Posts Tagged: home care

Home Health Care vs. Older Adult Home Care

It can be confusing to find the exact service and care necessary for an older adult. You may encounter terms for home health care, home care, personal care and companion care services that can be tricky to understand. At Corewood Care, we provide many of these services across the greater Montgomery and Prince George’s counties in Maryland, Northern Virginia and the Washington D.C. region, in accordance with our licensures. In this guide, we’ll explain the difference between home health and older adult home care to make it easier to find the necessary services for you or your family member.

What Is Home Health Care?

Home health and home care services have some similarities in service capabilities, but they are not the same. Let’s begin with home health care. This term describes more in-depth, skilled medical care that comes to the home so the client doesn’t have to visit a doctor’s office or other medical provider. Home health care may be necessary to treat a chronic health condition or during recovery from surgery or a serious illness or injury. 

These services are considered clinical or skilled care, so licensed caregivers provide them. Home health caregivers can range from a registered nurse (RN) to a certified nurse’s aide (CNA), according to pertinent licensure requirements. Private insurance companies or Medicare and Medicaid will usually cover these services. 

Providers often prescribe home care or recommend it as part of a care plan. Older adults may need home health care if they require supervision after a medication change, recently received a discharge from a skilled nursing facility or rehabilitation center, or lack the ability to travel safely to a doctor’s office. Other older adults may need this care if they experience a decline in their functions that requires therapies to help regain their independence. 

Home health services can include health monitoring, medical tests, medication administration, pain management and wound care. Although a home health care provider may offer some similar services as a home care provider, such as medication reminders, they will not deliver the same personal touch, social interactions or daily activity assistance as home care.

What Is Non-Medical Older Adult Care?

Home care usually refers to making life better for older adults as they age in whatever location they call home, including independent living facilities, apartments or houses. Home care is non-medical care and can include services like transporting the client, assisting with dressing and grooming, house cleaning and toileting assistance. Some people also refer to home care as a personal care service because caregivers will use a holistic approach to meet the client’s needs while helping with hygiene, medication reminders and other unique challenges.

Home care can be a long- or short-term service. For instance, home care may be a temporary need for someone recently released from the hospital. Home care can also provide valuable social interaction, making older adults feel more comfortable. 

Choosing Home Care or Home Health Care

Ultimately, choosing home care or home health care will depend on each client’s unique needs. If a client needs wound care, specialized therapies or medication administration, they will be more suitable for home health care. Meanwhile, older adults needing assistance navigating activities of daily life (ADLs) can benefit from home care. 

Chart of services for home health care versus senior home care

However, when choosing necessary services, you should also consider price. Although both types of care typically have an hourly rate, home health care services may be more expensive because the caregiver can administer licensed medical support. If an older adult needs or wants both types of care, it’s possible to create a more budget-friendly schedule that allows for each type of assistance. This way, the client can receive the medical attention they need from home while also accessing a supportive and dedicated caregiver to help them navigate daily activities.

Get Support at Home From Corewood Care

At Corewood Care, we tailor in-home care services to each client. Our home caregivers also help keep the client engaged during our visits with conversation and interaction. The term companion care refers to the more social side of home care — these clients perhaps do not need help with bathing or grooming but would benefit from someone to play cards with, reminisce with or engage in activities that keep the brain stimulated.

Corewood Care can provide the customized in-home care an older adult needs to feel comfortable while they rest, heal or navigate their homes. We’ve served clients across the region with home care services, respite care and 24/7 care for many years. If we can be of service, answer questions or help find the right service, please give us a call at 301-909-8117, schedule a free home assessment or use our chat.

Oral Health in the Elderly

A recent study published in the Journal of the American Medical Directors Association points out the need for oral health in the elderly. The study says that older adults with tooth loss have a higher risk of cognitive impairment and dementia. The more teeth that are missing, the increased risk.

Researchers reviewed records of 24,074 participants, of which 4,689 had cognitive impairment or dementia. They found that each missing tooth was associated with a 1.4% increase in the risk of cognitive impairment and a 1.1% increased risk of dementia. Those with 20 or more missing teeth had a 31% higher risk. Participants who had missing teeth but also used dentures were not found to have a higher risk.

The connection between missing teeth and these risks is not clear. Perhaps missing teeth create problems chewing food so much that nutritional deficiencies or chemical imbalances occur. If there has been poor oral hygiene, increased bacteria in the mouth or gum disease may also have a connection.

