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

The Other Global Health Crisis
Wearing a face mask is the new front line of defense against the spread of the war on COVID-19,...
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November 17, 2020
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One More Sign of COVID?
I have written about Alzheimer’s disease…a lot, its warning signs and caregiving probably more than any other topic. Even...
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October 6, 2020
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None of the Above…
While everyone is awaiting the next vaccine to prevent COVID-19 or help in the treatment of the condition among...
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September 29, 2020
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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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In the Caregiver's Words

Recent Client Praise

If the classic symbol for Valentine’s Day this past week has been the heart, then the older loved one in your orbit should be their own valentine! By that, I mean they should be taking care of their own heart. I spoke with a gentleman last week who is well only over 70 years old, and he was offering his advice on how to train for a triathlon. I am going to tone it down a bit here and offer some advice from the American Heart Association on a combination of small steps and exercises that can help your older loved one to get into better shape and that goes for more than the heart. From what the American Heart Association recommends, I offer six different exercises that can be done with or without these little guys in the picture. And I encourage your older loved one to take these seven exercises seven times each and then repeat for a total of three times. The first step however is a visit to the physician. If the physician signs off on what the American Heart Association recommends, then you and your loved one are on the way to not only better heart health, but also better fitness overall. Please let me offer a big caveat: ask the physician how many times per week they put into working out. If they do not exercise, you may want to look for a second opinion. Recall my earlier blog posting when I warned against “taking it (too) easy.” You will note that there are no numbers on the weights in my picture here. Find a weight that allows your loved one to successfully complete the seven times for each of the weight exercises…and maybe start with one set of seven per exercise before progressing to three rounds for each. But here are the seven:
1. Arm Raises: With a weight in each hand let the weights down on each side. Then, lift each arm until parallel to the floor. Hold for only a second and then slowly return to arms at sides.
2. Biceps Tone: With arms at the sides and extended, raise the weights up to just touch the front of each shoulder. Lower gently back to fully extended at the sides.
3. Triceps Tone: Starting with a weight in each hand extend arms to the ceiling. Then, gently lower backwards so the weights are behind the head on either side of the neck. Raise vertically again and repeat.
4. Leg Muscles: Without the weights and while sitting, lift a leg from the foot on the floor to the leg parallel to the floor…hold for a few seconds before lowering the foot slowly to the floor. Then try the other leg. Seven times per leg.
5. Stomach Muscles: Again without weights and while sitting lift both feet a few inches off the floor; hold for a few seconds before lowering the feet once again to the floor.
6. Balance: Using a wall or hall rail to steady themselves have your loved one walk heel to toe steps, each foot just ahead of the toe of the other foot for ten steps.
7. Chest stretch: While sitting with their back to a wall, have your loved one clasp their hands behind their neck and gently bring their elbows to touch the wall. Relax and repeat for seven times.
Okay, hit the showers if you wish, and do it again tomorrow. 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.
For caregivers to older loved ones in northern climates, winter is more than just a warning about dressing for the cold. Especially with the recent round of record cold temperatures across two-thirds of the nation, here are some recommendations for assuring that your older loved one will be safe throughout the rest of this season. It is the Ice. It is not just the cold that can be a threat to your older loved one's safety, it is the slippery surfaces that accompany p[lunging temperatures. With about 1.6 million Americans visiting the ER because of a fall each year, it is important to prepare your loved one for treacherous walkways. Encourage your loved one to think of going outdoors as an athletic event; wear shoes that are appropriate for the conditions and do some stretching before heading out. Skin Protection. Older skin is both thinner and drier which means that an older person will bruise or cut more easily. They also may be more prone to nosebleeds. All of this encourages keeping indoor humidity a bit higher in order to have skin as prepared as possible for the assault of the cold, dry outdoor air. And boost your older loved one's inner humidity by encouraging more aggressive hydration with fluids. Prepare for Outages. Encourage your older loved one to stock up on staples should outdoor conditions get in the way of the weekly run to the store. And should the power go out or the pipes freeze, have them stockpile a few gallons of extra water - just in case. Flashlights with extra batteries along with candles and blankets are also essential back-up, and have a system in place for regular wellness calls by phone as well as from willing neighbors throughout the season. Keep Warm. This may seem obvious, but remember than an older adult's sense of feeling is diminished with age or because of chronic conditions like arthritis, diabetes or just poor circulation. Keeping the thermostat at or above 68 degrees F is a good marker, but still be listening in your wellness calls for any sign of cognitive difficulties like slurred speech which could be signs of hypothermia. Seasonal Affective Disorder (SAD). The long nights and short days of winter can take their toll on anyone, but age has its own way of exacerbating depression. Encourage your older loved one to get out and socialize and be alert to the glum noises of SAD in your regular wellness checks. All of these general warning signs also should be a reason to reach out to neighbors or programs that can call on an older loved one. Meals on Wheels, for instance, is only partly about food; it also is a way to keep isolated people from becoming even more disengaged. And this may not be just about your older loved one if you are a distance caregiver; check around your own community to see where you can be that neighbor who checks on someone whose day will be just a bit warmer for your reaching out. Take heart - Spring is only a bit more than two months away! 