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

Negative Thinking Causes What?
What could be worse than a COVID pandemic? How about the uptick in depression and anxiety that mental health...
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July 7, 2020
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Dementia: We’re Not Post-COVID Yet
If you have a family member or loved one with dementia, this pandemic and its restrictions have been exponentially...
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May 26, 2020
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Distance Caregiving Through a Wall
I’ve written numerous times about distance caregiving, and one of the observations I have offered is that distance is...
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May 19, 2020
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Caregiving During COVID: Four Tips for Reengagement
You may recall that I have recommended limiting your news consumption, because it really does add to our stressed...
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May 12, 2020
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Listen to an Astronaut about COVID-19
A small percentage of us may be coping with symptoms of COVID-19 or we know someone who is, but...
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March 24, 2020
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Trusted Voices on COVID-19
The news cycle calls the COVID-19 crisis a rapidly developing story. It unfortunately also has been one with a...
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March 17, 2020
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One is Number One Threat to Seniors
We’ve all had times when we desperately need our own space…time to ourselves, just ourselves. And it’s good to...
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March 10, 2020
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Helping Your Older Loved One – AND You – Avoid COVID19
All of us here know how to prepare for a blizzard, people in the South know how to prepare...
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March 3, 2020
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Part 2: Five Important Tips for Caregiving and Self-Care
In my last post, I gave you some tips on distance caregiving that arguably could be called the 30,000...
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February 18, 2020
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Tips for Distance Caregiving: Up Close and Personal at a Distance
If you think being a caregiver to an older loved one is hard–with all the trips to help them...
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February 4, 2020
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In the Caregiver's Words

Recent Client Praise

If you are a caregiver to an older loved one or a person with a disability who may be sent to physical or occupational therapy, you need to know about Medicare's new rules on medical necessity. For the past decade Medicare spending on outpatient therapy has been increasing at a rate of more than 10 percent a year, but the number of patients receiving therapy has been growing at less than three percent a year, so there have been about 1300 pages of changes.

       It really all comes down to the physical therapist. Even if your physician writes a prescription for outpatient therapy, it is up to the physical therapist to determine if the therapy satisfies the Medicare requirements. So that your loved one does not end up paying for service (because they can have therapy on demand), understand what the therapist looks for:

1.    Therapy must be aimed at addressing a functional deficit (such as the patient being restricted in some vital activity of daily living).

2.    The therapy has to be something that actually requires a therapist - that is, it could not be a self-improvement home effort.

3.    The therapy is not for maintaining good function; it has to be directed to - and make progress toward - improved function.

4.    Therapy must focus on improving something that makes a difference in the patient's daily life; Medicare will pay for efforts aimed at self-care around their home, but not for training for a marathon.

5.    Therapy has to have a chance of succeeding; the therapist must determine that there is a strong likelihood of achieving goals that have been set forth.

       The guidelines are fairly clear and the therapist's documentation must speak to these issues for the program to be covered. And it is important to appreciate that Medicare's governance will not object to any legitimate use of therapy; they just set the standards so that physical therapy is more than simply "going through the motions." You don't have to read the whole 1300 pages of Medicare's guidelines to appreciate how the revisions will affect therapy. Check out what the American Physical Therapy Association says about making the guidelines work for the beneficiaries (click the link).

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.
In the meantime, we invite you to download the below featured FREE white paper - offering both personal and professional advice for those who care for the elderly or people with special needs. Make sure to come back and visit us for more great FREE resources.

A Caregiver's Guide for Changes & AgingCoping with change can be difficult. It often involves tough decisions and conversations with the person you care for. Discover strategies to help you and your loved one feel more comfortable with transition.Download
In earlier posts I have talked about some ways to broach difficult subjects with an older parent, talks that are about life changes, one of the harder among them was giving up the car keys. This is going to be the first in a two-part series in which I will offer perspectives on some of the changes in life where you as the child of an older parent may be required to step up to help your parent or see that proper help is available. The second part will be devoted to conversations about preparations for end of life, life's final transitions. It may surprise you to learn that the former can be a lot more difficult than the latter. Harder because everybody expects to die someday, but many people have greater difficulty in addressing their potential loss of independence along the way.