Or it’s possible that people who are experiencing cognitive decline become less able to take care of their teeth, eventually leading to tooth loss. There’s still a lot to be studied on this issue but one thing is clear: aging adults often need more care. At Corewood Care, we serve seniors and their families with in-home care, allowing the elderly person to age in place in their own home.

Our caregivers are trained to help with the physical needs such as toileting, bathing, dressing and basic oral care, as well as help in the home with light housekeeping, meal preparation, medication reminders, and companionship and compassion during every visit.

If you or a family member are struggling to keep up with the tasks of daily living, let us help. Contact us for a no-cost home consultation for senior home care services across the greater Bethesda and Washington DC region.

Local vs National Home Care Companies

If you’re looking for a home care service in the Bethesda-Montgomery County-DC Metro region, there are many options. Dozens of in-home care companies offer care for seniors. Some are large national companies; others, like Corewood Care, are locally owned.

What differences might be found between a corporate home care agency and a locally owned home care service? You may be more familiar with the big-name national companies. Several of them run nationwide TV commercials, hire well-known actors or former television news people, place ads in magazines, or send direct mail to your home. All of that costs money which is factored into the rate they charge.

Services that match you to a home care company, assisted living facility or nursing home can have very high fees that are paid for by that business. Those also have to be factored into the rate they charge for their services.

Locally owned senior home care agencies have a smaller management structure and less overhead cost. That means that if you ever have a concern, you can easily speak with top management or the home care agency’s owner. At Corewood Care, our company was founded by Mary O’Donoghue. Following her experience caring for her father in the family home on Corewood Lane, she believed in-home care for the elderly entailed more than physically helping the senior adult. She set out to build a company that employed caregivers passionate about helping people, caring for their emotional and physical needs.

It’s that desire to find the most caring and compassionate staff, provide excellent training and hands-on care management that often sets local senior home health care agencies apart. Corewood Care offers no-cost home assessments before we match a caregiver to the senior client. We work to make that a good relationship from the beginning, whether it’s for respite care, post-surgery care, or 24/7 in-home care.

Senior care services can help with dressing, bathing, medications, and activities of daily living, as well as light housekeeping, meal preparation and companionship. We’ll tailor a specific plan to help care for you or your senior family member, and always be available to make the senior care services meet your needs.

Loneliness in the Elderly

As people age, loneliness and social isolation can become very real concerns and create health risks for dementia and other medical conditions. A report from the National Academies of Sciences, Engineering and Medicine (NASEM) indicates that nearly one quarter of adults 65 and older are considered to be socially isolated. 

Aging seniors are more likely to live alone, often after the death of a spouse; and are more likely to experience the loss of family or friends who may pass away or move to another location. Chronic illness and loss of hearing also contribute to isolation and loneliness. A recent study found that social isolation increased the risk of premature death to nearly the same extent as smoking, obesity, and physical inactivity.

At Corewood Care, we work to address the issues of loneliness and social isolation for our senior home care clients and their families. Often, we are brought into a senior’s home because they, or their adult children, recognize that they need help with bathing, housekeeping, or meal preparation. Our caregivers are adept at providing that physical, tangible assistance, but they are also trained in the importance of companionship while they’re performing other duties in the home.

That companionship is part of our company philosophy; it’s our mission to help our clients thrive and grow. That means we’re attuned to the issue of loneliness, and we make an effort to reduce those feelings in our clients during our visits. So while our caregivers help a client bath and dress, they try to engage each client. These conversations might be inquiring about the places the senior lived or the type of work they did; their families; the weather or news of the day. While our caregiver prepares meals for the senior, they might ask about their favorite meal or what memories he or she has of holidays, or about hobbies or interests he or she enjoyed.

Our hope is to not only provide home care but to make a difference. Senior home care is not just about physically helping the senior with activities of daily living as they age, it’s also about caring for their mental health by offering friendship and companionship. Corewood Care is a senior home care company serving Montgomery and Prince George’s counties in Maryland; Fairfax County, Arlington and Alexandria region in Virginia; as well as Washington DC area. Call on us for assistance with home health care services, 24/7 care, and respite care for your family.

