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

To B or Not to B12?
I have written a lot about dementia over the years as well as other issues that can mimic the...
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May 11, 2021
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Three Milion More Victims…
We see the numbers on a daily basis. How many have died from COVID, to date, we all probably...
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April 27, 2021
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Everything to Lose
Not a day goes by that the sun does not linger a bit longer, that the landscape gets a...
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April 20, 2021
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Not Just Spring…
We’ve heard of Spring Training for those who follow baseball teams like the CUBS or the SOX, and we...
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April 13, 2021
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Three Steps to the Now Normal
Yes, it has been a long year, maybe in part because it has been more than a year of...
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April 6, 2021
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As If COVID Were Not Enough
We’ve all heard about COVID’s symptoms…the GI upset, the shortness of breath, the fever, the added symptoms of the...
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March 30, 2021
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Diseases that Mimic Dementia…But Are Treatable-part 3
As you can tell from now a third installment about other medical conditions that can mimic dementia, it’s not...
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March 22, 2021
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Diseases that Mimic Dementia…But Are Treatable – part 1
Dementia is the condition that adult Americans fear the most, and tragically there are conditions that can give a...
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March 9, 2021
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Can I Have A Hug?
I doubt there is anyone who does not have something that they have not been able to do during...
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March 4, 2021
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A Game Where Everyone Wins
Pick your metaphor. If you want your knife to slice easier, you sharpen it. If you want to improve...
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March 2, 2021
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In the Caregiver's Words

