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

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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Food Fight
When you hear the word cancer a lot can come to mind such as “cancer survivor,” “living with cancer,”...
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August 23, 2022
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The Will To Do the Right Thing
This whole idea to write up a legal document to give surviving loved ones clarity about how to take...
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August 9, 2022
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Why Mister Rogers Was Right
Mr. Rogers Told You…but were you listening? And it wasn’t just once that he shared the message; it was...
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August 2, 2022
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In the Caregiver's Words

Recent Client Praise

In my last posting I shared geriatric care management services for caregivers communicating with a loved one who may be suffering from dementia. If you have a loved one who has Alzheimer's or one of the other types of dementia, you know all too well that they are not the same person they once were. But have you actually spent some time trying to understand who they are? Have you tried to understand what it is like inside dementia? Try this hypothetical situation. As you awaken tomorrow morning, you make note of the time, and you know that the dogs need to be walked because they have been in their crates all night. You have just enough time to walk them and then have breakfast and get to work. As you go downstairs to the kitchen, the crates are not there, the dogs are not there. In a minor panic, you turn to your wife who is there and ask where on earth the dogs and their crates are? If your wife of many years tells you the dogs have been dead for six years and that you have dementia which is making you confused, how do you feel? ...probably confused, anxious, frightened, and then sad - very sad. That used to be what professionals recommended to caregivers of individuals with dementia - a bit of reality-grounding, but today, the more accepted approach is one of empathy or what therapists call redirection and validation. So, this kinder approach to the situation might be to apologize for not letting your loved one know that the dogs are being groomed and that if they wish you can prepare a breakfast for them. A patient with dementia may suffer from delusions or hallucinations, and these can be intense and stressful events. So, affirming their feelings and then helping them to shift to something more soothing can be very helpful. This older adult who just happens to suffer from dementia still is the person with feelings who is just behaving in what they perceive to be a rationale manner. By validating their feelings and then redirecting their behavior, you are helping them to cope with the world as they see it. Some therapists even suggest that this helps to restore a sense of self-worth that will be helpful in avoiding some future episodes or anxiety:
1. First, ask questions that will help you understand what has triggered the response. I had a client who saw little people around the perimeter of the room painting the baseboards. Once we understood that these people did not speak or harm him, we could incorporate them into his world while still interacting with him.
2. Don't think that it all has to be logical. It is more about how your loved one feels than it is about if it makes sense. Just go with it.
3. Especially if your loved one is upset, try to gently find out what makes for the upset. Then, validate by agreeing that you would be troubled also if its happened to you. You will find that the anxiety for both of you will subside.
4. The bottom line for all of this is to gently give your loved one an out and a chance to save their self-esteem.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends who provide geriatric care management services to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
If you are a caregiver to someone with dementia you may have found that communication can be frustrating, but you need to remember how frustrating communication is for the patient as well. As a geriatric care management professional, I'm going to offer a couple of postings on how to get the most out of communication with someone suffering from Alzheimer's or other types of dementia. The figures reported suggest that as many as one in every ten people over age 65 will develop some form of dementia. It is important right off the top to appreciate that the dementia patient is going to be frustrated as they try to address not just your questions, but perhaps even who you are. This confusion can manifest itself as anxiety (imagine being always lost), irritability, poor self-esteem or depression (by only if they are aware of their condition). Appreciate also that most forms of dementia are progressive medical conditions that will worsen over time requiring you to adapt your communication to meet the changing needs. Follow these tips for more effective communication for you both:
1. When you first approach the patient, do it from the front so as not to startle them; use their formal name - Mr. Jones - as you address them and maintain eye contact.
2. Be calm and reassuring by speaking slowly and in a gentle tone, using simple words; repeat yourself if necessary or rephrase only after trying the same wording a couple times.
3. Take your time speaking so that the patient can take their time to process your question and formulate a response; and remember just one question at a time.
4. How you speak and how you look will be as important as what you are saying, so smile and speak in a gentle voice.
5. Humor can be relaxing to both you and the patient, but always be careful to not make the patient feel they are the object of the humor.
6. If the patient is a loved one, hugs and touches are every bit as important now as they may have been when the patient was more lucid.
7. Try to keep to a regular schedule of daily activities with a dementia patient to help them feel the comfort of a routine; change is difficult and can create unnecessary anxiety.
8. Appreciate that early learning may stay for a long time after the patient no longer tracks a given conversation; in religious services I have found that a patient may not track a scriptural reading, but they can recite the Lord's Prayer.
9. While a dementia patient may take longer to dress themselves, it is important to allow them to do so. If you begin doing tasks for them, they may lose the ability to take care of themselves entirely.
