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

This is one of the most emotionally-charged questions I hear when I am called by a family member who is concerned for the well-being of their older parent/s living alone at home. There is a lot of emotional attachment to "home sweet home," "home as castle" and more that has been learned over time. The question of whether home is still the best or safest place for an aging loved one is not just about the physical space. When invited to evaluate a situation, we look at both the individual's capacity to reside in a space and the environment's capacity to accommodate their needs. In this posting I talk about how we help explore the individual's capacity to get around in their home.

If you as a family are unsure about a loved one's ability to safely live independently, you can start with an assessment of how that person handles the basics of what we call activities of daily living (ADLs). Here is a checklist of the six basic categories of ADLs and how you can make an initial assessment yourself:

Hygiene: Do you see signs that they are not bathing, brushing, grooming as regularly as they once did?

Continence: Are there signs of "accidents" that they or their spouse may be trying to hide?

Toileting: Very simply, can they manage the bathroom on their own?

Dressing: Do they have the balance or strength to change in and out of clothes?

Eating: Do they have the dexterity to bring a utensil from the plate to their mouth, cut their own meat, etc.?

Transferring: Can they get from a chair to the bed, from the bed to another location, in and out of a car, etc.?

Take the example of one of my client's; I'll call Rose. Rose was living alone and independently. The first sign she might be having trouble was when she "forgot" to turn off her gas stove (fortunately it was lit); the kids bought her a microwave. When she consistently burned toast, they took away the toaster. It wasn't until she flooded her basement three times by leaving a kitchen sink running that the family accepted that either moving out or 24/7 in-home care would be their only recourses.

If your loved one is having difficulty with any of these, they may still be able to live independently, but some accommodation may be necessary. A GCM can help with an objective assessment of these functions as well as recommendations for accommodations. We are objective, because we don't represent a retirement home, a home health agency, etc. Also, a GCM can help with assessing the more nuanced or complex activities, what are termed instrumental activities of daily living (IADLs). These are more of the cognitive issues that may either be accommodated by outside assistance or be the red flags that home no longer is a safe or secure environment. Examples of these activities can include looking up phone numbers, cooking meals, doing housework, managing medications, etc. Here again a GCM or social worker can help assess if these are insurmountable shortcomings or if outside accommodations can provide the right level of assistance.

Just because a person does not always remember to take their meds or does "not get around" as they once did are not necessarily reasons to move them from their home. Accommodations, particularly those that can be brought to the home, will be in my next blog.