Recent Client Praise

Associate Care Manager Gregory Peebles returns with a talk about hidden signals of aging that need our attention. Gregory is both 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 my team for over a decade. – Charlotte Call it self-reliance, gumption, stick-to-itiveness, or fierce independence, but most of us are very proud of this aspect of our national character. We manage ourselves and try to not bother our neighbors. We may need help, but we try to not ask for it. There’s plenty to be proud of in taking care of ourselves, but no matter how hard we try to remain staunchly independent, we ultimately need each other, and most of us don’t get much practice asking for help. Consequently, when we do need to ask, we can feel like a failure (we’re not!) and don’t want to reveal our vulnerability. Please allow me to share three signals that your older loved one may be in need of help but not be able to ask. Older adults embrace their independence and hate admitting they need help as much as anybody else. More often, they are told they need help. After some type of health scare (statistically, an in-home fall), a doctor or loved one gets tasked with “The Talk”. Life will be different. There will be more physician visits. There will be more caregiving. There will be less self-rule. The defining incident, which has usually been a long time coming, may register as a shock to the adult children or other loved ones of an older adult who may be focused on their hectic lives. After the life-changing incident has occurred, everyone’s eyes are opened to what they couldn’t see before. Here are three warning signs your loved one may need your help but hasn’t asked.
1. Presentation.– “Keeping Up Appearances” isn’t just a show on BBC. This is how individuals and families signal health and success in all aspects of their lives. When self-presentation declines, something is wrong. It’s that simple. Look for changes in housekeeping habits. Lack of interest in hygiene or grooming can signal depression, or a change in body mechanics. Weight loss can be because meals get forgotten, or because they are just harder to prepare. It doesn’t matter which one.
2. Mood and Memory. – We’re not talking about minor lapses of judgement or awareness. Everybody has a bad day or two in a row. Everybody forgets stuff. If, however, your loved one is more irritable than usual for longer than usual, or is more emotional than usual, that’s a signal of change. Losing one’s glasses or forgetting the day of the week are not necessarily causes for alarm. Even procedural memory loss (temporarily forgetting how to do something) is more common than we think. It’s always time to talk, but it’s probably not time to call a doctor until your loved one moves from forgetfulness to inability to process events into memories…instead of where are the car keys…what are the keys for?
3. Mobility.– It’s hard to ignore a body that has slowed and become harder to maintain. So don’t. When offering an elbow on the stairs just isn’t good enough anymore, it’s time to talk about the logistical changes necessary to keep your loved one as independent as they can be. Walkers, chair lifts, in-home caregivers, ride services, and a host of other options can facilitate.
Seeing these signals gives you an advantage for continued health and high quality of life for your older loved one. If your loved one lives at distance, services like those CCM, Inc. can identify and coordinates can help ease your mind and provide your loved one with just enough support to preserve their independence and their safety. 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.
About one in ten American adults, or approximately 44 million people who provide unpaid care to another adult, are caregivers to a loved one. Some of that care is episodic, some of it is around the clock and the rest is at all the points in between. The Family Caregiver Alliance estimates that this work force of volunteers provides about 80 percent of the long term geriatric care management in America today. So, the vast majority of Americans who are receiving long term care support are doing so with the help of a family member or friend. But these 44 million people are not an "industry," so the result is one potential crisis at a time while all of these volunteers cope with the stresses of finding time in their days and the resources to care for a loved one. Unlike the professionals in long term care facilities, the family or friends who volunteer for caregiving typically do not have the professional education or experience on which to draw. Here are nine strategies that will help make for a successful effort for all concerned:
1. Start with normal. If the caregiver has not been in the loved one's inner circle, it will be important to establish a baseline of "this is what mom is like/needs."
2. Get a complete physical. This is a medical way to understand where you are starting and what care or treatment is appropriate.
3. Be informed. Once you have the baseline and any diagnoses learn as much as you can about the conditions, their prognoses and treatments.
4. Make a plan. This should cover the activities of daily living and more: hygiene, housekeeping, medical care, emotional support and ongoing supervision.
5. Revise and evolve. A plan is not a static set of instructions like a recipe; it is a work in progress that you will revisit regularly as conditions change.
6. Talk to an attorney. You need to be aware of a loved one's financial resources as well as any legal paperwork in place or needed.
7. Elder-proof the home. An older adult as well as an aging household can pose a safety hazard; search this blog for key words like safe home, safety, etc.
8. It takes a village. You are one of 44 million caregivers, and you will benefit from the group support and understanding that will come from talking to others.
9. Care for the caregiver. You deserve caring every bit as much as your older loved one, and you cannot care for another if you neglect yourself.
For more information and resources, I strongly recommend the Family Caregiver Alliance website, or do a keyword search of our blog here using the word "caregiver." Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified elder 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.
When Medicare is defrauded by crooked providers, pharmacists, or any person posing as an expert who can make a telephone call or door to door solicitation, we all lose. Our tax dollars foot the bills. Anyone keeping an eye out for an elderly loved one knows the usual scams. The challenge is that the crooked folks keep coming up with new ploys to dupe Medicare recipients, and Medicare processes 4.4 million claims each day, all of which must be paid within 30 days. If you are a caregiver to a Medicare beneficiary or you, yourself are “of an age,” here are some of the latest scams.
1. Bait and Switch Okay, the notion of offering something that appears legitimate and of value, but then swapping it for something worth a lot less is not new. The latest scam, however, is new in that it promises a new high-tech osteoarthritis kit that “Medicare will reimburse.” So, the scammers promise state of the art, but they deliver cheap Velcro braces. And they bill Medicare for the high-end goods.
2. No Place Like Home Along the same lines of the bait and switch for arthritis, scammers have been known to deliver health services or other domestic help services to Medicare beneficiaries in their homes. But it is when the scammers turn around and up-bill Medicare for more costly professional services that the taxpayers get taken for a ride.
3. Mental Wealth Still another scam involves mental health services in outpatient settings. Medicare recipients are referred to an outpatient facility that in reality is just a social gathering. Socialization is good for one’s mental health, but the scammers up-charge Medicare for a psychological consultation instead. And as with the other scams, the taxpayers pick up the tab.
Medicare paid nearly one-quarter trillion dollars in 2013-the latest data available, and estimates of fraud range from 10% of this total to as high as 30%, but there are measures we all can take to help address these criminal activities. The federal Centers for Medicare and Medicaid Services recommend: • Know your coverage under Medicare so that you are not duped by scammers. • Guard your Medicare number as closely as you do your social security number. • Beware of any medical service provider who reaches out to you unsolicited. • Ask your personal physician about any and all service or device prescriptions. • Scrutinize your monthly Medicare statements for anything unusual. • Say something if you see something…don’t hesitate to call 1-800-MEDICARE. All of this will help you or an older loved one to not fall victim to scammers, and it will keep the money with the taxpayers instead of the scammers. Charlotte Bishop is an Aging Life Care Professional and 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.
Nearly 32 million people in America have measurable hearing loss, and more than one third of those people are 65 years of age or older. In fact, one's age is a fairly good predictor of whether and to what extent a person may have hearing loss with the prevalence increasing with age. Hearing loss also is much more common among men than among women. But one fact that you perhaps did not know is that hearing loss also is linked to dementia.