Ten COVID Scams Older Adults are Falling for Right Now

Across the country, federal and local law enforcement agencies are warning older adults about COVID-19 scams and requesting personal information or making false promises about COVID-19 cures and test kits.

Corewood wants to make you aware of these coronavirus scams. We also want you to know that experts believe the number of new schemes will only increase over the coming months. Some of the most common scams include:

  • Individuals selling treatments for COVID-19 vaccine, cure, or insurance.
  • Online sales of high demand medical supplies such as N 90 or N95 masks.
  • Phishing calls, text messages, or emails from national or global health authorities asking for personal and/or financial information.
  • Calls or emails requesting contributions for obscure COVID-19 treatments.
  • Appeals for donations for individuals affected by COVID-19.
  • Unofficial COVID-19 apps and downloads that can potentially compromise a person’s computer or phone with malware.
  • Financial planners alleging they have “inside information” to prevent, detect, or cure COVID-19.
  • Scammers calling as contact tracers claiming the individual has been exposed to COVID-19 and needs to act quickly. They then request the person’s social security numbers, insurance information, or advanced payment for bogus COVID-19 tests.
  • Calls claiming to be from the Social Security Administration (SSA), claiming that benefits will be interrupted unless the caller provides their social security or bank account number.
  • Scammers impersonating bank employees who claim that banks are falsely limiting access to funds or alleging security issues with bank deposits.

Top TEN Tips for Avoiding COVID-19 Scams:

  • Discount claims about COVID-19 vaccine, cure, or treatment.If there is a medical discovery, it wouldn’t be reported through unsolicited emails or online ads.
  • Depend on official sources for current information on COVID-19.Review your state’s health department websites, the Centers for Disease Control and Prevention, or the World Health Organization for the latest developments.
  • Know that the safest place for your money is in the bank—your funds are physically secure and federally insured, something you don’t have when your money is outside the banking system.
  • Be on guard for phishing scams.  Do not click on links, pop-up screens, or open any attachments from sources you don’t know. NEVER share your password, account number, or PIN with anyone.
  • Investigate before donating. Be circumspect about any individual, charity, or business requesting COVID-19-related donations in cash, by wire transfer, gift card, or through the mail.
  • Keep your computers and mobile devices up to date. Using the latest security software, web browser, and operating system are your best defenses against viruses, malware, and other online threats. Turn on automatic updates to get the newest fixes.
  • Avoid bogus website links. Hackers embed malicious links into devices by tricking you into downloading malware or route users to bogus websites. Fraudulent links are often disguised by simple changes in the URL, such as www.ABC-Bank.com vs. ABC_Bank.com.
  • Enable multi-factor authentication for critical financial accounts. Multi-factor authentication is a second step to verify who you are. This often means you will receive a text message to verify your status before gaining access to a site.
  • There is a high potential for fraud presently. Be leery of any company claiming the ability to prevent, detect, or cure coronavirus.
  • Help others by reporting coronavirus scams. Contact the FBI’s Internet Crime Complaint Center at ic3.gov to report suspected or confirmed scams. The Federal Trade Commission also provides an updated list of the latest coronavirus scams at ftc.gov/coronavirus.

Have questions? Feel free to contact Mary Ann Buckley, Director of Care Management, at maryann@corewoodcare.com. We’re here to help.

Care Manager Success Story

Years ago, we were honored to help a woman decide a move from her home into a senior living community where her sister lived. The older sister was unrelenting in telling her younger sister to move to her community and as soon as possible. She told me it was reminiscent of childhood with her older sister bossing her around.

This situation was causing a rift in the sister’s relationship, and they both were stressed. The sisters went to the same Physician who learned of the disagreement from each sister’s viewpoint. He recommended a Care Manager to help the younger sister choose a senior community based on her desires, needs, and budget.

The Care Manager met with her and reviewed all her preferences for her ideal housing type to meet her needs now and in the future. She always visited her sister and enjoyed her community but was not sure it was the one for her.

The Care Manager identified three communities that met the younger sister’s preferences, and they toured all three with an open mind. They compared each community, even making a pro and con list, and discussed the long and short-term advantages.

In the end, the younger sister chose the senior community where her older sister lived, but it was only after she had the time to look at her options and make a decision that was best for her. She felt confident that the move was the right one for her and not what her older sister wanted her to make.

