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

There is an ‘I’ in Caregiver: 5 Tips to Avoid Burnout
We all have heard of coaches exhorting their players to work together by saying “there is no ‘I’ in...
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September 25, 2018
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Singing is a Breath of Fresh Air for Caregivers
Associate Care Manager Gregory is a Certified Senior Advisor (CSA) and Certified Dementia Practitioner (CDP) whose work focuses on...
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February 12, 2018
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Insta-Gram: It’s a Date!
Associate Care Manager Gregory Peebles returns with a series on the Internet and aging. Gregory is both a Certified...
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September 23, 2017
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In the Caregiver's Words

Recent Client Praise

How many times have we all seen the commercial with the plaintive actor on the floor crying, "Help, I've _____ and I can't get up." No one would ignore a plea for help from an older person who has fallen and cannot get up. But a lot of caregivers may be ignoring a similar plea with all of the health threat that a fall can represent. It is just that this fall is in slow motion. And it goes like this: "Help, I am so fatigued that I don't feel like getting up." Tired often does not get enough attention in medical circles, but it is a common symptom reported by people age 65 and older. We tend to discount fatigue, because we cannot accept that a person who has retired and now enjoys six Saturdays and a Sunday every week could not be well-rested. And if you are a caregiver to an older loved one, you may find it a bit challenging to muster the sympathy for your older loved one when you already are stretched across your responsibilities for your children, your partner, your job and... Yet, we should all pay attention to the subjective complaints of fatigue in our older loved ones, because tired can be a symptom of more serious medical conditions and because tired can lead to serious physical decompensation. Let's start with the other medical conditions for which fatigue can be a warning sign. Perhaps the most common clinical condition that presents with fatigue is depression, itself one of the most common comorbidities of aging. Depression often can arise from the hallmark aspects of getting older - loss, diminished physical capacity and social isolation to name a few. Chronic fatigue also can be a symptom of sleep apnea, restless leg syndrome, fibromyalgia, chronic obstructive pulmonary disease and any number of heart conditions. Poor quality sleep may also be indicative of musculoskeletal conditions or pain. If your older loved one is consistently tired, it may be time to accompany them on a visit to their physician for an assessment and a conversation. Sleepiness can also be just one more step along the slippery slope to frailty. Fatigue can be a strong disincentive for your older loved one to be as active physically as they once may have been. Fatigue also puts a damper on appetite which in turn reduces the quality of the fuel the body consumes to run the body's engine which leads to increased tiredness and low motivation for physical activity. And all of this translates into decreased mobility and frailty. Medical professionals refer to frailty as a "pre-disability." So, if the tiredness has gone on for an extended time, begin to look for signs of genuine frailty. No surprise, the signs include exhaustion ("hyper fatigue?"). Frailty also is predicted by weakness in grip and slower walking pace. And by weakness, we mean a quantum reduction in ability to grasp, and by slower we are talking a fraction of former strides. All of these point to diminished physical activity. Think of frailty as one step away from a permanent reliance upon a walker or wheelchair. The next time you are speaking with an older individual who reports being consistently tired, it may be time to wake up and take stock of their overall health. 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.
First, I want to thank everyone who helped get the word out on our recently-orphaned therapy dog, Annabelle. I am happy to report that Annabelle has found a new, adoptive home and that dog and master are doing great. Thank you for making our internet community work. Now, shifting gears… Hospitalization seems to figure prominently in most of the new clients we see. It is either a recent trip to the hospital that triggers the call to a care manager, or it also can be a surprise discharge from the hospital that sets everything in motion. You may ask, why should a discharge be the urgent situation? Well, the practical side of health care as we know it these days revolves around a big push to discharge patients “sicker quicker.” It can happen with the nurse or an aide walking into the hospital room and simply announcing to the patient and whomever is at their bed side that it is time to leave…often for a nursing home. Most patients and their families will scramble to comply. Nobody really wants to be hospitalized, but how prepared is the patient or the family for a return home or a quick departure for the nursing home? The fact is you need to know your rights. A family in this circumstance can file what is called a “fast appeal” of a pending discharge with a Medicare Quality Improvement Organization. Make that telephone call on the spot, and the patient can stay in the hospital until an independent physician reviewed the circumstances. Every 65+ year old adult admitted to a hospital as an inpatient has the right to challenge a discharge if he or she feels unprepared to leave. But few people understand the process that’s involved. In fact, all Medicare patients upon admission should receive a written notice of their rights. It will be labeled: “Important Message from Medicare” and in it you will be supplied with the name and a phone number for your Medicare Quality Improvement Organization (QIO). These are the people who handle fast appeals and other quality of care issues. Once you make a call, you or your loved one may be asked to fill out a form that allows the QIO to act on their behalf. Once that fast appeal has been filed, the hospital cannot transfer the patient. But you don’t necessarily have to be surprised. Ask on a daily basis what the expected departure date may be. Now, there is fast and there is really fast. Make sure that if a patient is to be discharged under the 24 hour mark, the stay may not be considered an inpatient hospitalization. It may simply be labeled as “observation” and therefore may not be covered as a hospital stay. Make certain of your rights here so that you are not billed inappropriately. Make sure that your primary care physician and possible also a care manager are in the loop so that you will have an advocate. 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 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:
1. Go to the map to get the data and also those of competing facilities around the region where your loved one may move;
2. Get references on facilities from care managers or other health care professionals from your locale; and
3. 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.

