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

The High Cost of Wellness
Once in a while “yesterday’s news” is also tomorrow’s news. Earlier this year you probably heard or read that...
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August 15, 2023
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Long COVID’s Long List of Symptoms
The COVID pandemic is not yet done with us in the United States, and the story certainly is different...
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February 7, 2023
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A Viral Trifecta?
To get to the question in the email first, the Spanish flu of 1918 did not get its start...
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December 13, 2022
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Saying “No” May be the Right Answer
Saying “yes” when someone asks you to do something can be like eating candy. It feels right or good...
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November 15, 2022
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Doing Your Homework on Medicare Coverage
If you or an older loved one are at that age in the magical transition – otherwise known as...
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November 8, 2022
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Planning for the Holidays is More than a Menu
The latest news reports suggest only about 10 percent of American Adults have received their seasonal booster for COVID. ...
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October 24, 2022
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What’s Scarier than Halloween?
The short answer to this question is cybersecurity breeches. First, how do you know if that spam in your...
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October 18, 2022
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Treatments for Alzheimer’s Disease
September is Alzheimer’s Awareness Month, and this is the third of four posts we’ll offer on the subject. I...
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September 20, 2022
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Diagnosing Alzheimer’s Disease
September is Alzheimer’s Awareness Month, and this is the second of four posts we’ll offer on the subject. A...
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September 13, 2022
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Dementia, Distraction, Delirium and Depression
September is Alzheimer’s Awareness Month, so we’re going to be sharing four posts that will help everyone with what...
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September 7, 2022
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In the Caregiver's Words

Recent Client Praise

Yesterday, we talked about dealing with stress and melancholy during the holidays. Here are even more tips that you can use to cut down on stress and post-holiday blues while caring for a loved one. Remember, it is okay and understandable to feel down during and after the holidays. But the more you are prepared, the better your holidays may be.
1. It’s okay to say no. When it comes to holidays, if you feel the need to cut down on the amount of gatherings you’ll be able to attend this year – there’s no need to worry. Pace yourself – you’ll have a much better time, especially you tend to feel overwhelmed when running around place to place.
2. Keep gatherings small. You may find that scheduling festivities with smaller groups is much easier to manage as well as much more comfortable for you and your loved one.
3. Communicate. If you plan to host a gathering or go to one, be sure to talk to your loved one about it often so he or she is able to anticipate being social. In addition, talk to your guests beforehand about your loved one’s condition if they haven’t visited in a while.
4. Give yourself and your loved one a break. Realize that it is okay to take time out for yourself as a caregiver. You may find that setting aside a bit of time to relax is just what you need to reduce stress levels. Recognize that your loved one may need some quiet time too.
Last but not least, monitor how you’re feeling as you go through the holidays. If you’re feeling melancholic during festivities because you’re remembering how things were in the past, understand that this is okay and you should let yourself feel them. However, it may be a matter of focusing as much as you can on positivity, your loved ones, your happiness, and the present moment. You can find more these tips at Caregiver.com.

