Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • geriatric careChicago's Geriatric Care Manager Center of Excellence

Nursing Homes Still a Risk for COVID-19?
It has been a tough pandemic for everyone, but it has been especially difficult for residents of nursing homes...
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August 31, 2021
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Your Flight to Nowhere is Boarding
You have probably put off a vacation or most any travel for more than a year with the threat...
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August 10, 2021
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The Side Effects Physicians Don’t Talk About
You all have heard about the side effects of FDA-approved medications that make their sales pitches on your television. ...
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June 29, 2021
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Breaking News for Alzheimer’s … part 1
The big splash on the medical news this past week gratifyingly was not COVID-19, but instead an approval of...
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June 15, 2021
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If You’reOnly as Old as You Feel?
We’ve all been asked a question like “How are you feeling?” And we probably didn’t take but a moment...
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May 25, 2021
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To B or Not to B12?
I have written a lot about dementia over the years as well as other issues that can mimic the...
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May 11, 2021
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Three Milion More Victims…
We see the numbers on a daily basis. How many have died from COVID, to date, we all probably...
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April 27, 2021
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Everything to Lose
Not a day goes by that the sun does not linger a bit longer, that the landscape gets a...
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April 20, 2021
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Not Just Spring…
We’ve heard of Spring Training for those who follow baseball teams like the CUBS or the SOX, and we...
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April 13, 2021
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Three Steps to the Now Normal
Yes, it has been a long year, maybe in part because it has been more than a year of...
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April 6, 2021
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In the Caregiver's Words

Recent Client Praise

Be honest if you’re a caregiver and you can answer YES to more than one of these questions. Sit tight if you can affirm more than one per set.
- Do you feel depressed? Sluggish? Physically Drained? Have Hopeless thoughts?
- Do you feel isolated from your own support system? How long has it been since you’ve been carefree and social?
- Do you find yourself mad about “the little things”? Perspective getting tough to keep?
- Do you find yourself either punishing yourself more or needing more compassion than usual? Do you feel guilty for being independent?
Here come the Holidays, with stress enough to bowl anyone over, but for caregivers, they can be particularly exhausting. Lots of stuff to worry about “going right” for the rest of the family while keeping an eye out for the care receiver. You may also be worried about staving off any old, unresolved family tensions. Who wouldn’t be exhausted just preparing? First things first. You’re doing a great job, and I know you don’t want to hear this, I know you’re tired of NOT hearing it, and I know you’re not sure if it’s worth the trouble of telling someone else how to do what you already know how to do. You deserve respite care. And you can have it. Respite care comes in a few packages:
- Geriatric Care Managers – That’s us at Creative Care Management. Among many helpful options, we coordinate services using experience and trusted relationships so that you can relax when someone else is taking the wheel. We’re happy to help, but you should know your options, and you can start by searching for GCMs in your area here.
- Adult Day Care Centers – These facilities provide a safe environment either for a few hours at a time, or for a full day while a primary caregiver is elsewhere.
- Home Care/Home Health Agencies– These non-medical service providers make home visits and give care so you can catch your breath. Home health can also manage tasks like meals or laundry, or help with smaller errands, like shopping.
Friends and community can also be great, inexpensive resources; however, as they’re on a volunteer basis, they’re not as dependable as professional resources. If your loved one is independent enough, a senior center can also provide enough respite to rebalance. You deserve to have the best holiday available this year. Your loved one deserves you to be at your best. More than anything, if you think you need the break that respite care can provide, pick up the phone and call someone. I’ve been doing this for more than 20 years, and if I can’t help you directly, I’ll help find someone who can. 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.
The wait is over – for me, I mean. I have been really excited to share our book, How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia. Now, I am going to share a special discount to those of you who have been following my blog, but it’s just for this week. Of course, if you want to pay full price, you can do directly to Amazon: https://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=c.+charlotte+bishop But if you would like $10.00 off the Amazon price, I invite you to follow this link: https://www.createspace.com/7325804 Apply the discount code: ZH3VK3U6. I am offering the discount for just this week. Please let me share one of the case studies from our book. This is a real-life experience from one of the more than 30 Care Managers whom we interviewed to compile 350 case studies. We call this Case Study 1.4: • Elopement is a home security risk from the inside out • Dementia is a risk for scams, assault and exposure • Identify what can still be done safely – independently or with help The caregiver is the 59 year old daughter, one of six siblings, who are dispersed around the country. Their father, a widower, is an insulin-dependent diabetic, but in good physical health otherwise. The father manifests some frontal lobe dementia, a condition which increases impulsivity, and which has caused him to lose almost a million dollars on women and gambling, the combination of which has placed him at risk for bankruptcy. Enter the professional care manager into what amounted to a five-alarm fire. With a coordinated intervention, the father was placed on a strict budget with his son, a banker, overseeing his bankruptcy proceeding - which is about to be resolved. While the father is under financial control, he still must be kept in a monitored environment as he is too aggressive with younger women owing to his poor impulse control. He has been successfully moved to assisted living to help mitigate his elopement risk and better manage his blood glucose levels. The father has been “a handful” in the words of the staff, but once trust had been established, he could be cajoled into responding to reasonable demands. His long-term prospects are very favorable. OUR TAKEAWAY: Helping the father get to a facility and to care that could set appropriate boundaries and protect him from exploitation could not have been possible without proper legal paperwork in place. While guardianship may not be a necessary part of a solution in a case like this, having powers of attorney for both healthcare and finance had been key. The professional care manager extolls the virtues of the staff who could gain the care receiver’s trust, and soon he was relatively easy to redirect – or as she put it, cajole – him into more socially-appropriate behavior. In the 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, many 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.
Awhile ago, a colleague reported that his dad had brought up an awkward topic in passing. His father, a fairly robust man in his eighties had mentioned that he "would not mind if his wife and he could have occasional sex." I asked at the time what my colleague had said in response. He admitted that he really had no idea what to say at the time, largely because it came out of the blue. He and his father had always had a very open line of communication, but he had not been prepared for talking about the "birds and the bees." With the aging Boomers, we actually are seeing a substantial increase in sexual activity among adults well beyond age 65. Men are more active than women, but women also are more likely to have been widowed or otherwise lost a partner of longstanding. What researchers at the University of Chicago's National Opinion Research Center found is that chronic disease is more often the obstacle to mutually-satisfactory intimacy among older adults than age. So if you are a caregiver to an older loved one, what should you say if the subject comes up. 1. Try not to be awkward, because your older loved one may actually be talking simply about being intimate with their spouse or partner. And that does not always mean sex. Depression can be a common problem for older adults, and touch is a great way to address the isolation that can fuel the depression. 2. Help them to appreciate that it may not be the same as when they were younger. Arousal issues are particularly challenging to women who report dryness or diminished libido. You may also find a way to tactfully suggest trying intimacy earlier in a day than had been a couple's custom. They will be more refreshed and vigorous before the demands of a long day have taken their toll. 3. Caution against too much alcohol as the inhibitions of alcohol become more pronounced as one's natural responsiveness to intimacy is diminished, especially for men. Other illicit drugs also out to be avoided. 4. For older adults who came of age before all the sexually-transmitted diseases of the current era, it will be important that they be introduced to "safe sex." The current rates of STDs have been testimony to this problem with the incidence more than doubling among some cohorts. 5. Finally, intimacy is not just narrowly defined as intercourse. Getting back to the importance of touch as an antidote to depression, your older loved one may be talking about just being close to their partner. In fact, it may be that actual sexual engagement may not be possible for an older adult suffering from certain medical conditions or on certain medications where sex may be inhibited. It may be helpful to consider this more than an awkward conversation. It is the first of what could be many in which you can communicate adult to adult with an older loved one. Along the way, it will be important to be aware of the potential to fall back into old patterns of parent-child communication. Your older loved one and you will both be the beneficiaries. For more information on the "talk," check out the Mayo Clinic's site (http://www.mayoclinic.com/health/senior-sex/MC00057/NSECTIONGROUP=2) 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.
Legal trusts can help a disabled individual get added help beyond what government programs like Medicaid offer and without sacrificing what these programs do offer. You may recall Gordon Gault, a Chicago attorney who specializes in trusts, wills and probate among other legal areas, who spoke with me some time ago about guardianship. Recently we also talked about trusts available for elders or others with special needs. Gordon explained that the concept behind a special needs trust is that a person can qualify for Medicaid, Social Security and other government programs while at the same time having money set aside for supplemental services or benefits. In Illinois a trust can be handled in one of three ways.

