Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • caregiver coachChicago's Geriatric Care Manager Center of Excellence - Since 1991 | Page 5

Why AND Is the Most Important Word
Do you recall the 1991 movie called City Slickers? It was another great role for Billy Crystal, but it...
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July 19, 2022
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Looking Out for Your Older Parent 24/7
There will come a time for everyone with an aging parent that the question will arise, “Is it still...
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July 11, 2022
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Why a Flamingo Stands on One Leg
You’ve all probably heard the old joke about why a flamingo stands on one leg…and we have all seen...
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June 28, 2022
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What You Can and Cannot Change About Dementia
Let me start with the short answer to a question we raised in the email announcement of today’s post. ...
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June 21, 2022
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Age and “Long Covid”
There seems to be a cliché for everything, so we’ll start with this go-to for COVID: “We’re not out...
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June 7, 2022
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A Good Habit Missing for Most Older Adults
Even among those older adults who dodged COVID, “gymnesia” may be a lingering effect. Please let me explain… What...
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May 24, 2022
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When Being in Demand Isn’t Healthy
If you’re a musician, you want to be busy, because gigs represent a better living. If you’re an actor...
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May 17, 2022
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HDL Graduates from “Good” to Better
You may have had the conversation with your physician about your cholesterol levels during your annual physical; there are...
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April 26, 2022
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When That Doesn’t Stink…
There are a lot of tests and exams we all know that are important to catching a condition early...
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April 12, 2022
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Respect and Inclusion
I was very pleased this past weekend that my son and his wife invited my husband and me along...
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April 5, 2022
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In the Caregiver's Words

Recent Client Praise

Caregivers to loved ones with any of the many forms of dementia deal with their loss quite poignantly on special holidays like the one on our calendars for this Friday. While a loved one who is suffering from dementia may not remember what calendar date it is, they likely will have at least some distinct memories of past Valentine's Days just the same. So, if you are a caregiver to a loved one with one of the forms of dementia, there are ways to still share a special moment...even special memories with your older loved one. You doubtless have photo albums of moments shared with your loved one, and some of those photos may evoke a genuinely positive emotional response from your loved one. A walk down that memory lane can be surprisingly positive for both of you. Staying in the moment also can have its rewards. You can make it a point to bake festive cupcakes or cookies with a Valentine's look, or if your loved one is willing and able, you can even arrange flowers for the date. And maybe the flavor of chocolate will evoke "taste bud memories" in your loved one? Because more distant memories will be clearer than what has happened even earlier today with some patients, you can make Valentine's Day an opportunity to talk about first meetings, first kisses or first dates. And if you have special memories of a specific romantic movie that you had enjoyed with your loved one, you may find that a viewing now will evoke some of those good feelings again. Or at the very least, even if they do not remember the film, it may elicit similar positive feelings now just as it had back when you both first viewed it. In a similar vein, you and your loved one may have had "your song" or a number of songs that you enjoyed in an earlier time. If the song is one that you all learned the words and tune, you may find that your older loved one still remembers enough to sing along with certain refrains. Finally, in the spirit of Valentine's Day, hugs and gentle touch are every bit as important to an Alzheimer's patient now as they would have been before the onset of the condition. Alzheimer's patients also will respond to gentle talk as well as good humor...just as long as they do not feel they are the object of a joke. And while we are talking about caring for your loved one who may be wrestling with a fading memory, please remember my cardinal rule. You will do a better job of caring for your loved one if you also are caring for you, the caregiver. 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.
This month we’ve addressed ways to mitigate holiday blues and that familiar feeling of melancholy for both the caregiver and the loved one throughout the season. However, for an older loved one, that feeling of unhappiness, especially if it lasts well after the holidays may be signs of depression. Depression can be common in older adults and can come in many different forms. There are also many different reasons why depression might be triggered – including being associated with various medical conditions. For instance, depression has been linked to viral infections, malnutrition, stroke, lymphoma, hyperthyroidism, and others. Some medications are also commonly linked with depression.

Moreover, when an older adult or parent starts to lose some of the independence that they once had – whether caused by a deterioration of mental or physical capabilities – they might develop thought processes associated with “learned helplessness.” This happens when the loved one starts to see their failures (whether perceived or not) as a sign of being completely helpless and having no control over their own lives. Also, as mentioned in previous entries, the sense of loss can weigh heavily on a senior parent. This is not just due to loss of another family member, but also the loss of their previous capabilities, roles, or responsibilities.

It is extremely important to not diagnose depression on your own. Have your loved one assessed by a professional. What they may be experiencing might not be a disorder at all. It may be signs of another issue. However if you are certain your loved one has depression, here are three different eldercare solutions you may want to consider:

Antidepressants. This is usually provided as primary treatment for moderate to severe cases of major depressive disorder if preferred by the patient. Be sure to double check with doctors to ensure that these medications don’t interfere with anything else your loved one might be taking.

Psychotherapy. For those who are uncomfortable taking medication for depression, this is a suitable option. Psychotherapy helps identify factors in your loved ones lives that might be contributing to depression as well as teach valuable coping skills.

Depression Care management. This is a great treatment option for those who already are within an in home care system or care management program. Care managers will help identify signs of depression and facilitate treatment options, including ensuring that a healthy regimen is kept while working alongside a psychiatrist or physician.

