Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • caregiverChicago's Geriatric Care Manager Center of Excellence - Since 1991 | Page 3

Looking Out for Your Older Parent 24/7
There will come a time for everyone with an aging parent that the question will arise, “Is it still...
Read more
July 11, 2022
0
0
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

In the Caregiver's Words

Recent Client Praise

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.
Medicine today is full of miracles. But Aging Well magazine (Jan/Feb, 2009) reports that although the over 65 set in America constitute only about 13% of the population they account for about 30% of all prescriptions filled. Their share of over the counter (OTC) drugs is estimated to be closer to 40%-50% of all retail meds sold. The report goes on to say that nearly two in five hospitalizations each year are a result of medication issues associated with elders. The elderly are fully half of all prescription drug-related deaths annually.

Let me tell you about a list you should know about. If some drugs have added baggage beyond the healthy effect sought by a prescriber and a patient, a doctor named Mark Beers, MD, and his associates have been the “baggage handlers” since 1991. That is when they first came out with the “Beers List.” Beers and his associates were concerned that certain commonly prescribed as well as OTC drugs were causing what are referred to as adverse drug events (ADEs, sometimes shortened to just AEs). Beers, a doctor specializing in geriatric care, found that the elderly were particularly susceptible to many of the undesirable effects of these drugs because their older bodies tend to have less water content and more fat content than younger individuals. This, coupled with their bodies’ diminished efficiency in metabolizing or processing chemicals through their systems helped to account for the disproportionately high rate of AEs and associated hospitalizations and deaths among the old.

Beers' most recent list of 48 drugs and drug classes has been published in the Archives of Internal Medicine and has been embraced by the Centers for Medicare and Medicaid Services (CMS). Beers and his associates have established a set of criteria for determining if a drug poses a risk, that is, is it a potentially inappropriate medication (PIM) for the elderly. Using an expert panel of internationally-recognized experts, Beers and associates were able to find consensus on the drugs that are part of their list of potentially-hazardous medications. It is an important elder resource you should know.

The Beers list has a number of “old friends” as well as exotic medications of which most of us have never heard. You will find the likes of over the counter Naprosyn or Aleve (generically known as naproxen sodium) as well as Benadryl (diphenhydramine) and Chlor-Trimeton (chlorpheiramene). There are also household names like Valium (diazepam), Tagamet (cimetidine) and Prozac (fluoxetine). It is important not to take the Beers list as a blanket generalization that these are simply drugs to avoid. It is not quite that black and white. Some agents are on the list because they can cause complications among specific groups such as diabetics, asthmatics, or insomniacs. Others are contra-indicated for individuals with balance or gait problems because they become prone to falls, some for individuals who have bladder outflow compromise or still others who suffer from chronic obstructive pulmonary disease, emphysema.

The list goes on, and in some cases it is simply a dosage or extended release formulation warning that justifies being included on the list. Check it out: Beers List

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.
Everybody eventually learns to accommodate the “empty nest” that inevitably follows the busy days of child-rearing and child-launching. And then – maybe after a rather substantial wait – there is, once again, the prospect of more little ones in the house. This time, however, they are grandchildren, and as much as everyone who raises kids knows how not to drop a baby, the world has changed. It translates into a new kind of child-proofing different from a generation ago. This is advice for seniors who may be hosts to little ones for the first time in a lot of years.

1.    First, it is important to start with an open mind. It is too easy to slip into a mindset of “what was good enough for my kids,” but times have changed and so has safety. So, some of the old toys may still be considered safe, but the old car seat, play pen or infant swing may not be just outdated; they may be dangerous. Defer to the new mom and dad for advice on what will still work and what needs to be replaced by the next new thing. This approach is also politically helpful in empowering the new mom and dad.

2.    Remember also that when you raised your own children, you may not have had any of the chronic conditions you now have. And you also would not have the medications associated with those conditions, so develop a plan to store medications safely and out of reach of kids. While you may not want the nuisance of those safety bottles, you really need to be certain that medications that will be attractive nuisances to little ones on the prowl are locked up. This is especially true if one of the older grandparents uses the “day of the week” pill reminders that often are stored in the kitchen as a reminder for prescription schedules.

3.    For an add layer of safety, go to the source. The Consumer Product Safety Commission has a twelve-step approach to fully kid-proofing your home, and a number of their recommendations like smoke alarms and carbon monoxide detectors which are great safety measures for everyone. They have a downloadable two page brochure to walk you through the steps (click here for brochure).

4.    This last one is making the grandparents house safe from what the toddlers or young children will bring with them. Falls among seniors are often caused by the unexpected, and there is nothing so unexpected as the little dolls, cars or a myriad of other items that you will buy for the kids or that they will bring with them. Make it a habit of picking up after play time, because you may not see the little hazard on the floor…especially after sunset.

