Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • caregiver coachChicago's Geriatric Care Manager Center of Excellence - Since 1991 | Page 6

Consult Your Lifestyle Physician
You, or your older loved one, have a consistent pain in your hip, and you finally get a referral...
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March 29, 2022
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Gaining More than Birthdays
We’ve all heard someone explain…typically referring to that paunch around our middle…that their “metabolism has slowed” from what it...
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March 22, 2022
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When the IRS Calls…
How about a show of hands regarding the Internal Revue Service (IRS)… Have you ever filed a tax return...
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March 8, 2022
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Dementia from a Pet’s Point of View
Fetch! Come! Sit! Stay! Remember! So, I’ve given away that I’m a dog owner rather than a cat or...
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March 1, 2022
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It All Begins with a Mouse
I don’t know how many of us would like to live full-time in Disney World, but most of us...
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February 22, 2022
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The “Other” Health Concerns for Older Adults
It was just two weeks ago that I underscored the fact that “older adults have a greater fear of...
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February 1, 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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Not Where You’d Expect Protection from Dementia
You may recall the debate on approving Biogen’s Aduhelm for Alzheimer’s this past year. Prior to this approval there...
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December 28, 2021
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If It’s Not Happy or Merry?
I explained in an earlier post about why we refer to Holidays in the plural, and how we are...
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December 14, 2021
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Making Your Holidays Happy Again
Yes, “holidays” is a plural word here. Please allow me to digress on this plurality and simply point out...
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November 16, 2021
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In the Caregiver's Words

Recent Client Praise

Tony Bennet has arguably been one of those “one in a million” kind of musical talents, but sadly he now also is one of more than five million. Mr. Bennett has been diagnosed with Alzheimer’s disease, a condition that has robbed more than five million people in America of their abilities to understand or participate in the day to day activities that we call living. Mr. Bennett was diagnosed four years ago at age 90 as his family began to notice differences in his behavior, his speech and in how he related to friends and business associates. Would you know if a loved one in your orbit was developing Alzheimer’s disease? Here is what to look for, because early detection can mean better accommodation of the patient by protecting them from accidents of daily living. If you notice anything in your older loved one (older means most typically above 65 years of age, but there are early onset cases) that shows they are not interacting as they used to, talk to their family doctor:
- Difficulty processing information or content becomes difficult, and it is because the Alzheimer’s brain does not make memories as well or perhaps not at all in advanced cases.
- Facial changes or changes in facial recognition may give them a blank, uncomprehending demeanor or they may not as readily recognize when someone is joking…they may come to not recognize a friend at all.
- Difficulty concentrating or finishing tasks reflects their inability to cognitively keep up as they used to with reading, games, music and activities that used to delight them.
- Inability to multi-task, because their cognitive capacity becomes overwhelmed with more than one focus, and ultimately even single tasks become too much.
- Disorientation with both time and place may make them more anxious with familiar places or events, and unfamiliar places like restaurants or venues outside home can be absolutely overwhelming.
- Difficulty with word finding can make conversation increasingly difficult for the Alzheimer’s patient to understand what is said to them, and it ultimately may lead to withdrawal into silence.
But please don’t be alarmed at every instance of a memory lapse, because we all have lapses…but we typically remember the elusive name or date if given time. There is presently no cure for Alzheimer’s, but there are almost 1,300 clinical trials into therapies in the United States alone, so there is hope. And staying healthy is the best way to avoid Alzheimer’s: mental and physical exercise, low carb diet, low fat intake and don’t smoke. 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.
Geriatric Care Plans
At Creative Care Management, we understand that adjusting your life to provide care for a loved one can be confusing and stressful. Building and managing a geriatric care plan alone is overwhelming, and you may be asking yourself: What sort of care do they need? Are they safe alone? What happens as their condition progresses? That’s where we come in. We are a top rated in Chicago geriatric care management provider, which means we serve as a resource and a guide through the process of developing and managing a senior care plan designed specifically for you and your family.
Developing a Geriatric (Senior) Care Plan
Through our four step process, we personally take you through assessing your loved one’s needs, creating an all encompassing plan for their care and then setting that plan in action.
Step One: Meeting and Assessment
To begin the process, we meet with you in order to fully understand your unique situation and concerns. At that first meeting, we conduct a thorough assessment of the physical, mental and social health of your loved one to determine their current and future needs. We also look into their current living arrangements, and decide which steps can be taken to assure their safety at home. If you are concerned with the safety of your loved one at home, we suggest you take a look at our Home Safety Checklist to identify common hazards in and around their living space.
Step Two: Creating a Care Plan
Based on the assessments in Step One, we collectively develop a Geriatric Care Plan covering all aspects of caregiving in order to suit your specific needs. Although no plan is identical, here’s an example of a Geriatric Care Plan for you to better understand our process.
Step Three: Setting the Plan in Action
Once we have a solid plan, we work with you to set it in action. We facilitate connections with quality elder care service providers to meet your needs. We want the best for you and your family, so we only recommend providers and facilities that meet our high standards. Recommendation of care providers and facilities are based on 3 key factors:

Responsiveness of the provider to a client’s needs.

Reliability and consistency when it comes to the provider’s quality of service.

The established level of training and certification required by the provider for their facility and/or employees.

Step 4: Overseeing the Plan in Action
We understand that elder care is an ongoing and ever changing process, which is why our geriatric care plans always include the option of our continued involvement and oversight. As conditions change, we are there to help you make the necessary adjustments. Geriatric care management is about helping you and your older family member find the best care possible, without the stress of handling everything on your own. If you are concerned for a loved one but aren’t sure where to start, we can help you get organized by creating and implementing a care plan built specifically to meet the needs of you and your loved one.
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Recent Client Praise

Twenty two minutes. Every twenty-two minutes someone over age 65 dies as a result of a fall, and this is almost double what that figure was just ten years ago. These are called severe falls, and it is not that the individual dies at the time of fall as much as they will succumb to other complications subsequent to the fall. Because just as the incidence of falls has increased, the incidence of heart disease, stroke, arthritis, diabetes and other chronic conditions has increased among older adults. With the increasing numbers of medications that older adults take for their medical conditions, there also is an increased risk for confusion, delirium or imbalance as side effects of the prescriptions. We also are seeing an epidemic of severe - but not fatal - falls, nearly 2.5 million of which result in trips to the emergency room in America each year. This is fifty percent more than just ten years ago, and the incidence is double for women what it is for men, because women are living longer. So what can caregivers do to help their older loved ones living safely and independently? Take your cue from some innovative senior residential facilities around the country. In past postings I have talked about making lights within reach of bedside for older loved ones who may be getting out of bed during the night or in the early morning hours of darkness. There are now new ways to install floor lighting around the bed or along the usual paths from bed that are motion-activated. As your older loved one sits up in bed and their feet reach toward the floor, lighting strips like those on jet airline aisles are activated and light the way to a safe trip to the bath. In the bath, motion sensors turn on enough lighting to make navigating what can be the most dangerous room in the house much clearer and safer. One other innovation being introduced into senior residences is color contrast seats for the commode. Instead of the interior design rule of matching colors, some residences are making the toilet rings black against a white commode to provide an easier contrast for those whose eyesight may not be as sharp as it once was. And grab bars in the bath as well as along any halls and stairways to give a ready assist to older loved ones who may be sufficiently willful to ignore the doctor's orders to use a cane or walker. And who said floors can only be made of wood or tile? Interior decorators are coming out with attractive new floor coverings that absorb shock as a last line of defense against fatal falls. Consider also tasteful color contrasts to help older eyes distinguish step treads on the stairways as well as paths along halls. For anyone who recalls my "mitten test" for household door handles, switches, etc., you will like this suggestion. Get a pair of cheap sunglasses and rub Vaseline over the outside of the lenses. As you walk through the house you will have a much greater appreciation for what older vision - particularly vision impaired by cataracts - can literally look like. Add six pair of socks to your feet and you will be able to take a walk in their eyes, instead of a walk in their shoes. 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.
We have all seen the advertisements for the on-line services that will help you find your ancestry by taking a sample of saliva and matching up your genes against many thousands or even millions of others. My husband found he is related to his sister…wow? But on a more serious note, scientists are delving into the genes that can be predictive of serious illness risks or genes that may make us more prone to certain conditions. They even have found in a huge study of millions of veterans that certain genetic types are more susceptible to PTSD. In other words, trauma affects different people differently based on their genes. Your genetic profile to delve into your family history tells you up front how much it costs, and what you will get from it. But there has been a scam that has been targeting age-qualified seniors to take a genetic screening with the false promise that Medicare will pay for it. Well, Medicare requires a doctor’s orders for most genetic tests, and Medicare won’t cover all requests. Some genetic tests are quite sophisticated and have a ticket price of thousands of dollars. And your doctor is unlikely to request it on your behalf. So how has this worked for the scammers? The enterprising scammer in this case paid kickbacks to telemarketing companies and even to doctors to approve the tests. In addition to the telemarketing companies, this particular fraudster posted on Facebook and Craig’s list and sponsored booths at senior fairs soliciting eligible seniors. In some cases, the seniors were offered gift cards to entice them. Once approved by a doctor - taking a kickback – the Lab doing the testing billed Medicare. According to the Department of Health and Human Services more than $3,000,000 was billed by one of these scam rings at about $6,000 a test. Federal authorities are prosecuting the perpetrators. If you have an older loved one, please follow these four recommendations to avoid genetic testing fraud:

