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

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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Five Things You Need to Know about Coronavirus
Okay, there may be more than five things you want to know about the coronavirus, but these five basics...
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January 28, 2020
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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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A House is Not a Home (Part 3)
At CCM, home and safety are as important to us as to you, so it’s no surprise that it’s...
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June 18, 2017
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A House is not a Home (Unless You’re There)
At CCM, home and safety are as important to us as to you, so it’s no surprise that it’s...
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June 5, 2017
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In the Caregiver's Words

Recent Client Praise

I attended a medical visit along with one of my clients recently, and he was presented with a document on his rights and responsibilities as a patient. As geriatric care managers and care professionals, we often accompany our clients to a doctor's office visit so that we can help ask the questions a patient may not consider and assure that the patient understands all the provider's explanations. Some organizations these days call them their "patient's bill of rights," and they typically contain all the usual information on how they promise to safeguard a patient's privacy and the confidentiality of their records. This particular document spelled out some of the patient's responsibilities, such as asking questions if they don't understand something. But it also stated that the patient is responsible for taking an active role in their medical treatment and following the instructions offered by the provider. I thought to myself, "You mean like taking the medication that is prescribed for the patient's condition?" Well, it turns out that failure to comply with prescription instruction is a really big problem; in fact, it is referred to by policy folks as American's "other drug problem." Did you know that:
- more than half of 65+ year olds take five or more meds routinely
- about 25% take between 10 and 19 pills each day
- nearly 60% in a recent survey admit that they miss doses
- among those on five or more meds, the percentage missing doses is 63%.
The economic impact of all this non-adherence is estimated to be $100 billion annually. Non-compliance also is the cause for 125,000 deaths in America annually and $290 billion in emergency room visits and other avoidable medical expenditures. Non-compliance also is the root cause for an estimated 23% of nursing home admissions (estimated to cost $31 billion) and 10% of admissions to hospitals (estimated at $15 billion). The cause can be just plain forgetfulness or cognitive shortcomings like dementia or Alzheimer's. Some older adults still choose between food and medicines if they are on limited means. If you are a caregiver to an older loved one, you can help improve their compliance and here’s how:
1. Communication: If an older adult understands the severity of their condition, they are more likely to be compliant; help to ensure the provider explains this.
2. Participation: Patients are more likely to be compliant with a regimen if they are engaged as partners in their own care; empower your older loved one.
3. Pharmacists: It can be easier to order prescriptions by mail, but the engagement with a pharmacist can be very helpful in reinforcing what a provider has said.
4. Support: There are groups of people with like conditions that can meet and support one another's compliant behavior; birds of a flock feather together.
5. Memory Aids: There are more than day of the week pill boxes available; some dispensers are computerized to help track missed doses and avoid over doses.
All of this reinforces medication adherence, but also remember that as a caregiver you should be on the lookout for drug-drug interactions, some of which can make adherence difficult. Tell the provider if you see new behaviors or symptoms as soon as you notice. Charlotte Bishop is founder of Creative Care Management, certified professionals and geriatric care managers who are advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.
Excess weight is not healthy and obesity definitely is not healthy, right? When it comes to your older parent or loved one, the answer is a bit more ambiguous. Picture you have been going to the physician with your older mother for a number of years, and mom has been “robust,” BMI 29, but not what would strictly be termed obese. (BMI, or body mass index, is calculated from a person’s height and their weight, and technically 30 or higher is considered obese.) This year, however, mom’s BMI is up to 30, yet she has not gained a pound. So, by the book she is “obese?” Not necessarily…this is part of what is termed the “obesity paradox.” As a person grows older, there is a tendency to lose muscle mass, and it can get replaced by body fat. There is also a tendency to lose height while maintaining a stable weight as in the case with “mom” above. As people age, they may accumulate more “protective weight,” weight that can be a reserve against unintentional weight loss. Among the young obesity is associated with adverse health impact in the form of risk of hypertension, diabetes, heart disease, certain cancers and a negative effect on most organs of the body…and reduced life expectancy. Yet, some older people who are patently obese have dodged these ill effects. These are also part of the “obesity paradox.” The fact is that a lot of their younger cohorts may already have succumbed to disease before they got so old, not unlike the octogenarian who has smoked a pack of cigarettes a day and continues to smoke without any seeming impact on their health. So, should mom lose weight? If it is all weight around the mid-section, weight loss is called for. Appreciate that any weight loss regimen is likely to result in loss of muscle as well as fat and therefore deconditioning. The rule is that weight loss in the 5 to 10 percent of body weight range tends to have positive effects. Also, weight loss that owes to real life style changes such as diet and exercise are positive. This kind of program should also include sufficient intake of protein to be safe. The American College of Sports Medicine also recommends exercise at least twice a week. This exercise should include strengthening exercise and resistance training. They identify what some call “muscle confusion” training which simply means changing up the regimen frequently to encourage a more nimble and flexible gait, balance and core strength. It is also helpful to involve your older loved one’s primary care physician to assure that their medications do not introduce issues of balance or body hydration. But beware of the physician who cautions against exercise for a “person of this age.” Don’t let them discount mom because of birthdays. Get a second opinion. And remember that it ultimately is about quality of life…and a healthy weight. 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.
