Chicago's Geriatric Care Manager Center of Excellence – Since 1991 | Chicago's Geriatric Care Manager Center of Excellence

GOOD NEWS FOR CHRONIC CARE
Associate Care Manager Gregory is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP), and Medicare Counselor, whose work...
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August 6, 2018
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Long-Term Doesn’t Mean Put It Off Until Later
Gregory Peebles is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP), and trained Medicare Counselor, whose work focuses...
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June 24, 2018
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Medicare Doesn’t Cover WHAT?!
Gregory Peebles is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP) and trained Medicare Counselor, whose work focuses...
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June 18, 2018
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Understanding Medicare as Easy as A, B, D?
Associate Care Manager Gregory Peebles is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP), and trained Medicare Counselor,...
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June 11, 2018
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Do You Sea a Hero in Yourself?
Associate Care Manager Gregory is a Certified Senior Advisor (CSA) and Certified Dementia Practitioner (CDP) whose work focuses on...
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June 4, 2018
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What May Flowers Bring
April showers are supposed to bring May flowers, but what does May bring? It brings Mental Health Awareness Month…among...
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May 28, 2018
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Singing is a Breath of Fresh Air for Caregivers
Associate Care Manager Gregory is a Certified Senior Advisor (CSA) and Certified Dementia Practitioner (CDP) whose work focuses on...
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February 12, 2018
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Five Tips for Winter Because It’s Not Spring Yet
There is a lot of advice that goes around for older loved ones in our orbits when we see...
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January 16, 2018
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Is This Normal?
As we age, our bodies give us feedback we’re not used to. Activities that never required a second thought...
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October 23, 2017
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Insta-Gram: It’s a Date!
Associate Care Manager Gregory Peebles returns with a series on the Internet and aging. Gregory is both a Certified...
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September 23, 2017
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In the Caregiver's Words

Recent Client Praise

I have really lost track of how many conversations and/or blog postings I have had about Caregiver Stress. As a certified geriatric care manager, we work with families, and a substantial part of my focus is upon the stress of a caregiver trying to both deal with a loved one's eroding health, but also the demands on them from the others who depend on them. I would like to devote a bit of space here to addressing the stress of the aging loved one and how a caregiver can help them to cope with what life throws their way. Retirement is a break from the stressors of a workaday world, to be sure. But as one lives to do what one wishes as a reward from a long career, there comes a time when new stressors emerge. There can be increasing physical challenges from a medical condition that is not going to get better. Many of these conditions like arthritis, cardiovascular or pulmonary issues just get worse with time. As a person becomes less and less able to do the things they used to do to take care of themselves, the stress mounts. Other very common stressors are those that come with needing an elder caregiver, a spouse or partner to help with every day tasks; it takes an increasing toll. With general changes in health status can come a profoundly diminished sense of well-being and just plain depression. So much for the Golden Years. As a caregiver, look for these warning signs of excessive stress in one or both of your older loved ones:
- signs of anxiety, undue worry or outright panic attacks
- irritability or angry outbursts
- sadness, melancholy or lethargy
- indecisiveness or difficulty focusing
- difficulty getting to sleep or staying asleep
- an array of aches, pains or other issues of nonspecific origin
- rashes, breathing problems or other "new" allergies
- drinking or eating too much or too little; or
- an increasing number of prescription or OTC medications on hand.
As a caregiver, you can help by helping your loved one to find a remedy for the stress. There is no absolute way to rid ourselves of all stress at any age, but the key is finding help to cope more effectively with the stress in our lives. For your older loved one, consider:
1. Gently and persistently encouraging your loved one to be more socially engaged with friends, clubs or outings in order to get a break from the stress cycle;
2. Help your loved one to find seek out talk therapy; it is not about getting another prescription nearly as much as "unloading" to a trained therapist;
3. Seeking a physical aid in the form of gentle massage therapy, exercise classes like yoga, relaxation therapy or just getting out for longer walks.
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@creativecasemanagement.com.
I have written in earlier blog postings about dementia: “preventing” Alzheimer’s Disease, Alzheimer’s from the inside out, maternal genetic links to Alzheimer’s, and women’s predisposition to Alzheimer’s. I would like to share some research that shows dementia to be tied to a number of other chronic conditions we often find among the elderly. This posting is about monitoring and managing other medical conditions in order to reduce the chances of developing dementia, and it underscores one of the most important parts of geriatric care management specifically or caregiving generally.

Dementia is more common among people with diabetes than among the non-diabetic population. Diabetes seems to be more related to vascular dementia, but research shows also some risk for Alzheimer’s among diabetics. One study found that even a 1% rise in long term glucose levels (referred to as A1c) was associated with declines in three different measures of cognitive function. Researchers have long known that poorly controlled diabetes is associated with renal and cardiac complications. These same micro-vascular issues associated with diabetes can lead to brain disorders, with some suggesting that Alzheimer’s disease could be considered “type 3 diabetes.”