As a geriatric care manager, the most common comments I get when I speak to groups seem to start with “I wish I had known you when…” The “when” is usually followed by a family story of mom’s fall and broken hip, dad’s dementia diagnosis, a dear friend who has THAT diagnosis. We may call it care management, but Dr. Phil calls it “crisis management,” and in his recent book titled Real Life, he says: “For most of us, our formal education and other life experiences don’t give us any information about crisis management, problem solving, or even problem recognition.” So, in an age when you can Google anything, most people do just that when the crisis hits. But when you Google anything, that is just about what you find…anything. Not only that, but it rarely is just one crisis that caregivers to older adults have to address. In interviews with three dozen Care Managers in 2016 and 2017 we asked them to talk to us about their clients. Their experiences with families going through crises of caregiving fall into the following categories:

TYPE OF CASE	%
Alzheimer’s Disease, Dementia	66.2
Home Safety	66.2
Medication Questions, Complications	58.2
Acute Medical Crises	50.3
Inadequate Self-Care	48.0
Chronic Medical Condition	46.8
Family Support	45.5
Residential Transition	39.9
Patient Discharge, Home Care	38.6
Financial Challenges	33.7
Other	34.5

What is the important takeaway from this table? It’s the numbers. We asked the Care Managers whom we interviewed to tell us what percentages of their clients fall into each of the categories you see. It may be no surprise that clients may have more than one issue going on at a time, but the sum total of what you see here is well over 500%...527% to be precise! It gets complicated when more than one thing is going on at the same time. The older parent of this family is diagnosed with Alzheimer’s disease, but in all likelihood this person also is at risk for what professionals term elopement, or wandering. They may just wander off, and not recognize where they end up. Hopefully they will be fortunate and be found by a well-intentioned neighbor or police officer who can help them return to the safety of home. So, right off the bat we have dementia and home safety issues, but they also may not be compliant with their medications for a chronic cardiac or respiratory condition because they do not remember. They may have been victimized by a telemarketer to whom they have given their credit card information which is how the family identified that dad has memory issues in the first place. And now the family reaches out for help to find a secure residential option. So, it rarely is just one issue that creates a crisis for the new caregiver; it’s a five alarm fire. Okay, I share this brief example not to scare you to death, but rather to get your attention and let you know what the caregiver reality is all about. What caregivers need to do is first, realize they do not have to go it alone. Second, it can be really helpful to find someone who knows the good options from the bad options, because Google offers options, but does not know the difference. 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.

