Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • care managementChicago's Geriatric Care Manager Center of Excellence

Lessons from Margaritaville
Jimmy Buffet has left a multi-faceted legacy…his distinctive musical style and lyrics, his upbeat and his laid back lifestyle...
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September 12, 2023
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Medicare’s Surprising Cost Savings
Medicare has been one of those political footballs where both sides of the aisle have had an entrenched position...
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September 5, 2023
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The High Cost of Wellness
Once in a while “yesterday’s news” is also tomorrow’s news. Earlier this year you probably heard or read that...
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August 15, 2023
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How Old You Really Are
One of my staff worked with a senior community in upstate New York near Elmira a number of years...
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August 8, 2023
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Three Words Are the Cure
Some have called it an epidemic. And it’s particularly virulent within the senior population. The epidemic leads to even...
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July 16, 2023
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Not Just Dark Chocolate…
If you’re like me, you may have had moments when you’ve looked at the latest clinical information on the...
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July 10, 2023
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Update on Dementia – part 2
I had left you last week with what may have seemed to be an optimistic note regarding the latest...
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June 26, 2023
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Update on Dementia – part 1
You may have heard the noise about a new drug for treating Alzheimer’s disease and other dementias. It would...
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June 6, 2023
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It’s About You
This is personal! Yes, it’s about you! I’d be willing to wager, however, that most of you haven’t thought...
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April 18, 2023
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Follow Your Gut…You’ve Got No Choice
It was back in the sixties and seventies that so many folks embraced the mantra: “You are what you...
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April 11, 2023
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In the Caregiver's Words