If a genetic testing kit has been mailed to your older loved one have them refuse it unless it was ordered by their personal physician.

Encourage your loved one to report anyone or any company offering a “free” genetic test.

Be an advocate for your older loved one and be certain of the medical reason for any genetic test, even if Medicare is expected to cover it.

As always be suspicious of anyone requesting the Medicare number of your loved one; report it.

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.
April is Parkinson's Awareness Month, and I thought it might be helpful to share some of the facts on this chronic and degenerative disease as well as dispel some misunderstandings. About a million people currently live with Parkinson's in the United States and another 6 to 9 million people throughout the rest of the world also manifest the condition.

While the one million may not seem like such a large number, it is more than all of the people who manifest muscular sclerosis, muscular dystrophy and ALS (or Lou Gehrig's disease) combined.

Parkinson's is most noted for its movement disorders, but as a degenerative disease, it can start out almost undetected as gastrointestinal, olfactory or sleep issues.

Men are more likely to develop Parkinson's than women. The relative incidence of Parkinson's increases with age, but about four percent of cases annually reported are among patients under the age of 50. Michael J Fox may be the most noted example of a young Parkinson's patient having been diagnosed when he was only 30 years old.

The overwhelming number of Parkinson's cases are not genetically linked, but there is a slightly greater percentage - about four to nine percent greater - of Parkinson's patients who have had Parkinson's in their families.

While the movement disorders that are the hallmark of Parkinson's are quite stark, there really is no standard test to diagnose the disease. Neurologists who are trained in movement disorders typically start by ruling out other conditions before coming to a diagnosis of PD.

There is no cure for Parkinson's but there are a number of medical treatments that help replace the dopamine the brain is no longer making as neurons die off as well as address the more severe of the stiffness or other movement disorders.

There has been a good deal of funding for research into Parkinson's Disease and other movement disorders, but there is not yet a cure. Sadly, the limiting factor to finding more effective treatments or a cure is that there are not enough patients volunteering for the clinical trials required to test these new options. To learn of the trial opportunities, go to: www.PDtrials.org. To learn what you can do to help the cause, go to: www.pdf.org/en/clinical_trial_inv.

