Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • caregiversChicago's Geriatric Care Manager Center of Excellence - Since 1991 | Page 4

Scammer v. 23.1
Call it Ocean’s 65+…instead of Ocean’s 8 or Ocean’s 11…but it doesn’t have a caste of Hollywood stars, and...
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March 7, 2023
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Another Side to the Story
It was just a year ago that Bruce Willis’ family disclosed that the actor would be retiring from acting...
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February 27, 2023
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Ain’t No Sunshine…
…When She’s Gone.” Or how about, “You are My Sunshine, My Only Sunshine?” or “Here Comes the Sun?” or...
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February 21, 2023
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How to Say ‘NO’ to Dementia
It was about two and a half months ago that we posted about the diagnostics telling Chris Hemsworth he...
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February 14, 2023
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Long COVID’s Long List of Symptoms
The COVID pandemic is not yet done with us in the United States, and the story certainly is different...
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February 7, 2023
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A Defensive Game Plan for Dementia Outbursts
It’s not just about forgetting or being confused. If you have a loved one with dementia, it is also...
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January 31, 2023
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Happiness is a Long-Term Investment
If I were to ask you to make a New Year’s Resolution for your own happiness, what would your...
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January 17, 2023
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To Sleep, Perchance to Dream
No, this isn’t a refresher course on Shakespeare and the famous Hamlet soliloquy. (Spoiler Alert – Hamlet was ranting...
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January 2, 2023
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A Viral Trifecta?
To get to the question in the email first, the Spanish flu of 1918 did not get its start...
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December 13, 2022
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Saying “No” May be the Right Answer
Saying “yes” when someone asks you to do something can be like eating candy. It feels right or good...
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November 15, 2022
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In the Caregiver's Words

Recent Client Praise

I recently had the opportunity to speak with Dr. William Krowinski of Life Works Erie (link) about something I have noticed over the years. That is, during all of this holiday period, there are a lot of folks who just seem pretty down. So, I asked him about this thing with "holiday blues," or is it actually depression? Here are his answers.

Is there such a thing as holiday blues or is it just another name for depression?

"Holiday blues as a psychological condition is distinct from clinical depression. We tend to think of the holidays as a joyous time, getting together with family and friends, preparing and exchanging gifts and well wishes, fixing and partaking of traditional desserts and meals. However, for some, particularly the elderly, they can also be a time of sadness with a sense of loss.

Why is that?

Our mind is always referencing the past to make sense of and guide us in the present. We don’t invent Christmas or Hanukkah each year. It’s an annual celebration whose meaning and rituals are largely derived from past celebrations. So this holiday is in many respects a reflection of past experiences. Whether consciously aware of it or not, we ask ourselves where was I last year, who was I with, who was there, what did we do, how did I feel and so on. For many elderly, this referencing inevitably involves realizing who isn’t here this year, including spouse, friends and family members; and what did I do in the past and am I able to do it now? Recognition of these significant losses and limitations produce feelings of loss and sadness.

Do all elderly suffer from holiday blues?

If they have experienced significant social losses and physical limitations, I would say yes but with some qualification. Some people are psychologically resilient so loss is not as devastating and their sadness isn’t as severe. Some people have a large social network full of friends and family members, which tends to offset any one loss.

Is there a difference between holiday blues and depression?

Yes. Examining the duration and severity of the sadness, as well as identifying other symptoms allows us to differentiate between the two conditions. Regarding duration, holiday blues end when the holiday is over. Clinical depression continues for months and sometime years if left untreated. With depression, a person’s ability to socialize and take care of him or her self is negatively affected. Other symptoms tend to include loss of appetite and weight, insomnia, anxiety, difficulty concentrating, feelings of discouragement and hopelessness, lack of energy and motivation, and sometimes-suicidal thoughts.

What can be done to help a person experiencing Holiday Blues?

First let me say what you shouldn’t do. Don’t tell the person “you shouldn’t feel that way” or “just snap out of it.” We don’t choose our feelings. People suffering from the holiday blues or depression need to be treated with empathy and compassion. In addition to recognizing the person’s feelings, ask, “Is there anything I can do to help?” Offer to take the person shopping, to church, for a walk and other activities. Offer to include him or her in holiday preparation activities such as baking cookies, buying a Christmas tree, decorating the house and so on. Even if the person declines your offer, they know you are thinking about him or her.

Do you have any suggestion for the person who is experiencing Holiday Blues?