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 Peebles is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP), and trained Medicare Counselor, 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 This is the first installment in a three-part series to help clear up some common misconceptions about Medicare. Medicare isn’t intentionally confusing, but with all the cross-talk surrounding Medicare, even if understanding it isn’t as intuitive as “1,2,3”, it’s at least as easy as “A, B, D.” As a care manager, I know first-hand that there are lots of people with the wrong idea that Medicare is a cheap, single-payer, universal care package for US citizens who have retired from the work force. There is a fantasy at work in the minds of many Americans that once they have “paid their dues” and transition into retirement that their medical concerns will be easier to manage, and that all care is covered. Unfortunately, folks who have enrolled in a Medicare plan and those helping to coordinate their care already know that this is only partially true. While Medicare, our government-subsidized health insurance program for adults 65 or older, is somewhat simpler to manage because it is a single-payer service, it has changed significantly since its implementation. But the real shock to many is that coverage was never meant to be universal. Medical providers who agree to take Medicare “assignments” agree to maximum prices able to be charged for services. This does keep costs down, and Medicare pays 80% of those contracted prices; however, service receivers are expected to pay the remaining 20% of costs, not including prescription drugs. When the source of payments is a fixed income, that income gets spent very quickly on covering the “gap” that Medicare does not pay. So, while Medicare may be inexpensive in comparison, it is still rarely easily afforded by those who use it. What Medicare was designed to be is a program to help offset medical costs for aging adults. It was consequently split into two broad categories – Medicare Parts A and B – which correspond to two primary methods of treatment. Part D, added later, supplemented Original Medicare as the trend for prescriptions for aging adults increased.
- Part A – [Original Medicare] Covers in-patient stays (including hospital stays, or stays in rehab facilities, etc.)
- Part B – [Original Medicare] Covers physician visits (including PCP visits, or referrals)
- Part D – [Addenddum under the Medicare Modernization Act of 2003] Covers select prescription drugs.
These broad categories do cover the bulk of what we would call internal medicine, yet there are surprising omissions in coverage, which we’ll talk about next time. Another consideration for those about to transition to Medicare is that the program is not one-size-fits-all; rather, it can be individualized (within limits) to the patient’s needs. Much like traditional insurance, if the selected plan is not optimal for the patient, parts of the plan can be modified during open-enrollment periods. We’ll talk about this, too, when we fill in another “gap” and talk about Medicare Part C. 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.
So, you may be asking yourself, is there unintentional caregiving? The answer is “yes,” and there is a lot more than you may at first think. We have all heard people use expressions like “I was so busy I didn’t know which way was up.” What they really may have been saying is that “I got so caught up in the chaos of the moment that I was doing more motion than making progress.” I have talked in earlier postings about the dementia of distraction. Well, that was a reference to the forgetfulness that comes from dividing our attention across too many simultaneous tasks. Well, life in the current high tech environment has us all stimulated by any number of people, things or gadgets. I am not going to recommend that caregivers unplug entirely from caregiving as some technology gurus encourage going through tech detox and simply disconnecting from all things tech periodically. Caregiving does not allow that, but intentional caregiving can be a way of engaging in what maybe a Zen master might call contemplative caregiving. Intentional caregiving is the opposite of the overwhelming chaos that can be the caregiving that comes from doing everything that is in front of us, everything we are guilted into doing and not giving any thought to whether we are really getting done what needs doing! Intentional caregiving is about recognizing that every task we set out to do for a care receiver is an opportunity to make choices that help us be centered, thoughtful, productive and on-task. By being more intentional we actually get more done with less …less time, less energy and less anxiety. Here are some tips:
- Keep it Simple: Try to do any task or series of tasks individually. A Logical sequence would be nice, but at the very least avoid multi-tasking; multi-tasking results too often in every task being done sub-optimally.
- Don’t forget to Breathe: I will get even more Zen than this, but appreciate that slow and even breathing is a way to give calming feedback to your brain. That feedback also helps to relax tension in the muscles. If you notice that your tongue is protruding while you are engaged in a task, you are probably holding your breath. Breathe…
- Try Something New. Even caregivers are susceptible to the old adage: “If you keep doing what you always have been doing, you will keep getting what you always have been getting.” Try new approaches, look for an app for whatever the task is, and maybe even change up the schedule a bit. Perhaps a hot shower at the beginning of the day is a way to soothe your muscles and refresh you mind before plunging into your chores.
- Yes, Meditate. This is the real Zen part. It is as simple as assuming lotus position…or anything that does not have your knees or ankles crossed and practice slow breaths …in through the nose…out through the mouth. Repeat.
- Recharge your Batteries. I knew a caregiver who started out conversation by observing that he had gone from five hours of uninterrupted sleep a night to five hours of interrupted sleep. That is not sustainable. Seek out a geriatric care manager for local resources, check out respite care, get other members of the family…or the village…who can contribute. You need rest.
Ultimately, intentional caregiving is a win-win. Not only does the care receiver get a better outcome for whatever task, but you as a caregiver are taking better care of you. 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.
