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

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. ...
Read more
June 21, 2022
0
0
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...
Read more
June 7, 2022
0
0
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...
Read more
May 24, 2022
0
0
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...
Read more
May 17, 2022
0
0
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...
Read more
April 26, 2022
0
0
Heavy Drinking Helps?
Let’s take a short quiz. Question: Who prefers coffee…and who prefers tea? Which is healthier for you? Answer: ...
Read more
April 19, 2022
0
0
Respect and Inclusion
I was very pleased this past weekend that my son and his wife invited my husband and me along...
Read more
April 5, 2022
0
0
Consult Your Lifestyle Physician
You, or your older loved one, have a consistent pain in your hip, and you finally get a referral...
Read more
March 29, 2022
0
0
When the IRS Calls…
How about a show of hands regarding the Internal Revue Service (IRS)… Have you ever filed a tax return...
Read more
March 8, 2022
0
0
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...
Read more
February 1, 2022
0
0

In the Caregiver's Words

Recent Client Praise

Until quite recently there were rules governing what Medicare will reimburse if a qualified adult was prescribed physical therapy, occupational therapy or speech therapy. Patients needed to show documented improvement if Medicare was going to continue to cover their therapy. As with all insurance rules, a patient or the patient's families could pay out of their own pockets for any services a provider may prescribe, but until this year, the government was not going to pay for therapy without an improved health status. All that has changed now with a federal ruling that it is no longer necessary to show improved status to get reimbursed. If you are a caregiver to an older loved one or someone else with special needs who is covered under Medicare, therapy now will be offered to maintain a patient's present condition or to prevent "backsliding." Translated, Medicare now must recognize and support a patient who is attempting to stay as well and as active as they can be. As a geriatric care manager, this is very gratifying as a large part of what we do is to help our clients to maintain a quality of life, because beyond a certain age improvement is simply not realistic. Many of the old rules are still in place regarding where therapy may be received. It can be received at an outpatient center, a therapist's private office, in a nursing home or in a patient's own home. Authorization simply requires a doctor's order, so make sure your physician knows about the change. The same dollar caps on how much Medicare will cover still remain, and that is $1,900 a year. And even residents of nursing homes who have used up their 100 days can still get coverage for therapy, so long as they do not exceed the cap for the therapy. This, too, can be challenged , in certain cases, so be sure to check in with a local office of the Centers for Medicare and Medicaid Services for the terms. And claims for patients who may have been denied before this year may still be honored retrospectively back to the date when the lawsuit was first filed January 18, 2011. For more information on:
- the outpatient therapy cap limits,
- getting exceptions to the cap limits,
- who can give therapy services under the rules,
- where therapy services can be received, and
- how to find out what the therapy services will cost,
go to http://www.medicare.gov/Pubs/pdf/10988.pdf or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. To find a resource in your own state, just visit: http://www.Medicare.gov/contacts. 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 ccbishop@creativecasemanagement.com.
Full Name:*
[text* fullname 75/ id:Full_Name]
Phone Number:
[text phones 75/ id:Phone_Number]
Email:*
[email* emailc 75/ id:Email]
Your Question:
[text question 75/ id:question]
Type the Characters Shown:*

[captchar captcha-220 class:contact-input]
[captchac captcha-220 class:contact-image size:m]

[submit class:ccm-send-btn1 "Get In Touch"]

Personally committed to you and your loved one's well being.