First, recognize that there is reason to feel sad. Accept the sadness and view it as a messenger. Frequently our sadness informs us of the joy that a deceased loved one has brought our life. Next, try not to isolate yourself. Don’t turn down opportunities to be with family and friends. Regarding physical limitations, grieve the loss of what you once could do; while at the same time do what you can do. Remember that life is a about transitions – the athlete becomes the coach, the actor the director, the mother the grandmother and so on. Celebrate the past but let go and embrace the season of your life. And remember there is always someone who needs your help. Helping others, even in small ways, creates meaning and purpose in our lives.

Dr. William Krowinski Ph.D., LCSW, a psychotherapist specializing in marriage and family and a guest speaker at LifeWorks Erie (www.wjkphd.com). Lifeworks Erie, located in NW Pennsylvania, is a partner of CCM. They provide services and resources for seniors interested in staying mentally and physically active.

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.
As geriatric care managers, we provide advice, counsel, advocacy and support for older care receivers or other people with special needs of any age. Care managers, however, also provide support to the front line caregivers to these care receivers by adding our CMs eyes and ears when the caregiver cannot be present, our advice based on the experience we have that first time caregivers just cannot have and support for the caregivers themselves. This last is important, because the person most often neglected by the caregiver is they, themselves. They do not sufficiently care for themselves while they are involved in caregiving. That said, there are different kinds of caregivers, and the care they need will be different. We can make a lot of distinctions about kinds of caregivers, but one important dimension that I see a lot very simply is defined by the relationship to the care receiver. By that I mean, the difference between intra-generational caregiving and intergenerational caregiving. Let me explain. Intra-generational Caregiving. According to all the surveys I have seen, one of the most common caregiver relationships is that of one spouse caring for the other. But it also can be siblings who care for one another as one falls ill, or it can be friends, cousins, neighbors and more. These intra-generational caregivers could benefit from the greater knowledge of community resources that GCMs have, the correct questions GCMs can ask at a medical appointment, the help GCMs can bring to the caregiving to avoid harm to the caregivers. This last is especially true when both the caregiver and the care receiver are older and frail. I have seen cases in which the caregiver is injured in a fall while trying to attend to their fallen care receiver. Yet, such accidents can be avoided if a care manager is brought in to "leverage" the good intentions of a caregiver. But a caregiver may feel guilty about asking for help when they perceive they should be taking care of everything. The family needs to talk about helping the caregiver. Intergenerational Caregiving. The other common caregiving relationship is the son or daughter (most often the daughter) who is trying to be the caregiver for mom or dad. This same daughter or son, however, are also responsible for a spouse, or their own children or a job. These are the truly stressed caregivers who would benefit from a trained care manager to attend the medical appointments and to ask the right questions that will get the best care for mom or dad. They also would benefit from a very subtle form of counsel on just how to establish the new ground rules for caregiving. I hear some caregivers say something to the effect that the roles have been reversed, and now mom (or dad) is the child and they are the parent. Wrong! The roles have changed, but they have not reversed. When a child to an older parent steps up to the caregiving role, there need to be some difficult conversations about everyone's expectations and about the older loved one's dignity. A third party like a GCM can be an invaluable arbitrator, not to mention a great resource about all the options in the community that can make caregiving much less stressful and much more rewarding. As I have said in other postings, just as it may take a village to raise a child, it also takes that same village to care for all our older loved ones! 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@cr eativecaremanagement.com.
Remember the ads that started with a plea: “Help, I’ve fallen and I can’t get up?” That is so twentieth century. Today, it is Alexa, please turn off the lights in the living room. Alexa, please play Guns and Roses…you get the point. Now, Alexa is making house calls for your older loved one. This past week, Amazon rolled out new software tools that are Alexa-compatible to help people at home communicate with their providers. Think about mom or dad now able to let their doctor know that they are able to get up and about at home following their surgery. Or they can report that they are having very little post-op recovery pain or that the infection seems to be under control today. That is all well and fine, others would say, but that patient feedback is strictly confidential. The good news is that Alexa communicates with your loved one’s health care provider … just like a healthcare provider. That is, the communications from home to hospital are HIPAA-compliant. The software developers have built in protections so that what is communicated by way of Alexa or Siri or Amazon or Google stays confidential. Amazon specifically is keeping tight control on who can use the platform with only six companies so far having received access. It used to be that “telemedicine” was via phone connectedness…and then via computers, but now it is just a voice away with an in-home set of ears sharing everything with a health care provider. Soon enough, those who cannot ambulate as easily or drive can order their prescription refills through Alexa. Developers are also at work to develop software that can understand medical records as well as ask the right questions of patients at home to help keep medical status current for the humans at the clinic who wish to check up on patients in their homes. There is more:
- Cigna has a system available to its large national clients so that they can better manage their health and wellness goals;
- Express Scripts allows for prescription renewal as well as tracking progress as the pills get delivered home.
- Another health system enables a home device to enable residents to identify the nearest provider with appointment availability when needs arises.
- Another digital health company interacts with people in their homes to manage chronic conditions like diabetes.
I cannot help but imagine Alexa helping that diabetic patient at home by monitoring their cookie and ice cream purchases…maybe tech gone too far? 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.
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.
If you’re like me, you have been following too much news on the pandemic, but hopefully you also have been following the good news of the new vaccines being released. Yet, national polls show that more than 40% of Americans claim they will not take a vaccine when it becomes available, evidently a carryover of years of false science from anti-vaxxers and maybe a present mistrust of government. So, how effective can a vaccine be if only about 60% of Americans will accept the cure? Well, scientists say that until we can vaccinate 70% to 90% of the population (and this can be combined with those who have had COVID-19 and recovered), we won’t have herd immunity. Let me start with my title of this week’s post and remind everyone that the vaccine only works if you take it. Second, let me give you the breakdown on how these rather unique vaccines will work. But first, please allow me to take an historical detour to the first scientifically-proven vaccine and Dr. Edward Jenner, considered by many to be the father of modern immunology. This is also where the drawing here originates. Edward Jenner lived in the late 18^th century when smallpox was a viral killer. There had long been rumors in Jenner’s time that milk maids contracted something called cowpox from their occupation, but that they were subsequently immune to the feared smallpox. Long story short, Dr. Jenner proved that to be the case, and cowpox vaccination as a prophylaxis against smallpox ultimately became the standard of care. Flash forward to here and now, and we have some new vaccines that make use of the messenger RNA which facilitates the replication of COVID-19, but is not the virus itself. Scientists can wrap each piece of mRNA into a nano particle of lipid (natural fat) and inject it into a patient. The lipid melts away, and the patient’s immune system sniffs out some alien messengers (the mRNA) which triggers the body’s alarm system to its immune system. Immune system rallies and attacks all cells with that mRNA code and sends more of its responding troops to their ready position throughout the body. If anything tied to COVID-19 sets foot in the human territory the responding cells are ready and in force. Boom. Immunity. This should be one of those films we used to get in school about why we are supposed to wash our hands during flu season. Or some of you can recall polio vaccines and how polio has been nearly eradicated through the ongoing work of Rotary International and the Bill and Melinda Gates Foundation’s efforts. Rotary has this disease down to only Afghanistan and Pakistan, and sadly efforts have been sidetracked by the current viral plague called COVID-19. Yet, the volunteers with Rotary and allied organizations have been so relentless that we have very nearly eradicated polio in the world. You have to believe in something during this unprecedented time; choose to believe in the science. 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 hear a lot of news these days about the obesity epidemic, and it is important to appreciate the impact of excess body weight/fat on the heart and the circulatory system. Some also point to the impact that excess weight has on a burgeoning epidemic of Type 2 diabetes, the type that does not require insulin injections to manage blood sugar levels. But some doctors like Dr. Robert Lustig are saying that it is not fat that makes for the increasing rate of diabetes, but it is the consumption of processed sugar like fructose. While Dr. Lustig is a pediatric endocrinologist, his advice has a lot to offer older adults also.

