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The Synergy Between Seniors and Earth Day!
April 22 is Earth Day, a date that has brought together activists and celebrants since its inception in 1970. ...
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April 22, 2024
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Can’t Find Your Keys?
When I speak to some clients our conversation moves from their work lives and forward to their retirements now....
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April 16, 2024
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If You Want to be More Fit, Don’t Exercise…
Just coming off Super Bowl Sunday, it’s easy to talk about who could run faster, who could pass more...
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February 12, 2024
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How to Get All the New Years You Can
It’s not a magic pill or a quick transformation, but it’s not difficult either. The “it” is greater longevity,...
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January 17, 2024
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A Happy – And Well – Holiday for All
It’s the season of holidays. We started with Thanksgiving and then Channukah, and we have yet to tackle Christmas...
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December 19, 2023
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A Live Well Retirement is Not Just About Money You’ve Saved
Last week I talked about Ice Cream, Lunch and Light Bulbs as part of a retirement plan. Those three...
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December 12, 2023
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It’s Never to Late for Hip
We’ve had a nice trend over the recent years, a trend in which hip fractures in America had been...
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November 28, 2023
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Ask the Doctor
Don’t ask just any doctor…and don’t just ask your primary care provider (although they may have some insight)…ask a...
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October 31, 2023
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The New Pandemic That Has a Cure
I’ve been hearing it from my clients, from my friends, from my family and from virtually every channel on...
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October 23, 2023
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Memory Doesn’t Have to Decline with Age
Memory decline doesn’t have to be part of a person’s aging process. You may know that I have written...
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October 17, 2023
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In the Caregiver's Words

Recent Client Praise

I explained in an earlier post about why we refer to Holidays in the plural, and how we are working to be inclusive of all people’s end of year celebrations of faith. That was the “Holidays” part, but what about the “Happy?” The holidays are also a period of rather widespread unhappiness, if not outright depression, and it’s even more common among our older loved ones. How often have you heard comments like: “Oh, mom is just a bit blue;” or “Her husband died six years ago during the holidays…she should just snap out of it;” or “He just likes his time to himself during the holidays.” They are all ways to discount what is something of an epidemic among older adults in America today: depression…an epidemic that has exploded during the present and ongoing pandemic. If you are a caregiver to an older loved one, the symptoms may be slow to show themselves, but depression is a real medical condition to be addressed every bit as much as dementia or heart disease. Adults 65 years of age and older may only be just 16% of the population, but they account for 18+% of suicide deaths. Inexplicably, suicide rates for most older Americans have trended down during the pandemic, but depression is substantially up. Older adults with depression have healthcare costs 50% higher than non-depressed adults. And depression is common – more than seven million older adults manifest some degree of clinical depression each year. Where should you look for depression? I mentioned widowhood at the beginning. Well, one-third of widows and widowers meet the clinical criteria for depression within the first month after losing a spouse. And half of these are still depressed a year later. Depression also is a classic comorbidity of a number of medical conditions like Parkinson’s, Alzheimer’s and even cancer, arthritis and heart disease. But the prevalence of depression is really just an opportunity to take action. The data show that fully 80% of depression in older adults can be effectively treated with either medication or talk therapy or a combination of both. If you are a caregiver to an older loved one, however, encourage them to see a mental health professional who can offer the best of both medical and talk therapy. About 55% of older adults who do seek help for their depression reportedly go to their primary care physicians. While your loved one’s personal physician may prescribe, they are not schooled in talk therapy. If you suspect an older loved one in your orbit is depressed or maybe just down, consider the holiday gift that actually does keep on giving. Give your older loved one your personal time…and consider the installment plan…the plan that includes a whole calendar schedule of giving into the new year! Charlotte Bishop is a Caregiver Coach, an Aging Life Care Advisor, 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 co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
It is absolutely great news that Pfizer and BioNTech have brought a vaccine for COVID-19 from discovery to approval by the US Food and Drug Administration just today. We all can see the promise of “normal” on our collective horizon and almost breathe a collective sigh of relief. We have been more than a bit distracted by COVID-19 for how long…ten or more months? And what used to be the major concern of everyone with an older loved one can now get some press. And there may be good news in the Alzheimer’s fight as well. A company called Cassava Sciences has shared results from a Phase 2b clinical trial that show its therapy helps to block a protein that triggers brain inflammation and the loss of neurons. They are moving to Phase 3 trials on patients who have been diagnosed with Alzheimer’s Disease. The drug is called sumifilam, and it is an oral medication that can be taken once a day. The Phase 2b study focused on how oral administration in a range of dosing could block the proliferation of a protein called HMGB1 that causes inflammation in the brain. The same drug also helps to restore both the shape and function of a beneficial protein in the brain called filamin A, and while it is doing that it also is strengthening the natural defenses of brain by blocking access across the blood brain barrier of inflammatory proteins like albumin. In more straightforward lay terms, this tablet can help manage three pathways by which Alzheimer’s disease can negatively impact the brain. Part of the evidence the scientists presented to get approval to move forward with a Phase 3 clinical trial focused on some of these biomarkers of harm to the brain. Simifilam also showed a reduction of Ptau-181, the “tau tangles” that are a physical characteristic of Alzheimer’s as well as improved performance on cognitive tests. As this promising therapy rolls out with a Phase 3 trial across a number of sites in Arizona and Florida among patients with mild to moderate Alzheimer’s Disease who are 50 to 85 years of age, I will keep you informed of findings. You also can follow any reports to the public by going to a government site for clinical trials related to Alzheimer’s. Spoiler alert – there are nearly 1,300 trials currently in motion on some aspect of Alzheimer’s Disease. We will keep you posted on anything truly noteworthy coming from any of these trials so you don’t have to work on your doctorate in biochemistry to decipher what the reports tell us. So, please consider this two doses of good news on the medical front this week. And when it comes to clinical trials, please remember that the two key tests the FDA applies are that a treatment or vaccine is safe and effective…in that order. Please do not be sucked down the rabbit hole of those who suggest otherwise. Just Google thalidomide…FDA withheld approval of that therapy when the European Medicines Agency signed off. 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.
For the Caregiver
Make Care Giving Work
Peak Over the Wall
The Caregiver Blues

