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

Medicare Doesn’t Cover WHAT?!
Gregory Peebles is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP) and trained Medicare Counselor, whose work focuses...
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June 18, 2018
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Do You Sea a Hero in Yourself?
Associate Care Manager Gregory is a Certified Senior Advisor (CSA) and Certified Dementia Practitioner (CDP) whose work focuses on...
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June 4, 2018
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What May Flowers Bring
April showers are supposed to bring May flowers, but what does May bring? It brings Mental Health Awareness Month…among...
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May 28, 2018
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Five Tips for Winter Because It’s Not Spring Yet
There is a lot of advice that goes around for older loved ones in our orbits when we see...
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January 16, 2018
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Is This Normal?
As we age, our bodies give us feedback we’re not used to. Activities that never required a second thought...
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October 23, 2017
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Insta-Gram: It’s a Date!
Associate Care Manager Gregory Peebles returns with a series on the Internet and aging. Gregory is both a Certified...
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September 23, 2017
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Insta-Gram Part 2: The Internet and Aging Adults
Associate Care Manager Gregory Peebles returns with a series on the Internet and aging. Gregory is both a Certified...
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September 4, 2017
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What to Look for When Your Loved One Needs You But Can’t Ask
Associate Care Manager Gregory Peebles returns with a talk about hidden signals of aging that need our attention. Gregory...
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July 31, 2017
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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 (Part 2)
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 12, 2017
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In the Caregiver's Words

Recent Client Praise

Okay, "Grain Brain" is not something that immediately tells you what it is all about. Grain Brain is the phrase that neurologists and other brain scientists are using to describe a link between blood glucose levels from high carbohydrate consumption and dementia. A book by the same name is going into its 15th straight week on the New York Times bestseller list, so the concept is getting a lot of attention. But what does it mean for you or an older loved one in your orbit? In a scientific study recently published in the prestigious New England Journal of Medicine, researchers followed a large group of men and one of women for an average of almost seven years. During this nearly seven years they regularly measured the individuals fasting blood glucose levels. At the end of the study they found that people with higher blood glucose levels were more at risk for developing dementia that those whose levels were not as high. They found this to be true even with people who did not have diabetes. It is true, that this kind of study cannot say that increased blood sugar levels actually cause dementia, but the link is sufficiently clear that the New England Journal would publish the findings. Scientists also find that not all grains have the same negative effect on cognitive ability. Those with the highest gluten content seem to be the worst offenders. This is not the first research to show negative health outcomes associated with elevated blood sugar. Researchers have well-established proof that a high carbohydrate diet and the associated elevation of blood sugar poses a risk to one's heart and to the immune system. And there are other studies. in a 2012 study in the Journal of Alzheimer's Disease, researchers reported that risk for cognitive decline was 89% greater among those on a high carb diet; those on a high fat intake diet saw a 44% decrease in their risk for cognitive compromise. And researchers in another British journal, Lancet Neurology, estimated based on their findings that as many as 54% of the cases of Alzheimer's Disease in the United States could be avoided with exercise, weight reduction and steps to reducing blood pressure. This last study really drives home a great point. If you are a caregiver to an older loved one, you both will see great returns on a few basic investments of time and effort. Increase the daily amount of exercise, reduce the carb intake and the rewards will be weight loss, reduced blood pressure, a healthier heart, a more vigorous immune system and more acute cognition. Sounds like a really great return on investment to me. So, will you and your older loved ones be among those who avoid the "grain brain?" 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.
You may recall nearly two decades ago a George Clooney movie came out that revolved around some men who made their living as fishermen. It was called “The Perfect Storm,” and the title drew upon what happens when not just one storms hits a ship at sea, but two storms. It was quite dramatic. Well, Alzheimer’s disease is like that Perfect Storm, but it is not just two storms. Those with dementia who are 65 years or older have not just two storms; they have an average of four chronic conditions – what doctors call comorbidities – along with the dementia. An average 65+ year old individual has about two comorbid chronic conditions. The most common comorbidities for Alzheimer’s patients are diabetes, urinary infections and depression, but there are also other cognitive aspects to dementia that impact more than memory. We often refer to the manifestations of Alzheimer’s disease as “cognitive impairment.” But cognitive impairment isn’t just about memory issues. If you have a loved one who has had the diagnosis, there is another facet to cognitive impairment called apraxia, and it is the most common manifestation of cognitive impairment. The healthy brain is a complex data processor that routinely connects things. It knows what a fork is and it knows food on a dinner plate when it sees it and it also knows how to use the fork to transport the food to the mouth. Rinse and repeat. But apraxia can put up a significant road block between those two cognitive processes. The brain sees the fork and it sees the food and the brain then comes to a halt…at least until someone helps to move the fork with the food to the dementia sufferer’s mouth. Clearly the apraxia can take on a number of basic forms, and understanding what your loved one is now unable to do can help in getting assistance as well as treatment for your loved one with dementia. Health care providers categorize apraxia along these three lines:
- “Ideational apraxia” describes the cognitive deficit of the person unable to process what an object is for…they see a car key, but don’t know how that enables driving a car.
- “Ideamotor apraxia” describes the kind of activity for which a person with dementia needs to be “primed” to do. They recognize a hair brush, but need to be prompted in how to use that brush for their hair.
- “Dressing apraxia” describes all the roadblocks in what used to be a taken for granted process. Think about seeing buttons, but not remembering how they align with button holes…or how a zipper zips, etc.
These are all important for the caregiver, because if you understand the deficit you can help your loved one and you to minimize the frustration of what have become mind boggling tasks. It will help you in asking for the appropriate assistance in respite or residential care. You can explain that “mom needs help dressing in the morning,” and the staff will understand and be proactive. Or “dad will need help with dinner and cutting meat,” and they can help dad do as much as possible on his own and with the least embarrassment. Within all of this it is about maintaining quality of life for your loved one with dementia, and that takes patience. And your patience can come from knowing what to expect and how to respond. Here are a couple resources on how to address apraxia: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341309/ https://medlineplus.gov/ency/article/007472.htm. 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.
In a posting last week, I shared some advice from a Senior Relocation Expert on how to help an older parent or loved one make their decision to move (or not) from the family home. Picking up where we left off, I have had the good fortune of meeting with Erin Marcus, a Transition Specialist with a company called Caring Transitions. ( www.estatemoveglenviewil.com ). I posed some questions about the move itself and how a Transition Specialist can make it as easy as possible for a senior dealing with a life's accumulation of "stuff."