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’s not just about forgetting how to get to where they are going. Older adults – even in the early stages of dementia – are simply at a much higher risk of accidents while driving. While adults over the age of 85 make up only about 9 percent of the population, they are involved in 13 percent of the fatal crashes and 17 percent of the pedestrian accidents resulting in death. Overall, the fatality rate of 85+ year old drivers is 17 times that of drivers 25 to 65 years of age according to the National Highway Traffic and Safety Administration. Is dementia a part of that? Yes, but only a part. Aging is a process that not so subtly erodes an adult’s visual capacity for judging distance, recovering from glare and distinguishing objects in dark or semi-dark conditions. Add to that the physical limitations that osteoarthritis can impose along with slower muscle reaction time and yes, memory deficits, and 85 plus year olds have the highest per-mile accident rates of any cohort beyond the teens. If you are a caregiver to someone within this older cohort - 85+ - this is not a mandate to talk about the car keys just yet, but it is important to be alert to what may be unfolding. Medical surveys of outpatients suggest that as many as 30% of older adults who have dementia may still be behind the wheel. What to look for? Dementia does not simply mean that an older driver gets confused in the parking lot at the mall or gets lost on the way home. Dementia in the driver’s seat translates into unexplained dents or scratches on the car. If you have occasion to drive with the older adult watch for difficulty in lane changes or lane wandering, challenges on turning or difficulty judging distances. Accidents typically are the result of a growing series of mistakes and near misses on the road. Early stage dementia patients may actually be safe drivers, but you should talk to your older loved one’s primary care physician. They will not be able to speak to you about your loved one’s medical condition without sign-off from the patient, so that is a starting point. And appreciate that not all physicians are well-schooled in diagnosing dementia, let alone treating it. If you are concerned about dementia as it may be affecting your loved one’s driving, start by asking the physician about your loved one’s ability to pass a mini-mental exam or other cognitive tests such as the Clock Drawing Test that help assess executive function. If the physician is not able to help, ask about possible referrals. You may find that there are hospital providers who have actual testing programs or driving schools to help assess your loved one’s safety behind the wheel. If the decision is made that your loved one is not safe driving, begin immediately to explore your transportation options. Some older adults will be relieved that the stress of uncertain navigation is no longer a challenge, but others may view it as a significant loss of independence. Be prepared to be an empathetic listener. Steer clear of sentences that start with “at least” such as “at least you did not have an accident…” Picture what you might feel in a similar circumstance and go from there. Don’t try to gloss over the genuine loss your loved one will feel. What are the public transportation options? That may depend on how advanced the dementia is, because navigating train or bus routes can be as challenging as driving. Paratransit and chauffeur services may be an option if they are affordable, but be careful on vetting the services. Check with your local ombudsperson on aging for a secure option. 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.
No, this isn’t a refresher course on Shakespeare and the famous Hamlet soliloquy. (Spoiler Alert – Hamlet was ranting about death, not slumber.) Do you find that despite how tired you feel, you still can’t get a full night of restful sleep? You’re not alone, because the older one becomes, the harder it is to get a good night’s sleep. Dr. Abhinav Singh, the medical director of the Indiana Sleep Center, suggests we view our sleep as if it were an older car that just doesn’t work quite as well as it once did. Ready for a tune up? As we age…especially if you’re a woman, it takes longer to fall asleep, we may have more wakeful times throughout a night and we may make up for these by napping during the daytime. Older adults’ sleep is not as deep and rejuvenating as younger people’s sleep, and that negatively impacts our immune system, our brain’s ability to organize memories and our ability to grow or repair bones and muscle. And all of this cascades into some real health issues the older one becomes. How about you? Is it trouble falling asleep, staying asleep or just feeling refreshed when waking from a night’s sleep? It may owe, in part, to checking out of the workforce which means we no longer have the demands or structure or early risings of work life. It also may be attributable to the loneliness or loss or just plain depression that can become part of the older brain. Older adults may also have medications for their blood pressure that give a nightly wakeup call to visit the bathroom. Women also have menopause that will exacerbate all of these elements that affect both men and women. Here are some tips from those like Dr. Singh who have devoted a lot of focus on what can go wrong with healthy sleep and what can be done to make your sleep more … well, restful and restorative:

Recreate a daily routine that has you waking and sleeping at the same times;

Avoid late afternoon caffeine – my husband makes 2pm his cut-off point;

Walk every day with a goal your phone can track…10,000 steps maybe;

Exercise more aerobically for 40 minutes 4 to 5 times a week;

Soak up sunshine or use a Seasonal Affective Disorder lamp daily; and

Schedule breakfast, lunch and dinner around the same time each day.

And maximize the effectiveness of your sleep time itself by:

Ask your doctor about CBD or melatonin or other aids to a good night’s sleep;

Keep your phone off and away from your bedside;

Stretch and/or do some yoga each night prior to hitting the bed;

Replace your pillow with one that truly supports your neck and head; and

Purchase a new mattress that supports you and doesn’t squeak.

Some folks even recommend an upgrade to your sheets or a white noise machine to cancel disruptive night sounds. Wow, that’s an exhaustive list…maybe we all can sleep better having laid all the issues to rest? 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.
The most common question I hear after "What is a geriatric care manager?" is, "When do I know that we need a GCM?" It may actually be more accurate to frame the question as 'When would my family benefit from a care manager working with us?" And that is when I usually respond with a question of my own, "What is it that encouraged you to reach out to me now?" Usually there is an event or a culmination of events which encourage a person to look for a solution to a problem, an answer to a question or just plain help. Here are five of the common circumstances people with whom I speak talk about:

There has been a sudden event in your older loved one's health, and you are wrestling with what to do. This can be a stroke, a heart attack, a fall or just the most recent trip to the hospital with a condition that has been worsening. It represents one of those forks in the road where it seems that keeping on with the way things were will not be adequate, and the caregivers need to know their alternatives. GCMs have answers.