For the Family Caregiver

For the one leading the charge, the drains are not always visible.
Care giving can be just as demanding as a full time job. Days are long and it is hard to take a break. This is why it is so important to watch for your own symptoms as a caregiver. You want to be as good for yourself as you are for your loved one who depends on you.

Are you…

missing a lot of work?

not exercising and instead eating a lot of unhealthy foods?

having nightmares or disturbing dreams?

feeling lethargic or maybe even depressed?

angered by minor issues, or are you impatient with your loved one?

MAKING CARE GIVING WORK

While keeping yourself and your family strong
Family care giving 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 everything against a full-time job, parental responsibilities and a marital partner. Caregivers often don’t get much explicit attention as part of the tremendous contributions. The most recent report on family care giving published by AARP is required reading for caregivers and their families. It provides a sense of the huge and important work that caregivers are providing for their families in America today.

Creative Care Management recommends three points that cannot be repeated 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.

PEEKING OVER THE WALL

After surviving the climb

5 Steps Towards becoming a Better Caregiver:

Become educated about your loved one's condition in order to be as effective as you can be.

Recognize that you are not superman or superwoman; set some limits on what you and others can expect from you.

Do not beat yourself up about feeling angry, afraid or even resentful; instead find ways to vent

Talk is important as a principal way to vent – especially to a therapist, counselor, clergy member, and even trusted friends.

Lift smart. As a caregiver, be smart about not hurting your back when lifting, pushing and pulling; keep yourself in shape and use an assistive waistband if your physician recommends it.

For more tips for the caregiver, Chicago IL care resources and more, don't forget to visit Charlotte's Blog and please make sure to learn more about what we do at elder care services page.

THE CAREGIVER BLUES

Building a Prevention Strategy
With the amount of stress and pressure caregiving can produce, many choose to ignore signs of caregiver depression. The sad irony is that the caregiver feels guilty about even talking about the dark cloud that seems to be hanging over them, guilty that they do not feel the fulfillment of taking care of the parent who once took care of them. This, despite the fact that the caregiver of an older adult more often than not has other family responsibilities already. More than 20 million Americans suffer from depression, and family caregivers are more likely than the average person to get something that is not just the "blues." We all recognize the time and work that a caregiver puts in to help an older adult, but they also may be giving up the time they would have been spending with their spouse or significant other –or the nights out with friends and acquaintances, the moments during any given week that would give a break from the routine, make them laugh or fulfill them.