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 still in the throes of the COVID-19 pandemic, and the consensus among public health experts is that this will continue for some time. Getting back to “normal” – whatever that was – is an elusive target, and many suggest that for the most vulnerable we are working toward a new normal – whatever that is. So, what are the lessons learned thus far that can help us to protect our older loved ones from COVID-19, especially those who are living in senior communities where the virus has done most of its damage? The biggest cause of infection in these senior communities has been asymptomatic staff or residents with largely unrestricted access to the facilities. If you have an older loved one in a “senior community” or nursing home or any other supportive residential facility, you should ask about these specific steps that every residence should have implemented by now:
1. Testing – staff should be tested frequently, some suggesting as much as twice a week is required to stop the spread of COVID in a facility which has been likened to fire in dry grass;
2. Telemedicine – in order to maximize medical monitoring while still maintain distancing, facilities should have the means by which any residents can receive the care they need without the added risks of transport and exposure to medical facilities;
3. Monitoring – staff at facilities need to know all the residents well enough that they can notice when there are small changes in diet, sleeping or behavior so that health care providers can be called upon sooner;
4. HVAC – air circulates as people talk and the air they exhale is recirculated through a facility’s heating and cooling system – there should be an ultraviolet exposure to all air with each cycle through a facility;
5. Barriers – Plexiglas and plastic sheeting as well as routine applications of disinfectants should be used in all areas to block transmissions where staff and residents can come within close contact; and
6. Masks – the last and first line of defense is to protect others from the air we exhale, and this is true of staff and residents in senior facilities.
If you want to see what Illinois specifically is doing to protect residents of senior facilities and nursing homes as we move with and through COVID, click here. 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.
I had left you last week with what may have seemed to be an optimistic note regarding the latest Alzheimer’s therapy to gain FDA approval. I am going to hand this second part over to one of my senior team members, Steven Steiber, Ph.D. Steve has his doctorate in behavioral science and nearly 40 years in clinical and market research in biopharma. Please read what he has to say: “I’d like to start with some of the reaction to the Centers for Medicare and Medicaid Services (CMS) current unenthusiastic opinion on whether they will cover Lecanemab. When FDA approves a medication, it’s on the simple premise that the drug is first “safe” and second is “effective.” That sounds pretty rigorous, and yes, there’s a good deal of statistical testing with relatively large samples of patients in double-blinded (neither the patients nor the clinicians know if they’re using the new medication or a placebo) clinical trials. CMS takes this a step beyond what the numbers say and asks if the therapy is both “reasonable” and “necessary?” I believe they’ll announce their final decision in early July. I’ve had the good fortune to have attended a webinar this past week sponsored by the International Alzheimer’s Institute. They had a panel of professors, physicians and even a biostatistician discussing the “data” on Lecanemab. The first important point raised was simply to lay out that the amyloid plaque that lecanemab helps remove isn’t the source of Alzheimer’s. It’s the result of what Alzheimer’s does to the brain. It’s like rheumatoid arthritis in that the inflammation which swells joints is not the disease, but a result of the disease. And how much amyloid does Lecanemab eliminate? The 18-point scale used to measure the effect against placebo showed those who had received the Lecanemab injections had .45 units less amyloid at the end of the trial…2.5 percent less amyloid. The trial also used a cognition scale that could show no statistically significant difference between the experimental group and the placebo group. Clinical trials are also required to track any side effects reported by participants during the trial as well as after the trial is closed. The Mayo Clinic has a list of more than 30 side effects associated with Lecanemab, and one of the panelists on my webinar, a neurologist at Northwestern University Hospital, reported a macrohemorrhage in an otherwise healthy patient. She subsequently died. I won’t pass judgment on a new medication…above my pay grade…but I will continue to look for treatments that actually address cognition or can work upstream from the plaque accumulation that Alzheimer’s leaves in the brain. I would rather hire a contractor who can build a great house that the critics call brilliant than one whose only claim to fame is how tidy they leave the site when their work is done. I would encourage you all to follow other trials for a way to address Alzheimer’s as well as those therapies that target other neurodegenerative conditions like Parkinson’s or Huntington’s. I’ve got a number of start-up companies that I am following, and we’ll updte you when new information becomes available. Meantime, let’s see what the final word from CMS on lecanemab is." Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of, 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.
What is the most widely used drug by seniors? It’s the same one that is most widely used by all adults: caffeine. It’s estimated that about four in five adults world-wide consume at least one caffeine-containing beverage daily. I am going to share with you not one, but three quizzes on this go to “medication.”
1. Considering caffeine and some common medical conditions, which of these is true?
a. Patients with chronic kidney disease who drink caffeine have significantly lower mortality.

b. Caffeine improves motor function in Parkinsonian patients.

c. The risk for rosacea is dramatically increased with caffeine consumption.
Odd as this may sound, it is “a”. People with chronic kidney disease have a lower risk of dying if they consume caffeine. It was a study among 5,000 chronic kidney disease patients, and those who drank caffeine drinks had a 25% lower risk of dying. Drinking more caffeine did not get more benefit from the caffeine.
1. Which one of these is true about caffeine and heart health?
a. Consuming unfiltered coffee significantly increases the bad cholesterol and triglycerides in the blood stream.

b. Moderate caffeine consumption increases the likelihood of elevated blood pressure.

c. Regular caffeine consumption increases the deposits of calcium in the arteries.