At times like this, a Care Manager can provide professional, impartial guidance and options to consider. The Care Manager also assisted the younger sister with all of the steps required to sell her home, downsize, pack/move, and settle into her new home at the senior community on a different floor than her older sister.

New to Care Management? How a Care Manager Works with Clients and their Families

Corewood’s Care Management team works with clients and their families on a wide variety of issues, health conditions, and family dynamics. You may not know about all we do, so please let me provide a brief overview of the most noteworthy tasks we undertake.

Determining Where an Older Adult Should Live

Every family’s situation is different. Some older adult clients are temporarily immobilized due to a fall or hospitalization, or one spouse has a condition that will worsen over time, such as Alzheimer’s. Can the spouse or caregiver help with bathing and dressing? Does the older adult need constant supervision or someone to check in on them occasionally?  The answers to all of these questions – and many more – will need to be taken into consideration when deciding where an older adult will live. Care Managers are trained to look for warning signs to determine if an older adult is safe living at home alone. Whether or not an older adult remains at home, there are concerns that the Care Manager will review to ensure safety.

  • Making a Home Safe – If an older adult is going to remain in at home, a Care Manager can recommend modifications to make the home safer.
  • Finding Senior Housing – If an older adult can no longer live independently, a Care Manager can assist with a move to a senior housing facility, such as assisted living or CCRC. Throughout the process, a Care Manager will evaluate a community based on the level of care a person needs now and in the future as well as consider their lifestyle.

Covering Your Legal Bases

If you, your spouse, or your parent were suddenly incapacitated, who has the legal authority to act on their behalf? A Care Manager works with older adults and their families to avoid legal red tape and make sure older adults have the right legal documents in place. They will recommend and work with an attorney to be sure there is a power of attorney, advance care directives, a will, and, if needed, guardianship.

Organizing Finances

Would you know what to do if you suddenly had to take over managing money and paying bills for your spouse or parents? Care Managers work with older adults and their families to be sure trusted individuals know where the essential paperwork is kept and how to access funds if need be. Care Managers also work with older adults to review long-term care insurance to help cover the cost for care as well as help them determine their eligibility for Medicare, Medicaid, or Veteran’s Assistance.

Managing Medical Care

Care Managers are often first called when there is a medical crisis. Care Managers are older adult’s front-line advocates who know the medical system, know the older adult, and can help provide the best care. Before a crisis occurs, a Care Manager knows an older adult’s full medical history, record all of the prescription medications, and have attended doctor visits with an older adult in the past. They know how to ask questions and bring up concerns with a doctor and can summarize and take notes of the encounter to be discussed afterward with all interested parties.

Talking About the Future

When an older adult is ill, plans for the future must be made. Holding a family meeting helps make sure everyone is informed and on the same page. Care Managers are often called upon to facilitate these difficult conversations that must take place. They work to ensure an open, honest conversation but are also prepared for resistance. The goal is to determine the older adult’s current needs, limitations, and concerns, and let them state their wishes for the future.

Coping with the Reality of Caregiving

The emotional and physical health of the lead caregiver is always a top concern for the Care Manager. They work to prevent burnout and isolation as well as provide relief time for the caregiver. A Care Manager may coordinate coverage so that the lead caregiver can get out to dinner, a movie, or a walk in the fresh air. Without such relief, the physical and mental toll can be heavy on the lead caregiver.

Care Managers are trained professionals who work with older adults to find support and resources to make their daily life more comfortable. They are especially helpful when family members live far apart because, as we age, it is imperative to have supporting eyes and ears available locally.

COVID 19 has shown that supporting an older adult is not a process that can be managed long-distance, even as in-touch as we are with cell phones, text messaging, and Zoom conferences. A relationship with a Care Manager can allow a spouse or children of an older adult to be the spouse or the children, while someone else manages the situation.

When a spouse or daughter is providing hands-on care, the quality time they have to be there emotionally for their spouse or parent is limited. A Care Manager can handle the difficult interpersonal issues, address the immediate problem, remain connected once the crisis passes, and get back involved as the situation requires it.

When is it Time to Hire Home Care Services?

Home care services can be a good solution for older adults who want to maintain their independence, but who need help with their medical procedures or day-to-day living. Every situation is different, but there are a few signs that may indicate it’s time to hire a home health aide.

