In the Service Of Seniors – As Seen on Union Tribune

Posted on July 14, 2014

San Diego Home Care Provider

San Diego Homecare Provider, Gabriela Brown featured on the San Diego Union Tribune.

Find us featured in the San Diego Union Tribune. The Tribune interviewed CEO, Gabriela Brown about some of the difficulties in convincing families to consider homecare before an emergency arises. Most often families do not consider homecare until a scary event arises in the life of their aging family member, and it becomes clear that they need help. Read the entire article below.


Fun in the Sun – Facts About Senior Dehydration and Tips to Prevent It

Posted on July 1, 2014

Summer is just around the corner and as the temperatures rise, so should our awareness of DEHYDRATION in SENIORS. Although dehydration can occur in any season and in any climate, summer can bring it about quickly, catching many seniors and their caregivers off-guard.


  • 31% of residents in Long-Term Care facilities are dehydrated
  • 48% of adults admitted into the hospital through the emergency department had signs of dehydration in their lab results
  • Dehydration is one of the 10 most frequent admitting diagnoses for Medicare hospitalization according the Health Care Finance Administration.

There are many reasons why seniors are particularly vulnerable to dehydration:

  • The body is not as efficient in regulating fluid balance
  • The body is  not as efficient in regulating internal temperature
  • The ability to sense thirst and hunger decrease
  • Medications can cause excessive water loss through sweating and urine output
  • Diarrhea
  • Diabetes
  • Lack of access to adequate hydration, due to mobility or strength issues

Inadequate daily fluid intake can result in mild to severe dehydration, even death. In fact the average human being can only survive about 4 days without water. Dehydration in seniors can occur quickly with serious consequences.


Signs of Mild Dehydration:

  • Dry mouth
  • Sticky saliva
  • Decreased urine output that is dark in color (should be clear to light yellow)
  • Cramps in limbs
  • General weakness
  • Dizziness or increased dizziness upon standing
  • Falling asleep easily during the day
  • Irritability
  • Headaches
  • Little tear or sweat production
  • Confusion
  • Constipation


Signs of Moderate to Severe Dehydration

  • All of the above AND
  • Fever
  • Increased infections
  • Dry, sunken eyes
  • Skin that doesn’t snap back when lightly pinched (on arm)
  • Fast, shallow breathing
  • Low blood pressure
  • Severe cramps in legs, arms, back and stomach
  • Bloated stomach


Long-term effects of moderate to severe dehydration

  • Urinary tract infections
  • Debilitating loss of strength and balance
  • Debilitating confusion
  • Kidney failure
  • Pneumonia
  • Bedsores
  • Fever
  • Convulsions
  • Death


Even with the stakes so high, many seniors find it difficult to get enough fluids every day. With a little planning, however, they can do it.


Here are a few tips to help everyone on their way to full hydration:

  • Drink approximately 1/3 of your body weight each and every day. Example: If you weigh 150lbs, your minimum daily intake should be approximately 50 oz of fluids a day.
  • Sip throughout the day, Don’t wait until you feel thirsty
  • Avoid alcohol
  • Limit caffeinated beverages. This doesn’t mean eliminate, you can still enjoy a morning coffee or tea. Moderation is key.
  • Get a nice water bottle and note the total ounces with a Sharpie to measure intake.
  • Foods with a lot of water count! Melons, vegetables, fruit juice and soups are full of water.
  • Limit time spent in the sun. If you will be out for a prolonged outing, bring extra water or be sure to stop frequently for a beverage.


To start off your hydration program, weigh in and then monitor weight DAILY. A loss of 2% indicates mild dehydration; a loss of 4% indicates severe dehydration. Example: If you weigh 150 a loss of 3lbs is considered mild to moderate dehydration. Severe dehydration would be a loss of 5-6 pounds.  In the case of severe dehydration, contact your doctor immediately and sip liquids high in salt and potassium such as fruit or vegetable juice, Gatorade and broth, to restore electrolyte balance as well as fluid levels.


Happy Hydrating!


Gabriela Brown, CSA

Constant Companions Home Care




This article is not intended to replace the advice of a physician.

