand as the baby boomers age. It is a challenging business, though, and it takes a special person with a passion not only to serve our unique clientele but also to have the stamina to hang tough as this type of business is difficult to grow. While there are huge emotional payoffs when successfully helping clients to have an improved quality of life, the down side is that there are those who try to discredit this type of business. A business owner needs the fortitude to withstand those attacks, even though they might be infrequent. If you are considering starting a similar business, here are some suggestions:

1. Consult a business advisor - The SBA offers assistance for free. The advisor can assist you with the details of the business end because you could have the best idea in the world but if you don't pay attention to the business end of things, you will fail.
2. Don't believe people who say that all you need to do is hang out a shingle and you'll be swamped with work. This business needs time to establish credibility just like any other business. Bridge Builders, Ltd. is a great idea but we can have quite a challenge convincing prospective clients.
3. Realize that you need to develop yourself as an expert in the field and this takes time. I am at the end of eight years and only this year have I been receiving comments that indicate that my staff and I are considered experts. Eight years may seem like a long time if you're just starting but, believe me, the years fly by.
4. Watch your cash flow like a hawk. I only started tracking our cash flow on a weekly basis about two years ago. I wish I had started this at the beginning! I can now look back a couple of years to see if the cash flow is typical, better or worse. Also, if the cash flow is less than my target amount for the month, I tell my staff that they need to focus on tasks that generate billable time and/or it an employee would like to work a little less, now is the time. This can really made a difference at the end of the month.
5. Be careful with credit. Early on I was seduced by easy credit. When you start a business it seems like everyone wants to give you credit. While most businesses require having a certain amount of debt because cash flow isn't consistent, use credit cautiously and wisely. My brother is growing a business without debt, which is great and I am very proud of him, but it really slows down the growth doing it that way.
6. Charge what you are worth. That is a very difficult thing to do, especially in a business that provides services to people. But if you don't value your time, your client's or prospective clients won't either. Over the years, we periodically got calls from prospective clients who wanted something for nothing. After spending copious hours over the years trying to convince these people that we are worth what we charge, I just don't bother wasting my time anymore. If someone calls and, after discussing services and rates, says we're to expensive, I'm happy to give them some numbers where they might be able to piece the services together themselves. Sometimes these clients resurface later and sometimes they don't. I don't worry about it anymore.
7. Hire qualified staff. My business advisor told me once that the staff of an entrepreneurial business need to be pseudo-entrepreneurs. These are people with the experience you need who are willing to work for peanuts because they believe in what you are doing. It will take longer finding these people but it is well worth the wait. My bookkeeper, who has been with me from almost the first, was looking for a part-time job with some challenge that would be flexible and fun. She hasn't been disappointed and I have been the blessed with her knowledge over the years. All of my staff worked uncomplaining for years without raises because there was no money for raises. How did I find these people? Sometimes by networking and sometimes they would hear about my business and come to me. I've learned to be choosy, though. It pays off in the long run.

You need to realize that this is a business that you will be in for the long run. I've had people call me saying that they wanted to start this type of business, run it for ten years and then sell it at a profit. They think that the need is so great that they will be swamped with work out of the starting gate. When I explain that it isn't so easy and why, I don't hear from them again. You need to understand that this business is about serving people. People are not a commodity to be sold at whim. If you are named as Power of Attorney for clients, it is expensive for the clients to change this. Guardianships need to go through expensive court hearings. Your client depend on your to be there for them. That's a heavy responsibility for some people. I find it to be an honor.

Tips for working the Long-Term Care "System" - Federal Government

Trying to help a friend or loved one navigate through the elder care system can be daunting. Here are some tips so that you can avoid unnecessary aggravation:

Social Security: Did you know that Social Security doesn't recognize Power of Attorney documents? Well, they don't. It has something to do with Social Security being Federal and Powers of Attorney being State. So, if you need to do business with Social Security on behalf of someone else or manage someone's Social Security money. You either have to be their court appointed guardian or you need to apply to become the loved one's Representative Payee. You can find the application online if you look really, really hard. You can also go into the Social Security office and request an application.

• If you go the the Social Security office do not go at the beginning or end of the month or the beginning of the week. The office is crazy busy during those times. Pick early afternoon on a Wednesday or Thursday.
• When filling out the Representative Payee application you will need to include the name, address and phone number of your loved one's doctor. It doesn't say this in the instructions and there is no place on the application for it but if you don't have it the application will be handed back to you.
• I have occasionally run into a situation where the doctor doesn't want to fill out the form. I have found that writing a letter explaining why I need to manage the client's [loved one's] money and why Power of Attorney isn't adequate in a very humble way seems to help.
• When you receive the letter appointing your Representative Payee, keep it in a safe place because you will need to produce it at the bank and other places from time to time.
  

Veteran's Administration: They don't recognize a Power of Attorney, either. If your loved one cannot sign a release of information form allowing you to be their advocate, you have no choice but to initiate a petition to become the loved one's guardian. If you become the court appointed guardian, always keep a copy of your Letters of Guardianship handy so you can wave them in the face of the person who quips, "We only deal with the veteran, not the spouse [family, friend, etc.]. In this day and age of HIPAA Laws, everyone is afraid to say ANYTHING without the appropriate legal document.

• Try to always have an appointment. The walk-in clinic is a real nightmare. If you can't avoid it, plan on being there an entire day.
• If your loved one needs to apply for benefits for the first time, contact the local Veteran's center (VFW, DAV, etc.) to learn the best way to submit the application so that it will be processed as quickly as is reasonably possible.
• If your loved one is a low-income non-service connected veteran, plan on the application taking a year. If they need financial assistance before then, get them signed up with your State's version of Medicaid.
• You can fill out an application online at http://www.va.gov/ but please remember that you still need to print it out, have the veteran sign it and send it in even though you can electronically submit the application.
• DON'T forget to send the required documentation. Can't find the DD-214? (Discharge papers) You can send to a certified copy on the http://www.va.gov/ web site.
• If you send a copy of the DD-214, you will get a letter stating that you need to send the original or a certified copy withing a certain length of time. Writing them to tell them when you expect to be able to send it will keep the application "live."
• Give the application a couple months before checking on the status but by all means check. Sometimes these applications seem to fall into a black hole or something. Be especially diligent if the veteran was just in the reserves. We have had more problems with applications going missing for the veterans who were in the reserves as opposed to active duty.
• Once the veteran is approved for benefits, send updated medical records, bank statements and medical bills (paid) to the VA on a regular basis. You might want to mark your calendar for every three months or so.

If the process seems overwhelming to you, please get help with this. Call your local Area Agency of Aging to find out where you can go to get assistance. While it takes longer, the benefits from the Veteran's Administration come with fewer "strings" than the State Medicaid program.

Amazing Will to Live - Update 11/7/2010

Amy has started eating, and keeping what she eats down. (She had been having a lot of nausea) Last Monday, she slept through the entire night for the first time since her surgery. She is now joking with the caregivers and recognizing the staff at the facility. She still has a fair amount of agitation but the caregivers and staff are trying to deal with it using exercise instead of medication. The medication makes her sleep during the day and then she is up all night. She is no longer on the oxygen. She actually gave herself a black eye fighting with the tubing! But her oxygen saturation is O.K. now. WOW!

The only real casualty was a cell phone that took a swim in the toilet. Those cell phones just don't swim well at all!

I'm looking forward to taking her to her appointment with the surgeon at the end of the month. I'm sure the surgeon will be amazed, too!

This is what Amy wanted, a chance to live pain free. She wasn't afraid to fight to beat the odds, even with severe dementia. She has taught me so much!

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!

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!

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.

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.