Recent Client Praise

The prescription for aging well starts with the opposite advice that you may have heard. You may have heard people advise you to "not sweat the details." Well, that is good figurative advice, but when it comes to being active the best literal advice is to absolutely break a sweat...often. Daily, vigorous exercise is one of the best medicines you can take. That said, don't start any new exercise regimen without first consulting your provider. And the added caveat, take a close look at your provider before you consider asking them for this advise. You really do not want to ask the provider who never sets foot on the running path, dips a toe into the lap pool or lifts anything heavier that a pencil about getting into shape. So, if you are a caregiver to an older loved one...or if you are a caregiver approaching the "golden years" yourself, get a prescription for fitness. Admittedly, everyone starts this process from a different place. Some may already be marathon runners, so the prescription is all about more of the same...or cross-training. If you are not up for 26.2 miles of hard work and endorphins, then a much more modest start would be in order. No matter where you start, your fitness prescription may be just the ticket for avoiding cardiovascular disease, osteoarthritis, osteoporosis or type 2 diabetes. Consider aerobic exercise to be the first line of preventive medicine for all of these conditions associated with weight or physical decompensation. Sound too good to be true? The scientific evidence supports the merits of cardiovascular fitness. Dutch researchers studying nearly 3,500 patients for more than four decades found that people who were overweight at age forty lived, on average, three years less than their more fit counterparts. Truly obese individuals had a life span fully six to seven years less than others. In a Dallas University study of men in their early 50's, researchers found that just six months into a weekly exercise regimen of about 4-5 hours a week, these fifty+ year olds had cardiovascular fitness more like what one would find in twenty-somethings. If you are convinced, then start now...even if you start small. Just because those fifty+ year old men got into the shape of twenty+ year olds does not mean they did the same exercises or ran as fast or as far as twenty year olds. Beyond a certain age, we are all looking at our persona records as historic - not future - events. But, don't think of getting old as giving up anything...think of it as gearing up and tuning up! Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@cr eativecaremanagement.com.
There are those who have not seen any changes in their lives in the midst of this pandemic and quarantine. They’re our older family members with Alzheimer’s disease or some other form of dementia that has robbed them of the ability to even comprehend the restrictions of this pandemic. They have been isolated as protection against COVID, but their quarantine experiences are not the same as ours. I bring this up because as more of us are able to be vaccinated and resume some semblance of life before the pandemic we also will likely be able once again to visit Mom or dad who have been under strict quarantine and may have some questions for us. How you answer their questions and engage in conversations in general is necessarily going to be more about them than it will be about you and the rest of the world that has been upended. Honesty is going to be the first casualty of the pandemic when we encounter a loved one who has Alzheimer’s or dementia, but I am not talking about lying. At its core dementia is a progressive decline of the brain’s ability to process what has happened in “their world.” You ought not view your initial reunions with older loved ones with dementia as a “chance to catchup.” We have to be prepared to join their reality using a technique health care professionals call “therapeutic fibbing.” You will need to learn to “go along” with the reality they know by first asking them about themselves, their recent experiences, and what’s going on. This may go against how we all were raised, but telling the truth may be cruel to someone who is not processing reality in the same way we are. An example helps. Picture you’re talking once again with your mother who asks where your Dad is. He had told her, she recounts, that he was going to get the car and come by to pick her up for an outing. The unfortunate truth is that dad died last year, but she keeps coming back to scenarios in which he is just temporarily gone, and understandably is looking for his return. You don’t tell her he died, because she will experience the awful loss all over again, she’ll cry hysterically and become agitated. And since she has short term memory issues she will forget again so she will be primed for experiencing the grief anew the next time you correct her. Instead you might say that Dad suggested he would be delayed a bit and that he had asked you to offer her a snack until he can make it back. She agrees that a snack is a good idea and you get into another conversation. Or, your father with dementia tells you that he is going to go get the car and take mom for a ride. They like their Sunday afternoon drives…it does not have to even be Sunday. So, maybe you can ask how the car is running and suggest it would be nice to have a snack with him for their ride. While you prepare the snack perhaps look out the window and remark on the sunshine or the birds or anything. Then start talking about the view and ask him questions. Share the snack with him and get into a new conversation. My clients with parents or spouses with dementia talk about their “therapeutic fibbing” as really hard at first until they can see their loved one actually brightening with the diversions. And once they both have a brighter conversation, they both have now had a better day. And tomorrow will be another chance to brighten both of their days…and tomorrow…and tomorrow. Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
Associate Care Manager Gregory is a Certified Senior Advisor (CSA) and Certified Dementia Practitioner (CDP) whose work focuses on helping aging adults and folks with limited independence by providing resources and support to help them discover and lead their best life. Gregory has been a part of CCM, Inc. for over a decade. – Charlotte Caregivers often have incredibly stressful, non-stop lives. That kind of tension builds up over time and needs an outlet if we want to maintain the health and stability needed to continue to do all that’s asked of us. There’s no shortage of advice columns on ways to combat the stress of caregiving, but my problem with most of those methods is that they almost always seem like another obligation to me, and when my time isn’t being spent in the necessities of caregiving, I want my life to be as fun as it can be. Singing, either by oneself, or with a group, is an incredible pressure release-valve for anyone struggling to cope. Singing for comfort is an act as old as humanity. Mothers sing to calm their children. We “whistle in the dark” when we’re feeling spooked. In times of cultural grief, we come together and lend our voices to the songs that mean the most to us. And it helps. Music helps a lot. It’s one of the easiest things to forget that when times are tough, any situation can be transformed by music into deep feeling, or even into play. A wonderful singer herself, Julie Andrews, as Mary Poppins, provided us all with a “life hack” by reminding us what we knew as children: “In every job that must be done, there is an element of fun. You find the fun, and snap! The job’s a game.” Whistling while we work (as it were) is an incredibly useful trick to help caregivers maintain balance, but some find singing helpful enough that they take it another step and join a church choir, or community, barbershop, or symphonic chorus—whichever type of music best suits them. The benefits of singing by oneself are vast, but when we get together to sing, the benefits get boosted even more! I can think of these major benefits without trying too hard:
- Increased oxygenation - You gotta breathe deep to sing. When we’re stressed, deep breathing is one of the first things to go. Singing helps remind our bodies to breathe, re-establishes mood stability, and even releases endorphins.
- Physical coordination – Singing is a total body experience, using virtually every muscle group, and the vibrations act as a massage for the whole body. Singing also keeps the body acting as a unified organism.
- Decreased isolation – Showing up for a group effort of singing, or offering our singing to others, connects us to our communities and lowers the risk of depression. A sense of belonging has an almost immeasurable psychological health benefit.
- Brain Fitness – Besides possibly singing in more languages than English, participating in music helps the brain maintain its plasticity by learning new coordination skills. This staves off cognitive decline and keeps verbal, spatial, and temporal centers in the brain active and connected to each other.
- Longevity – Singing promotes overall mental and physical health which in turn increases life expectancy.
If you’re a caregiver, find your tune, or your group, and you will have found something to hold on to through the tough times. Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia .
In many of my postings on family caregivers I have talked about the really hard job of caring for an older adult or someone else with special needs. At the personal level it truly is an enormous responsibility with great demands on a person’s time and their emotional well-being. The most recent report on family caregiving published by AARP, however, really provides a sense of the huge and important work that caregivers are providing for their families in America today. It is required reading for caregivers and their families.