  1. Balance Issues

Does your loved one walk in an unsteady manner that worries you? Do they experience pain while sitting or walking? If they do, they may be at risk of falling. So it’s best to hire help to them get around.

The inability to stand for long periods can make many aspects of home life more difficult. It can be hard to do basic chores like sweeping, vacuuming, or cooking. Home elder care will help with everyday chores and housekeeping. They will also help plan and cook nutritious meals, follow dietary guidelines, and keep track of intake if it is necessary for medical care. This can take a significant burden from seniors who have difficulty walking or standing.

  1. Forgetfulness

Although mild forgetfulness is a common part of aging, chronic forgetfulness is a problem. If you are worried about your loved one’s memory, then you might need to consult a doctor. A home health aide supports the senior deal with memory lapses, reducing the impact of memory loss.

  1. Missed Medication

With age comes more medications. As the number of medications increases, it can be difficult to keep track of what to take when and what might interact. One of the leading causes of ER visits in older adults is medication interaction, so it’s important to take these issues seriously. If you or a loved one is having a hard time keeping track, a home health aide can help keep records and make sure that all medications are taken at the correct time. Home care services can also include checking vital signs and mental state for conditions that require continuous monitoring.

  1. Decline in Personal Care

If your loved one is unable to take care of their personal hygiene, which could include having difficulty with daily personal grooming and care, or needs help getting in and out of a wheelchair, home care might be a good option. Cleanliness is important for health and healing, as well as general well-being. This help may include bathing, grooming, and dressing.

  1. Decline in the Home Environment

If there is expired food in the fridge, laundry piling up, unopened mail, and a general decline in their home environment then it’s an indication that your loved one can no longer keep up with the household chores and requires help.

  1. Depression or Loneliness

About half of seniors report feeling lonely. Although your loved one might be able to live on their own, loneliness can take a toll on their mental and physical health. If your loved one is spending too much time in front of a television and has lost interest in their favorite activities and hobbies, then they may be displaying signs of depression. In this scenario, they will benefit the most from companionship care.

  1. Desire to Remain Independent

Assisted living at home is a good alternative to nursing homes or full-time care. It allows an older adult to stay in his or her own home and maintain a usual routine whilst providing the medical and domestic attention necessary. Some older adults value their independence over all else, but still could use extra help, looking into home health care agencies might be the right choice.

  1. Family Caregiver Stress

Aging and elder care can be stressful for the older adult as well as their family. If the stress is putting a strain on everyday life or family relations, it may be time to find help. Home health care agencies will help educate the parent and the family about care and provide companionship for the parent throughout the day. Home health care can ease the strain and the workload for everyone involved.

Hiring home care is an important decision, and it may be a critical next step in helping an older adult remain safe, healthy, and happy at home. Home Care services can be medical or non-medical and can be easily customized to meet a person’s unique and changing needs.

Be sure to reach out to Corewood Care if you are considering home care services. Our services are available throughout Montgomery County, the District of Columbia, and parts of Northern Virginia for a few hours a day or around the clock. We’ll customize our care to meet your schedule.

Diet and How it Can Help Your Memory

Even though a plate of fries and a beef burger sound delicious, you might want to know this before you order: what we eat has a high chance of affecting our memory.

Research has shown that the probability of developing dementia and having poor memory is linked to the consumption of saturated fat. Saturated fat increases blood and cholesterol levels, which speeds up the formation of beta-amyloid plaque in the brain. This plaque damages the brain and causes Alzheimer’s.

Confused about what to have for lunch now? Here is a list of foods you can have, which will also boost your memory.

Fish

Salmon, mackerel, tuna, and other fish are linked to lower levels of beta-amyloid proteins in the blood and are, therefore, good for health. Further, eating fish, rich in omega-3 fatty acids, is crucial in the proper functioning of neurons.

Salads

Having salads does not only keep your body in shape but also your mind. Martha Clara Morris, director of the section on nutrition in the Department of Internal medicine at Rush University, clarifies that salads make for a good diet as they are high in Vitamin E.  This potent vitamin helps in the prevention of Alzheimer’s disease by protecting nerve cells.  

Berries

Blueberries, strawberries, and acai berries are good for memory. Tuft University highlighted that consumption of such fruits can improve memory or delay memory loss. Toxic proteins that kill off cells are kept at bay by Anthocyanin- protective compounds found in Berries.