Again, it is “a”. It is all about how the coffee is prepared, because unfiltered coffee can have some bad effects on blood cholesterol. The lesson here must be that filters good; no filters bad.
1. Although this may vary by individual, what is the “toxic level” of caffeine in the blood system of a healthy adult?
a. 400 mg per deciliter.

b. 600 mg per deciliter.

c. 800 mg per deciliter.
Okay, you may be on to me if you said “a”. There is variability across individuals, but 400 mgs is the limit, so more of a good thing can be a bad thing. And the very young have even lower threshold which is a bit scary with all the high caffeine canned beverages available to your people these days. By now, you have to be wanting to know how many milligrams in a cup of caffeine. The answer is about 95 milligrams, but of course, that may vary depending on who is making the coffee. Now, how did you do on the test? If you are satisfied with your score, figure out how much caffeine you have had so far today to see if you should reward yourself with a trip to the coffee maker. 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.
Let me first say that Medicare is absolutely a boon to older adults who will face many medical issues associated with aging at the same time they also are on more modest fixed incomes than they had enjoyed in their earlier years. Now, shift gears from Medicare to Medicare Advantage, or Medigap as it is often called. These are also called Part C plans, and they can pick up what otherwise would be out of pocket costs like copays or deductibles not covered by Medicare. Medicare Advantage plans have more than 22 million enrollees, and no one would term these supplemental plans (whose open enrollment just closed) a scam. But there are some not so obvious costs embedded within many Medicare Advantage plans that everyone should know. You don’t always hear about what happens if you switch carriers for Part C. Especially if you have had a medical event like a surgery or diagnosis or accident that may lead to ongoing issues…or not…issues such as if you’ve had a medical event…which will then become a “pre-existing condition. Try to change plans and suddenly some care coverage will be denied or some of your specialists are not “in network” or coverage may even be denied. All of this is not something that we can fully address in a single blog post, but every 65+ year old deserves an advocate who can help sort through a very complex minefield of coverages. So, if you are a caregiver to an older loved one, you have almost a year to do some research in anticipation of the next enrollment period, and here are some resources to help. Specifically, check out this: Medicare.gov Medicare also has a resource titled: "When can I buy Medigap?" And there is another Medicare publication that explains the rules for getting in or out of a Medigap plan. As I have said, you have nearly a year before the next open enrollment period. Please do your homework…and maybe even consider it advance planning for your own future. I had used the plural –scams. Continue to help protect your older loved one from:
- Winning a Sweepstakes – if they get the call that they have “won,” and all they have to do is give some personal information or pay a “fee for the transfer,” hang up!
- Tech Support – may call to help your loved one defend themselves against a “virus” or “malware,” don’t let them go to a site, log on to anything…just hang up!
- Old Crushes – may reach out with a text or email harkening back to a school crush from back in high school – log off or hang up!
- Social Security – if someone calls about benefits or technical issues, don’t give them any information – first hang up and then call the Social Security Administration directly – 800.722.1213.
Now, you will have made someone’s world safer. Please enjoy the run-up to your holidays, and embrace your families. 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 past couple of entries have been about facing difficult decisions about transition with an older parent, perhaps toward independent living and out of the family home. The initial conversation of moving is very difficult and challenging for a number of reasons. Memories of watching children grow up, birthdays, anniversaries, and more still live within the space. It’s hard to give up the home you’ve worked for, lived in, and raised a family in. Therefore, if you do believe that moving out is an option that your parents should consider, approaching them compassionately and openly will help make the conversation easier.

The most important thing you can do in a conversation like this is to schedule time away from other personal distractions. Make sure you have time to really listen to your loved one as this conversation may not be resolved in one sitting or even two. However long it takes, it is important to really understand your loved one’s concerns and try not to be or seem dismissive. As stated in a previous entry, this decision should ultimately be theirs to make. You might find yourself focusing on convincing or persuading rather than investigating how they feel about their options. By listening, you may discover that there are other options for them you wouldn’t have otherwise considered.

Another important tip is to come to the conversation prepared. Learn about independent living communities that they might be interested in. Once you’ve heard their concerns and worries, you might be able to address them in a more informed manner. It is also important to avoid pushing the issue if you feel they’re getting angry or upset – try to come back to it at another time.

Most of all, it is best to be understanding without trying to rush the decision. This is why it is never too soon to have this very important talk.

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.