Love, Live, Laugh

Tips for Caregiver Blues

Include you; make time each day to do something that delights, relieves or distracts you.

Make lists; prioritize your caregiving duties, make lists and you will see you are making progress even when there remains more to do.

Request help; appreciate that it is gratifying to the others whom you may ask for help to be of help to you and your elder.

Leverage your abilities; the others who can give you respite are actually better equipped for what you may delegate than you are.

Make yourself laugh; hard work like caregiving can seem devoid of fun, so you have to take time to have some fun.
Raise your hand if you ever had a disagreement with a brother or sister as you were growing up. It may sound like an odd question, but it highlights of the "iron rules" of family dynamics that I have seen in my years as a certified geriatric care manager. Most families tend to play out a lot of the family dynamics that had characterized them during the formative years of the family. They simply are older now that they were when mom and dad were raising them as children. We also still find that caregiving to mom or dad as they age generally falls to the daughter in the family and not the son. According to sources woman (daughters) caregivers outnumber men (sons) about two to one. SO what can one do to manage the family dynamics so that the caregiving actually is productive instead of combative. In part because caregiving can be demanding and stressful, it can bring out some of the family's old tensions or unresolved issues. Some siblings may be the optimists and others the pessimists, but quite often the tension that already exists is exacerbated because the duties are not seen to be shared equitably. Here are some guidelines that can help to diffuse a tense predicament and hopefully move things to a more productive plane:
- Make it a point to appreciate all points of view, and be open to compromise; as I often say, "Would you rather be right or happy?"Recognize that not all siblings can contribute equally; everyone comes from a different place with different abilities and different constraints.
- Don't forget "please" and don't forget "thank you;" show appreciation for everyone's contribution to caring for mom or dad.Make it a point to share all the information; if one of the siblings does not know their help or input is needed, it is not going to be forthcoming.
- Remember to frame your suggestions and actions around what mom or dad would have wanted, not what you specifically may want.
- You may not be required to "forget" a perceived wrong from a sibling, but you do have to "forgive" the slight so that you all can move forward.
- If you are the caregiver who is not getting sufficient help from the siblings, you still need to find professional (or otherwise) respite care.
- Be open to seeing when you need to call in help just to work together as siblings; seek the facilitation of a therapists, counselor, social worker other third party.
- Remember one of my other iron rules, and that is "Care for the Caregiver;" you cannot be an effective caregiver if you are not caring for yourself.
This may seem like a lot, but productive resolutions of issues will in the end be better for your older loved ones. The lessons you learn in working through your sibling tensions also can be tremendously illuminating as you look to prepare your own children for roles that they will one day face. Charlotte Bishop is a certified Geriatric Care Manager and founder of Creative Care Management, professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.
The rest of the oft-quoted phrase is a pejorative about how “Nobody’s Home.” And we know it’s supposed to connote low wattage of an intellectual sort. Well, burglars who may be watching for when your mom and dad go on the vacations with which retired folks are supposed to be frequently indulging themselves are also watching to see if the lights are on. According to law enforcement they take the lights on as a sign that, in fact, nobody’s home. So what can one do to safeguard home? Well, the same bad guys also look to see if the lights go on at the same time a couple nights in a row, so timers are about as effective as letting the house stand all lit up all the time. Technology has a better answer…actually a couple of them that involve “smart lighting” that can be a safeguard both indoors and outside. Smart lighting outside can use motion detectors that sense anyone approaching the house and flood them in conspicuous lighting that burglars like to avoid. And these particular smart lights can be “trained” to respond to only larger disturbances, so that pesky moths do not have your porch flashing all night like a pinball machine. The sensor outside could also be set up to turn on a light or two inside the house to make it appear as if someone inside is alert to anyone approaching the house. You will want a sensor that also is “outdoor rated” to be sealed against moisture. Smart lighting inside can be a real safeguard against night time falls for an older loved one who may make the middle of the night run to the powder room. A small light can be a big assist for someone just starting to awaken, but already in motion down the hall. And both indoor and outdoor sensors can be set to turn themselves off after a desired lapse of time, again looking more real life. And there is a whole line of smart devices that connect home indoor and outdoor lighting to an app on a smart phone. And you don’t have to ask Siri to attend to the lighting for you. It is all literally in your hands. Of course, if you’re trying to be helpful to an older loved one you will want to confirm specifically when they are and are not home so that you don’t unsettle them with an unannounced light show. 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.
Senior Home Safety
Having a safe home is a large part of senior health that is often overlooked until it’s too late to prevent an accident and serious injury. According to the National Institutes of Health, six out of ten falls happen in the home where we feel safe and secure. Our elder care management plans place an emphasis of senior home safety for just that reason. Small details like dim lighting, loose carpeting, hard to reach items or an uneven driveway, become safety hazards for aging adults.
Common Safety Hazards
As we grow older, we become more limited physically. Eyesight, strength and agility deteriorate, and we need to be more careful with our bodies as years progress. Addressing physical limitations by making changes around the home before an accident happens, can keep an older adult safe and comfortable at home. Be aware of clutter on the floor, inconveniently placed furniture, slippery or uneven flooring and area rugs that could cause a problem. Bathrooms and kitchens are often the most hazardous rooms. Add extra railings for support in the bathroom and on the stairs, improve the lighting in dim areas and place items at an easy to reach height to keep your older family member safe.
Are You At Risk?
If you are concerned about safety hazards in your home, review our Home Safety Checklist for common hazards and solutions to keep your loved ones from harm, and contact us for an assessment of both the condition of your loved one and their home as well as further recommendations for geriatric care services in Chicago.
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Recent Client Praise