Another risk factor associated with higher rates of dementia is elevated blood pressure, or hypertension. And the flip side is true as well with one clinical study documenting that well-controlled hypertension actually reduced the risk of dementia. And blood pressure registering above 140/90 evidently encourage Alzheimer’s or other dementias.

Finally, alcohol use taken to excess can lead to impaired cognitive function for anyone. For older adults, excessive alcohol consumption has been associated with dementias and also have been found to aggravate existing dementia or Alzheimer’s disease.

A care manager or caregiver should always be alert to any signs of impaired executive function in an older adult as this may mean that the diabetes or hypertension are not well-controlled, or that there may be alcohol abuse. Be alert to an elder’s:
- poor organization,
- loss of attention or train of thought,
- poor judgment sorting good from bad ideas,
- faulty short term memory, weak reasoning and even
- lack of awareness of their deficits.
A medical provider can assist in administering a Mini-Mental State Exam to confirm any deficiencies as well as address these other co-morbidities. Acting early can save an elder from the slippery slope that is dementia.

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.
Well, not exactly, but if you or an older loved one goes to the hospital, beware of what can happen that is not outpatient, and it is not inpatient. They call it Observation, and it may seem like your loved one has been admitted for an overnight stay, because they do get “discharged” – but in this case in just about 23 hours. Because it is NOT an inpatient stay, it has a different payment requirement and according to recent research, it seems to unfairly target poorer Medicare-eligible Americans. According to the longstanding rules of Medicare, patients with this coverage pay a fixed cost for an inpatient stay and that is going to cover the majority of costs incurred while in the hospital as well as follow-up nursing care and even repeat hospitalizations that occur within two months of that first visit. There are also rules for the short stay that is less than 24 hours; they call this an “observational stay.” And if you are a caregiver to an older loved one, you will want to ask for a very clear answer whenever your loved one is in the hospital. You will want to ask the registration people or the nurse on their unit if this is an observational stay or an inpatient stay. The reason you need to ask is that there are substantial cost differences. A patient under “observation” will be billed for a one time out of pocket fee along with 20 percent of any hospital services bills and the tab for any medications. If you are told that this is to be an “observational” visit, get in touch with your loved one’s physician and have them go to bat for you. The hospital makes more money on an observational visit…and it may not be warranted. There is more. The poor pay more…more often that is. In a recent study by some policy researchers published in The American Journal of Medicine, they looked at the Medicare claims data for some 132,000 hospital observations across 97 percent of all the U.S. counties. They compared the wealthiest quarter of these patients with the poorest quarter and found that the patients in the poorest quartile were 24 percent more likely than their more affluent counterparts to have three or more observational stays in a year. We would like to think that no hospitals are looking to take undue advantage of poorer patients, and there is the potential for Medicaid to offset some of the difference. It does suggest, however, that less affluent patients may not have someone who goes to bat for them, someone who will ask the right questions. So, if you are a caregiver to an older loved one, now you know to ask the right questions. And you know what the answers should be. 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. She also is the Amazon Bestseller and author of How Do I Know You: A Caregiver’s Lifesaver for Dealing with Dementia.
I started in my last post talking about older loved ones and “aging in place.” That first post was about the aging part and Activities of Daily Living. In this installment, I have a tip on how to assess the “place” part of aging in place. I call it the “mitten test.” If you live in the upper portions of the U.S., your winter mittens may just about be ready for the storage closet. But your mittens have another useful purpose that can help you make home an easier place for your older loved ones. You can use them to identify spots in your loved one’s home that can be adapted to fit their changing capabilities. As our bodies age, certain of our nerve pathways begin to fail, and the human anatomy uncannily reroutes many of the circuits as they stop firing. But with age, more and more of those pathways may slow or fail for a variety of reasons, and it just makes it harder for older adults to do the simple manual tasks they used to do without even a thought. Turning a door knob, turning on a lamp or taking the lid off a jar become challenging, maybe even impossible. It is hard for those of you who may be in the prime of your lives to really get this, no matter how empathetic, so I recommend an easy exercise to help you experience what this erosion of manual dexterity and fine motor skills feels like. In doing so, you can also help identify challenging hardware or activities that can be more easily managed with a bit of creative help. With a pair of mittens, walk through each of the rooms in your elder loved one’s home and go through the normal activities of the person who lives in those rooms. As you enter a room, it is may be more challenging to flip a light switch or twist the switch on a lamp with your hands in mittens. These can be remedied by retrofitting wall switches with the larger rectangular switches that one merely presses on and off. Likewise, the lamp twist switches that are challenging with mittens can be replaced with wider winged grips. And even before you enter a room, the door knob may be your undoing if the knob is too small or too slippery. Handles may be an appropriate replacement. The mittens are effective barriers to everything from opening the ketchup bottle to a twisting the lid on a jar of apple sauce or beverage bottle and more. And if a key itself is hard for an older loved one to grip when opening a door, hardware stores have over-sized sheaths to make gripping easier. With your mittens still on, try tying your shoe laces or buttoning a shirt or blouse. It may be time to get creative with Velcro-equipped shoes or other substitute hardware for buttons. And go through the motions of other self-grooming activities to determine what challenges are manageable and which are just out of reach. The number of what are called “assistive devices” will amaze you as you look to television remote controls, computer access and more. Check out the Department of Health and Human Services Assistive Technology site. 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.
Okay, so it has been five days since you received that box of chocolates from your sweetheart on Valentine’s Day. And if you did not consume truly massive quantities of chocolate all at once, how do you feel? The answer is you should feel the calm that comes from lower blood pressure. This, according to a group of physicians headed up by Dr. Dirk Taubert who did a clinical study on generally healthy people who had elevated blood pressure to find out what happens to their blood pressure if they eat dark chocolate over a period of time. Very simply, they found that it statistically significantly lowered the people’s blood pressure. I bring this up because as a geriatric care manager, a lot of the clients I see have blood pressure that is above what it should be. And I can tell them that the doctors say they should have a diet that regularly includes some amount of dark chocolate. People with dietary restrictions, however, need to check with their physicians.