It is true that sugar is not really good for us, but it is more important to recognize the differences between good sugar versus "bad sugar." Honey is a natural, or good, sugar and a lot of fruits and some vegetables also contain complex carbohydrates which can be beneficial foods. But beware of thinking orange juice is as good as eating a whole orange, for instance. Most products actually add sugar to the orange juice to make it more appealing, so that they have made a good food into a potentially bad food. Look for the "bad sugars" on the label with names like fructose, diastatic malt, dextran, ethyl maltol, panocha and sorghum syrup.

And being overweight is not inherently the real problem. If you are a caregiver to an overweight older parent or loved one, you may have seen the futility they feel when they exercise but cannot seem to lose weight. Lustig suggests that it may be okay to be fat and fit. That is, it is simply harder for some overweight people to lose pounds, especially if they are older and really do have slower metabolisms. So the real issue is about avoiding the bad sugars.

Lustig also points out that almost all the successful diet books have two suggestions in common. They recommend meals that are high in protein and are high in fiber. In other words, encourage your older parent or loved one to eat fewer processed foods. Lustig goes so far as to suggest that if the food has a label to read, that already is a bad sign as processed foods are so typically light in protein and fiber, but also high in sugar (and salt). He points out that naturally-occurring fructose like that in sugar cane, fruits and some vegetables is "protected" by quantities of fiber. He also jokes that honey - also high in fructose - is protected by bees.

You may wish to go the source: Robert Lustig - Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity and Disease.
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.