The mid-summer holiday – Independence Day - may be behind us, but the heat of the summer is upon us. If you have an older loved one in your orbit, you need to be aware that summer is more than just about sun screen among older adults. Their biologic thermostats do not work as efficiently as a younger person’s and that can mean real medical consequences from overheating. And if they have any medical conditions like hypertension, etc., it is even more important to protect them from the heat. First, be aware of the signs of overheating; it is more than the obvious thirst that all can feel. The signs can include sudden dizziness, nausea, headache, cramping, swelling in the ankles, lack of coordination or coherence and unusually cool or even clammy skin. Encourage your older loved one to follow some simple rules during the heat of the day … or the heat of the night when even sunset brings relief from the rays of the summer sun but not the residual heat.
- Avoid strenuous exercise midday to early evening. The added ten to twenty degrees that midday adds to the early morning can make a critical, deleterious difference. Encourage that daily walk during the morning or post-dinner hours.
- Drink plenty of fluids. The old rule of thumb has been eight glasses (eight ounce capacity) of water daily. Beware that drinking caffeinated beverages or liquor do not count as substitutes as they are diuretics and will actually remove fluid from the system.
- Shade helps. In the early or later parts of the day, the sun gives more shade as well as less direct heat. And when they have a choice, encourage your older loved one to walk on the shady side of a street. There will be a ten to twenty degree difference.
- Apply and reapply sunscreen. People can forget that sunscreen tends to “wear off.” Read the label for recommended intervals for reapplying sunscreen to avoid the harmful accumulation of rays to the skin. Sunscreen may not make a person cooler, but it will guard against the rays that can result in melanoma.
- Light colored clothes can make a difference in exposure to harmful UV rays and in body temperature. Ever notice that tropical clothing tends toward the lighter side of the spectrum? There is a good reason; it helps protect the body from the sun’s assault.
So, as we all enjoy the summer blooms and even a day at the beach, help protect your older loved ones…and yourself. And have a tall, cool drink of water for good measure. 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.
(Today's Guest Posting is from Senior Planning Services, a Medicaid eligibility assistance company) Sleep is an essential part of life no matter the age. As people age, acquiring a healthy amount of sleep oftentimes becomes challenging. A variety of psychological and physiological aspects can impact sleep. Uncovering reasons behind sleep issues, plays a part in improving the sleep pattern changes people face in later years. The recommended quantity of sleep needed for people varies throughout life. By older age, a healthy night’s sleep consists of seven to nine hours. Unfortunately, many older adults experience a range of sleep issues that interfere with the ability to fall or stay soundly asleep. The aging body undergoes many inevitable changes. Some of these changes may contribute to changing sleep patterns in older adults. The body may produce less melatonin, a hormone that promotes sleep, or symptoms of a disorder can interfere with quality of sleep. Possible physical causes of sleep problems can include: • Physical pain from chronic conditions • Congestive heart failure • Frequent need to urinate • Neurological conditions • Certain medications or supplements As people age, they often face a number of emotional stresses. Adjusting to life with a chronic illness or disability causes many fears, frustrations and worries. The loss of a spouse can lead to feelings of depression and loneliness. Financial concerns over rising medical expenses or retirement funds also lead to higher stress levels. Emotional stress and financial concerns interfere with quality sleep. Sleep affects the ability to concentrate and focus, impacting attention span, memory and mood. The risk of accidental falls increases with inadequate sleep, which can result in injuries. Poor quality of sleep also impacts the immune system, making it difficult to fight infections or recover from illness. If left untreated, depression and anxiety can worsen, causing additional problems. A general loss of interest in favorite activities or social withdrawal may occur, making feelings of loneliness worse. These feelings can exacerbate trouble sleeping. Poor sleep is not an inevitable part of aging. Many people that experience few health problems and emotional stresses generally sleep well. To address sleep issues, a primary care physician can diagnose any physiological causes and suggest a course of action. For example, pain relief or a decrease in the need to urinate may contribute to better sleep. Stress management and treatment for issues such as depression and anxiety can improve sleep. Doctors may prescribe medications to ease symptoms of mental illness or teach relaxation techniques to encourage restful sleep. Participation in social activities can positively impact mental health and reduce emotional stress. A financial plan for retirement, medical expenses or long-term care by a qualified Medicaid planning and consulting company can provide a realistic outlook on future costs, which can be broken down into manageable steps. An exercise regimen approved by a physician promotes better sleep in general as well as a boost in overall mood and mental health. Other lifestyle changes that may help improve sleep include: • A quiet bedtime routine • Avoiding stimulants and alcohol • Smaller meals before bedtime • Reserving the bed for sleep and sex only • A regular sleep/wake schedule Sleep impacts quality of life. Just because a person has reached a certain age does not change the importance of getting good sleep. Determining the cause of sleep issues will help identify ways to alleviate the problems and improve sleep. Overall physical and mental well-being can depend on the quality of sleep a person gets, affecting mood, alertness and health. Ultimately, sleep problems should not be taken lying down: just good sleep should. Senior Planning Services is the ultimate solution for optimized Medicaid eligibility. Thousands of Medicaid applicants and their families have relied on the expertise of Senior Planning Services. Please follow this link. 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.