Whole grains

In order to remember things, the brain needs energy. A steady supply of energy can be obtained through the consumption of fiber-rich whole grains.  Including these in your diet will increase concentration and focus.

If you are eating whole grains, it would be a good option to go for rice, pasta, cereal, and granary bread. Including these in your diet can reduce inflammation, oxidative stress, high blood pressure — all of which increase the risk of brain diseases.

Tomatoes

Research has suggested that a powerful antioxidant, lycopene, found in tomatoes can help protect brain cells from damage. The best way to consume tomatoes is to cook them and eat them with olive oil.

Incorporating the foods mentioned above in your diet is highly recommended as they keep you physically and mentally fit.

Top Tips for Finding the Right Caregiver

Most people want to continue to live in their own homes for as long as possible. For those who are older or dealing with a disability, remaining in their home can often be a challenge without outside help. For many individuals requiring assistance with their daily activities, they often rely on unpaid care provided by family members and friends.

More and more, older adults and their families are recognizing the benefits of hiring paid caregivers. Professional caregivers help seniors not only remain in their homes longer, but they provide additional comfort and safety. They also offer families peace of mind. More people are finding that they can afford paid caregivers because many state governments and insurance policies cover the cost of private outside help.

So how do you find the right elder care provider for your particular situation? Here are a few tips for choosing an in-home caregiver:

1.     Assess home care needs

Before you go out looking for a caregiver, know exactly why a caregiver is needed. Is there a requirement for more assistance with health care, personal care or household care? Is home health care the primary focus with the additional support required for physical therapy or medication management? Or is there more of a need for non-medical personal care such as bathing, dressing, toileting, and meal preparation? Maybe the focus is on providing a companion to escort or drive the older adult to appointments and outings. Do they want someone to help with housecleaning, shopping, running errands, bill paying or money management?

Determining what is required and the type of experience and skill sets a caregiver has to offer is a crucial component in finding a caregiver who is the right fit. Selecting a caregiver that matches the needs of your loved one is crucial for helping their overall health and wellbeing.

2.     Prepare a job description

Take the time to write a job description. Be sure to include details such as a certain level of healthcare training (for example, Certified Nursing Assistant, Licensed Practical Nurse, Registered Nurse) being able to drive or able to operate special equipment. Making a list of what the job entails can help the caregiver make an accurate decision about the duties required after the interview. For all parties involved it’s crucial, to be honest, and upfront about what tasks will need to be undertaken by the caregiver. You don’t want to hire a caregiver only to find out later that they are not qualified for the job. 

3.     Ask around

Research and get to know the resources in your community that hire caregivers. It is essential to ask family, your church group, neighbors, medical professionals and members of your local Village about the positives and the negatives of a caregiver agency to narrow down options. Read online reviews for agencies. If you know someone who has used a caregiver from an agency, follow up on that lead.

After determining which caregiving agency you’ll work with, ask to interview the potential in-home caregiver. Don’t go exclusively on a resume. Many caregivers can look good on paper, but will not be a good fit for your situation because of cultural, religious, social or some other reason. Once it’s time to schedule an interview, prepare a list of questions to ask a caregiver. You may wish to invite another family member or friend to provide a second opinion. An interview is a powerful tool for determining a person’s personality as well as how the caregiver will interact with your loved one. Be sure to ask any potential candidates if they have done the types of tasks required and about their qualification. You may wish to introduce your loved one during the interview and assess how the caregiver interacts to determine if this is the right fit. 

4.     Follow up

Once you have agreed upon a caregiver, be sure that the agency has checked references and conducted a criminal background check. You’ll want to be sure that the caregiver is licensed and bonded by the agency. If they are not, you may want to look somewhere else.

After, the caregiver has started to work, set up a schedule to monitor the quality of the services the caregiver provides. Schedule informal meetings by making regular home visits. Get periodic reports from the agency. If there are any problems, address them immediately. Do not wait around. Also, be sure you have a backup plan in case the caregiver or the agency fails to follow through or if problems arise.

At some point, you or your family may also want to hire an independent care manager to monitor the situation if you are unable to do it yourself.

Finding a caregiver that matches the personality and the needs of an older adult can be life-altering.  The right caregiver can enhance the quality of life for a senior while also putting the family at ease knowing that a loved one is in good hands.

Call Us: (301) 909-8117