Holiday Depression

December 12, 2009

Many seniors report satisfaction with life, many times even more than in their younger years. However, there are common risk factors for depression in seniors that are not necessarily common in other age groups, including:

  • Loss of a loved one
  • Diminished sense of purpose
  • Diminished health
  • Medications
  • Loneliness and isolation


Any life-change or transition can trigger a depression. Many times if the change or transition is isolated and the person receives enough support during that time, the depression is most likely ‘situational’ and it lifts on its own or with a little counseling or group support. However, if major events happen concurrently, the result can be devastating. With seniors, the chances of these changes happening together in a small period of time are most certainly higher than the general population. One change or loss triggers a sort of domino effect, increasing the chance that they will move from a situational depression to a clinical depression.

Many seniors are resistant to the diagnosis of depression and treatment options due to generational prejudices regarding mental illness. What MUST be understood is that depression is an illness NOT a character flaw or weakness and neither is the taking of medications to treat it.

If you or a loved one is exhibiting the following symptoms it may be depression:

  • Decreased enjoyment of favorite activities
  • Slowed movement
  • Lack of interest in personal care or appearance
  • Unexplained or worsening aches and pains
  • Irritability
  • Anxiety
  • Memory problems
  • Feeling hopeless or helpless
  • Thoughts of death or suicide


The good news is that depression is treatable and through lifestyle choices, preventable. Some things that you can do to ward of depression include:

  • Develop interests or hobbies
  • Stay in touch with friends and family.
  • Exercise regularly, this helps you both physically by warding of disease and degeneration and mentally, by providing the brain with ‘feel-good’ endorphins.
  • Eat right, this helps you maintain good blood sugar levels, nutritional requirements and fuel for activity.
  • Anticipate life changes and transitions; try to insulate yourself with friends and family during those times, but getting out, even for a cup of coffee. Don’t shut down and isolate yourself.


If you can seem to shake the blues, talk to your physician. You and your physician can explore various options from group support to counseling to medications (or any combination) to make sure that you are able to move past the depression and begin living life to the fullest.

As always this column is intended for informational purposes only. It is not intended to diagnose or treat any condition. If you are concerned for yourself or a loved one about any information in this article please contact your primary care provider as soon as possible

Written by Gabriela F. Brown, CEO

Constant Companions Home Care, San Diego, CA



Senior Nutrition

October 13, 2009

Senior Nutrition


By 2030, Americans over the age of 65 will reach 71 million, approximately 20% of our population. Further, almost 90%  of Americans over the age of 65 have one or more degenerative disorders. These conditions were once thought to be a natural consequence of aging but recently there is evidence that many conditions like heart disease, cancer, osteoporosis, arthritis, diabetes can be either prevented or lessened by good nutrition and exercise.


There are increasing obstacles to proper nutrition as we age: Chronic illness, recent hospitalizations, depression, mal absorption, medications, dental problems, diminished taste and smell, restricted diets, limited income, loneliness and isolation. However, it is important to realize that without the proper mix of fuel and nutrients, symptoms of malnutrition can appear and increase the symptoms and debilitation of any of the above listed conditions. In essence it is a vicious cycle that can only be broken by a commitment to learn and apply better eating habits.


Malnutrition can be seen as increased forgetfulness, dehydration, frailty, delayed wound healing and decreased muscle mass that can lead to falls and fractures. Indirectly, malnutrition could be a significant factor in many hospital stays and lengthy rehabilitations. Additionally, it can make worse any chronic conditions.


Some seniors may be at a healthy or even heavy weight, but still experience malnutrition.  Because metabolism can decline by as much as 30% in people over 50, it is important to eat fewer calories. With fewer calories, we run the risk of fewer nutrients, so the foods must be packed with nutrients. A good start is to limit high-carb, high-fat, nutrient deficient foods and increasing nutrient rich foods like vegetables, fruits, whole grains breads and pastas and to add supplement drinks if necessary. A multivitamin will also go a long way to maintain your stores if your nutrient values rise and fall day by day.