At CCM, home and safety are as important to us as to you, so it’s no surprise that it’s a common topic of our discussion. I have asked Gregory Peebles to talk about this topic from the vantage point of his experience. Gregory is both 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. An Associate Care Manager, Gregory has been a part of our team for over a decade. – Charlotte Home. Not only is there no place like it, conveniently located wherever you hang your hat, that fits--like an old, comfortable shoe, but it’s also a place that once we leave, to which we can never return. While most find this very stressful, some are secretly happy for a new chapter. Indeed, lots of people confirm they like adventure, but small is the number who enthusiastically embrace major residential change. So what’s the difference? Well, for one, the direction of action: people elect to go on adventures, but change just seems to happen to us. This is a major life change, and those inclined deserve the opportunity fully to grieve their loss of home sweet home. However, once the initial grief has been addressed, we’ve got work to do! Change isn’t the end, and there’s plenty of life and happiness yet to be found no matter the location. Where that happens is up to you. The diversity of the experience of aging can be exciting, and, with the number of Americans joining the group of aging adults, the kinds of communities that now exist will only become more varied. Right now the kinds of accommodations available generally fall into a few groups.
- Active Adult Communities – Often neighborhoods with individual bungalows, these communities are based on the model of so-called “snow birds” who opt to transition to such a residential community rather than maintain a larger space. Living in one of these communities requires a high level of independence (and income). Individuals or couples with highly social personalities thrive in this setting.
- Independent/Congregant Living – Facilities of this type, while slightly less luxurious than an Active Adult Community, feature many of the same accommodations with a denser population. In an urban setting, they are often high-rise apartments indistinguishable from nearby housing, with dining, health care, and leisure activities on the premises. If considering this type of facility, be sure to keep nearby entertainment and accessibility in mind.
- Assisted Living – A senior for whom it has become difficult to care for themselves either because of physical limitations or decreasing independence will often find an exciting new life in such a facility, either through public assistance or private pay, where skilled staff are present to provide diverse care. If the care receiver is also living with cognitive decline, such a facility with a “Memory Unity” may be advisable.
- Skilled Nursing – On average, aging adults who become residents within skilled nursing facilities – SNFs - are those who have health problems, who require 24-hour care, and whose ability to manage the Activities of Daily Living is severely impaired. Nursing home care, too, is expensive, but public assistance programs such as Medicare or Medicaid relieve the cost.
Change is difficult, but not unmanageable. New identities await us and are only limited by our willingness to embrace them and the imagination we bring to our experiences. Change is scary, and rightly so, but when we weather even the most difficult transitions together, and our lives are no longer recognizable from before, we may--if we choose to--learn that home is something that we take with us wherever we go, and that it is recognizable not by its address, but by the love shared and the people with whom we share it, common to both our memories and our futures. One final thought: This is when people often reach out to Aging Life Care Professionals to help smooth the transition to a new residence and to ensure ongoing care. CCM has helped countless families like yours succeed in this new chapter. Contact us today and let us assist you. 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.
In my last posting I shared geriatric care management services for caregivers communicating with a loved one who may be suffering from dementia. If you have a loved one who has Alzheimer's or one of the other types of dementia, you know all too well that they are not the same person they once were. But have you actually spent some time trying to understand who they are? Have you tried to understand what it is like inside dementia? Try this hypothetical situation. As you awaken tomorrow morning, you make note of the time, and you know that the dogs need to be walked because they have been in their crates all night. You have just enough time to walk them and then have breakfast and get to work. As you go downstairs to the kitchen, the crates are not there, the dogs are not there. In a minor panic, you turn to your wife who is there and ask where on earth the dogs and their crates are? If your wife of many years tells you the dogs have been dead for six years and that you have dementia which is making you confused, how do you feel? ...probably confused, anxious, frightened, and then sad - very sad. That used to be what professionals recommended to caregivers of individuals with dementia - a bit of reality-grounding, but today, the more accepted approach is one of empathy or what therapists call redirection and validation. So, this kinder approach to the situation might be to apologize for not letting your loved one know that the dogs are being groomed and that if they wish you can prepare a breakfast for them. A patient with dementia may suffer from delusions or hallucinations, and these can be intense and stressful events. So, affirming their feelings and then helping them to shift to something more soothing can be very helpful. This older adult who just happens to suffer from dementia still is the person with feelings who is just behaving in what they perceive to be a rationale manner. By validating their feelings and then redirecting their behavior, you are helping them to cope with the world as they see it. Some therapists even suggest that this helps to restore a sense of self-worth that will be helpful in avoiding some future episodes or anxiety:
1. First, ask questions that will help you understand what has triggered the response. I had a client who saw little people around the perimeter of the room painting the baseboards. Once we understood that these people did not speak or harm him, we could incorporate them into his world while still interacting with him.
2. Don't think that it all has to be logical. It is more about how your loved one feels than it is about if it makes sense. Just go with it.
3. Especially if your loved one is upset, try to gently find out what makes for the upset. Then, validate by agreeing that you would be troubled also if its happened to you. You will find that the anxiety for both of you will subside.
4. The bottom line for all of this is to gently give your loved one an out and a chance to save their self-esteem.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends who provide geriatric care management services to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.