Power of Attorney. You may want to talk with your family attorney before this conversation so that you can keep the details straight. There are two types of power of attorney (POA): one for health care and one for finance. The legal system has defaults in place to handle decisions for a person's finances or health and well-being if they are deemed unfit to do so on their own. However, those decisions have to go to a judge and the process can be time-consuming and costly. If one of your older parents is unable to make financial decisions - and they own property jointly with their spouse - it becomes difficult to liquidate the house if funds are needed for long term care or other health care issue. Health care POA can offer similar relief in the event your older parent requires some choices in where and how they will be cared for. In both cases, it can be easier to broach the subject if you, yourself, have had the papers drawn up for your own situation and offer your own experience and questions as an example to your parents. At any age, there is benefit in knowing that decisions will be made in our best interests if we cannot make them ourselves.

Long Term Care Insurance. Assisted living or home health care can be expensive, and the right long term care (LTC) policy can make life a lot easier to the bear financially. But be aware that there are a lot of different types of policies with an array of benefits and payout mechanisms. And the cost to buy LTC insurance will depend on the age at which you sign up as well as some other variables. To be sure you are getting your or your parents' money's worth, look for an independent broker who is not captive to a single insurer. But before you talk with a broker about your older parent, check out an authoritative source. The American Association for Long-Term Care Insurance has a consumer information section you may find helpful. And as with the conversation about POAs, you may investigate a policy for yourself as a foundation for having the conversation with your parent. Part 2 will post on Thursday.