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 attended a medical visit along with one of my clients recently, and he was presented with a document on his rights and responsibilities as a patient. As geriatric care managers and care professionals, we often accompany our clients to a doctor's office visit so that we can help ask the questions a patient may not consider and assure that the patient understands all the provider's explanations. Some organizations these days call them their "patient's bill of rights," and they typically contain all the usual information on how they promise to safeguard a patient's privacy and the confidentiality of their records. This particular document spelled out some of the patient's responsibilities, such as asking questions if they don't understand something. But it also stated that the patient is responsible for taking an active role in their medical treatment and following the instructions offered by the provider. I thought to myself, "You mean like taking the medication that is prescribed for the patient's condition?" Well, it turns out that failure to comply with prescription instruction is a really big problem; in fact, it is referred to by policy folks as American's "other drug problem." Did you know that:
- more than half of 65+ year olds take five or more meds routinely
- about 25% take between 10 and 19 pills each day
- nearly 60% in a recent survey admit that they miss doses
- among those on five or more meds, the percentage missing doses is 63%.
The economic impact of all this non-adherence is estimated to be $100 billion annually. Non-compliance also is the cause for 125,000 deaths in America annually and $290 billion in emergency room visits and other avoidable medical expenditures. Non-compliance also is the root cause for an estimated 23% of nursing home admissions (estimated to cost $31 billion) and 10% of admissions to hospitals (estimated at $15 billion). The cause can be just plain forgetfulness or cognitive shortcomings like dementia or Alzheimer's. Some older adults still choose between food and medicines if they are on limited means. If you are a caregiver to an older loved one, you can help improve their compliance and here’s how:
1. Communication: If an older adult understands the severity of their condition, they are more likely to be compliant; help to ensure the provider explains this.
2. Participation: Patients are more likely to be compliant with a regimen if they are engaged as partners in their own care; empower your older loved one.
3. Pharmacists: It can be easier to order prescriptions by mail, but the engagement with a pharmacist can be very helpful in reinforcing what a provider has said.
4. Support: There are groups of people with like conditions that can meet and support one another's compliant behavior; birds of a flock feather together.
5. Memory Aids: There are more than day of the week pill boxes available; some dispensers are computerized to help track missed doses and avoid over doses.
All of this reinforces medication adherence, but also remember that as a caregiver you should be on the lookout for drug-drug interactions, some of which can make adherence difficult. Tell the provider if you see new behaviors or symptoms as soon as you notice. Charlotte Bishop is founder of Creative Care Management, certified professionals and geriatric care managers who are advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.
In my last posting, I gave a checklist of the preventive health touchstones for men over age 65, and you will see some fairly predictable parallels to women's health as they hit 65 as well. But take note of the differences if you are a caregiver to an older woman. I am going to start Bone Health - all women need to have their bone density tested even before age 65, and it is largely because of the hormonal changes that are associated with aging. the bone density test is called a DEXA scan, and if you are a caregiver to an older woman, you should approach her doctor about having it done as well as ask about what amount of calcium supplement will be a helpful part of her daily intake. Again, exercise will be important as well. Breast Health - there are risk factors that every woman ought to know, but on average, a mammogram every year or other year depending on their risk factors. All women of any age should learn self-exams as part of their monthly ritual as well. Pelvic Health - once a woman stops ovulating, and 65 is well beyond that, PAP smears are no longer part of the annual routine unless they have had a positive test result at some point along the way. The rule is that three negative tests within the past decade makes for a safe future but check with the physician. Blood Pressure - women should have their blood pressure documented annually as with men. With diabetes or heart disease, this maybe more frequent. If blood pressure is above 135/80 blood sugar levels should be tested regularly. Oral Hygiene - as with men an annual cleaning and exam is a must. Again, oral health tracks with heart health, so twice a year has more benefit that just a great smile. Cholesterol Levels - if cholesterol has been within normal ranges, a check about every three to five years is adequate. With heart disease or diabetes, this should be more frequent. Colon Health - up to age 75 a "virtual colonoscopy" every five years. A stool test every year, a sigmoidoscopy every five years and a colonoscopy every 10 years without a history of family colon issues or cancer. Eye Health - again, a vision exam is recommended every two years as a screen for glaucoma and visual acuity. If the older patient has diabetes, more frequent testing. Immunizations - as with older men, keeping current with all immunizations is important. For pneumococcal vaccines, every five years; flu shots annually. And the shingles vaccine if she has had chicken pox when younger. A tetanus booster every ten years is recommended, and talk to the primary care provider about anything else. Everything else - as with men annual exams are a time to weigh in, record height and test hearing. And women as much as men are prone to depression as they age. A physician can offer an assessment as well as a consult on all medications and any possible interactions . 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 all have seen the news stories in which older adults who are in a senior residential facility or dependent upon caregivers who come to their homes are intimidated by the people charged with their care. It can be physical abuse, emotional abuse, abuse by neglect or theft of the older residents' valuables and money. But we do not often think of identity theft as an abuse targeting older adults. If you are a caregiver to an older loved one, you need to be a vigilant advocate and be prepared to report any suspicious behavior. How can identity theft pose a threat to an older adult? Because someone has to look the part to get away with that, right? A growing number of cases nationwide suggest that older adults are perhaps even more likely as targets of identity theft than other younger people, and the reason very simply is that the person using a credit card in any number of transactions will rarely be asked for photo identification as they use the card. Even so, there are just too many "faceless transactions" for photo identification to pose any kind of barrier to abuse. Filling the tank at a service station or making a purchase on-line or purchasing by phone order are just a few examples. But why target seniors? Well, that is where the money is. By the time one retires, the house typically is paid off and they have accumulated their nest egg for the "golden years." And seniors are not likely to be making those big purchases for which a credit check is necessary, so they are not vigilantly tracking their credit scores nor is a lender. They may also not be using their credit card daily, so if it goes misses from a purse or wallet, it may be days before the loss is discovered. There also are more interactive scams that can defraud seniors. There are fake phone solicitations by what seem to be worthy charities or the call from someone posing as a grandchild or other family member with an urgent need while in another town. There are investments for which they may be "prequalified" with rates that will always be above what the older investor is earning from bonds or other safer investments. And who has not had an opportunity to help retrieve prize or inheritance money from someone in western Africa? As a caregiver, how can you help protect your older loved one?
1. Warn your loved one to the possibility of this kind of abuse.
2. Be alert to caregivers in your loved one's home and limit their access.
3. Suggest a credit card statement audit by a money manager who can spot fraud.
4. If your loved one is already having difficulty keeping up with bills, step in to help organize their finances and give everything due scrutiny.
5. If not you, personally, there are daily money managers who can fill this role (check the top listing on our resource page). 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.
With this posting, I am introducing a colleague and guest blogger, Pamela Holtzman, who is a therapist I know locally. Pamela is an R.N and L.C.S.W. who combines her medical background with a combination of cognitive therapy, traumatic release with EMDR and EFT and integrative psychotherapy, to facilitate wholeness and wellness, in her clients. Her perspectives on being well while getting older are worth sharing:

“Have you had that birthday yet which made you suddenly realize that you really are getting older? I don’t mean older in a decrepit, breaking down way. I mean older in a wiser, stronger, and more mature way. I had discovered that I had reached that phase during my recent 60th birthday “initiation by storm” as I came face to face with IRENE, the Class 3 hurricane that wreaked havoc at the doorstep of our home in the Bahamas. What followed was a week-long power outage, and a chance to do a lot of soul searching.