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 have talked in the past about making home safer for seniors as well as geriatric care management services for those considering a move to residential communities. But the financial and practical fact of the matter is that owning the family home may prove to be less affordable as well as less livable for adults in retirement. Never mind that classic picture of older adults whose kids have graduated college. They have burned the paper of a paid-off mortgage and can now live for free! Well, a lot of seniors were hit by the Great Recession just like other homeowners, and the house is not really free and clear. For virtually everyone, the cost of the house still includes real estate taxes which continue to rise even though housing values have declined in most markets. And the costs to maintain a house tend to come in big chucks like the cost to replace roofing or a new furnace or a hot water heater and more. Some older adults never got to the point where they could buy their own home in the first place. A study issued by the Joint Center for Housing Studies of Harvard University found that older adults make up about 13 percent of the rental market in the U.S. That is precisely the share of the U.S. population that is 65 years of age or older, and the percentage is expected to grow with the baby boomers adding to the number of renters. Finances and age are just a part of the decision to rent or buy; also important are health and lifestyle. Regarding health issues, if you are a caregiver to an older adult you may find that they can maintain their independence longer in a rental property that in a conventional home. Rental properties typically can offer a residence all on a single floor for any older adult with difficulty getting around. More current housing also will offer elevators to make getting from the ground floor to their apartment unit easier. And don't overlook the convenience of having a landlord taking care of the heating and cooling systems, the laundry machines and the roof. They also will maintain the lawns and walks. Regarding lifestyle issues, older parents may wish to have the added security of being able to be away from home for extended trips without the worry about safety of their homes. The added safeguard of two front locking doors and nearby neighbors can make it easier to take a vacation or a trip to visit the kids and grandkids in another part of the country. And don't forget that lifestyle also can include the freedom that may come from not having the added weekend duties of a lawn and grounds. That extra time back in the week can be a real bonus for an older adult who really does have something better to do. Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends who provide geriatric care management services to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
I have asked our vice president for senior services, Steve Steiber, Ph.D. to share a guest posting about the recent news on prescribing combination medications including acetaminophen. Dr. Steiber has two decades experience in pharmaceutical and medical device consulting prior to joining CCM about 8 years ago. He reports: Let me start by saying very unequivocally that when taken as directed, Tylenol (acetaminophen) is a safe and effective analgesic. That said, the US Food and Drug Administration (FDA) has recently asked healthcare professionals to stop prescribing prescription pain relievers that contain more than 325 mg of acetaminophen per dose. The reason is very simply the potential for liver toxicity. This is not news. Medical providers have known for some time that acetaminophen in excess of 3,000 mgs a day can shut down the liver; some even place the bar lower at closer to 2,000 mgs. This latter threshold may be most appropriate for older adults as their systems do not process chemicals out of their bodies as readily as younger bodies do. The most recent attention from the FDA is for the number of what are called combination medications - those that contain two or more active ingredients. Acetaminophen is one of the more common additives to other pain medications, cold and flu medications or allergy medicine. In fact, - which contain Tylenol in addition to something else. It is estimated that there are in excess of 70 medications that contain some amount of Tylenol in combination with something else. FDA has set the dose limit of acetaminophen very simply because there seems to be no evidence that doses in excess of 325 mgs does any more good than the lesser dose. Although acetaminophen is classified along with drugs like naproxen or ibuprofen as non-steroidal anti-inflammatory drugs (NSAIDs), unlike these other two, it is a very weak anti-inflammatory. In short, more is not necessarily more effective. FDA's action will have the most direct impact on some of the heavy hitters among pain medications, those also containing an opioid like codeine, hydrocodone or oxycodone. In some of these mixtures, there is as much as a 750 mg dose of acetaminophen. According to the FDA: "There are no available data to show that taking more than 325 mg of acetaminophen per dosage unit provides additional benefit that outweighs the added risks for liver injury. Further, limiting the amount of acetaminophen per dosage unit will reduce the risk of severe liver injury from inadvertent acetaminophen overdose, which can lead to liver failure, liver transplant, and death." FDA had asked that drug manufacturers comply with this request by January 14 of this year, but it would still be advisable if you are a caregiver to an older loved one on one of the affected medications that you read the label and the doctor's recommended dose. This will be particularly true of over the counter (OTC) medicines that contain acetaminophen as they are not covered by this action. Please let Steve know if you have any questions about drugs, their side effects or the unique medical challenges faced by older adults or others with special needs. Please email to: ssteiber@creativecaremanagement.com
I have talked in a lot of my postings about advanced directives and how we all need to prepare for the end of life crisis that will face us ... and our family members. If you are a caregiver, you should have had the talk with your senior loved ones about what care they want under a variety of life's end game scenarios. And hopefully your older loved one has placed in their physician's file or medical chart at the hospital what they would want to happen were they were attached to a respirator or worse. These are those quality of life decisions. That said, you may still face all the questions we all will when we are addressing the mortality of a mother or father. What would mom or dad want? And that is the right question. We all should know with some certainty before the time comes what mom or dad have expressed as their desires should help to avoid the tough decision of life support or end of life. And the one person we really cannot ask is the physician. As a geriatric care manager, I am involved in decisions like this with some frequency, but I always make it clear that my counsel is not based on what I would do in someone else's place as much as it is about honoring the wishes of an older loved one. So, the children of the older loved one can always ask about health care options. What are the likely outcomes of whatever course of treatment and what alternatives does the family have are important conversations to have with your loved one's provider. I recently read of a doctor who was asked by the children of an older patient consigned to the ventilator what he would do if in their situation. Realistically we cannot ask the provider what he or she would do when facing and end of life decision for his or her parent. That is their decision, and it should have been based upon conversations the doctor will have had along the way with the doctor's parents. It is not a medical decision; it is a personal decision. So, the simple point is that if you are a caregiver to an older loved one, you should already have a good idea what the answer is to that kind of ultimate question is. And if you do not have a clear answer, then it is time to restart the conversation. Yes, it will seem awkward at first, but you may be surprised to find that your older loved one already has given this a lot of thought and likely has an answer to help prepare you and them. 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.
