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

The Fear is Mutual: What Caregivers to Alzheimer’s Patients Need to Know
I’ve talked about this often in past posts: older adults have a greater fear of Alzheimer’s than of any...
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January 25, 2022
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It’s Not a Resolution – It’s Self-Care
A caregiver to an older loved one or other person with special needs takes care of everything, right? A...
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January 13, 2022
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Password Protected?
I often offer advice on how to help your older loved one with challenging tasks or how to protect...
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October 26, 2021
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What Does It Mean to Age Gracefully?
I think I can say with high confidence that your parents taught you how to walk…or what the kinesiologists...
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September 21, 2021
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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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In the Caregiver's Words

Recent Client Praise

I've talked about being on the lookout for signs of early onset dementia as we all begin our holiday gatherings. Dementia may be difficult to detect for a number of reasons. First, early onset can be evidenced in very subtle or small changes in behavior or recall, so it may be the accumulation of a number of tells that begin to tell us there is some slippage. Second, most of us are so fearful of losing our faculties that we tend to deny it or try to hide it from others, and after all who doesn't forget someone's name at some point? Third, loving couples tend to compensate or cover for one another. One partner may see the lapses in the other, but work to help their partner feel as empowered as they were before this decline. For all of these reasons, it underscores how we all should work to be empathetic and sensitive to the special needs of a loved one who may experience some form of dementia, because they can still function very well with some accommodation.

            So, once you do notice something or perhaps any number of things that are just not quite right in your older loved one, be sensitive about how you broach the issue...if you bring it up at all. As dementia sets in, it may cause a great deal of anxiety in the person with the symptoms. The anxiety understandably comes from a feeling of helplessness, and it is important to not provoke the anxiety into full blown defensiveness or angry outbursts. Here are three suggestions for friends, families, and caregivers on how to soothe an older adult with some form of dementia while maintaining a meaningful line of communication.

1.    As you plan the holiday gathering, think about the way these events have always been hosted in the past. Keep the surroundings and the routine familiar, and avoid noisy restaurants, especially places where the older person may be unfamiliar. If there has always been a certain way you prepared the pie, do it that way again, and you may be amazed how the tastes and the smells bring a wonderful memory back even to someone with memory loss.

2.    It may be appropriate to downsize the gathering a bit. In the past you may have invited a whole host of friends and family, but a smaller gathering of familiar faces will prove much easier for a person with dementia to navigate. While not every face will have a name for a person with dementia, familiar faces will put them more at ease.

3.    Appreciate that it is short term memory that is the most common casualty in dementia, but you can still talk about the early memories which everyone can replay and enjoy together. And it does not hurt to hear a wonderful memory repeated more than once at a family gathering.

            Finally, it is really all about family and sharing a positive moment, so be sensitive. If a story is repeated more than once you can indulge that. The most important thing to remember is to just enjoy the family moment. Follow your instincts about what has always been special in the past, and it likely will be pleasant for everyone again this year.

            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.
Everyone's abilities and needs change as they age, but home may still be the same physical space it was twenty or more years ago. It's important not to wait until there is an accident to make changes that can help accommodate an older person's changing needs. It is easy to get ahead of where you need to be by presuming that the decision is about whether the best place for a loved one is home or an assisted living facility, a skilled nursing facility or some other new residence. I wrote in my last blog about the basic categories of "activities of daily living" (ADLs) that help us evaluate how a person is caring for themselves. The ADLs are hygiene, continence, toileting, dressing, eating and transferring. As a GCM, I often do what you might call an audit of the older adult's home while they are there. In that audit I look for signs of what they can and cannot do for themselves and what may pose hazards given their abilities.

Take for example, hygiene. Even a cursory observation can tell you if the older person has bathed or shaved recently, if their clothes are clean, etc. It can be as easy as securing the services a home care aid who can be present in the mornings or evenings or even just a few times a week to help with personal grooming or showering. Dressing is linked to this, and it may be that more frequent visits may prove necessary, because the older individual's range of motion may be limited making it difficult to get easily in or out of clothes.