As a result of a life-long practice of maintaining a healthy mind and body balance, I was able to remain calm, peaceful, and resourceful throughout this life altering and potentially devastating experience. How can you stay balanced through life’s unexpected challenges:

Be Present – learn and practice living in the here and now, don’t worry about the past or future. No matter what life is offering, take time to do a morning quieting practice. Good options are yoga, Tai Chi, meditation, or anything that includes a level of mindfulness.

Be Healthy – have regular medial check-ups, and use a preventative approach to health. A good place to start is by eliminating the four poisons from your diet: hydrogenated fats, high fructose corn syrup, processed foods, and sugar. Develop and maintain a routine of ample rest, and follow a Mediterranean diet (high in fruits and vegetables, whole grains and cereals, nuts and seeds, oily fish, and olive or avocado oil, keeping red meat and diary to a minimum.) Try some new grains like farrow and quin. Make sure to drink plenty of water, and, of course enjoy a daily treat of dark chocolate.

Simplify – let go of what you don’t need. Clear that which creates clutter and/or complicates your life. This includes identifying and spending less time with ‘maintenance friends’ who rely upon you, but don’t offer reciprocity in your friendship. Decrease or eliminate activities that drain your energy, as opposed to replenishing your reserves. Remember balance.

Get Moving – of course there’s the physical benefits of exercise (increased bone density, muscular strength, endurance, energy, and better posture), but exercise also provides stress relief and improves mood. I have learned as I age –if I want to move, I’ve got to keep moving! It’s fun to mix up your routine and keep learning. Try Zumba, Nia, Barre, go to a dance class, or water aerobics. Keep exercise fun and playful, and do it every day.

Have a Massage – many enjoy getting one. But you don’t need to pay someone to enable your body to relax, detox and stimulate the lymphatic system. You can do reflexology for yourself on your hands or feet (it’s as good as a whole body massage.) Or try “dry brushing” before your shower, which natural detoxifies and is very stimulating.

Embrace Change – and recognize that change is good. It keeps your mind active, challenges flexibility, and opens up new ways of being in the world. Remember to soften into life, rather than contract in fear whenever you’re not familiar with a situation or are uncomfortable in life. Let go of the need to be right, to be heard, or be acknowledged. As you mature, you can learn to be comfortable with who you are without the need for outside validation.

Fill Your Soul and Spirit – learn to have fun. Think about what fills your reserves, what feels cohesive to your sense of self. For me, it is being with my grandchildren, or doing anything in nature. For you, it may be travel, volunteering service work, or just being home with a good book. You will be able to tell you’re being true to yourself because you will feel happy, rejuvenated and renewed.

If you want to continue to improve and grow as part of your aging process, it is necessary to continue working on balance and integration as part of your daily healthy lifestyle practice. Then, no matter what life challenges you face – you’ll be ready for them. For more information and techniques on healthy living, refer to my book Healthy Lifestyle Path of Wellness."

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.
It has been over a year since my first posting when I started this blog by talking about why a person should call a Geriatric Care Manager (GCM). Since I have answered this question with almost everyone of the calls I get from people looking for our help, it seemed like a good idea to revisit our “job description.” GCMs are:
1. Local professionals who know what resources are appropriate for your older loved one and which are most appropriate. What I often tell people is that we are “option-makers” for the decision-maker.”
2. Eyes and ears that can help long distance caregivers be aware of any changes that may affect an older parent’s independence or well-being. The long distance family caregiver may have bought mom the walker, but the local GCM can be there to see whether mom is using it.
3. Bridges to help an older family member make life transitions from fully independent living through home assistance and ultimately to assisted living at the appropriate times. Earlier involvement with a geriatric care manager also can help your elder family member develop a rapport with a professional who can facilitate the bigger changes later because they have been there earlier for the smaller changes.
4. Peace of mind by being the professional buffer to a long distance caregiver for some of the minor or major crises that may otherwise be very stressful for the entire family.
Finding a GCM is easy. The national association that certifies GCMs, the NAPGCM, has a comprehensive, searchable list of all the professionals in good standing. You can search geographically by simply entering a zip code or you can search by name. The search tool also asks you to check what kind of GCM you are seeking; check the “Certified GCM” box to see a complete list of professionals in good standing. Here is a link to another site that offers a range of resources, including care managers, Aging Care. Finally, Caring.com offers a listing of GCMs specifically in the state of Illinois.

As you make contact with a potential GCM for your elder, I encourage you to look for a good communicator, because this professional is going to be your loved one’s advocate. You also want to ask about their experience, and check professional references who can speak on their behalf. Finally, it is important to ask about fees since insurance does not cover a GCM. A recent article in Reuters suggested that fees nationally range from $60 to $300 an hour.

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.

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

Singing is a Breath of Fresh Air for Caregivers

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