This dietary recommendation does not take the place of the other recommendations we routinely get from medical professionals about fruits and vegetables and maintaining reasonable portions, but it does offer us a chance for a “healthy” dessert. And the science in their clinical study is pretty solid. Most other studies that have cited the beneficial effects of chocolate have done that based on simply observing some people over time, but Dr. Taubert and his colleagues actually set up a clinical trial with a placebo group and all the customary scientific controls.

This study was particularly relevant to me as geriatric care manager because all the study subjects were 56 to 73 years old. Half the group received 30 mg daily of polyphenol-rich dark chocolate, and the other half of the adults got no polyphenol in their chocolate. Polyphenol is the stuff in dark chocolate that is supposed to confer the benefit. Well, 18 weeks later, Dr. Taubert and colleagues found what a lot of people have been claiming all along. Without any changes in their body weights or their lipid or glucose levels, the group who got the good stuff in their chocolate had their incidence of hypertension decline from 86% to 68%.

To add to the credibility of Dr. Taubert’s research, it was published in 2007 in the Journal of the American Medical Association. You can click on Cocoa Intake and Blood Pressure to see the article. But seriously, don’t eat chocolate just to lower your blood pressure. Do like I do: eat chocolate and savor the flavor.

geriatric care Chicago

…and Happy Belated Valentine’s Day.

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.

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May is National Stroke Awareness month. As a certified geriatric care manager, I maintain that it is a good time to review not just the warning signs of stroke, but also what you should do if you are a caregiver to a loved one who may be susceptible to a stroke. You may have heard of the acronym we often use to make it easy to remember what to look for as possible sign and symptoms of stroke: F-A-S-T. F-Face: Strokes can manifest themselves in a slight droop on one side of the face, and a clear way to test for the possibility of stroke s to ask your loved one to small. If you notice one side of the face does not match the other side you may be seeing the immediate aftermath of a stroke. A-Arms: Ask your loved one to raise both arms above their head. If they have had a stroke, one arm may tend to drift away from being straight up or they may be unable to lift one side. S-Speech: Ask your loved one to say a short sentence and listen for any slurring of words. Try something like: "No ifs, ands or buts." They may also manifest the stroke with inability to retrieve the right words to describe how they feel, their surroundings or something else. T-Time: Time works against the stroke victim, so it is essential to act quickly by call 9-1-1 and get help as soon as possible. Especially if the cause of the stroke is a clot (versus a hemorrhage) it is critical to get them to a hospital for examination and possible intervention using new medicines for breaking up a clot within three hours of the stroke event. The symptoms of stroke are not slow to develop which should make it easier to spot them. If your loved one comments on a sudden numbness or weakness in any of their limbs or on the side of their face, try the FAST test and call 9-1-1. If they are having difficulty speaking or appear suddenly confused, test them and then make the call. If your loved one has blurry vision, is suddenly clumsy, dizzy or has a severe headache, remember FAST. In all of these potential scenarios, you will see a general pattern. The symptoms come on suddenly, and they are most often asymmetrical, affecting one side or the other depending on which side of the brain is manifesting the stroke. And your FAST response as a caregiver can make all the difference in how severe the stroke will be and how fully your loved one may recover. Charlotte Bishop is a certified Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric care managers, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.