With continence, it may be the family who may notice that there has been "an accident." Remember, however, that this is highly embarrassing to the older adult. They may even be embarrassed to purchase adult diapers at a store. The fix may be as simple as making the purchases discreetly for them. Toileting itself may become difficult owing to diminished dexterity. Grip bars in the bathroom as well as an elevated seat for the commode may be in order. You can also assess how well the older adult is able to feed themselves by either seeing them at the dining table or just look at the front of their clothes for evidence of spills. Or are they not eating or losing weight? They may need someone to prepare nutritious meals, because it is a real pain to cook only for one.

Finally, if just getting around the house has become a challenge to the older adult, watch their gait. Do they shuffle or are they unsteady? Get rid of scatter rugs in the house; they are a fall waiting to happen. Consider grip rails along hallways or a walker for getting around. I have an 84 year old client who had broken a hip, made it through rehab, but did not want to be seen using a walker. What won her over was finding a sleek machine in hot red that looked like it belonged in the Tour de France. She is not using a walker now; she is showing off.

We have resources listed on our site, but think about calling on a local home care agency for personal care, Meals on Wheels for food preparation or look for a durable medical equipment distributor for a walker. Hire a handyman to refit the bathroom or halls with grip bars, put bigger handles on kitchen cabinets, build a ramp for the stairs and more. You don't hire a Geriatric Care Manager to do this, but we can spot solutions to needs you may not see and know the resources that you may not know.