Seniors and Alcohol – The Good, The Bad and The Ugly

Posted on April 30, 2014

Many seniors partake of alcohol in moderation, however, due to physiological and psychological reasons, moderation can be too much for some seniors and for some it is leading to drinking problems or outright alcoholism that can complicate already complex health conditions.

As with all ages, alcohol affects men and women differently due to muscle mass and blood volume. Women also suffer more consequences with an increase in breast cancer and osteoporosis by drinking more than recommended amounts. It is recommended that women drink only one alcoholic beverage daily and men may have two.

One drink is equal to one of the following:

  • One 12-ounce can or bottle of regular beer, ale, or wine cooler
  • One 8- or 9-ounce can or bottle of malt liquor
  • One 5-ounce glass of red or white wine
  • One 1.5-ounce shot glass of hard liquor (spirits) like gin, vodka,

Seniors face life stressors that can lead to the increase or onset of alcohol consumption and the symptoms are often dismissed or mistaken for age-related conditions. Not all seniors who drink regularly have a drinking problem nor do people who do have a drinking problem drink regularly. The key is awareness of your current drinking habits and to evaluate if they are having an effect on your physical, psychological or social well-being.

The Good:

The good news is that a daily drink is beneficial to otherwise healthy seniors, especially red wine.

  • Research is showing that light to moderate drinking after 65 may prevent cognitive decline and dementia by 35%-45%.
  • For postmenopausal women, moderate drinking has been linked to a reduction in the risk for osteoporosis and an improvement in bone density.
  • A daily drink has been shown to raise HDL, the good cholesterol and prevent atherosclerosis.

The Bad:

Physiological Effects:

  • Less able to clear alcohol from the body, leaving excess alcohol, even at moderate amounts free to damage brain, liver, heart.
  • Lower immunity for those who those who consume too much.
  • Decreased balance and strength.
  • Chronic alcohol dependence increases the risk for depression, anxiety disorders, heart disease, liver disease and cancer.

Psychological Effects:

  • Isolation and loneliness is eased with the use of alcohol, making the person less motivated to seek out social situations, leading to more isolation.
  • If a person had a social network and is consistently seen drinking too much, friends withdraw, leading to isolation and more drinking.
  • Depression occurs in over 50% of people over 65. Alcohol is a depressant. It can increase the feelings of depression in those already suffering from depression.


Some medications can increase the effects of alcohol or be toxic in combination. Here are some examples:

  • If you take aspirin and drink, your risk of stomach or intestinal bleeding is increased.
  • When combined with alcohol, cold and allergy medicines (the label will say antihistamines) may make you feel very sleepy.
  • Alcohol used with large doses of acetaminophen, a common painkiller, may cause liver damage.
  • Some medicines, such as cough syrups and laxatives, have high alcohol content. If you drink at the same time, your alcohol level will go up.
  • Alcohol used with some sleeping pills, pain pills, or anxiety/anti-depression medicine can be deadly.


  • Many seniors do not eat enough as sense of taste wanes with age. When drinking, less food in the stomach increases the rate of alcohol absorption into the blood stream
  • Dehydration is a common issue in seniors – dehydration causes lower blood volume which can increase the total blood alcohol level per drink.
  • Alcohol is a strong diuretic increasing the risk of dehydration.
  • Heavy drinking can take the place of adequate food consumption providing empty calories with no nutritional value.

The Ugly

Among persons over 60, up to 10% in community-based living fulfill the criteria for alcohol abuse. For those admitted to hospitals, the rate of alcoholism is 18%-20%, 38% in psychiatric institutions and 40% in nursing homes. The number of seniors who drink heavily is increasing and women are catching up to men.

It has been shown that many seniors who drink beyond recommended amounts over long periods of time:

  • Suffer more falls and injuries.
  • Exhibit symptoms of dementia or Alzheimer’s such as being forgetful or confused – some of which can be corrected by cutting down or abstention. However, after prolonged use some damage cannot be reversed.
  • Make diagnosis and treatment of certain diseases or conditions more difficult for physicians.
  • Can worsen conditions like osteoporosis, high blood pressure, diabetes and ulcers.
  • 70%-80% of hospitalized seniors have some problem with alcohol.
  • In a study of suicides in persons over 65 years of age, alcohol abuse was identified in 35% of men and in 18% of women. This is 18 times greater than seen in a random population control group.
  • Alcohol reacts negatively with more than 150 medications.