The caregiver in your family seems to be approaching "burn out." Caregiving usually falls to one of the adult children in a family, typically the daughter or the one who lives closest to mom or dad. This lead caregiver wants to do all they can, but there may not be enough hours in the day, and the guilt about not delivering may keep them from asking for help until you see the signs: fatigue, forgetful ness, irritability, depression or other signs they are overwhelmed. GCMs help the older loved one, to be sure, but they also are there for the caregiver.

It may be clear that something needs to be done on behalf of your older loved one, but the family does not know or cannot agree on what to do. A GCM has answers, because this is what they do. Think of a GCM as a "wedding planner" for getting older. A GCM does not bake cakes or cater meals, etc., but they can lead you to the best professionals who do. A GCM also can be a helpful mediator to help get everyone back on the same page for mom or dad.

If your older loved one does not seem to be getting the benefit from their care providers or they seem anxious around the care attendants, follow your instincts. A GCM can spot elder abuse and respond with the advocacy necessary to assure your older loved one's safety and well-being.

Your older loved one may just be confused, but it may also be signs of a more serious deterioration of their faculties. A GCM will help by finding a diagnostician to assess your older loved one's capabilities. A GCM also will help to assess if your loved one would benefit from social activity, better nutrition, exercise, etc.

These are just a handful of the kinds of first conversations I often have with those who reach out to us. You will find much more on the web site for the national association who accredits us as geriatric care managers. If you are a caregiver to an older loved one and you have questions, visit: CareManager.org 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.

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For caregivers to older loved ones in northern climates, winter is more than just a warning about dressing for the cold. Especially with the recent round of record cold temperatures across two-thirds of the nation, here are some recommendations for assuring that your older loved one will be safe throughout the rest of this season. It is the Ice. It is not just the cold that can be a threat to your older loved one's safety, it is the slippery surfaces that accompany p[lunging temperatures. With about 1.6 million Americans visiting the ER because of a fall each year, it is important to prepare your loved one for treacherous walkways. Encourage your loved one to think of going outdoors as an athletic event; wear shoes that are appropriate for the conditions and do some stretching before heading out. Skin Protection. Older skin is both thinner and drier which means that an older person will bruise or cut more easily. They also may be more prone to nosebleeds. All of this encourages keeping indoor humidity a bit higher in order to have skin as prepared as possible for the assault of the cold, dry outdoor air. And boost your older loved one's inner humidity by encouraging more aggressive hydration with fluids. Prepare for Outages. Encourage your older loved one to stock up on staples should outdoor conditions get in the way of the weekly run to the store. And should the power go out or the pipes freeze, have them stockpile a few gallons of extra water - just in case. Flashlights with extra batteries along with candles and blankets are also essential back-up, and have a system in place for regular wellness calls by phone as well as from willing neighbors throughout the season. Keep Warm. This may seem obvious, but remember than an older adult's sense of feeling is diminished with age or because of chronic conditions like arthritis, diabetes or just poor circulation. Keeping the thermostat at or above 68 degrees F is a good marker, but still be listening in your wellness calls for any sign of cognitive difficulties like slurred speech which could be signs of hypothermia. Seasonal Affective Disorder (SAD). The long nights and short days of winter can take their toll on anyone, but age has its own way of exacerbating depression. Encourage your older loved one to get out and socialize and be alert to the glum noises of SAD in your regular wellness checks. All of these general warning signs also should be a reason to reach out to neighbors or programs that can call on an older loved one. Meals on Wheels, for instance, is only partly about food; it also is a way to keep isolated people from becoming even more disengaged. And this may not be just about your older loved one if you are a distance caregiver; check around your own community to see where you can be that neighbor who checks on someone whose day will be just a bit warmer for your reaching out. Take heart - Spring is only a bit more than two months away! 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.