What, you say? Did I hear you right? Yes, a researcher named Frank Lin, MD, at the Johns Hopkins University School of Medicine, has reported on the link between hearing loss and one's gait, and on the incidence of falls and most recently on the ties between hearing loss and dementia. Dr. Lin and his associates have been sorting through data collected over a long time and have found that people who have difficulties also have higher incidences of cognitive issues. And people with cognitive issues like dementia also are more likely to have hearing difficulties. In other words, they do not yet know which causes which.

One explanation is that people who have difficulty hearing are not as socially active - maybe even isolated - and so their mental processing tends to lag. Their second explanation is that people with trouble hearing are straining so hard to just hear the words that their ability to actively listen and respond becomes more diminished over time. Imagine that you are struggling so hard to hear that by the time you have deciphered what someone has said they already are on to the next sentence. It could be very confusing.

But potentially even more troubling, it may be that some common issue is causing both hearing loss and cognitive loss. Is that common issue a genetic defect, something in one's space, something about people's hearing aids, or something else entirely? The scientists are still at work, but the findings offer a cautionary note.

If you are a caregiver to an older adult or anyone who begins to show signs of diminished hearing, get immediate help for a clear diagnosis and then an intervention. We tend to think that a physician should catch a hearing problem, but that is far from the case with only about 13% of physicians routinely testing for hearing capacity. And don't forget that a physician's office tends to be a relatively quiet environment where patients can more easily hear what the doctor says because the background noises are minimal or nonexistent. Depending on which of the three possible explanations of hearing loss and dementia you accept, getting your loved one's hearing check will help their hearing, their social integration, their mental health or all three!