The Bottom Line

Otherwise healthy seniors should feel free to enjoy their favorite alcoholic beverage but the definition of moderation can change later in life. If you are currently suffering from a chronic condition, you may not benefit from light to moderate drinking. Continue to monitor and be aware of alcohol’s effects on you and adjust accordingly.

  • Be kinder to your body. If you are consuming more than 7 drinks in a week or more than 3 drinks a day, consider cutting down or quitting altogether.
  • Always check with your physician to make sure that there are no adverse reactions that may occur with any over-the-counter, herbal or prescription medications.
  • If you cannot cut down, don’t be afraid to ask for help. As with all stages of life, alcohol abuse and dependence can sneak up on a person for various reasons. Your physician or local social services agency can help direct you to the resources that you need to get your life back on track.
  • If you are witnessing an alcohol problem with a loved one, remember to approach them with love, support and compassion in an effort to help them to help themselves.


The Use of CareProfiler in Full Swing

Posted on November 6, 2013

Care Profiler was developed to help healthcare organizations find caregivers that are responsible, attuned, and capable of creating meaningful connections with the people they care for.

The Questionnaire takes about 20 minutes to take and looks for strengths and weaknesses in:

Interpersonal Workstyles: 

  • Empathy and EQ
  • Hospitality
  • Dependability
  • Self Control

Care Core Areas:

  • Comforting
  • Motivating
  • Socializing
  • Enriching

Performance Workstyles: 

  • Open to learning
  • Persistence
  • Stress Tolerance
  • Attention to Detail
  • Achievement

The results are then analyzed by the program to provide a detailed picture of each candidate to provide the most compatible placement with our clients. We have been using this tool since June 2012, and it has been a tremendous success for both Constant Companions and the seniors that we serve, as it goes far beyond the resume and interview. Not only can we qualify caregivers based on skill and experience, but we can now provide clients with caregivers that are more attuned to their particular personality and situation, a must when working in the home.

If you would like to learn more please visit our website at If you would like to take the test, go to the “Click Here To Apply’ link on the home page. Indicate that you are taking the test ‘Out of Curiosity’. Please don’t forget to put in your email if you would like us to email the results to you.

The Launching of Affordable Alternatives

Posted on November 6, 2013





Constant Companions continues to serve the senior population of San Diego and SW Riverside with a full-service, employee-based home care model. However, throughout 2011 and 2012, as our care coordinator met with many seniors and their families, they were increasingly turning down traditional home care agency services and opting to look on Craigslist or another private set-up. Private hire caregiving can be risky, if not downright dangerous. We felt we needed to provide a solution to families that offered them the assurance of background checks and care oversight.

In January of 2013, Affordable Alternatives was created. Affordable Alternatives is a separate Home Care Referral Agency that seeks to provide seniors with a safer alternative to inexpensive home care.

All of the caregivers at Affordable Alternatives must pass the same rigorous screening process as Constant Companions’ Caregivers:

  • 7 year/50 state background check
  • Employment/Reference check
  • CareProfiler Questionnaire
  • Interview
  • Orientation

Affordable Alternatives is insured with both general and professional liability in addition to being bonded. All caregivers registered with Affordable Alternatives are independent contractors that are allowed to set their own rates and the agency collects a set fee for care management and administration (billing, payment, compliance, and maintaining insurance).

As with Constant Companions, Affordable Alternatives clients receive a comprehensive in-home assessment, care plan and regular contact to make sure all is going as expected and to make any adjustments in the care plan as necessary.

Rates for Affordable Alternatives begin at  $15.60 per hour and $156/day.

