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

COVID’s Other Deadly Toll
During this pandemic, over 13,000 more Alzheimer’s and other dementia patients have died than expected from these cognitive disorders,...
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September 22, 2020
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It’s Not a Sprint
I think it occurred to me Sunday afternoon last week, and I was anticipating Monday. But Monday was Labor...
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September 15, 2020
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That’s Not A Senior Moment
We all hear the phrase used as an excuse for a bit of memory lapse … that it’s just...
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September 1, 2020
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Heard or Herd?
I am really, truly, seriously, absolutely in need of good news – heard news and herd news. Today, I...
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August 18, 2020
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Hold Your Friends Close and Stangers Closer
Miss your friends, your older loved ones and those summer get togethers in the backyard? We can get together...
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August 11, 2020
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Pre- Instead of Post-?
When was the last time you studied after a test? Or prepared your dinner after you had dined? Or...
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July 21, 2020
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Negative Thinking Causes What?
What could be worse than a COVID pandemic? How about the uptick in depression and anxiety that mental health...
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July 7, 2020
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Abuse Thrives in Pandemic
Guest post author Gregory Peebles is a team member at CCM whose work focuses on helping aging adults and...
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June 16, 2020
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Distance Caregiving Through a Wall
I’ve written numerous times about distance caregiving, and one of the observations I have offered is that distance is...
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May 19, 2020
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Caregiving During COVID: Four Tips for Reengagement
You may recall that I have recommended limiting your news consumption, because it really does add to our stressed...
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May 12, 2020
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In the Caregiver's Words

Recent Client Praise

When I say there is no ‘D’ in dementia, it is not that I am Deficient in spelling. Medical research has been accumulating that people with low levels of vitamin D in their bloodstreams are more likely to experience cognitive decline and even develop Alzheimer’s Disease. When I say cognitive issues, it is not all aspects of brain function. The declines associated with vitamin D deficiency are focused on episodic memory loss and deterioration of executive function. Researchers from University of California, Davis and Rutgers University studied 382 adults whose average age was 75.5 years old. These adults received cognitive assessments which categorized them as having dementia (17.5%), having mild cognitive impairment (32.7%) or as cognitively normal (49.5%). Vitamin D levels were lowest for those diagnosed with dementia, but there was only very nominal difference in vitamin D levels for those who were mildly impaired and those who were classified as cognitively normal. All of these adults were studied for nearly five years and then assessed again. During that time the magnitudes of decline in episodic memory and executive function were greater in adults who had been diagnosed as vitamin D deficient or vitamin D-insufficient. The investigators found that regardless of their baseline cognitive assessment, their ethnicity or a range of other risk factors, those who had been vitamin D deficient at the beginning of the five year period were at greater risk of developing Alzheimer’s Disease. Scientists continue to study the association between vitamin D levels and dementia. While there are no studies that suggest taking vitamin D supplements can prevent Alzheimer’s, doctors in practice are not waiting. They are prescribing D for their older patients, especially those who are already at low blood levels of the vitamin. We who live in northern regions should be particularly on top of getting enough sun to activate our natural vitamin D, consuming more dairy products and green leafy vegetables and augmenting our diets with vitamin supplements. Charlotte Bishop is an Aging Life Care Professional and 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.
So last week, the turkey turned out really great, the pumpkin pie was awesome, the home football team prevailed, and most of the family showed up for the annual feast. Everybody ate, laughed and played together nicely, but you feel like crying. It just was not the same without mom or dad or some other loved one in the picture. You're not alone if you have this feeling of being let down or even depressed as you try to put on a happy face and enjoy the holidays that used to be so wonderful.

Psychologists call these responses to holidays or other special times of the year "anniversary reactions." The holiday itself may bring back memories of a time when there was a lot to enjoy - which makes holidays without a loved one all the more empty now that they are gone. Or the holiday may be the time when your loved one passed, and it is hard to find the good times in what now is a memory of profound loss.