Today we have a guest Post from Christina Padilla, a speech-language pathologist and Certified Dementia Practitioner living and working in Evanston, IL. Let’s face it: nothing about dementia is easy. It’s as hard on the individuals with dementia as it is on the people who love and care for them. But you can still maintain a rewarding relationship with your loved one by learning some communication strategies to improve your daily interactions throughout the progression of this disease:
1. Focus on the relationship. It is better to be in relationship than it is to be right. Your loved one is going to say things that hurt or upset you, possibly even accusing you of things that are not true. It’s important to understand that this is part of their disease and does not reflect reality. Arguing or correcting them with a “reality check” will only lead to anger and agitation but attempting to enter their reality and understand the true origin of their feelings will deepen your relationship.
2. Identify the underlying need. Given the communication difficulties people with dementia are experiencing, the words they say often don’t reflect the real message they are trying to convey. They may not be able to adequately verbalize when they need to go to the bathroom or feel hunger, pain, cold, loneliness, or sadness. They may feel they are living in a different time of their lives, as many people with dementia regress to an earlier time over the course of their disease. With a few well-placed questions and a little detective work, we can identify the need within their message and help meet it.
Having these two as a general grounding, use these tactics as you communicate:
1. Apologize sincerely. This is not admitting to wrongdoing, but rather offering an apology for the distress they are experiencing. It is important that you be sincere if you use this strategy.
2. This does not mean pretending something is true when it is not, but rather entering your loved one’s experience instead of denying it. If they are having an hallucination, you can ask them about what they see without pretending you see it too. If they accuse you or someone else, you can acknowledge it by saying, “You’re thinking I…” and then try a transition phrase such as, “Let’s figure this out.”
3. Ask simple questions. Yes/no questions are too narrow and will often end the conversation but offering either/or choices (Are you hot or cold? Are you hungry or is it something else?) or asking simple open-ended questions (Can you tell me more about what you see?) is a good way to get more information. Often acknowledging your loved one’s feelings/experience is all they need, and you can gently redirect them by suggesting an alternative activity or segueing into a new conversation. If they feel heard and seen, they will usually follow your lead.
Here are a couple of examples of situations and ways to respond that can help give you more information about what might really be going on:
1. Situation 1: “Someone stole my purse!”
Response: “You’re thinking your purse has been stolen! Let’s figure this out. Where do you usually keep it? Do you need something inside it or did you want to go somewhere?” In this situation, you are not only acknowledging your loved one’s feelings, but also gently helping them to find the lost item while at the same time investigating why they need it. Maybe they are looking for a tissue, want to go for a walk, or are living in a past where it’s their job to do the weekly shopping. Once you figure it out, you can follow their lead or redirect (e.g., why don’t we take a walk to the corner store).
1. Situation 2: “Help, I’m covered in ants! They’re crawling all over me!”
Response: “I’m so sorry, that must be very itchy! Why don’t we move to another chair and put on some of this lotion?” In this situation, your loved one is hallucinating based on a physical stimulus, possibly feeling itchy or even pain. By acknowledging their discomfort and then offering a possible solution, you validate their experience while at the same time calming and redirecting them, and the outcome is much more pleasant than if you had tried to convince them there were no ants. These are just a couple examples of how patience and your “detective skills” can improve your communication and deepen your relationship with your loved one living in dementia … remember that you are living with it and can walk away. They can’t. You won’t always get it right, and every day will present a new challenge, but the more you practice, the more easily you can flow along with your loved one’s experience, and your new understanding may just take you to some wonderful places! Christina Padilla is a speech-language pathologist and Certified Dementia Practitioner living and working in Evanston, IL. She has spent the past 11 years working with adults with neurogenic disorders and disease and their families to improve communication, swallowing, and cognition for a better quality of life. If you wish to ask her a question or wish some help within your own orbit, please email by way of: info@creativecaremanagement.com . 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.