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.
If you are a distance caregiver who will be home with an older loved one during these holidays, it is a great chance to have great conversation and to do a caregiver check up with your older loved one. You may beneficially find it helpful to raise some questions in your catch-up conversation to get a clearer sense of how well your elder is caring for themselves. Try these: 1. How are you sleeping? It is common knowledge that as we age, we simply need less sleep, but there is a real health difference between needing less sleep and actually suffering from insomnia. Consistent loss of sleep can be a real health risk in itself. Medical researchers find that as the hours of lost sleep pile up, blood pressure also rises. With rising pressure, there is rising inflammation or even weakening of blood vessel walls. People with genuine insomnia have twice the chance of suffering a stroke. Recommend end of day habits that will be less stimulating...like less television and more reading. It may be helpful to even suggest a white noise machine or some sound devices that mimic wave action or light rainfall to soothe your loved one to sleep. 2. Do you enjoy a good cup of coffee? At the opposite end of the sleep continuum, don't discourage your older loved one's coffee during the day. At the same time you can encourage decaf or a switch to non-caffeinated teas after the lunch hour to avoid stimulation that can fuel sleeplessness. But coffee actually imparts measureable health benefits. It has been demonstrated to reduce the risk of type 2 diabetes, heart disease and even some forms of cancer. 3. Do you have a place for safe walking? Walking just half an hour daily - or even six days out of seven - has had a demonstrably beneficial effect on reducing belly fat. And the effect is more than cosmetic. Walking or even jogging can reduce the middle and at the same time lower the risk of the three above: diabetes, heart disease and cancer. With any exercise, always encourage your loved one to consult their physician and to get comfortable and supportive footwear. 4. How are you feeling? This sounds like a vague question, but it is a chance to talk about anything that has changed lately. Research shows that unusual chest or arm pain are common precursors for heart issues in men. In women, it is not so clear. In fact, fewer than a third of women report discomfort before a cardiac event. But nearly all women have symptoms like indigestion, pain, anxiety or other cues before a heart attack. Listen for what may be brushed off as "nothing." If you are a caregiver to an older loved one, enjoy family and the holiday, and take the conversational opportunity to make it a healthy holiday and new year. 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.
42 million is a big number. That is how many caregivers to older loved ones AARP estimates there are in the United States, and no surprise, the number of sons and daughters and husbands and wives of older adults with needs is growing. We do not see this mushrooming segment of the population, but it is changing the lives of the caregivers in fundamental and often unhealthy ways. One of the reasons we do not readily see caregivers is that the AARP survey reported that 44% of the caregivers simply do not talk about the unpaid job they do. No one, it seems, wants to look like the unloving family member who is having difficulty performing their caregiving tasks. As a result, about one third of caregivers report they are either sad or just plain depressed. Another third avoid any decisions that might give them a break or better leverage their time with their loved one. And another third simply go it alone, isolating themselves from their friends, colleagues or any support networks. Fully 38% report they are sleeping less, and nearly a quarter are eating more on top of that. Caregiving can be bad for the caregiver's health! Most of this symptomatic profile of the stressed caregiver owes to the simple fact that caregiving is their "other job;" more than six in ten caregivers age 50 or older also have a full-time salaried job. As geriatric care managers (GCMs) caregivers are the people with whom we work in support of their care receivers, and the services we provide to the caregivers can be every bit as important as those that we offer their older loved ones. If you or someone you know is a "stressed caregiver," please consider the following from a professional "stress reliever" to stressed caregivers:
1. Ask AARP. The AARP website is a veritable wealth of information for caregivers to older loved ones, and they have a dedicated portion of their web site devoted to caregiver resources.
2. Involve the Family. Don't try to go it alone if you have siblings or other family members. Not only can many hands make fast work, but fresh perspectives and energy can help the caregiver doldrums that arise from too much solo stress.
3. Catch a Break. If you do not have siblings, check your community for respite care services. If there is a senior residential community in your locale, they often have drop off facilities for non-residents...which gives everyone a break.
4. Talk to Your Employer. This is in step with not going it alone. If you are stressed with caregiving it will show at the workplace. Rather than be judged as a suboptimal producer, talk to human resources about possible flex time or a leave.
5. Call a GCM. To more fully explore your options, call the option-makers for the decision-makers. You can find a GCM in your locale by going to the association web site.
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.
We have all heard someone this season say, “It’s just a cold,” or “I have a touch of the flu,” or similar expressions that pretty much write off a lot of what is going around. And nobody gets pneumonia, right? Wrong! It may sound like a small number, but about 6 of every 1000 people in American will have a bout with what is termed “community-acquired” pneumonia this year. Still sounds small, but the rate triples for 65 to 69 year old people…18.2 per 1000. And for 85+ year olds, the number skyrockets to 52.3 cases per 1000 people. So, if you have an older loved one in your orbit, be vigilant to signs and symptoms that can tell you they have graduated to pneumonia. There are six signs that should alert you to something that deserves a visit to the doctor or emergency facility:
1. Productive cough – the kind that almost rattles with the mucous as a person coughs to clear their lungs.
2. Fever or not – Fever with a pneumonia infection is common among younger individuals, but pneumonia actually can suppress body temp in older cases.
3. Chest aches – While we are most often concerned about heart issues with chest pain, breathing with pneumonia can give similar symptoms.
4. Tired – While the immune system fights pneumonia, it takes energy away from the rest of the body resulting in fatigue.
5. Fuzzy head – The lungs are not the only congested organ; the brain gets a bit muddled with pneumonia also.
6. Breathless – With congested lungs, it should be no surprise that a patient with pneumonia may also be short of breath with even modest activities.
The rules of engagement with pneumonia are simple.
1. Doctors’ orders - especially with completing the full course of antibiotics…be sure your loved one takes all the pills prescribed.
2. Sleep – give the body a chance to devote its undivided attention to fighting the bug by resting and getting help around the house.
3. Fluids – think of it as “flushing” out the system, and it also helps get rid of the congestion in the lungs.
And remember that the risk may be lower for younger people, but the operating rules are pretty much the same. Give all the support you can to help your body fight the invaders too! 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.