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.
Family crises don’t make appointments…they just happen whether you are ready or not. In fact, our clock is ticking: • Every 67 seconds another person in America is diagnosed with Alzheimer’s, and that is just one of the nearly 100 types of dementia; • Every three minutes an individual 65 years of age or older is taken to an emergency room; 14% of the subsequent admissions are for broken hips. The list goes on. You wish mom or dad could have the life they want…to stay in the home you grew up in … to stay independent. In fact, they may have made you promise that you would see to it. But dreams and promises can’t always come true. Are you ready? The clock is ticking. Do you dread the phone call that may come in the middle of the night- or during the work day? The call that tells you something out of the blue has happened to someone you love? I got that call- I was working full time with school age children at home when I got the call that my mother was diagnosed with cancer. Right then and there I had to deal with my mother’s medical needs, her health crisis, her finances while caring for my family and running my business. One of our employees got the call that his mom had to be out of her independent living facility within 30 days…she was no longer “independent.” How many of you have had a similar experience- or are hoping you never get the call? Well, hope is not a strategy for your inevitable family crisis - you need a plan. A plan starts with having the necessary documents for your older loved ones, and the basics are: a POLST, a Living Will, a Power of Attorney for Healthcare and a Power of Attorney for Finance. Some of our clients also have found that mom or dad wanted to lay out their plan for a funeral, but that may be getting a bit ahead of things. You also need to know their physicians – that’s right, it’s plural; there likely will be more than one. You also want to know their preferences…which hospital in the event they need to go to one, a document to inform any medical interventions. And, of course, where their health insurance card is, their will, and who their lawyer is. You may get some resistance, so just remember that resistance is just fear putting up a wall. Empathize with their fear. Imagine now your next step. Imagine what it would be like to have the peace of mind that a plan can give. The possibility of sleeping at night. The possibility of having more time with your family. The possibility of being able to do your job. The possibility of feeling more in control of all the chaos. Check out what I had to say about planning for the crisis that doesn’t make an appointment on ABC News. Watch it below (after a brief commercial).
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.
Here in Chicago we just had a day time high temperature of 88 degrees this week, but I am thinking of the holidays. The grass may still be green and the leaves may still be on the trees, but Yom Kippur is less than a month away, Thanksgiving is only two months, and so on. And I have a speaking engagement next week we are co-sponsoring with SASI (Services for Adults Staying in their Homes) called “Holiday Observations” – details are at the end of this posting. I will not be talking about how to “observe a holiday;” rather, I am going to be speaking to those who may be caregivers to older loved ones and what they should be looking for when families get together for any of the end of year holidays. Let me give you the sneak preview… When I speak with caregivers who will be reuniting with older loved ones, I encourage them to be observant for signs that their loved one’s "quality of life” may be compromised and to engage in conversation to get feedback on how their loved one is actually doing. What should you look for?
1. Household Clutter – You older loved one does not have to be a hoarder to be at risk with the accumulated clutter of daily living. Every year one in three adults over age 65 fall, and most of these falls are at home. Look for worn carpeting or scatter rugs that may be trip hazards. Or stacks of newspapers and magazines or wires that may be obstacles to walkways in the home.
2. Pantry Stocked – While you may be able to tell if your older loved one is losing weight, whether they are eating well may be a bit more subtle. You will surely have occasion to have coffee in the kitchen, so use it as a chance to surreptitiously check that your loved one is well-provisioned.
In your conversations with your older loved ones, take it one step further than simply asking the glossy “How are you doing?” What can you ask?
1. How are you sleeping? – We all know that as we get older we simply need less sleep, but insomnia is another matter altogether. They may show the wear of too many sleepless nights, but the poor sleep could be a symptom of poor nutrition or even depression. When we talk to employers we often ask what keeps them awake at nights; not a bad start with your older loved one either. A pattern of poor sleep can lead to other health problems: increased blood pressure, inflamed blood vessels, increased stroke risk and more. If you do not ask, it may be you who loses sleep.
2. Coffee in the Kitchen? – I had mentioned this as a way to get a current take on how well your loved one is eating. But ask about when they have coffee. Coffee during the early half of the day can impart all sorts of healthy benefits: reduced risk of stroke, diabetes and even some types of cancer. Taken too late in the day, however, we get back to sleep issues.
3. Activities? – What does your loved one do on a regular basis that keeps them engaged or keeps them active? They do not have to wear a pedometer to track their activity levels, but it is important that they get out and move. Walking about an hour a day has a marked impact on wellness by way of increasing caloric burn and helping with cardiovascular circulation. It's true that if they do not use it, they will lose it.
4. How are you? – I started by saying we have to move beyond the general questioning, but it is important to ask how your loved one is feeling. Depression often has some very tangible tells. .And cardiac issues can have warning signs that can occur months before an attack. For women the signs are less clear than they are for men, so don’t assume that indigestion is about food or any other subtle cues are just a passing issue. Listen for what they may call “nothing;” it can be something.
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. You also are invited to the SASI/CCM event: 6pm - Tuesday, September 27 Bradley Investment Center 3000 Central Avenue, Evanston Noon – Thursday, September 29 Evanston Chamber of Commerce 1609 Sherman Avenue, Ste. 205, Evanston These workshops will be free, but registration is required. Please call – 847/864-7274 or email – info@SASIathome.org End of year gatherings and visits can provide an opportunity to observe the older adults in your family in a new way. What should you look for? What can you do if you have concerns? Come to find out…and bring your questions. Charlotte Bishop is a certified Aging Life Care Professional (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.