Provider Profile: Always Best Care, Sugar Land, TX

One morning, Guido Cubellis called his mother, Teresa, to let her know he could take her to see her cardiologist later that day. The busy owner of a home health agency with 40 to 50 clients at any given time, Guido found that his schedule was wide open, a rare occurrence. 

His mother had other plans, however.

“She had rescheduled her appointment to another day,” said Guido, who has led Always Best Care Senior Services of Sugar Land, Texas since he purchased the franchise in 2016. “When I asked why, she said, ‘Because Eunice will be here that day and she can take me.’” Teresa was referring to Eunice Butler, her caregiver from Always Best Care and one of Guido’s employees. His mother was one of his agency’s clients.

“When I said I had hoped to be there when she met with the cardiologist, my mom said, ‘Well, you can meet us at the doctor’s office that day if you want,’” Guido said.

His mother’s preference for her caregiver happened again later on when Teresa, who had signs of dementia, was hospitalized. Guido visited her there one day to tell her he had arranged Eunice’s schedule so she could be by Teresa’s hospital bedside.

“You should have seen my mother's face when I told her Eunice was coming,” said Guido. “I said, ‘I'm your own son and you don’t react like that!”

For Guido, whose company is a provider in the CareScout Quality Network, these stories really brought home the power of person-centered care, which incorporates client preferences into the plan of care. It also emphasizes caregivers taking the time to get to know their clients and their life stories to create a strong connection, which leads to better care.

“Person-centered care is all about forming that relationship with the client,” said Guido. “It's just beautiful to watch it blossom and see how the clients feel so secure.

“Because that's our job. Our job is to make you feel safe, secure, and to take care of you.”

The day his mother rescheduled her doctor’s appointment was a great example, said Guido. “That brought tears to my eyes,” he said. “I thought, I'm so happy that you feel that comfortable with somebody. Instead of getting mad, I just laughed and said, okay, we'll go with what you want to do.” 

That was back in 2022. Eunice continued to care for Teresa until she passed away in 2023 at the age of 86. As with Guido’s other long-term employees, Eunice continues to work for Always Best Care today. “She’s wonderful,” Guido said. “The best experience I've ever had running this company was having my own mother as a client. It was such an eye opener.”

These and other experiences as well as working with CareScout have caused Guido and his team to refine how Always Best Care-Sugarland creates a person-centered care climate for its clients and caregivers. It comes down to at least four strategies: a thorough client intake process, going the extra mile to honor client preferences and rewarding staff when they do, a multistep training process for staff, and ensuring continuity of care when there is a change in caregiver.

Guido wasn’t familiar with the term “person-centered care” until last year, when he began the process to join the CareScout Quality Network. “I realized, however, that that’s what we’d been providing,” he said.

One reason: a thorough intake process for clients his company had put in place prior to working with CareScout. “It’s a two-step process,” said Guido. When Always Best Care receives a referral, the first step is for its community liaison to visit the client to do an assessment and gather the basics.

Their client service director then performs a follow-up visit, a critical step because clients and families are often stressed during the first visit and can leave out important information. “That second visit is to get more specific, said Guido. “Let’s get down to really, really minute details of what we can do for you to make you happy and to be successful."

Teresa’s case was a great example. “My mother was a wonderful cook,” Guido said. “That's what her passion was. She loved to make pizza. She couldn't do it anymore because of the arthritis in her hands.”

Armed with that information, Eunice came up with a meaningful activity for Teresa. “My mother called me one day and said, ‘Guess what? Eunice and I are making pizza tomorrow,’” said Guido. “They made three pizzas and put a photo on Facebook. There's my mother, all smiles. She was beaming like she did 30 years ago when she used to be in the kitchen making the pizza herself.”

A thorough intake can make a difference right away, said Guido. “We had a new client start with us last Monday morning,” he said. “Monday afternoon they called and left a message saying, ‘We just want to let you know that the first day's over, and we were so pleased. We can't wait for the next visit.’”

Recognizing caregivers who deliver such exceptional service helps reinforce the value of person-centered care, said Guido. He recalls a letter he received from a client’s widow. “She told us how wonderful the care was and named the staff who she thought were exceptional,” Guido said.

Those staff members received bonuses. “For this client to write that letter after her husband passed away told me that our care was still on her mind, and that our employees had touched her,” said Guido. “How could I not reward the people who were part of that and made her feel that way?

“To me, that's the basis of person-centered care,” he continued. “Look what you've done for that person. You made such a positive impression. And now they have continued peace of mind that they did the right thing for their loved one at the very end.”

Another key to maintaining a person-centered care climate is making sure staff are well-versed in its principles, said Guido. “We take a three-pronged approach to training,” he said.

The first part includes monthly training for all caregivers that includes mandatory knowledge, such as infection control. The second part includes training according to each employee’s background and skill set. Those factors can vary widely because Always Best Care’s hiring criteria look beyond professional qualifications.

“For us, the challenge is not getting applicants, it’s finding people who are the right fit,” said Guido. It takes someone special to do this work and with the right attitude, he added. “We really look at the person versus a degree or certification that they might have.”

The third piece covers the specific needs of the client an employee is caring for, which enables caregivers to provide highly individualized care. Guido recalled one complex case involving a couple in which the wife lived with dementia and the husband lived with Parkinson’s disease. This called for two very different types of care and required specialized training for the employee, said Guido. 

"The caregiver was going to have two different people in the room,” he said. The husband would be able to understand the caregiver but not be able to communicate well due to physical limitations. The wife would be able to communicate but not remember what the caregiver was communicating. “The training helped the caregiver know what to expect going in and how to respond and provide care for both these clients,” said Guido.

One of the most important aspects of person-centered care is making sure the client feels the staff knows and cares about them as a person. When there is a change in caregiver, that feeling can be compromised if the new caregiver is unfamiliar with the client or their specific needs and preferences. 

To keep those transitions as smooth as possible, Always Best Care has two “floater” caregivers on staff. “Floaters are super-skilled caregivers who know all the clients and are on standby,” Guido explained. “When there is a change in caregiver, a floater will monitor the new caregiver for two shifts to make sure they do everything right.” He noted that the addition of floaters was an operational change Always Best Care made after beginning to work with CareScout.

When asked what advice he would give other providers seeking to create a person-centered care climate, Guido didn’t hesitate. “I would tell them CareScout is serious about this,” he said. CareScout’s initial response to his inquiry about joining the Quality Network was thoughtful, thorough, and impressive, said Guido. 

It made him excited to join the network. “I thought, this will help us to become better at what we already do, because they will partner with us in making us better at person-centered care,” he said. “Then their members will benefit from it. It's a win-win for all of us, and that's what it has to be in the end.”

For Guido, providing person-centered care is simply the right thing to do for his clients and his employees. It’s also the right thing to do for his company.

“For Always Best Care, it’s become a differentiator,” he said.