It is not just about dates on a calendar. There are other potential triggers that bring on a sense of grief and loss almost as fresh as the moment of the initial loss itself. Certain places when we come "home for the holidays" can be triggers for melancholy. Certain smells like those of a favorite dish or of the frost in the air or the candle smoke as the Chanukah candles burn down or the Christmas tree that may soon stand in the corner. And there may be the sounds that open the flood gates as we all shift to the holiday music that will be with us until the day after Christmas. But you don't have to simply resign yourself to the blues; here are some ways to reconstruct a more positive version of your holidays.

1.    Crying gets the sadness out. It's okay to be honest about how you feel by simply letting the emotions out. Crying can be a great emotional release and a relief that will let you then get back on with more positive holiday emotions.

2.    Reflect back on the positive activities that you had enjoyed with your deceased loved one. Find someone - children or grandchildren - with whom you can share the activities, and you may find they begin to give you a new satisfaction.

3.    Memory of loss can stand in the way of other positive experiences that preceded the loss. Talk with close friends or relatives, some of whom may have shared those positive events. By reconstructing the positive, you re-experience moments you had cherished with your loved one.

4.    Collect some of the photos of the good times you have enjoyed with your loved one. Or maybe it is a letter written or other memorabilia that you can place in a special box or album so that you can have stimuli that help to re-experience the moments that have been special.

      These suggestions are not intended to take the place of professional counseling if your depression weighs heavily on you, but they are steps that may help restore the "happy" in your holiday.

      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.
This is not going to be a course in economics, but quite often caregivers of family members get more focused on how much respite care casts instead of on how much everyone benefits. Talking about costs first, there are three kinds of costs for respite care: dollars you pay, dollars someone else pays and what you can get for free. Starting with the dollars you pay, give careful consideration to the level of care you need for the older adult for whom you may be the caregiver. If the adult in your charge needs help with a whole range of activities of daily living such as eating or toileting, then there will be a higher hourly rate in order to get qualified respite care. If, you are closer to the other end of the continuum and mom or dad can get around quite well, but need to be watched so that they do not wander, then you may be able to save significant dollars by simply engaging the services of an aid or similarly-trained individual. Getting respite care for free? First, don't forget to consider other members of your own family. Even a brother or sister who has a day job can offer respite care in off hours or on weekends. Get to know other caregivers in your own circle of friends so that you can get some respite when one of them is willing to watch your mom or dad along with their own and vice versa. It is good for everyone when your respite becomes their chance to socialize. Check out resources for Chicago senior services, local community colleges or even high schools for students who either need to generate hours for community service or need hours toward course requirements in social work or other helping profession. And consider the following resources that may subsidize respite care:
Most important, don't forget the benefits of respite care. The most important of which is you will do a better job caring for someone else when you care for yourself.
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. Learn more about What We Do and how we can help you support your loved one.
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Choose the Senior Home Health Service That's Right For You

Home Health
Home Health involves licensed medical professionals (often nurses or physicians) trained in providing aid to those who need health monitoring and assistance. This service is ideal for those who have recently been hospitalized, are in need of rehabilitation or medication assessment, or have suffered a decline in physical mobility.

Home Care
Home care provides services for those who need help with ADL (Activities of Daily Living) tasks. For instance: transportation to doctor’s appointments, grocery shopping, house cleaning, and other every day needs. This service is ideal for a family caregiver who needs someone they can trust to take care of their mom or dad while they are away. It is also helpful to those who need short-term assistance after a hospital stay or during physical rehabilitation.
When I get a call about our geriatric care management services, most people are not asking for a geriatric care manager, per se. They are asking a question about something they have noticed or been told about their older parent or loved one. The question most often is about a change in the older parent that sets off the caregiver alarm that something is just not quite right. In this posting I am going to go through some of the questions I hear and then explore some of them in more detail in later blogs. Please also let me know any questions you may have or any telltale signs you may have seen in an older loved one that give you concern.