In AARP’s snapshot of caregiving in America, they estimate that as many as 42.1 million people in 2009 were providing some sort of help with activities of daily living to an older adult. That number jumps about 50% when you look at all the people engaged in some sort of caregiving at any point during the year: 61.6 million people. And these individuals are offering their support as unpaid caregivers. If this were an “industry” instead of a voluntary contribution of time and energy, it would be generating an estimated $450 billion a year, an increase of about 20 percent over the prior year.

Family caregiving is the single biggest contribution to an older adult being able to stay in their own home and age in place. Caregivers do everything from transporting the older adult to and from medical appointments to coordinating the services of other medical providers, managing multiple medications and advocating on behalf of their family member. It takes time and weighs heavily on the caregiver who still must balance caregiving potentially against a full-time job, parental responsibilities and a marital partner. Caregivers often don’t get much explicit attention as part of the team or for their tremendous contributions. The AARP article notes that: “…ignoring family needs can place caregivers at risk for negative health consequences that can jeopardize their ability to provide care in the home. Interventions that include an explicit focus on assessing the needs, strengths, values, and preferences of family caregivers are important. Such interventions can be designed to reduce burdens and health risks that can impede a caregiver’s ability to provide care, prevent unnecessary hospitalizations, and prevent or delay institutional care. Strategies to strengthen and sustain caregiving families will enable them to continue as caregivers, and will reduce costs.”

It really comes back to three points I cannot repeat often enough. One, caregivers’ contributions need to be appreciated by the entire family who benefits. Two, the whole family also needs to help in caring for the caregiver. Three, it takes a village for all of the above.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.
Do you know how kinesiologists refer to walking…at least some of them with whom I have spoken? (These are the folks who specialize in the mechanics of body movement.) They call it “controlled falling,” and we can really appreciate this if we look at toddlers just beginning their first adventures with “walking” upright…it is mostly a series of failed attempts at walking that initially end mostly in falls. Fortunately for toddlers they are built pretty close to the ground, so the falls rarely inflict any real damage. Not so with older adults. June is National Safety Month, which makes it a perfect time to highlight one of the bigger health risks among those 65 years of age and older: falls. And this is a good time to underscore the scope of the risk. Like, one in four older adults has a fall each year, but only about one in two of these are ever reported to their physicians. Yet, over three million of these episodes each year are seriously enough for the individual to end up in the emergency room owing to a resulting head or hip injury. By the way, more than one in four of these ER visits result in a hospital stay owing to a fracture or contusion or worse. If you have an older loved one, don’t wait for the phone call; here are some simple steps you can take to assess your care receiver’s risk as well as help bolster their safety:
- Assess your loved one’s risk for falling using the CDC’s questionnaire;
- Make certain your loved one gets an annual eye exam, and keep their glasses (if needed) are current with their vision;
- If you accompany them to their doctor visit, ask about their feet, posture, leg strength and agility;
- Help assess and address any clutter or other safety issues in your loved one’s “space,” and remember that a lot of this revolves around lighting and ease of access.
This last one has a lot to it. If you would like, we have a home safety checklist that you can use to identify potential trouble spots in your loved one’s house. Just email me at info@creativecaremanagement.com, and I will send you a copy. You may have noticed that I have nearly 600 postings in this blog. Please just type in “home safety” or “fitness” in the search box on the Blog…or any other keywords that are top of mind for you about your loved one’s safety. So, let’s all end this month with a spring into summer, not a fall. Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
Guest post author Gregory Peebles is a team member at CCM whose work focuses on helping aging adults and folks with limited independence by navigating resources and support to help them discover and lead their best life. Gregory has been a key member of the CCM team for over a decade. – Charlotte I know I'm not the only one who would rather not talk about abuse. Wanting to avoid difficult conversations is natural. Unfortunately, the social discomfort surrounding abuse makes a space for abusers to thrive unquestioned. So, if you have a dependent older loved one, now is the time to take stock. Since COVID-19 is a part of our daily lives, the physical distancing necessary put in place precisely to protect vulnerable older adults makes abuse even easier to perpetuate. Now, with fewer eyes watching, there's even less fear of consequence than before the pandemic. This article will discuss the nature of abuse and the identity of abusers while offering professional experience across three common abuse scenarios: “The New Friend”, “The Family Secret”, and “The Forgotten One.”