To Reach a Care Coordinator 24/7, please call:  888.713.3268 

Here’s the Skin(ny)—The Importance of Skin Integrity As We Age

Posted on November 6, 2013

No, I am not talking about weight; I am talking about the largest organ on your body, your skin.  As we age, the skin, like every other organ in our body, begins to decline. While we don’t have any way to reverse this aging process there are things that we can do to boost it functioning and help to prevent skin integrity issues, a major complication for many seniors.


What does skin do for us?

·         Helps maintain proper body temperature
·         Wards off infections
·         Waterproof barrier that keeps moisture in and moisture out.
·         Provides sensory information about our environment and injury

As the body ages, the layer of fat under the skin starts to disappear as well as the blood vessels feeding the skin with lots of oxygen. As a result the skin becomes looser, unable to insulate us well, and thinner. The most visible evidence of this is wrinkling and sagging of the skin. As our skin becomes thinner, it becomes vulnerable to tears and pressure sores. Open skin is an invitation to infection and discomfort.

Risks Factors:


·  Diabetes – it is under-diagnosed and under-treated, so make sure you are checking for it regularly with your health care provider. Diabetes causes decreased blood flow to the skin and extremities, encouraging the formation of wounds where there may be pressure points. To make matters worse, it makes the body less efficient in healing wounds, once they have developed.

·  Immobility—Any condition that requires someone to be in bed or confined to a wheelchair for long periods of every day will increase the need to be especially vigilant for skin problems. Daily skin checks for tears and sores are essential. Also, making sure that skin is kept clean and dry is essential. If moisture is a problem, check with your health care provider about the use of barrier creams.

·  Hip fracture—In otherwise health and active people, hip fractures can cause long periods of immobility during the healing and rehabilitation process. This immobility can increase chances of developing a bed sores.

·  Dementia—Dementia can contribute to problems with overall skin integrity due to nutritional factors. Not remembering to eat or prepare balanced meals can cause a drop in weight and nutrients essential to the maintenance of the skin. Additionally, inadequate nutrition can contribute to a higher incidence of falls (weakness from low blood sugar and not enough calories) which can open the skin and lead to infection.

·  Rapid weight loss— The lack of ‘padding’, coupled with the underlying cause for weight loss, i.e. poor nutrition or disease, can be problematic for skin integrity.

·  Cancer— During treatment, immunity is compromised, appetite may decline, and chemotherapy can directly affect the condition of the skin. Special care should be taken to avoid a skin tear and to try to make sure that food and liquid intake is maintained as much as can be tolerated.

·  Smoking or history of smoking—Decreases blood supply to the skin.

·  Neurological damage—This can decrease ability to sense discomfort at pressure points that would otherwise prompt one to shift positions.

What you can do NOW

Nutrition is one of the best defenses against skin break-down. No matter what your current health status, making an appointment with a dietician is a great way to make sure you are getting the adequate nutrition you need to provide your skin the opportunity to keep working for you, not against you.

Nutritional factors that can help maintain skin integrity:

·  Stay hydrated

·  Eat a balance diet that includes protein

·  Include healthy fats in your diet

·  Make sure you are getting enough Vitamin A, C, E, K and minerals zinc, iron and copper

 While there is no cure for what age does to our skin, there are things that we can do to keep it in the best possible condition to help protect us when we are our most vulnerable.

Download – Here’s the Skin(ny)—The Importance of Skin Integrity As We Age

Written by Gabriela F. Brown, CSA

Constant Companions Home Care


Happy 10th Anniversary!

Posted on November 6, 2013

It was on October 14th, 2003, that we accepted our first client! 

We want to extend a heart-felt THANK YOU to all of our referral sources, community partners and clients for their continued faith, feedback and recommendation of our senior home care services.

Our 10-year anniversary is more than just a celebration, It is a time for gratitude, a time to reflect and a time to plan for the future.

Since 2003, we have continually looked for ways to differentiate us from the myriad of other agencies in the community. Over 10 years we have learned a great deal and are continuing to learn as the entire health care industry is facing new challenges including home care, which is facing new state-wide regulatory challenges.

As we plan for the next 10 years, we are very busy learning about these new changes in order to be an asset your organization and the overall well-being of each of our clients.