Any discussion of hygiene - whether in an older adult or anyone else for that matter - is an admittedly subjective discussion. It is not just about taking a daily bath or shower. In fact, in many other parts of the world, a daily cleansing is considered a bit excessive, and some people of earlier generations did not necessarily grow up on the daily dousing we call personal hygiene. Everyone potentially has their own take on how frequently they wish to bathe, but hygiene also can be an indicator that something else is not quite right in an older adult.

When I get a call from a client who is concerned about their older loved one's hygiene, I start by simply asking if this is a recent change from old habits or if it simply the way they always have been. If it is just the way the habit has always been, then it will not be easily changed...if, in fact, it even should be changed. Old habits are deeply ingrained. But a change in personal habits can be the sign of something else at work.

In an earlier post, I had pointed out that loss in appetite can be a warning sign of depression. The same holds for an older adult who has lost interest in how they look or how they smell. Depression is a bigger issue than hygiene, and in fact, if the older adult addresses the depression with talk therapy or medication, if indicated, they may find a renewed interest in self-care and hygiene.

And as with appetite as I addressed in the last posting, a change in hygiene can simply be a product of the older adult's diminished ability to smell what you as a caregiver may find offensive. Conversely, you may find that your older loved one has dumped excessive amounts of cologne on themselves, because they cannot tell that they have given themselves an overdose of the good smelling stuff. Regardless, any discussion you may have with the older adult about something as personal as how they smell should be a very sensitive discussion.

Your older loved one also may also be finding it difficult to navigate the bath like they used to because of their diminished agility. And modesty may preclude them from asking for help. So if this is the case, consider enlisting the help of third parties like home care aids who will not be as threatening to their sense of propriety.

Forgetting to shower or bathe can also be a sign of a larger pattern of forgetfulness, so try to assess hygiene against the "big picture." Does your older loved one also miss appointments or forget to pick up their clothes from the cleaners? Maybe suggesting a calendar with dates filled-in with the "things to do" can be an assist, because we all can forget things. If the forgetfulness, however, is part of a greater disorientation, be alert to early onset dementia. Even if this forgetting is part of a dementia, don't immediately push the Alzheimer's panic button. Mild dementia can be exacerbated by poor sleep or even a medication that has a side effect of confusion. Diphenhydramine (branded Benadryl), an ingredient in a lot of over the counter medications, can precipitate some amount of forgetfulness in a person of any age.
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 in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.

We are professionals providing home care and geriatric care services that enrich quality of life.