The old slogan holds true: "Hurt people hurt people"...

Abusers: Who Are They? Once a person has made the decision to continue the cycle of abuse, they've relieved us of making excuses for them. Still, the old slogan holds true: "Hurt people hurt people", so it's no secret that many abusers are themselves victims. Unfortunately, there's no such thing as one real "give away" regarding an abuser's personality. The sad truth is that abusers can seem to be very normal people. Even sadder is that abuse often comes from the very people victims love. The statistics tell us that older adults experience abuse from spouses or adult children at a rate at least as high as older adults in institutions experience neglect or deliberate abuse[1]. A Sneaking Suspicion Now that you think of it, maybe an older person you know might be a victim. Something has been off, but you can't quite put your finger on it, and no wonder. You're not an abuser, so you don't know what abuse "looks like" with older adults. Abuse manifests in as many ways as there are abusers, but here are some common warning indicators.
- Physical - bruises, grab marks, sprained or broken bones, skin burns; otherwise, disheveled appearance, poor hygiene, or weight loss
- Emotional - withdrawal, listlessness, lack of interest; conversely, can exhibit increased anxiety or irritability
- Financial - sudden changes in spending, request to change financial guardianship, or request for additional funds for/from caregivers
If that checklist didn't give you any pause, that's great news. However, The Word Health Organization (WHO) reports that as many as 1 in 6 older adults is a survivor of one type of abuse or another², so unfortunately, that doesn't mean that your older loved one is absolutely safe. I mean, surely, they would tell you if something were wrong, right? Well, not necessarily. As frustrating as it might seem, older adults don't necessarily disclose their abusive situations, most often because: As frustrating as it might seem, older adults don't necessarily disclose their abusive situations, most often because:
1. They have compromised agency of some form (i.e., dementia, etc.);
2. They depend on the abuser for care/financial assistance; or
3. They have attempted to disclose and been conversationally redirected.
These three reasons for non-disclosure correspond directly to three fairly common scenarios of abuse:
1. The New Friend (compromised agency);
2. The Family Secret (dependency); and
3. The Forgotten One (redirection).
We're going to look at each of these quickly and consider their specific warning indicators. Let's look at some "real life" examples. (All names have been changed, and some details altered slightly to protect the victims.)

"I mean, surely they would tell you if something were wrong, right? Well, not necessarily."

The New Friend Ed, a 62-year-old retired banking exec in the developing stages of undiagnosed dementia, met Tanya (36) a few months ago on a dating website. He doesn’t mention Tanya to his family at her request. She says she didn't want to cause any trouble for him because of the difference in their ages. Ed, lonely for the last four years since the death of his spouse, falls quickly in love with Tanya, who doesn’t seem to mind the whirlwind relationship at all. In a casual phone call, Ed mentions to his oldest daughter, Susan, that he is happier than he can remember being with Tanya, whom he accidentally calls by his late spouse's name. He has hope for the future, and he wants to marry. Susan, shocked to hear about marriage in the first conversation regarding Tanya, asks to meet Ed's new friend. Tanya agrees, but regularly cancels scheduled virtual meetings; meanwhile, Ed's lawyer calls Susan because Tanya contacted him about changing Ed's will. She wants it done as soon as possible. Susan obviously wants Ed to be happy, but she knows that this is a problem; however, she has absolutely no idea how best to respond. She doesn't even realize yet that this is an example of abuse. Ed is an easy victim, because his abuser has rightly assessed that Ed, who is lonely, is also not entirely in control of his cognition. For Tanya, Ed might as well have been carrying a flashing sign. In the world of the pandemic, new, non-virtual friends may not be as common, but anyone with an Internet connection can continue to socialize virtually, and the Internet is a place where it's easy to be in disguise. Older adults connected to the Web are at as great a risk of this type of abuse as before in non-virtual space. Luckily, Susan already has a relationship with a lawyer, so she can begin the process of securing Ed's estate against the abuser's attack. But it's not going to be easy. This type of relational, emotional, and financial abuse is particularly insidious because it can turn the abuse victim against the people trying to protect them. It's not always easy to talk to older family about love and sexuality, but asking uncomfortable questions can stop this kind of abuse before the grift is a score.