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. Read more about Our Story and Charlotte's mission.
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.

1 New contact form submission received from CreativeCareManagement.com - Caregiver Counsel on Senior Living Options [fullname] <[emailc]> info@creativecasemanagement.com, lynda@llvirtual.com From: [fullname] <[emailc]> Phone: [phones] Message Body: [question] -- This email was sent via the contact form on the Creative Case Management website, http://www.CreativeCaseManagement.com. 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. Please fill the required field. The field is too long. The field is too short. Date format seems invalid. This date is too early. This date is too late. Failed to upload file. This file type is not allowed. This file is too large. Failed to upload file. Error occurred. Number format seems invalid. This number is too small. This number is too large. Your answer is not correct. Your entered code is incorrect. Email address seems invalid. URL seems invalid. Telephone number seems invalid.
Did you have a great Thanksgiving Holiday or do you find yourself totally exhausted from all the preparations and clean-up and dreading (at least) four more weeks of the same? If you can see something of your experience in that description then you may be a caregiver who has not followed my "prime directive" for caregivers: You will always take better care of others if you are taking care of the caregiver first! I have said it somewhat differently on numerous occasions, but those charged with taking care of an older loved one along with everyone else in their orbit also need to care for themselves. Don't burn the proverbial candle at both ends.

So you agree in concept. It seems easy to say, but how does a caregiver start taking better care of her or himself? Here are three simple guides that you may find helpful in getting through the rest of the holidays. I think you actually will find that you better enjoy the opportunities for family and friends when you are in better shape yourself.

1.    Delegate! Recognize that when ten people (or more) gather at your house to dine for the holidays that there will be a lot of food to prepare. Don't go it alone. Request the two vegetable dishes from two of the guests, the rolls from another and the dessert from someone else. You may reserve the special dish that only you do for yourself, but share the opportunity to prepare the feast. And keep sharing after the meal. Those who cannot cook will clean! If you find yourself alone in the kitchen with a sink full of dishes after dinner, you did not delegate.

2.    Designate! Set up a schedule with "rest stops" for your days leading up to and including the day of the event. Set aside time for yourself just as you would set aside a break from a long drive in order to get out of the car and stretch your legs. Get out of the house for a nice walk in the crisp air or sneak away to your room with a magazine or book.

3.    Disengage! Don't compare yourself to anyone else. It is easy to set the bar way too high by thinking that "if mom or dad could do all of the work," then so should you. And that goes for recipes also. Be prepared to enjoy the meal in which everyone has a hand in preparing. In fact, it may even taste a bit better if you did not prepare all of the meal. (Refer to rule #1 above.)

      Enjoy the rest of our holiday season, and remember to take care of the caregiver.

      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.
Okay, "Grain Brain" is not something that immediately tells you what it is all about. Grain Brain is the phrase that neurologists and other brain scientists are using to describe a link between blood glucose levels from high carbohydrate consumption and dementia. A book by the same name is going into its 15th straight week on the New York Times bestseller list, so the concept is getting a lot of attention. But what does it mean for you or an older loved one in your orbit? In a scientific study recently published in the prestigious New England Journal of Medicine, researchers followed a large group of men and one of women for an average of almost seven years. During this nearly seven years they regularly measured the individuals fasting blood glucose levels. At the end of the study they found that people with higher blood glucose levels were more at risk for developing dementia that those whose levels were not as high. They found this to be true even with people who did not have diabetes. It is true, that this kind of study cannot say that increased blood sugar levels actually cause dementia, but the link is sufficiently clear that the New England Journal would publish the findings. Scientists also find that not all grains have the same negative effect on cognitive ability. Those with the highest gluten content seem to be the worst offenders. This is not the first research to show negative health outcomes associated with elevated blood sugar. Researchers have well-established proof that a high carbohydrate diet and the associated elevation of blood sugar poses a risk to one's heart and to the immune system. And there are other studies. in a 2012 study in the Journal of Alzheimer's Disease, researchers reported that risk for cognitive decline was 89% greater among those on a high carb diet; those on a high fat intake diet saw a 44% decrease in their risk for cognitive compromise. And researchers in another British journal, Lancet Neurology, estimated based on their findings that as many as 54% of the cases of Alzheimer's Disease in the United States could be avoided with exercise, weight reduction and steps to reducing blood pressure. This last study really drives home a great point. If you are a caregiver to an older loved one, you both will see great returns on a few basic investments of time and effort. Increase the daily amount of exercise, reduce the carb intake and the rewards will be weight loss, reduced blood pressure, a healthier heart, a more vigorous immune system and more acute cognition. Sounds like a really great return on investment to me. So, will you and your older loved ones be among those who avoid the "grain brain?" 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.