A special needs trust means that the benefits are not for room and board, but for special, or supplemental, needs. This trust is established by some one other than the disabled person so that the disabled person can receive government benefits to which they are normally entitled, but can also obtain extra health services not provided by the government, clothing, vacations, a television, or educational benefits. Gordon offered the example of someone with serious disabilities – mental or physical - where they qualify for government benefits. If the disabled person has a relative with a significant amount of money to be gifted to the disabled person and grantor does not want the money to prevent the disabled person from receiving government benefits, he can set up the special needs trust. The trust basically says that the trustee, whoever is selected by the grantor, can oversee the use of the trust funds. Upon the death of the disable person all of the remaining trust funds pass to whoever is selected by the grantor.

The second is an Omnibus Budget Reconciliation Act 93 payback trust, and it is federally-created. It allows an individual to create a first party trust, that is the individual for him-/herself. This is only for people under age 65. That person can take whatever money they have if they have become seriously ill, and do not want to lose all their money to health care costs. If they have a parent or grandparent alive, they can hand the money over to them with a trust document that has the same special needs language as the first option. If it is someone other than a parent or grandparent, they need a court order…a relatively simple procedure. There must be a regular accounting to the sate as trustees, but it is very straightforward. The balance of whatever remains in this trust after the beneficiary dies goes back to government to pay back whatever the government has expended. If there is excess, it goes wherever the trust says it will go.