            What are the major obstacles to making a successful move?

"It most often is the emotional attachment to the 'stuff'. If you are helping an older person prepare for a move, be cognizant that you are dealing with an adult...it is their stuff. You shouldn’t just be making decisions for them on what to keep based on what makes sense to you. Not only that, but it really is not even about the object; it is the emotions and memories associated with the object."

            How do you help an older person adjust to a new home?

"I have found in most homes, there is an area that you can tell a person spends most of their time. It may be the den or the area around a television, for example. When we help someone move into their new home, I make it a point to recreate that environment so that they immediately have a piece of their old home in a new home."

            Is a move different if the senior is moving to senior residential housing?

"Look for not where you will sleep at night, but how you will spend your days. Somewhere close to family…even closer to children tends to rank high. And Senior residential communities tend to really meet the social needs or an older adult."

            Can you give an example of what makes for a really successful transition?

"It really begins in the sorting process. It can make it go much more quickly with a third party involved. It eliminates the arguments. With the benefit of a third party helping, you relieve the stress on the family members to let them worry about the people and not the stuff."

            Any other insights from having been in the business?

"The first month in the new home is extremely important and can set the stage for a long time to come. Its important the people know they are not being put away or being ignored. Also, keep an eye on the routine and the adjustments that are being made."

Erin Marcus is the president of Caring Transitions, Chicago & North Suburbs.   Erin helps families through the process of moving, downsizing or liquidating their items as they move through life’s transitions. He can be reached at emarcus@caringtransitions.net or 224-374-1996.