Change in eating habits: Have you noticed that your loved one's clothes are fitting more loosely, that they miss meals or that they just don't have the appetite they used to? Losing interest in food or eating significantly less are not normal or inevitable parts of aging. But older stomachs do empty more slowly than a younger adult's, and food may be less appealing because the sense of smell and taste are diminished. Yet, the fact remains that malnutrition is a serious health threat to an older adult. “There’s a fair amount of evidence that suggests if you lose appetite as an older person, in the next six months, you’ll have a higher chance of dying.” This is according to Dr. John Morley, professor at the medical school and Director of Geriatrics at Saint Louis University Hospital.

The cause may not be directly tied to food losing its appeal, per se. It may be that your older loved one simply has poor fitting dentures that just take the joy out of eating; it is actually painful. Loss of appetite is also potentially a sign of depression among older adults.

Older adults also have had a lifetime of losses, such as retirement, debilitating chronic disease, death of a close family member or simply not being as socially engaged as they once were. And these losses can become a huge emotional burden that detracts from appetite.

Any of these causes that lead to a diminished appetite can also ultimately lead to malnutrition which is a slippery slope. Malnourishment can lead to a reduced immune system and the ability of the body to resist diseases or other assaults. Small cuts or bruises will be slower to heal or even be more prone to infection in a malnourished older adult. As the malnourished body looks for nutrition it will feed upon itself, particular muscle. Once an older adult's muscle mass is diminished they will, in turn, be more susceptible to falls or even degradation of bone mass and fractures. And it is hard to put the healthy weight back on.

So, when next you visit the older adult in your life or have a meal with them, take note of the food they consume and what gets left on the plate or not served. Also, check their refrigerator if they are living independently. Look for how well-stocked it is, signs of food well beyond expiration dates or spoiling. It is not just about eating a full meal as much as fueling a healthy, older body.
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.
I have spoken with Matt Margolis, an Elder Law attorney with Heartland Law Firm recently about VA benefits to which people may not know they are entitled. In this posting, he shares some valuable insights that may expand your options for care cost coverage.

            One very common question that comes across my desk on a daily basis is “Are there any benefits, other than Medicaid, to help pay for the care of my ___________ (insert: mom, dad, husband, wife, brother, sister, etc.)?” Typically, this is being asked because Medicaid is only available for someone in a Skilled Nursing Facility. Because of this, we refer to Medicaid as “nursing home financial aid.” My follow up question to this prospective client is usually asking whether the person they are calling about or their spouse was a Veteran.

            The Veterans Administration (VA) Aid and Attendance Benefit program is the benefit I will discuss with them. In the overwhelming majority of situations, the prospective client has never heard of this benefit. This benefit is actually classified as a “pension” by the VA and is a great source of funds for financially constrained wartime Veterans and/or their surviving spouses to use for their long term care costs such as living at home with a caregiver, adult day care, independent living with a caregiver, assisted living, and/or skilled nursing.

            While family income is one of the determining factors of eligibility, it is important to be aware that the VA allows individuals to deduct their unreimbursed medical expenses, which includes their health insurance premiums, home care, assisted living, adult day care, caregiver, and nursing home costs from their income. As a result, many Veterans who may not have previously qualified might now qualify if long term care has become necessary for them or their spouse.
As a general rule, to qualify for the Aid and Attendance benefit, a family's total assets (excluding their primary residence and vehicles) cannot exceed $80,000. Fortunately, many clients I meet with have assets in surplus of this number. The good news is that with the right strategies and planning, we can still position them to qualify.
            A few things worth mentioning:
In the end, the VA Aid and Attendance pension is a heavily untapped, but much deserved, benefit for those Veterans and/or their surviving spouses who served and fought for our country.

Heartland Law Firm is a holistic elder law and estate planning firm. Heartland Law Firm concentrates in assisting seniors and those in transition with understanding the landscape they are in and what protections and benefits are available to them and their loved ones. Visit their web site at: Heartland Law Firm.

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.