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

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

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.
I promised in my last posting to talk more specifically about what can be made safe for seniors who wish to age in place – room by room. I am going to start with the room in the home where most accidents happen, the bath. The bathroom for most elders represents the perfect storm of a confined space with potentially slippery surfaces. Nearly one-third of seniors over age 65 fall each year, and the majority of these falls happen in the bathroom. With basic planning and potentially some retrofitting, however, the bath can be made more safe and accommodating to an older person’s limited mobility and range of motion. Let’s start with surfaces.

There may already be a rug near the shower or bath area, but make certain it has a sticky, non-slip back to minimize falls when an elder enters or leaves the tub. If your older loved one uses a floor mat in the tub area when showering, make sure that the suction cups still offer good sticking poser. You may consider adhesive decals that stick to the porcelain tub surface with soft gripping rubber top surfaces. In the shower area itself, consider having a bath bench or chair with non-slip feet if your elder has difficulty standing for protracted periods or is at all unsteady on their feet. If your elder loved one is challenged by lifting their feet over the tub edge to step in for a shower, it may be time to refit their bath with a stall shower with a low or minimal curb in place of a tub/shower combination.

Having a non-slip, moisture-absorbent surface near the tub is a safety assist, but any other loose rugs should be replaced or eliminated. Look for uneven floor surfaces or thresholds and consider eliminating them, beveling surfaces or highlighting them with paint or tape. Loose cords from radios or hair dryers should be removed from walkways, and other floor level clutter like magazine racks should also be eliminated.

Just as in hallways, consider installing grip bars at strategic points in and around the tub or shower as well as either side of the commode. For seniors with difficulty getting up from chairs, consider also a raised seat for the commode as well as grip bars that flank the sides of the seat like arms on a chair. There even are hydraulic assistive devices that can be installed on the toilet seat with a lift that can help ease the senior into a seated position and then boost them slowly back up as they rise from sitting.

Lighting is as important in the bath area as it is in the rest of the house. If the present circuits allow, it may be as easy as upgrading to a higher wattage bulb in all the fixtures. In old houses, however, it may be safer to refit with new fixtures that can offer more lighting. And also as with other parts of the house, have a night light that automatically goes on when ambient lighting fades.

Finally, make sure that everything that your elder may need with any frequency while in the bathroom is within easy reach. Remove actual glassware or ceramics from the bath and replace with plastic, especially cups that have gripping texture on the outside. And while you are outfitting the bath, keep in mind bright colors and pleasant decoration. Just because your bath is now safe does not require that it look institutional. Next week, I will talk about what’s cooking in the kitchen.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.