Our Creativity: We look at you and your family's individual needs to produce the best possible solutions. Those solutions are not always easy to discover, nor are they always straight forward. Our experience in a wide range of care situations allows us to produce options that may not have been otherwise considered.

Our Care: By assessing emotional, physical, and medical necessities, we ensure your loved one is provided a safe, secure environment. Our motivation is seeing your loved one living as independently as possible and families supported with the tools they need to achieve the best living situation.

Our Expert Management: Seeking to lift your load as a caregiver, we help organize appointments and paperwork, oversee and develop thorough care plans, navigate the essentials for all aspects of senior living, and provide the support family caregivers need. We use real experience to help you make informed decisions about health, psychological, legal, economic and social needs.

Whether we’re finding the best way to help mom or dad live with Alzheimer's, or creating the safest in home care environment possible– you can trust us to be a reliable and knowledgeable resource for geriatric care services. We can connect you to the right local care providers/nurses and tailor care plans specifically for you and your family. We also serve as bridges to help a loved one (as well as their family and friends) make life transitions. Click here to learn more about our services.

Creative Case Management is a personal and professional story.

Charlotte Bishop
MS, GCM, CRC, CCM CDMS, LCPC, is president and founder of Creative Care Management. As a certified Geriatric Care Manager (GCM), Charlotte Bishop leads a team of qualified professionals dedicated to providing solutions to difficult care situations. They are seasoned experts in the field of geriatric and senior care, Chicago-based for over two decades, and happy to help you and your family through any care giving needs.

Caregivers...often find themselves stepping into a void. It only becomes clear that an aging parent or dear friend needs help when the dishes pile up in the sink. You find out that they have difficulty getting to the grocery store when they begin to show signs of poor nutrition or the refrigerator is bare. So the caregiver steps up to help where they can, and the list of what needs doing can seem formidable.
— Charlotte Bishop

President and Founder of Creative Care Management

There is an epidemic going on, and it involves that butterfly shaped gland in the neck call the thyroid. Since 2002 the prevalence has doubled in the US, but this is not because twice as many people have developed hypothyroidism as it is that the professional society that represents endocrinologists established new standards. The new standards for defining hypothyroidism have reduced the TSH (thyroid-stimulating hormone) range to be .3 to 3.0 from the earlier standard that had been about .5 to 5.0. And this is not just a trivial matter of definitions when what had been about 15 million people with hypothyroidism suddenly becomes about 27 million Americans. This is about one in ten Americans, and the prevalence of hypothyroidism is about twice as high among women over 60 years as it is for their younger counterparts. (Just for what it's worth, this is more people than the number diagnosed as diabetic in America.) Hypothyroidism is important also because there is a big connection between the thyroid gland in your older loved one's neck and their brain and heart. For anyone whose TSH levels are out of range, the impact on the heart would be through the potential for significantly elevated cholesterol levels. It is estimated that this could be as many as 10 million Americans. So, for people whose thyroid condition has not been diagnosed, but they have been put on lipid-lowering agents like the statins, their cure may be even easier. By taking a thyroid supplement, suddenly cholesterol levels may become better managed. Yet, fewer than half the adults with diagnosed elevated cholesterol levels in a recent survey were aware if they had ever been tested for elevated TSH levels. I had mentioned the brain connection, and there are two significant brain manifestations of hypothyroidism. Patients who are out of range on their TSH levels may be depressed or they may display signs of delirium. The former may have led to treatment with antidepressants, treatments that may now prove unnecessary, and the latter may be confused with dementia if the delirium goes unchecked over time. And there are other symptoms of hypothyroidism that you should be looking for if you are a caregiver to an older loved one: • thin, brittle, dry hair or skin • increased sensitivity to cold • fatigue • muscle or joint pains • constipation. You don't need to remember all the signs and symptoms of hypothyroidism, but you should remember to ask your loved one's physicians at the next annual physical what your loved one's TSH level is. If the number is too high or too low, begin advocating for help to avoid the other conditions. Yes, your loved one may take home one new prescription, but they also may get rid of one or more existing prescriptions...and feel a lot better. 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@creativecaremanagement.com.
I have to believe that you’ve heard the one about the patient who shows up at the doctor’s office. The doctor walks into the exam room and asks what has brought the patient in today. Patient says, “Doc, it hurts when I do this.” …Pause… The doctor replies, “Well, don’t do that.” Case closed. It seems that in many cases that approach to health and wellness has taken a backseat to more prescriptions for more pills. Yet, if you dig deep enough on line beyond all the classes of medications, you will find the following recommendations:

Engage in at least 150 minutes of physical activity per week,

Stop Smoking,

Limit sodium and alcohol intake

Enjoy a healthy diet with lots of vegetables and fruits

Get to a healthy weight

Manage your stress.