I have a small pillow in my living room that speaks to me. In stitched letters it says, "What? Chocolate is not a food group?" My family knows that one of my favorite "food groups" is chocolate, and I don't mean because I am on a health kick looking for the benefits of dark chocolate; I just like good, old-fashioned milk chocolate. But let me tell you that when I have a chocolate craving, my body may really asking me for something more than my brown, sweet treat.

There is a growing body of literature that explains many of our cravings as our body's signals for what it really wants; we just don't speak the language. We fail to translate the cravings in quite the way our bodies are trying to communicate. This has real implications if you have an older loved one for who you are a caregiver. As one ages the taste buds become less sensitive, and appetite wanes. And if you are taking your older loved one's interest in foods or cravings too literally as you listen, you may think you are satisfying their body's nutritional needs when, in fact you are not. Let me start with my own craving.

Chocolate. If your elder expresses a craving for chocolate, they may really be translating their body's need for magnesium, a very important electrolyte in the human body. While chocolate can offer some magnesium there are better sources. Chocolate is okay - thank goodness - but your body will benefit from a variety of magnesium sources such as certain vegetables, nuts and seeds. So if your elder has a regular craving for chocolate, try offering legumes, nuts and seeds to avoid the sugar and fats that accompany the magnesium in commercially-available chocolate.
Potato Chips. I see this in our household where a certain family member would prefer a bag of potato chips rather than a handful or two. So much for portion control. Potato chip craving may actually be an expression of an iron deficiency. This kind of deficiency triggers a craving for crunchy foods, and potato chips -while crunchy - come up short. Iron-rich alternatives include dark meats, fish, poultry and darker green vegetables. And this overlooks the huge intake of sodium that potato chips offer and nobody needs.
All of the Above. This is where the psychology gets interesting. Let's say your older loved one can still smell the peanuts that you just had, but they had been disciplined and translated their craving into having a portion of raw carrots. But a half hour later, they still can all but smell the peanuts and they cave in and subsequently gorge on the peanuts. They should actually feed some of their craving when it expresses itself, but in moderation. That still leaves room for the healthy foods they will eat later and moderates the caloric intake that has become such a national epidemic.

At the end of the day, it is about balance and understanding what our bodies are telling themselves. If you are that caregiver to an older loved one, don't become the food police, but perhaps there can be a role for a food translator to help them understand their own bodies' language when cravings make their voices heard.

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@cr eativecaremanagement.com.

We have all heard the phrase and it usually is a reference to someone who is just a little less on top of their game. Just last week, however, The New York Times released data on staffing in nursing homes that showed a tremendous variance in staffing levels on their units based on time of day and time of week. These staff levels are not inconsequential, because when we talk generically about “nursing homes,” we may be making reference to assisted living or skilled nursing or other supportive living facilities. This is all a way to say that the residents need help with any number of their key activities of daily living like toileting, dressing, bathing, eating and walking, etc. The New York Times reported variances from fully staffed to the understaffed weekends to be as much as a 100 percent difference. That is to say that the number of nurses or aides covering the residents on weekends was as little as half the number as during weekdays. Before the Affordable Care Act, nursing homes self-reported their staffing levels to the government watchdog agencies. Whatever they said was what was on record, so less ethical organizations could easily game a system where no one was minding the store. Since the ACA in 2010, these numbers are now verified. While ACA now more closely monitors staffing, there can still be day to day variances that may elude detection. Some defenders of the status quo claim that on weekends more family are visiting their loved ones allowing thinner staff to keep up with what is alleged to be lower demand. Maybe? How many visiting sons are comfortable helping mom to the toilet? If your older loved one is one of the 1.4 million Americans who are a resident in a nursing home, you can check on their staffing variances. The New York Times actually published a map on line that allows you to hold your cursor over a specific facility on the map to see how they rate from “much above average” to as low as “much below average.” They also will note for you the low and high resident to staff ratios of both nurses and aides. I have in our inset a picture of a facility in Nebraska as an example. So, do three things if you are helping a loved one move to, or have one already in, a nursing home…or may have one moving anytime soon:

Go to the map to get the data and also those of competing facilities around the region where your loved one may move;
Get references on facilities from care managers or other health care professionals from your locale; and
Once your loved one moves in, drop by as frequently as you can, but do so at different times of the day or week.

Consider all of these as steps toward catching a facility in the act of doing things right. If not, don’t be afraid to make a change of venue and a change for the better for you and your loved one. 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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