Copyright ©2011
This is the third in a series of posts on dementia in advance of the release of my new book, How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia. It will be released through Family Solutions Press of Los Angeles and available from Amazon the week of July 17. We will keep you up to date on details. Who are the experts on dementia? There are some incredibly useful on-line resources that families with an older loved one suffering from dementia can turn. We offer a lot of wide-ranging resources in our book, but here are the links on a couple of the more outstanding among them. Consider these national resources available to support the individuals who may need help when dementia rears its head. In these and other resources, there also are local or regional chapters that can be that personal touch that makes such a difference.: 1. Alzheimer’s Disease and Dementia Caregiver Center is an arm of the Association that has done the most to help patients with the disease as well. The Center provides training and other resources to caregivers as well as a 24-hour telephone hotline. http://www.alz.org/care/alzheimers-dementia-support-help.asp 2. Aging Care offers answers and support from those caregivers who also are facing the challenges of caring for a loved one with Alzheimer's or Dementia. The site allows you to “ask your questions and get helpful answers from caregivers, and memory care experts.” They also offer a free guide, "Life as an Alzheimer's Caregiver". The guide draws upon the experiences of elder care experts, caregivers to those with AD and patients themselves https://www.agingcare.com/Alzheimers-Dementia/Questions-1 In my book, we cover what we know about dementia, what can be done to stave off the effects of dementia and most importantly what caregivers can do for their loved ones with dementia and for themselves. We also offer a lot of resources, amny of them accessible on-line. 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.
At CCM, home and safety are as important to us as to you, so it’s no surprise that it’s a common topic of our discussion. I have asked Gregory Peebles to talk about this topic from the vantage point of his experience. 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. An Associate Care Manager, Gregory has been a part of our team for over a decade. – Charlotte Home. Not only is there no place like it, conveniently located wherever you hang your hat, that fits--like an old, comfortable shoe, but it’s also a place that once we leave, to which we can never return. While most find this very stressful, some are secretly happy for a new chapter. Indeed, lots of people confirm they like adventure, but small is the number who enthusiastically embrace major residential change. So what’s the difference? Well, for one, the direction of action: people elect to go on adventures, but change just seems to happen to us. This is a major life change, and those inclined deserve the opportunity fully to grieve their loss of home sweet home. However, once the initial grief has been addressed, we’ve got work to do! Change isn’t the end, and there’s plenty of life and happiness yet to be found no matter the location. Where that happens is up to you. The diversity of the experience of aging can be exciting, and, with the number of Americans joining the group of aging adults, the kinds of communities that now exist will only become more varied. Right now the kinds of accommodations available generally fall into a few groups.
- Active Adult Communities – Often neighborhoods with individual bungalows, these communities are based on the model of so-called “snow birds” who opt to transition to such a residential community rather than maintain a larger space. Living in one of these communities requires a high level of independence (and income). Individuals or couples with highly social personalities thrive in this setting.
- Independent/Congregant Living – Facilities of this type, while slightly less luxurious than an Active Adult Community, feature many of the same accommodations with a denser population. In an urban setting, they are often high-rise apartments indistinguishable from nearby housing, with dining, health care, and leisure activities on the premises. If considering this type of facility, be sure to keep nearby entertainment and accessibility in mind.
- Assisted Living – A senior for whom it has become difficult to care for themselves either because of physical limitations or decreasing independence will often find an exciting new life in such a facility, either through public assistance or private pay, where skilled staff are present to provide diverse care. If the care receiver is also living with cognitive decline, such a facility with a “Memory Unity” may be advisable.
- Skilled Nursing – On average, aging adults who become residents within skilled nursing facilities – SNFs - are those who have health problems, who require 24-hour care, and whose ability to manage the Activities of Daily Living is severely impaired. Nursing home care, too, is expensive, but public assistance programs such as Medicare or Medicaid relieve the cost.
Change is difficult, but not unmanageable. New identities await us and are only limited by our willingness to embrace them and the imagination we bring to our experiences. Change is scary, and rightly so, but when we weather even the most difficult transitions together, and our lives are no longer recognizable from before, we may--if we choose to--learn that home is something that we take with us wherever we go, and that it is recognizable not by its address, but by the love shared and the people with whom we share it, common to both our memories and our futures. One final thought: This is when people often reach out to Aging Life Care Professionals to help smooth the transition to a new residence and to ensure ongoing care. CCM has helped countless families like yours succeed in this new chapter. Contact us today and let us assist you. 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.
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.

Caregiver Advice on Bad Medicine Many are unaware of the massive scope of the pharmaceutical market and all the ways in which seniors are taking more and more unnecessary drugs because of it. We discuss how caregivers can look out for signs that their loved one’s medication is over prescribed and how to spot warning signs. Download
In my experience as a geriatric care manager, I field a lot of questions from people who are suddenly faced with caring for an older parent or spouse. For people who become caregivers overnight after a parent has a fall or experiences a significant medical setback of some sort, it can be an overwhelming responsibility. Where does one go to learn how to be a caregiver for an older adult or someone else with special needs? It is easy to tell a person how to become certified as a geriatric care manager (not as easy getting certified) or even a paramedic (again, not as easy getting certified), but how do you become a caregiver right away?

As much as some folks may have a predisposition for being “good with people,” being a caregiver poses some unique challenges and an aspiring caregiver can benefit from some special training. One of the resources I featured last month, Julie Northcutt – President of CaregiverList.com, talked about using summer visits as a time to take stock of the needs of aging family members of other with special needs. She has a new training module that has come to my attention, and I am sharing it with you here, because it may give a lot of you a jump start to caring for older family members or others in your orbits.

In her 10-hour on-line program, CaregiverList.com offers training that meets the requirements of state licensing boards for caregivers, and it also may offer peace of mind. I was impressed with its topical coverage:
- Communicating with Others
- Observation, Reporting and Recording
- Providing Personal Carburetting and Maintaining Good Mobility
- Elimination and Toileting
- Infection Control
- Environmental Hazards and Safety
- Basic First Aid
- Understanding Elder Abuse
At $49 it seems to be a reasonable investment in care for an elder and peace of mind and confidence for the caregiver.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.

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Singing is a Breath of Fresh Air for Caregivers

A House is Not a Home (Part 3)

A House is not a Home (Unless You’re There)

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