Associate Care Manager Gregory is a Certified Senior Advisor (CSA) and Certified Dementia Practitioner (CDP) whose work focuses on helping aging adults and folks with limited independence by providing resources and support to help them discover and lead their best life. Gregory has been a part of CCM, Inc. for over a decade. – Charlotte Lots of people play simple games on their phones while waiting. On this blog, we’ve often mentioned that any game play encouraging cognitive and spatial orchestration is great for the player’s cognitive future. But what if there were a fun game whose results also helped doctors learn more about dementia? That would be especially helpful, keeping our own brains sharp while we contribute to research. That sounds like double duty! Well, set sail at full mast, because that game exists. At first glance, “Sea Hero Quest” [iOS/Andriod link] is a fun mobile game like any other. It is special, however, because it exists to provide researchers with more data on 3D spatial cognition, often a first casualty to a dementia diagnosis. In the game, the child of a parent suffering from dementia sets out on an odyssey to recover their parent’s lost memories. On the path to discovery, there are navigation, orientation, and chasing adventures. The ways that the players advance levels is precisely the kind of valuable information hoped for; and the more people that play the game, the more information to help. Alzheimer’s Research UK is a major player in supporting the data obtained from gameplay, and it is hoped that the information gathered will make inroads towards early detection and consequent treatment. In addition to the regular mobile version, there is also a Virtual Reality (VR) release which combines the game with scene immersion. It tracks head movement and provides even more data to researches about how players obtain information about their environment. So, if you’re a mobile game player of any sort, consider the introductory video below, download, and start gaming! You just might have a great time helping your future self.
May is National Geriatric Care Manager Month, but I am thinking that most of you probably did not get the memo. You may have been following my blog – especially those with an older parent or loved one – and you know what it means to be a caregiver, but not as many may know what a geriatric care manager (GCM) is. Geriatric care managers are the people who work with caregivers to older parents who want time for their own families and confidence that their mom or dad will be well cared for. We also work with older adults who do not want to be a burden to their families as they navigate health care issues and make decisions about where and how they can live as independently as possible.

And a person does not have to really be a caregiver to seek the services of a geriatric care manager. We also work with professionals who want to get help for their aging clients when they have had a life-changing incident and wish to remain as independent as possible. These are professionals who want to help their clients maintain quality of life when life changes and coordinate the medical and other resources that make that happen.

I sum up what it is to be a geriatric care manager by describing the four activities where I am most involved in helping elders or others with special needs:
1. Resource: GCMs make the home of a loved one who is aging in place more secure. We help show families what services can be brought to an elder’s home and at some point identify what are the best alternatives to home. And quite often with sandwich generation adult children of older adults, we can be there at a doctor’s appointment when they cannot be there.
2. Counselor: GCMs help families to reach consensus about how to best care for mom or dad when there are so many options or in cases where it may seem that there are no good choices. We help caregivers to older adults or even spouses to sort out whether it is just tiredness or if it is depression or old age.
3. Advocate: GCMs help to coordinate the care from multiple medical specialists who may be attending to an older adult and make sure they are all communicating with one another and with the caregiver. We also work to document a clear care plan the helps to preserve the life an older adult really wants, and we are the eyes and ears to look out for what is best for an elder if they are living in a senior community, assisted living or nursing home. We are particularly alert to any signs of abuse or exploitation.
4. Friend: GCMs are also good listeners, because it can be really important that a caregiver have someone with whom they care share how hard it really is to reverse roles with the parent who had raised them from childhood. It helps for me to have been a caregiver, so I can personally and professionally empathize with what it is like.
For more information on geriatric care management visit Care Manager.

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 Charlotte Bishop.

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There is an ‘I’ in Caregiver: 5 Tips to Avoid Burnout

Singing is a Breath of Fresh Air for Caregivers

Insta-Gram: It’s a Date!

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