If you were diagnosed with dementia, would you want to be told? If you said “yes,” you are in agreement with nine of ten Americans in nearly two dozen national surveys on the subject. Even among patients actually diagnosed with some form of dementia, 85% said that they wanted to know their diagnosis. Yet, according to the Alzheimer’s Association fewer than 50% of Alzheimer’s patients or their caregivers actually have been told by their healthcare providers. Why the disconnect? I have written in the past about people’s greatest fears as they age, and it is not that they may (will) die; it is losing their cognitive abilities. A fair number of healthcare providers reportedly withhold the dementia diagnosis from their patients and the patients’ families because they are concerned about the stigma that knowing may represent. Others are concerned about the impact a misdiagnosis might have or they just do not know how to communicate with these patients or help the family learn to cope with the diagnosis. Some providers also write this off as just another part of “normal aging” or ironically they “forget” to mention these cognitive symptoms. Despite all the logic or the excuses, there remains an ethical obligation to disclose a dementia diagnosis and to help the patient and family confront the issues head on. There is a general appreciation that dementia is presently incurable, but knowledge of the diagnosis early can help families to decide on treatments as well as a future plan of care. There are currently five FDA-approved treatments for Alzheimer’s Disease … the acetylcholinesterase inhibitors like Aricept and memantine, Namenda. None of these can prevent or reverse the disease, and none of these is indicated for other dementias beyond Alzheimer’s. But they can slow or eliminate the build-up of beta-amyloid or tau proteins. In a recent posting I also talked about dementia being type 3 diabetes, so medications that can limit the inflammation in the brain or insulin resistance also can have some benefit for patients. And there are therapies in development that show some promise as well. While all states have some level of mandatory reporting of abuse on the part of healthcare providers, only a handful require dementia disclosure. More require reporting epilepsy as a traffic safety issue than require dementia. But it is more than a traffic safety matter; disclosure is one more step toward helping the caregivers to dementia sufferers get training and help in their day to day activities. As recently as 2012, it has been reported that more than 15 million Americans provided in excess of 17 billion hours or unpaid care to loved ones with dementia. If you are a caregiver to someone showing signs of cognitive decline, speak with your loved one first and then accompany them to their next physician’s visit. Speak with the physician about your concerns. Most likely you will need a referral to a neurologist who will put in an order for a brain scan. If you insist on a candid conversation, not only will you know what the actual diagnosis is, but you will be directed to a host of community resources to help everyone manage your care receiver’s condition. You and your care receiver will be better served. 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.
Yes, you read it right. I am posting this one about what caregivers should know about their Medicare. But you may ask, aren't home caregivers the ones supporting an older loved one...typically a family member? Well, yes, it is true that caregivers typically are caring for an older person; even older caregivers are caring for an older partner. But the average age of caregivers also is rapidly growing, with the average age of a caregiver who looks after a 65+ year old loved one at 63 years old. In fact, the average age of a caregiver today is about three years older than the typical caregiver of just eight years ago. Welcome to the mature boomers' generation. So, caregivers who approach or move beyond age 65 should be concerned with all the issues that have confronted aging Americans all along, like Medicare, for instance. And aging caregivers may not be paying attention if they are still in the workforce as growing numbers of people are. And that seem fine as long as they are employed and their employer keeps them on the group health plan, right? Wrong! If you are age-qualified for Medicare, you need to enroll as soon as you can. So, as soon as you turn 65, you should sign up for Medicare Part B which will cover your outpatient services. Or, if you stay with the employer, you still need to sign-up for Medicare within eight months of your retirement. If you do not enroll in Medicare during the predetermined time frames, you will face waiting periods just to enroll. And then you will face a waiting period for the coverage to kick-in. And here is the kicker. If you maintain your employer's coverage thinking that is all you need, you will be in for a surprise once you submit your first claim if you had been eligible for Medicare - but had not enrolled. Your commercial insurer will consider their coverage now to be your supplemental coverage, honoring only what Medicare would not cover. So, you would be one of those who have paid for the commercial insurance, but it will cover only a very small part of your bill. So, pay attention to your Medicare enrollment period regardless of your employment status. You are eligible to enroll in Medicare three months ahead of the month of your 65th birthday through three months after. And by the by, you will pay a penalty for every 12 months you delay enrollment beyond your 65th birthday month., That amounts to a 10% per 12 month period over the normal Part B premium permanently. So family or home caregivers, enjoy working as long as you wish or must, but pay attention to your calendar, because Medicare certainly will be watching for your birthday! Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends senior health services to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com