We will continue to have an open-door policy regarding any suggestions and concerns that you may have in our overall practices, compliance and customer service. In fact, we will be encouraging it as we discover new ways to continue being an asset to the health care community as well as the seniors in our community.

Once again, thank you ALL. We couldn’t have done this with out you. Our deepest wish, at this milestone, is to continue providing excellent services to the seniors of San Diego and SW Riverside for the next 10 years!

-Gabriela Brown, CSA 

Founder of Constant Companions Home Care 

Massage for Seniors: It’s a Good Thing!

Posted on September 6, 2013

There is growing evidence that seniors could significantly benefit from a regular massage session and a new specialty is rapidly growing to provide this service, tailored to the senior’s needs and concerns.


Download Massage for Seniors: It’s a Good Thing!

The benefits of massage therapy are well-documented; however, seniors are less likely to schedule appointments for a variety of reasons including:

  • Modesty
  • Cost
  • Health Conditions

Benefits of Massage:

  • Boosts immune function
  • Increased blood and lymph circulation which can help nutrients get to muscle tissue and increase medication absorption rates
  • Helpful in reducing pain and reliance on pricey meds for conditions such as arthritis, back pain , circulation problems and high blood pressure
  • Widely used to treat chronic pain and osteoarthritis.
  • Beginning to develop techniques to improve quality of life for Alzheimer’s patients
  • Reduces anxiety and depression
  • Decreases stress hormone and proteins related to inflammation and allergic reactions.
  • Increased flexibility
  • Reduced joint pain
  • Better sleep
  • Provides human touch, increasing overall well-being

Geriatric Massage Techniques and Tips:

  • Make sure your therapist is familiar with proper techniques for seniors. Gentle stroking, kneading and application of light pressure on specific points.
  • Most seniors require a lighter touch and shorter sessions.
  • If a general body massage cannot be done, massage to feet, hands or shoulders can produce beneficial results
  • Consult with your physician prior to scheduling an appointment
  • Be honest with your massage therapist regarding any conditions you have
  • If modesty is an issue, your massage therapist can accommodate what makes you comfortable. You don’t have to remove all clothing and you can get assistance on and off the table.

When Massage Therapy Should be Avoided:

  • Open or healing wounds or bedsores
  • Use of blood thinners – can cause bleeding under the skin
  • Thrombophlebitis – Blood clots that can come loose and travel to the lungs during massage
  • Broken or healing bones
  • Recent surgery – still healing
  • Some type of cancer

Uncertain Paths – Transitioning to Home Care

Posted on August 29, 2013

Your mom is in the skilled nursing facility and the social worker/case manager is talking to you about sending her home. It is recommended that she not be without personal care assistance/home care. All of a sudden, there are many decisions to make.

  • Do you bring her to your home?
  • Do you care for her every day in her own home?
  • Do you contact a home care agency or hire a caregiver privately?

No matter what is decided, this is unfamiliar territory that brings to surface many fears and anxiety. Hiring outside help for a parent creates a tremendous storm of emotions.


Download Uncertain Paths – Transitioning to Home Care

Normal thought processes include:

  • You know that no one can care for your parent the way you do, or at least not with as much love and concern.
  • You truly wish you could care for your loved one full-time, you just can’t.
  • Your parent is most likely in a vulnerable state.
  • They may not have ever needed to have an outsider care for them before. Their anxiety about this can easily increase
  • yours.

  • You know that at some point, you will have to get back to other aspects of your life, causing a sense of urgency.
  • You will not be able to oversee every detail of care once that care has been entrusted to a caregiver.

Here are a few helpful hints to follow to assure a smooth transition for you and your loved one.