All of these are good ideas, but a person has to search for them with all the other medications that are available for a medical provider trying to see more patients per day. It’s not all on the health system. A majority of patients also seem to want an “easy pill” which may account for the high demand for the current wave of weight loss drugs originally intended for diabetes, but very much in demand for those who want to lose weight more easily than dieting may afford. And then there’s the Toby Keith song about a conversation he had had with Clint Eastwood about his “secret” to living well and long. The lyrics go like this: Don't let the old man in…I wanna leave this alone…Can't leave it up to him…He's knocking on my door And I knew all of my life…That someday it would end…Get up and go outside…Don't let the old man in Many moons I have lived…My body's weathered and worn…Ask yourself how would you be…If you didn't know the day you were born Try to love on your wife…And stay close to your friends…Toast each sundown with wine…Don't let the old man in Many moons I have lived…My body's weathered and worn…Ask yourself how would you be…If you didn't know the day you were born When he rides up on his horse…And you feel that cold bitter wind…Look out your window and smile…Don't let the old man in Look out your window and smile…Don't let the old man in But to get to the real point, if you really want to live longer and live well, don’t look for another pill or procedure. Look for a chance to take a walk, a chance to get up from your couch or to step away from your desk or to push back from the dinner table. This may take more than a day, but it will reward you with many more days and a happier life. It’s part of my “Live Well Blueprint.” Charlotte Bishop is an Aging Life Care Advisor, Retirement Lifestyle Coach and founder of Creative Care Management, LLC, 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.
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.
When was the last time you studied after a test? Or prepared your dinner after you had dined? Or had a cup of coffee after you turned out the lights for the night? No, you say, you have things turned around. You study before the test so that you will do better, you cook your meal before you can dine and coffee is how you start your day. Yet, we seem to do things backwards when it comes to the way we deal with surgery or injury or illness. After surgery we are prescribed a rehab program to get “back to normal.” After an injury we are prescribed a rehabilitation program to get our agility back or rehab to get “normal” after an illness. What if we were prescribed “prehab?” Among medical professionals it is called preventive rehabilitation, or “prehab” for short, and it is increasingly prescribe to better prepare a body for the recovery following a surgery. It also can be just the thing to help prevent injuries by strengthening the muscle groups that may be most prone to succumbing to breaking down. And I would suggest that prehab may be a great way to prepare for a healthier aging as well. But back to prehab before surgery…why do it if you have to do the recovery work anyway? Medical professionals say that the evidence suggests that prehab before a scheduled surgery has some concrete benefits; patients who prehab:

Are better prepared both mentally and physically for surgery

See more successful outcomes

Have a shorter recovery time

Stay less time in the hospital recovering

Feel less post-operative pain and fewer complications

Show less swelling and greater flexibility of the affected areas.

For patients preparing to undergo a surgical or other invasive procedure, providers can prescribe a prehab regimen specifically to address their existing weaknesses as well as the anticipated disruption that surgery will represent. I mentioned “healthier aging” as a benefit of prehab. Prehab can be individualized to a patient to help build up strength or flexibility where needed or range of motion or better endurance and physical function. I like to add to this list “nimble.” A physical trainer I know is a real prehab specialist, even though he does not focus on pre-surgical clients. What he focuses on with his clients is preparation for doing better and that applies to aging well with what he terms “muscle confusion.” He continuously changes up the physical routine so it is never the same stretches or the same conditioning. By giving the body new challenges each workout, he helps keep older clients on their feet instead of falling and successfully working out or just working without a strain or a tear or just that pain. You do not need to have an injury to visit a physical therapy facility. They can assess your present condition and work with you for better posture, better lifting, a stronger core and training for specific tasks and most important a better aging. 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.

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