A good way to help a senior that you suspect of being malnourished, try to approach the situation delicately. As mentioned above there may be many reasons to not eat properly and you don’t want that person to become defensive and clam up. Eat with them, observe. Is there plenty of protein, fiber and health fats in each meal? Are vegetables and fruit included in each meal? Are most meals cooked at home, from scratch and healthy sources? If so, then they are on their way to good nutrition. Next find out if they are supplementing their diet with a multivitamin or nutrition shake. This can be done by placing the items in the home and periodically checking to see if they have been used. See how much they eat at every meal. A good measure for amount is the size of their fist. If it less than that, try to determine if they are eating more frequently. Many seniors cannot eat 3 large meals and choose to eat more often with smaller portions.  As long as the smaller portions and snacks equal 5 a day, throughout the day, all is well.


If a loved one is malnourished there are several things that you can do with and for them to encourage healthier/sufficient eating:

Enrich!  Add healthy proteins and health fats, like cheese, nuts and nutbutters. Cheese can be mixed in to a wide variety of otherwise bland and calorie deficient foods. Nutbutters are great on crackers and a slice of bread, add a little fruit spread if the diet permits, to moisten and make it easier to swallow. Nuts are great for snackers. Over the day these calories can add up and they are providing rich and healthy oils for the body.


Spice it up! Add some herbs, lemon, seasonings, as tolerated and enjoyed to make the food more flavorful and enjoyable. Make sure you check sodium levels. An adult should take in no more than 1500mg per day.


Socialize! Get them out or invite yourself over. Eating is a social behavior. We all eat much more when we are in the company of others. This has the dual benefit of providing an anticipated event and the eventual company, which can help to alleviate mild depression.


Call the Doctor! If you suspect depression or lack of appetite due to medications or ANY other underlying issues, call the doctor. Many times they will be able to do an overview of health and medications to discover or eliminate possible reasons for a lack of appetite.



Get Moving! Exercise gets everything in the body working more efficiently. Encourage walking, biking, chair exercises, swimming, WHATEVER that is possible to do safely and comfortably. The idea is to move the body every day. Metabolism will increase, mood will lighten, appetite will increase. Again, if you are at a loss for options, contact your health care provider for resources.


Supplement! Take a daily vitamin to cover any gaps in nutrition.


As always, my column is meant as general advice based on over 20 years of working with and learning about seniors. It is not medical advice. I encourage anyone who suspects that they or someone they love is malnourished to see their health care practitioner as soon as possible in order to establish an individualized plan that will put you back on track to better health.

Gabriela Brown, CEO

Constant Companions Home Care

All Things Senior Blog

October 13, 2009

I have been writing for a local paper in the Rancho Bernardo area for a while and I thought that I could post those articles for all to see. The articles deal with senior issues and interests in the San Diego area, primarily Rancho Bernardo, Poway, San Marcos, Escondido, Carmel Mt., Penasquitos and Scripps area. I hope to get the word out to the rest of San Diego and all the way up to Temecula and Murrieta areas. The articles you see here are going to be about home care and hospice as well as senior wellness, for those who are not in need of home care and hospice. When writing for the paper, I am limited to 300 words and there is so much more that I can say here, so look for the full articles here as well as antecdotal information about working with the senior community in San Diego and South Riverside Counties.

Private Hire vs. Agency Home Care Workers

September 3, 2009

Hiring a Caregiver – Private vs Agency


During these tough economic times it is more tempting than ever to hire caregivers privately, bypassing any placement service or home care agency. However, after reviewing the following information, we hope that you will see the benefit in contracting with a home care agency when looking to bring help into your home. There are TRUE benefits of working with an agency. Agencies can save you and your family long-term consequences, both financial and legal.


When you hire a caregiver, the going rate is approximately $15 per hour. When you hire an agency such as ours the going rate is $20. For an additional $5 per hour you receive the following benefits and protections.


  • The workers are covered by Worker’s Compensation, paid by the agency
  • The workers are covered by Unemployment Insurance, paid by the agency.
  • Employment taxes are split and submitted each payroll, half by the caregiver and half by the agency.
  • The worker’s taxes are pulled and sent immediately to the IRS and CA Employment Development Department (EDD). These taxes cover State, Federal, Disability, Employment Tax and California State Training Tax.