New contact form submission received from CreativeCareManagement.com [fullname] <[emailc]> From: [fullname] <[emailc]> Phone: [phones] Message Body: [question] -- This email was sent via the contact form on the Creative Care Management website, http://www.CreativeCareManagement.com. info@creativecasemanagement.com, ccm.eachost8@ecommercearchitects.com, <[emailc]> Your message was sent successfully. Thanks. Failed to send your message. Please try later or contact the administrator by another method. Validation errors occurred. Please confirm the fields and submit it again. Failed to send your message. Please try later or contact the administrator by another method. Please accept the terms to proceed. Email address seems invalid. Please fill the required field. Failed to upload file. This file type is not allowed. This file is too large. Failed to upload file. Error occurred. Your entered code is incorrect. Your answer is not correct. Date format seems invalid. This date is too early. This date is too late. Number format seems invalid. This number is too small. This number is too large. URL seems invalid. Telephone number seems invalid. This input is too long. This input is too short. on_sent_ok: "location.replace('/thank-you-for-contacting-us/');"
That’s not covered.
The estimate is that about 28 million older Americans have opted out of traditional Medicare and for what are called Medicare Advantage plans. They are not just Medigap which came about soon after Medicare was enacted to help pay for what Medicare did not cover, like prescription drugs and more. They are touted as plans that can offer better services, more services or better value, but these “advantages” have been brought into question lately. There may be value in these plans, but they also go on record with tens of millions of denials for tests or services each year. A report from Medicare administrators (part of the Centers for Medicare and Medicaid Services, or CMS) found that three-quarters of denials for medical services to covered patients were reversed on appeal. An investigation further found that 18 percent of payments for care that had been denied would actually have been covered by Medicare. Insurers use a step in the medical process that requires that approval be sought from an insurer before a procedure can be covered; they’re called prior authorizations. These “prior auths” appear to have been expanding well beyond what they originally were intended to do. The step was initially set up to stave off expensive or unproved procedures and medications. A new medication perhaps has been found to work against a different diagnosis than was originally approved by FDA, but it might not be approved for coverage until it has become a “standard of care.” But it has been used far more commonly to deny a host of services, tests or prescriptions, and patients may not know that they can appeal…or at least give the feedback to the provider who ordered the services, tests or prescriptions. If you are a caregiver to an older loved one who has one of these Medicare Advantage plans, be watchful of services or prescriptions that are denied. Become an advocate for your loved one with their provider and ultimately with the insurer. The real litmus test for the services that may be questioned is whether they would be allowed by Medicare. If Medicare would allow a service, Medicare Advantage plans must also provide for that service. Medicare Advantage plans may have their own criteria for processing services and reimbursement, but they cannot be more restrictive that Medicare. Federal investigators admit that even some of Medicare’s own rules may need to be updated. 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.
It is absolutely great news that Pfizer and BioNTech have brought a vaccine for COVID-19 from discovery to approval by the US Food and Drug Administration just today. We all can see the promise of “normal” on our collective horizon and almost breathe a collective sigh of relief. We have been more than a bit distracted by COVID-19 for how long…ten or more months? And what used to be the major concern of everyone with an older loved one can now get some press. And there may be good news in the Alzheimer’s fight as well. A company called Cassava Sciences has shared results from a Phase 2b clinical trial that show its therapy helps to block a protein that triggers brain inflammation and the loss of neurons. They are moving to Phase 3 trials on patients who have been diagnosed with Alzheimer’s Disease. The drug is called sumifilam, and it is an oral medication that can be taken once a day. The Phase 2b study focused on how oral administration in a range of dosing could block the proliferation of a protein called HMGB1 that causes inflammation in the brain. The same drug also helps to restore both the shape and function of a beneficial protein in the brain called filamin A, and while it is doing that it also is strengthening the natural defenses of brain by blocking access across the blood brain barrier of inflammatory proteins like albumin. In more straightforward lay terms, this tablet can help manage three pathways by which Alzheimer’s disease can negatively impact the brain. Part of the evidence the scientists presented to get approval to move forward with a Phase 3 clinical trial focused on some of these biomarkers of harm to the brain. Simifilam also showed a reduction of Ptau-181, the “tau tangles” that are a physical characteristic of Alzheimer’s as well as improved performance on cognitive tests. As this promising therapy rolls out with a Phase 3 trial across a number of sites in Arizona and Florida among patients with mild to moderate Alzheimer’s Disease who are 50 to 85 years of age, I will keep you informed of findings. You also can follow any reports to the public by going to a government site for clinical trials related to Alzheimer’s. Spoiler alert – there are nearly 1,300 trials currently in motion on some aspect of Alzheimer’s Disease. We will keep you posted on anything truly noteworthy coming from any of these trials so you don’t have to work on your doctorate in biochemistry to decipher what the reports tell us. So, please consider this two doses of good news on the medical front this week. And when it comes to clinical trials, please remember that the two key tests the FDA applies are that a treatment or vaccine is safe and effective…in that order. Please do not be sucked down the rabbit hole of those who suggest otherwise. Just Google thalidomide…FDA withheld approval of that therapy when the European Medicines Agency signed off. 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.
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:
1. 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.
2. Encourage your loved one to report anyone or any company offering a “free” genetic test.
3. 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.
4. 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.
It is not just because of the housing collapse that many seniors have decided to stay in their existing homes instead of moving into a senior community in recent years. It also is because it is easier to make home changes to keep up with the needs of older adults who wish to "age in place." In this two-part series, I am going to take you on a walking tour of an older adult's home with an eye to how to make life a bit easier and safer. If you are a caregiver to an older adult or someone else with special needs, think of it as a checklist room by room.

Front Door. Don't think of those few steps that lead up to the front door as a stairway; think of them as barriers to entry and exit. Recall from an earlier post that osteoarthritis becomes increasingly common with age, and what used to be four easy steps can now become a big challenge. Then, add an armful of groceries or a dark night when things are not as easy to see clearly, and you have an accident waiting to happen. Consider as alternatives either a no-step rehab to the entry way or a long ramp; I say long ramp, because it is important to keep the grade modest to accommodate a wheelchair, a walker, crutches or a cane. And get rid of the threshold - that strip of wood or molding that rises up between the outer wall of a house and the inner wall.

Garage Entry. For the older adult who still drives or is a passenger to someone who drives, getting from the garage to the house can be as daunting as those stairs in front of the house. Consider a hydraulic garage lift, especially if someone requires a wheelchair to get about.

Halls and Floors. Once in the home, turn on the light. Especially at night an older adult will find the abrupt transition from the bright porch light to the dark interior will make it hard for one's eyes to adjust, an invitation for trip or fall. For ease of use consider also replacing old light switches with rocker switches that are much easier for older, less facile hand to manipulate. Then, look at the floor surface as a potential obstacle. Throw rugs are just waiting for an older adult with unsure footing, and a fall is the outcome. Of if the carpet has been aging with the resident in an older home, there may be edges coming loose or seams that may trip the older adult who treads there. For any longer corridors or internal stairways, also consider hand rails for both walls. These rails can be the first line of defense for an older adult prone to slipping or tripping.

In the next installment, I will continue with a room by room walk through as you consider how best to refit your older loved one's home. I'll also add a web site that is full of useful resources for anyone looking to make it easier for older adults to remain at home and independent.
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.