  • Remember that this is a major life transition for both you and your parent.
  • This is causing anxiety for everyone involved because it is a significant departure from the ‘norm’. Give yourself permission to feel the anxiety, fear and guilt. However, don’t allow it to cause you to make sweeping decisions that might eliminate YOUR anxiety, but create more for your loved one.
  • Make a plan of action that takes into account EVERYONE’s needs and expectations. Don’t leave yourself out of the equation. Decide how much care and support you can realistically provide on a consistent basis and use this as a benchmark when hiring outside help. For instance, you could agree to do the grocery shopping once a week, pick up prescriptions, transport to medical appointments, etc.
  • Remember that your presence and involvement is still crucial. Even if the caregiver is Florence Nightingale reincarnated, your loved one still needs YOU. By continuing to offer assistance and support in a predictable way, you will be providing a sense of a familial continuity that cannot be duplicated. Just remember to set your boundaries so that you are not overextending yourself.
  • Have clear expectations outlined when meeting with your caregiver including housework, meal preparation, care needs and preferences, work schedule, personality preferences, etc. This provides a firm foundation on which to start, eliminating guesswork on the part of the caregiver and frustration on the part of the family.
  • Make sure these expectations and needs are clearly defined in a Plan of Care to be followed by the caregiver with an established system of reporting.
  • Let go. Allow your caregiver the freedom to establish a routine and rhythm in the home. Accept that they are not you and will have a different work-style. As long as good care is being provided and she/he is a good personality fit, you are ahead of the game.

When faced with a major life transition, we are forced to adapt. In order to adapt successfully, remember to be honest with all involved about your limitations, anxieties and fears. There is no ‘right’ way to be/feel. By focusing on the best solution for all involved, you will be able to come through for yourself and your parent, laying the groundwork for a smooth and successful transition.

Great Expectations in Home Care

Posted on August 29, 2013

Home Care is a very flexible and cost-effective way to provide a safety net for senior member of the family to continue living in their own home and communities. Even though home care requires less adjustment than a placement in a group home or assisted living facility, it tends to have strong undercurrents of emotion and expectations for the entire family.

Home care is a life transition. Having a virtual stranger coming into your home to help manage the most basic aspects of daily living can trigger deep emotional responses. For the senior in need of care, loss of autonomy, independence and privacy are very real. This may be piled on top of other recent losses in health and relationships. No one, in my experience, has EVER welcomed the need for home care as it is typically follows some sort of loss or series of losses.

For the family, guilt, fear and inadequacy are feelings that are very relevant and real as well. Many, if not most, adult children wish that they had the time or lived close enough to provide the care they feel their parents deserve. Fear enters in, with the control and direction they lose when hiring someone to provide the care. Feelings of inadequacy can surface, especially if they had attempted to provide the care themselves and it became overwhelming. These emotions are all very natural it is best to acknowledge them as they come to the surface. Often, the act of hiring outside help brings these feelings to the forefront. If left unaddressed, they can have detrimental effects on the success of home care assistance.

Often when people are not aware of or do not want to acknowledge these intense emotions, there is a tendency to place unrealistic expectations on the caregiver. No matter how hard the caregiver works, they will never be a replacement for the adult child. The caregiver is an individual with their own history and personality. They will not immediately understand every nuance and preference of each client.

Clearly defining tasks and reviewing skill is vital to beginning this professional relationship, which most reputable home care agencies will do with an in-home assessment and a plan of care. Once the expectations are established, they should remain constant as the caregiver establishes a rapport with the family and can be adjusted if the condition of the client changes.

At the outset, the focus of the caregiver should always be on the safety and well-being of their client. Housekeeping duties can be included, but shouldn’t be at the expense of quality care.  Obvious adjustments can be made as the caregiver settles in to their routine. Clearly, if a caregiver is just NOT the right personality, that should be addressed as soon as possible. However, if the caregiver is competent and professional, it may help to wait a little while rather than rush into a change. Learning the temperament and rhythms of a new client takes a little time. After a while, the caregiver will develop a regular routine based on these daily rhythms and will increasingly be able to anticipate situations and changes and how best to deal with them.

In short, no one can care for your parents like you can. However, if your situation requires outside assistance, do your best to understand the limits of the professional home care relationship and guard against placing unrealistic expectations. If the home care professional provided is caring and competent, provide space and flexibility for the relationship to develop. This should help everyone ease into this life transition with minimal discomfort and allow this new relationship to flourish.

- Gabriela Brown, CSA

Constant Companions Home Care