These taxes and insurances must be paid by ANY and ALL employers. The state of California is currently in need of revenue and is targeting individuals that consider themselves, “self-employed” or “contractors”.  If a worker is cross-referenced with an individual employer, the employer can always be held liable for back taxes. The reason for this is that the state claims that many of these individuals do not pay or file their taxes, so they are placing the burden on the employers to collect it and submit it.


In regards to Worker’s Compensation, consider this; your private caregiver is injured on the job. If the Labor Board determines that they are your direct hire, and they WILL, you will be responsible for the cost of their injuries and will be fined $1,000 per caregiver for not carrying Worker’s Compensation on that employee. Additionally, in order to continue to hire that employee, you will be required to take out a Worker’s Compensation policy for them to the tune of 7-9% or higher (Through State Fund) of their gross pay, each pay period. You will be audited and you will have to show documentation that you are in compliance. Additionally, your homeowner’s insurance may require an additional premium for having a domestic worker employed.  


Next scenario; the caregiver you hire just isn’t working out for you. You manage to dismiss their services (not always an easy thing to do). 2-3 weeks later, you receive a notice from the EDD, an unemployment claim. If your caregiver chooses this route, to recover unemployment payments, they WILL win. The EDD will consider that in any direct hire arrangements that you are the employer and they are the employee, regardless of any contracts, business licenses, etc.


Aside from the legal/tax benefits discussed above, agencies are simply a better choice for the following reasons.


  • You can switch out a caregiver that isn’t working out for you.
  • The agency carries liability insurance, both professional and general for all workers
  • The agency can supervise and direct the worker
  • Of course, all of our caregivers are screened. I would hope all agencies do the same.


This is the down-side of private hire. This is not to say that there are not some wonderful set-ups that work out well for all. However, one must consider the possibility that if a person is left without income for any reason, they have a wide variety of available options from which to recover what they may feel they are entitled to. It is always important to remember that it is in the best interest of state-run agencies to find in the worker’s favor. Not only will they assure revenue/justification for their agency, but this caregiver will now be in the “system” and they are better able to pursue them and you if the caregiver has not filed/paid taxes.


There will always be those who will continue to hire privately. However, I believe it is because many are not aware of the serious implications of doing so. I hope this article helps those individuals to at least make an informed decision when hiring outside help for the home. For further information regarding Employment of Domestic workers, please refer to California Civil Code Section 1812.501 and Unemployment Insurance Code Section 687.2.


Constant Companions Home Care has a blog!

September 2, 2009

My name is Gabriela F. Brown and I am the CEO of Constant Companions Home Care.

Our company provides non-medical personal care assistance to individuals who cannot care for themselves any longer. Our goal is help our clients maintain independence in their own homes and communities for as long as possible. Most people do better if allowed to stay in their own homes. With a little assistance, we make that possible. Many times all it takes is a daily 4 hour visit. The caregivers will check that medications are checked, meals are prepared and have been eaten and that the home continues to be clean and clutter free.

I started this blog to get the word out about Constant Companions. I have over 20 years of experience with the elderly and their families and I have lots to share. I know that if people know what I am about and how I run my business, they will choose us over any of our competition. Additionally, I love to educate and share my knowledge with people who are in the middle of difficult life transitions. Whether you are a friend, child or spouse of someone who has suddenly taken a turn for the worse, it can be frightening. On top of which you now have to navigate unfamiliar waters and usually very quickly. Due to my 20+ years, I can help decipher it all for you or I can direct you to another professional who can.

Welcome to Constant Companion’s Blog

July 8, 2009

We are happy to provide you with the latest updates on important information regarding your loved ones.

Please feel free to contact us with any questions and be sure to visit frequently for valuable insight.

You can also subscribe to our blog and be notified of our latest updates. Simply click on the ‘Blog Info’ link in the upper right hand corner and scroll to ‘Subscribe to Blog’.

Thank you.

With care,

Constant Companions