            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.
It was a story about a prescription shared over lunch recently. During the course of a lunch with a caregiver, he relayed the “prescription” his spouse had received some ten-plus years ago from a specialist when she was first diagnosed with a chronic condition. …and how that specialist had reinforced that same prescription now more than a decade later, because it was working so well. When originally prescribed, the spouse had just received a diagnosis for one of those chronic and degenerative conditions no one wants to receive. While offering a medication that would help to mitigate some of the physical manifestations of the condition, the doctor paused and added another prescription. He said, “I also prescribe that you stay active, you stay engaged and you stay loved.” Let me explain, and then let me share the outcome of this doctor’s prescription. The doctor knew that retaining the same level of activity as the patient had once enjoyed was not a realistic expectation, but to continue any activity was vitally important to her well-being. Staying active means walking when you can no longer jog, or going for a drive when you can no longer bike in the country or embracing new activities or hobbies, learn a language or take up arts or crafts when you may no longer able to do the heavy lifting of what used to keep you active. Staying engaged means not giving up, for sure. But it means sharing experiences with others. It can be as basic as attending a musical or drama event or being engaged in an organization that is focused on lending a hand to the less fortunate. It means seeking help and accepting help from others within the community or even going on line for support. There is a support group for almost every chronic condition, and sometimes the affirmation of just knowing that someone else actually has experienced what one is now experiencing can be a breath of fresh air. Staying loved is a special kind of engagement. And to stay loved, one also must extend oneself and love another. It also means that one must engage in self-care, the active effort to feel better. It can also be as simple as taking time to relax, binge on a favorite program, read a book or listen to some particularly special music…especially with someone that one loves. There are a couple bonuses in this particular doctor’s three-pronged prescription. One, this particular patient has not had a change in the other prescription dose or strength in that entire decade-plus. Their condition is, as they say, well-managed. Two, it is great advice that the caregiver could follow and derive benefit as well. I always tell caregiver’s that there is an “I” in caregiver. There also is an “I” in care receiver! 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.
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Until quite recently there were rules governing what Medicare will reimburse if a qualified adult was prescribed physical therapy, occupational therapy or speech therapy. Patients needed to show documented improvement if Medicare was going to continue to cover their therapy. As with all insurance rules, a patient or the patient's families could pay out of their own pockets for any services a provider may prescribe, but until this year, the government was not going to pay for therapy without an improved health status. All that has changed now with a federal ruling that it is no longer necessary to show improved status to get reimbursed. If you are a caregiver to an older loved one or someone else with special needs who is covered under Medicare, therapy now will be offered to maintain a patient's present condition or to prevent "backsliding." Translated, Medicare now must recognize and support a patient who is attempting to stay as well and as active as they can be. As a geriatric care manager, this is very gratifying as a large part of what we do is to help our clients to maintain a quality of life, because beyond a certain age improvement is simply not realistic. Many of the old rules are still in place regarding where therapy may be received. It can be received at an outpatient center, a therapist's private office, in a nursing home or in a patient's own home. Authorization simply requires a doctor's order, so make sure your physician knows about the change. The same dollar caps on how much Medicare will cover still remain, and that is $1,900 a year. And even residents of nursing homes who have used up their 100 days can still get coverage for therapy, so long as they do not exceed the cap for the therapy. This, too, can be challenged , in certain cases, so be sure to check in with a local office of the Centers for Medicare and Medicaid Services for the terms. And claims for patients who may have been denied before this year may still be honored retrospectively back to the date when the lawsuit was first filed January 18, 2011. For more information on:
- the outpatient therapy cap limits,
- getting exceptions to the cap limits,
- who can give therapy services under the rules,
- where therapy services can be received, and
- how to find out what the therapy services will cost,
go to http://www.medicare.gov/Pubs/pdf/10988.pdf or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. To find a resource in your own state, just visit: http://www.Medicare.gov/contacts. 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 ccbishop@creativecasemanagement.com.