The third is a pooled trust for a disabled person under age 65. Control does not go to a family member; it goes to the pooled trust, a non-profit organization monitored by the state. The organization provides the advantage that they are 100% trustworthy and they are professionals who know what they are doing. They know the rules and regulations are, and the money is well-protected. They provide the paperwork to the state oversight agency. The disadvantage is that it is not family making decision for the trustee; it is an agency. Upon the death of the disabled person, 15% goes to the non-profit and 10% goes to charities. Four percent of the overall pooled trust is taken on an annual basis for operating costs.

These are all specific to Illinois. Gordon Gault is available for consultations about Illinois trusts, and he encourages individuals to check with counsel in their own state if the expected beneficiary is not a resident of Illinois. 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 Charlotte Bishop
Do you remember when you had your last dental exam? Your last annual physical exam? Eye exam? How about flu shot? Or shingles or pneumonia vaccine? Gets to be a rather long list, doesn’t it? Your medical providers’ names and contact information? Now, if you have an older loved one, you now have another list of to dos and information to track. Yet you should have all of this and more at your fingertips, because knowing the stats could very well save your loved one's life ...because they may not have all of that information readily available either. The good news is that most health care systems these days keep all of that in a large data base that is accessible by patients, so you simply have to know your loved one’s user name and password. But you should get organized nonetheless. The categories of information you will want organized (consider an accordion file folder if you are more comfortable with paper or a file folder on your personal computer if you can digitize all information):
- Basic contact information, in case of emergency( ICE) and medical releases (If you need a form for this, please write to our info@creativecaremanagement.com -we will share one we use, powers of attorney (for medical), advanced directives, etc.
- Personal medical history of your loved one as well as relevant family medical history given that many medical conditions are genetically linked - "in the family."
- Current primary care provider information and predecessor providers if there has been any switch of providers.
- Other medical specialists whom your loved one has seen or continues to see, such as OB/GYN, cardiologist, endocrinologist, etc.
- Dentist contact information and a history of dental visits and any conditions of ongoing concern
- Alternative providers which may range widely from chiropractors to podiatrists, from acupuncturists to massage therapists and more.
- A record of all recent lab or other diagnostic tests and screenings.
- A history of all immunizations including the seasonal flu vaccines as well as less frequent TB tests, tetanus immunizations and beyond.
- A list of all medications (dose amount and frequency), over the counter medications (e.g., analgesics, sleep aids, etc.) and nutritional supplements.
- Insurance contact information as well as any forms or recent billing advice forms in order to track who has been reimbursed and who has not or even who has billed inappropriately.
- Allergies to foods or medications or other environmental risks (e.g., bee stings) of note.
- And, of course the "miscellaneous" category for everything else that may be relevant (e.g., pets and their food preferences, passwords, etc.).
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.
Medicine today is full of miracles. But Aging Well magazine (Jan/Feb, 2009) reports that although the over 65 set in America constitute only about 13% of the population they account for about 30% of all prescriptions filled. Their share of over the counter (OTC) drugs is estimated to be closer to 40%-50% of all retail meds sold. The report goes on to say that nearly two in five hospitalizations each year are a result of medication issues associated with elders. The elderly are fully half of all prescription drug-related deaths annually.

Let me tell you about a list you should know about. If some drugs have added baggage beyond the healthy effect sought by a prescriber and a patient, a doctor named Mark Beers, MD, and his associates have been the “baggage handlers” since 1991. That is when they first came out with the “Beers List.” Beers and his associates were concerned that certain commonly prescribed as well as OTC drugs were causing what are referred to as adverse drug events (ADEs, sometimes shortened to just AEs). Beers, a doctor specializing in geriatric care, found that the elderly were particularly susceptible to many of the undesirable effects of these drugs because their older bodies tend to have less water content and more fat content than younger individuals. This, coupled with their bodies’ diminished efficiency in metabolizing or processing chemicals through their systems helped to account for the disproportionately high rate of AEs and associated hospitalizations and deaths among the old.

Beers' most recent list of 48 drugs and drug classes has been published in the Archives of Internal Medicine and has been embraced by the Centers for Medicare and Medicaid Services (CMS). Beers and his associates have established a set of criteria for determining if a drug poses a risk, that is, is it a potentially inappropriate medication (PIM) for the elderly. Using an expert panel of internationally-recognized experts, Beers and associates were able to find consensus on the drugs that are part of their list of potentially-hazardous medications. It is an important elder resource you should know.

The Beers list has a number of “old friends” as well as exotic medications of which most of us have never heard. You will find the likes of over the counter Naprosyn or Aleve (generically known as naproxen sodium) as well as Benadryl (diphenhydramine) and Chlor-Trimeton (chlorpheiramene). There are also household names like Valium (diazepam), Tagamet (cimetidine) and Prozac (fluoxetine). It is important not to take the Beers list as a blanket generalization that these are simply drugs to avoid. It is not quite that black and white. Some agents are on the list because they can cause complications among specific groups such as diabetics, asthmatics, or insomniacs. Others are contra-indicated for individuals with balance or gait problems because they become prone to falls, some for individuals who have bladder outflow compromise or still others who suffer from chronic obstructive pulmonary disease, emphysema.

The list goes on, and in some cases it is simply a dosage or extended release formulation warning that justifies being included on the list. Check it out: Beers List

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.