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.
There are those who have not seen any changes in their lives in the midst of this pandemic and quarantine. They’re our older family members with Alzheimer’s disease or some other form of dementia that has robbed them of the ability to even comprehend the restrictions of this pandemic. They have been isolated as protection against COVID, but their quarantine experiences are not the same as ours. I bring this up because as more of us are able to be vaccinated and resume some semblance of life before the pandemic we also will likely be able once again to visit Mom or dad who have been under strict quarantine and may have some questions for us. How you answer their questions and engage in conversations in general is necessarily going to be more about them than it will be about you and the rest of the world that has been upended. Honesty is going to be the first casualty of the pandemic when we encounter a loved one who has Alzheimer’s or dementia, but I am not talking about lying. At its core dementia is a progressive decline of the brain’s ability to process what has happened in “their world.” You ought not view your initial reunions with older loved ones with dementia as a “chance to catchup.” We have to be prepared to join their reality using a technique health care professionals call “therapeutic fibbing.” You will need to learn to “go along” with the reality they know by first asking them about themselves, their recent experiences, and what’s going on. This may go against how we all were raised, but telling the truth may be cruel to someone who is not processing reality in the same way we are. An example helps. Picture you’re talking once again with your mother who asks where your Dad is. He had told her, she recounts, that he was going to get the car and come by to pick her up for an outing. The unfortunate truth is that dad died last year, but she keeps coming back to scenarios in which he is just temporarily gone, and understandably is looking for his return. You don’t tell her he died, because she will experience the awful loss all over again, she’ll cry hysterically and become agitated. And since she has short term memory issues she will forget again so she will be primed for experiencing the grief anew the next time you correct her. Instead you might say that Dad suggested he would be delayed a bit and that he had asked you to offer her a snack until he can make it back. She agrees that a snack is a good idea and you get into another conversation. Or, your father with dementia tells you that he is going to go get the car and take mom for a ride. They like their Sunday afternoon drives…it does not have to even be Sunday. So, maybe you can ask how the car is running and suggest it would be nice to have a snack with him for their ride. While you prepare the snack perhaps look out the window and remark on the sunshine or the birds or anything. Then start talking about the view and ask him questions. Share the snack with him and get into a new conversation. My clients with parents or spouses with dementia talk about their “therapeutic fibbing” as really hard at first until they can see their loved one actually brightening with the diversions. And once they both have a brighter conversation, they both have now had a better day. And tomorrow will be another chance to brighten both of their days…and tomorrow…and tomorrow. 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.
As our loved ones grow older, we probably are more acutely protective of their health and well-being, especially if we are in the role of caregiver to that loved one. We may even accompany them to a visit with their providers, or make a visit to the hospital is they are hospitalized Which of the following do you think is the greatest threat to your older loved one’s life: 1. heart disease 2. cancer 3. chronic lower respiratory diseases 4. Alzheimer's disease 5. Stroke 6. Ageism If you checked heart disease, the U.S. Census bureau would say you’re right, and the rest of them in order are smaller, but significant risks as well. But ageism takes a largely unseen toll on older adults. In a longitudinal study of a large sample of older adults, those who had a positive perception of aging lived an average of 7.6 years longer than those who did not. Where did they get this impression that could result in an early death? So, what constitutes ageism? One of the answers is in the care they receive from health care providers. If you are a caregiver who has accompanied mom or dad to a doctor’s visit, did you notice: • How much did the doctor maintain eye contact with you versus your love one? • How many times did anyone in the office refer to your older loved one as “dear?” • How thorough was the exam versus what you, yourself may have experienced? • How many additional tests were ordered for your loved one? All of these are signs of ageism. And then there is the cascading of one effect amplifying another. The last one about testing is quantifiable. Medicare is going to pay for the tests, so less thought may be given to ordering tests. In a study in 2018 Yale researchers were able to document that ageism accounted for about $63 billion a year in unnecessary tests in the United States. More tests and they will die younger simply because they are given the impression they are older? Young people don't need tests. Not just feel older, but less viable. Their age becomes a filter through which others view them and consequently treat them differently than folks who don’t have as many birthdays. So, the next time you accompany your older loved one to the medical visit, try these responses to the above: • Doctor, I am just here with mom/dad, please talk with her/him while I listen. • His/Her name is _____ (fill in name)! • Doctor, is it important to also check _____ (missing test or question)? • Doctor, I don’t recall these tests in the past; why are they needed? Charlotte Bishop is a Caregiver Coach, an Aging Life Care Advisor, 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. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
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It's official. May is National Geriatric Care Manager Month. And that means now is a good time to share some perspective on just what a certified geriatric care manager is. You would think that there is a boilerplate definition or description of what a care manager is, but my experience has taught me that a care manager is different for every family with whom we get involved. Different, because every family's needs are different, but there are a couple points that may shed some light. A geriatric care manager is someone who works both inside and outside the "medical model." That is to say, you would not go to a care manager for your annual physical, a blood draw or one of the other typical things we go to a physician or other provider for. But a geriatric care manager can take all that as information along with a lot of other inputs to assess a client's health along with something many consider to be at least as important, and that is their "quality of life." A geriatric care manager then works with an older adult and their family or caregivers to recommend a plan to optimize quality of life and well-being. I often refer to our job as one in which we are "the option-makers for the decision-makers." This assessment and plan creation can be an ongoing process as a person's needs change with time. What I also find is that we are the people who can go along for the physician visit when caregivers may be working their day job, taking care of their children or simply be too far away to attend to those duties. We are the eyes and ears for the family and caregivers when they cannot be present. In fact, we often have referred to ourselves as "your sister in Chicago" or Evanston, or Naperville or Lake Forest... You get the picture. So, why sister? According to both AARP and the MetLife Mature Market Institute, it usually is the woman who attends to family caregiving needs. For women, the total lost wages owing to time off from work or taking leave for caregiving averages $142,693. What family with caregiving duties would not benefit from having an extra sister on board? And it is important to know that Geriatric Care Managers are certified by the National Association of Professional Geriatric Care Managers (NAPGCM), an association formed in 1985 to advance dignified care for older adults and their families. Certified Geriatric Care Managers are professionals who have extensive training and experience working with older people, people with disabilities and families who need assistance with caregiving issues. They assist older adults who wish to remain in their homes, or can help families in the search for a suitable nursing home placement or extended care if the need occurs. The practice of geriatric care management and the role of care providers have captured a national spotlight, as generations of Baby Boomers age in the United States and abroad. For more information or to access a nationwide directory of professional geriatric care managers, please visit www .caremanager .org 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.