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.
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.
According to research reported in the New England Journal of Medicine, approximately one in five Medicare beneficiaries discharged from a hospital will end up back in the hospital within thirty days. It usually is for the same reason they were admitted originally. This means that it not only is bad for the patient who has to go back to the hospital, but it typically represents an expense that could have been avoided. And it is these sorts of statistics that give me a chance to talk about a question I get asked a lot: “What is it that geriatric care managers do?” Let me explain.

The typical picture of an older patient who is readmitted is one without a lot of social support locally, and this older patient:
- May not fully understand their discharge instructions.
- May not be taking their medications as instructed.
- May have complications they cannot handle.
In most of these cases, if the patient had had someone to be the information processor, interpreter and implementer, the readmission would not have been necessary. A geriatric care manager would be available to make sure the discharged patient understands any limitations on activity that the medical professionals have stipulated or understands how active they should be to recover from being in bed for the number of days they were in the hospital. A care manager can help to make sure that all the patient’s medications are organized or that a new prescription gets filled and its dosing gets integrated into the daily regimen. (Remember that seniors are about 13% of the population, but they represent about 30% of all the prescriptions written.

The National Transitions of Care Coalition offers a checklist your care manager or you as a caregiver can use with an elder for whom you are responsible as they leave the hospital:
1. Have a method in place to assure safe use of all medications.
2. Have a plan to facilitate the big change from hospital to home.
3. Engage all members of the family and personal network of the patient.
4. Share important information with all care providers and caregivers.
5. Find and read any educational materials about the patient’s condition.
6. Facilitate any follow-up provider visits, therapy, etc.
As a caregiver (or through your care manager) advocate for the patient to physicians, discharge planners or other providers responsible for the continuity patient’s care.

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.
I did not start out as a geriatric care consultant although I have been one for nearly 20 years. I actually started in care management helping injured workers, but it seems that life has come around full circle with an increasingly older work force. Larger percentages of workers are staying on the job beyond what had customarily been the "retirement age" of 65. Yet, today's older worker does not fit some of our historic expectations. The National Council on Compensation Insurance (NCCI) has offered some new research that may surprise a lot of people, especially those who claim that older workers will be more prone to costly injuries. The research showed, for instance, that workers under age 35 had more finger cuts than those over age 35. But workers over age 35 reported more cases of carpal tunnel syndrome or neck injuries than younger workers. This generalized to a lot of what are referred to as repetitive stress injuries like rotator cuff injuries. Even so, the differences were not very great in these latter categories. There also has been a pervasive notion that older workers' injuries will be more expensive than those of younger workers. Well, that depends on what you term "old." It turns out that workers under age 25 do have less expensive injuries with less time lost from work than those older, but it would probably be a stretch to suggest that a 30 year old employee is an "older worker." Moreover, once a worker hits age 35 and up, the costs of their injuries and the time lost from work are very much on par with much older workers. The researchers also found that the best way to reduce injuries and their costs is not to hire 30 year-olds, but to train workers in safety and to report injuries immediately when they happen. And there is one more similarity between the older worker and their younger counterparts, and it has to do with family responsibilities. We all expect younger, married workers to have family responsibilities they juggle with their workplace commitments, but older works are also jugglers. In their case, however, they are trying to manage caregiving responsibilities for older parents along with their maintaining on the job performance. And, of course, some of the "younger, older workers" are sandwich generation workers with kids at home or in college as well as parents who need help. No surprise, then, that an increasing number of our clients are not just the individual caregivers, but also the employers for whom they work who are looking to take some of the stress from their "older workers" by offering our services as a resource and support. Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric care consultants, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
With about 25 million Americans 70 years of age or older and licensed to drive – about four of every five adults that age -- the Boomers are poised to be a substantial force behind the wheel. But Boomers who drive will not be much different from other cohorts of drivers who have reached 70 and beyond before them. As a group they also will face vision and hearing deficits along with mental and physical challenges that will make some of them unsafe on the roads. If you are a caregiver to an older loved one, you cannot just leave it up to the states to monitor your loved one’s capabilities behind the wheel. Some states do require more frequent testing of older adults renewing their licenses, but they may not ask for the prescriptions your loved one may be on let alone their over the counter (OTC) medicine purchases. Many of the medications which older drivers may be taking, such as anti-hypertensives, antidepressants and more, have explicit warnings in their package inserts about “not operating heavy machinery while taking the medication.” Even a mini-Cooper is a heavy machine. And medications that can be purchased at the drug store have some of the same precautions. If your loved one takes an OTC medicine for a viral cold, for help sleeping or for allergies may have a drug-induced drowsiness hours after taking the medication. This chemical drowsiness coupled with the other “side effects” of aging can pose a substantial safety issue. I have been talking so far about “normal aging” and medications, but there are other chronic or degenerative medical conditions that can impair driving. Beyond dementia, Parkinson’s, Huntington’s and some psychiatric conditions may impair judgement and reaction times of older drivers. So, as a caregiver, you should look for the warning signs: their medications – all of them, their medical diagnoses and even the “small accidents” such as scrapes or other telltale signs on the car’s body. And if you attend your older loved one’s medical visits, take the next visit as an opportunity to ask the physician about mom’s or dad’s capabilities for driving. But do not pass the buck. Even physicians find these kinds of discussions that can constrain a patient’s freedom to be uncomfortable. I call this kind of conversation, the three E’s:
- Evidence that there is a problem needs to be clear and substantiated.
- Empathy in how you approach your loved one is key; how would you feel?
- Encourage them to make the decision; you do not take the keys…they need to surrender the keys.
Have a productive conversation ... and safe driving. 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.