Denise regularly calls her mother names. She also leverages care to control Anne's behavior with phrases like, "If you don't stop complaining, I won't come back tomorrow, and we'll see how much you have to complain about then."

The Family Secret Denise (52) has cared for her mother, Anne (74) since Anne fell down the stairs leading into the garage, leaving her mostly immobile. If it weren't for her only local daughter, Anne would already be impoverished paying for the required care. Unfortunately, Denise has come to resent her mother deeply for the level of care she needs. Denise regularly calls her mother names. She also leverages caregiving to control Anne's behavior with phrases like, "If you don't stop complaining, I won't come back tomorrow, and we'll see how much you have to complain about then." When other family members occasionally call to check up on her, they notice that Anne, who was quite opinionated before, always carefully chooses her words now. They notice that she is effusive in her expression of gratitude for tiny things like a phone call, or a card. When asked about Denise, Anne quickly says how thankful she is for Denise's help and just as quickly, perhaps even a bit more noticeably, changes the subject. It isn't until Denise makes an accidental call to another family member where she can be heard berating Anne for needing care that Anne's situation changes. To admit to being victimized by a person's own child is a wound to the heart, but unfortunately, Denise and Anne's story is not at all uncommon. The speed with which a family caregiving dynamic can turn abusive is shocking. Either because, like Denise, the caregiver resents their position, or even because a child may find the time ripe for taking emotional revenge from a perceived wrong decades ago, family caregivers of dependent adults must understand that exploiting the power dynamic between the caregiver and care receiver is a recipe for a batch of poison that will sicken anyone it touches. The Forgotten One Tim (60), who is disabled, has been in and out of care institutions his whole life. He's used to "going it alone", and he's used to having to wait long periods of time on someone to help him accomplish something simple, like toileting. The assisted living facility where Tim currently makes his life provides basic assistance for their residents, but the staff regularly verbalize where Tim can hear it that they find Tim's care to be too much trouble. Tim tells the staff director, but he is rebuffed. When the pandemic is announced, facility caregivers feel empowered to decide that they will help Tim as little as possible, the result of which leaves Tim utterly neglected and completely robbed of personal dignity. When Tim alerts the caregiver supervisors, they minimize Tim's neglect and suggest that perhaps the facility is no longer the right fit for Tim. Tim's family, at distance, believe Tim's story of neglect and help arrange additional care for Tim so that Tim doesn't have to add the stress of moving while disabled to the stress of surviving a pandemic. Tim's additional help bridges the gap between the negligent staff and Tim's care needs. Going Forward The necessary physical distancing in time of COVID-19 has turned so many families into distance caregiving situations - even when the loved one is in the same city. Consequently, we see less of our older loved ones now and depend more heavily on care provided by essential workers. While we don't have much choice except to trust in a caregiver's professionalism, we can insist on and help put in place virtual systems to monitor for abuse. Some families may be able to install full surveillance services, but most of us will need more frugal solutions. The quickest way to check on your loved one is using a video call. ZOOM is a popular video conferencing application right now, but most smart phones have a video call option. If your older loved one has a smart phone, you can "FaceTime" whenever you like. Otherwise, you'll need caregivers and others in your loved one's life to help facilitate. My advice is to "switch it up" regarding the calls.
- Pick different times for a virtual visit.
- Choose different people to facilitate.
- Redistribute and reorganize expectation so that you're not helping the abuser with a regular, predictable schedule.
And finally, if anything seems off, ask directly. So many victims are waiting for someone to notice before they feel they can speak. De-stigmatize abuse in conversation so that if it ever happens, your loved one knows that you understand that it's not their fault. Healing abuse is a long process. Preventing abuse and ending abuse happen when we end the silence that comes from shame. Gregory Peebles, CSA, CDP, is an Associate Care Manager with Creative Care Management and a contemplative monastic in Chicago (CMJ). When not studying or coordinating services for clients, Gregory enjoys attending and making music at Liederstube. He looks forward to a time post-COVID when this will be possible again
[1] https://www.who.int/news-room/fact-sheets/detail/elder-abuse [2] https://www.ncoa.org/public-policy-action/elder-justice/elder-abuse-facts/