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

One More BIG Addiction?
If you’re old enough to remember 1969, then you are old enough to remember this bold addition to the...
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December 6, 2022
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Would You Want to Know?
National Geographic has a new documentary series, Limitless with Chris Hemsworth, starring, of course, Chris Hemsworth of Disney’s Marvel...
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November 29, 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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What’s Scarier than Halloween?
The short answer to this question is cybersecurity breeches. First, how do you know if that spam in your...
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October 18, 2022
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Diagnosing Alzheimer’s Disease
September is Alzheimer’s Awareness Month, and this is the second of four posts we’ll offer on the subject. A...
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September 13, 2022
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The Will To Do the Right Thing
This whole idea to write up a legal document to give surviving loved ones clarity about how to take...
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August 9, 2022
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Before or After the Fall
I came across an informative piece in the Washington Post about a week ago, and it brought to light...
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July 26, 2022
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Why a Flamingo Stands on One Leg
You’ve all probably heard the old joke about why a flamingo stands on one leg…and we have all seen...
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June 28, 2022
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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. ...
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June 21, 2022
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When That Doesn’t Stink…
There are a lot of tests and exams we all know that are important to catching a condition early...
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April 12, 2022
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In the Caregiver's Words

Recent Client Praise

They call it Trendelenburg gait. You may have noticed it in the way your older loved one walks. It is a side to side upper torso sway for men and a side to side sway of the hips for women. It results in about a four degree shift in the opposite hip from the leg that is stepping forward, and that doesn’t sound like a lot, but it really impacts the knee on the side that is shifting…a 23 degree shift. Over time, the knees get a lot of exaggerated grinding which will wear down the cartilage. Parkinson’s or even dementia can encourage this exaggerated gait, and hip replacement and the gait pattern that can follow surgical recovery also can set it in motion. But Trendelenburg gait is not inevitable. We all have to grow old…versus the alternative, but we do not have to “walk old.” Physical therapists recommend a few exercises that help to strengthen core muscles that can prevent that side to side gait:
1. The Walk-Over – Stand in front of a mirror so that you can monitor your exercise. Standing upright with feet shoulder-width apart and a towel rolled up in front of one of your feet, simply lift your leg up and then step over the towel. Tap your foot to the ground in front of the towel while keeping your hips horizontal, and then lift your foot again and tap behind the towel. Do this back and forth for 30 seconds and then switch to the other leg. Do the exercise twenty times. This can be twenty times in one exercise or over multiple “exercise breaks” in a day. It’s a strengthening exercise, so picture yourself getting stronger the more repetitions you do. Do this as many days of the week as you can with three to four days as your target.
2. The Plank – You may wish to “Google” this so that you can see it. We are talking side planks which mean that you lie on your side, preferable on a soft carpet or exercise mat. With your elbow lifting your upper body, you form a straight line from your feet to your head and hold for 30 to 60 seconds. Alternate this pose and holding with the other side. Go back and forth between sides about three times and do this as many days a week as you are able.
3. Chair Sits – Begin by standing in front of a wooden chair with your arms folded across your chest and your fit about shoulder width apart. Lift one leg forward to form about a 20 degree angle with the other leg that is vertical. Slowly sit down with that leg extended. Once you have made contact with the seat of the chair keep the pose while standing back up again. Change to the other leg and repeat. Do this as many repetitions as the plank and as many sets.
I have been talking about helping your older loved one, but this may be perfect for us all so that we all can grow old…without walking old! 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.
The rest of the oft-quoted phrase is a pejorative about how “Nobody’s Home.” And we know it’s supposed to connote low wattage of an intellectual sort. Well, burglars who may be watching for when your mom and dad go on the vacations with which retired folks are supposed to be frequently indulging themselves are also watching to see if the lights are on. According to law enforcement they take the lights on as a sign that, in fact, nobody’s home. So what can one do to safeguard home? Well, the same bad guys also look to see if the lights go on at the same time a couple nights in a row, so timers are about as effective as letting the house stand all lit up all the time. Technology has a better answer…actually a couple of them that involve “smart lighting” that can be a safeguard both indoors and outside. Smart lighting outside can use motion detectors that sense anyone approaching the house and flood them in conspicuous lighting that burglars like to avoid. And these particular smart lights can be “trained” to respond to only larger disturbances, so that pesky moths do not have your porch flashing all night like a pinball machine. The sensor outside could also be set up to turn on a light or two inside the house to make it appear as if someone inside is alert to anyone approaching the house. You will want a sensor that also is “outdoor rated” to be sealed against moisture. Smart lighting inside can be a real safeguard against night time falls for an older loved one who may make the middle of the night run to the powder room. A small light can be a big assist for someone just starting to awaken, but already in motion down the hall. And both indoor and outdoor sensors can be set to turn themselves off after a desired lapse of time, again looking more real life. And there is a whole line of smart devices that connect home indoor and outdoor lighting to an app on a smart phone. And you don’t have to ask Siri to attend to the lighting for you. It is all literally in your hands. Of course, if you’re trying to be helpful to an older loved one you will want to confirm specifically when they are and are not home so that you don’t unsettle them with an unannounced light show. 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.
Today’s posting is from one of our long-time business associates and health care industry expert. Mr. John Marchica is founder and president of Darwin Health, a research resource and think tank in the industry. He is a published author and national speaker on the U.S. health care system. The Centers for Medicare and Medicaid services announced results from the second performance year of its Independence At Home demonstration. Evaluators found that participants saved over $10 million—on average, about $1,010 per beneficiary. CMS said all 17 participating practices improved quality in at least two of six quality measures and four practices improved quality on all six. Seven providers received a total of $5.7 million in performance incentives. “The Independence at Home Demonstration is a patient-centered model that supports providers in caring for chronically ill patients in their own homes,” said Dr. Patrick Conway, CMS acting deputy administrator and chief medical officer. “These results continue to support what most patients already want–the ability to have high quality care in the home setting.” In this demonstration, providers must meet the performance measures for at least three of the six following areas:
- Follow up contact within 48 hours of a hospital admissions, hospital discharge, and emergency department visit
- Medication Reconciliation in the home within 48 hours of a hospital discharge and emergency department visit
- Annual documentation of patient preferences
- All-cause hospital readmissions within 30 days
- Hospital admissions for Ambulatory Care Sensitive Conditions
- Emergency department visits for Ambulatory Care Sensitive Conditions The Independence At Home initiative serves about 10,000 Medicare beneficiaries. In order to be accepted into the program, participating practices are required to demonstrate experience in providing care in the home to high- cost, chronically ill beneficiaries. Selected providers include primary care and other multidisciplinary teams led by physicians or nurse practitioners, are organized for the purpose of providing physicians services, and serve at least 200
Last year, when Dr. Conway announced first-year results from the demonstration at an ACO conference we attended, the crowd roared. The comparatively modest program saved $25 million, or about $3,000 per beneficiary per year. Everyone was impressed. This year’s results appear to be more modest until you look deeper into the numbers. In 2014, the average target expenditure per beneficiary per year (PBPY) was $4,646. In 2015, the average PBPY target expenditure was $3,873—a 20 percent decline. Actual PBPY expenditures dropped 17 percent, from $4,290 in 2014 to $3,672 in 2015. Looked at another way, CMS’ target was more than $400 less in 2015 than providers actually received in the first performance year. They set the bar higher and providers still managed to save money. Unfortunately, isn’t possible to compare savings from both performance years because CMS changed the regression methodology used to calculate the control groups that allow it to determine savings. But the takeaway is clear: this program has been wildly successful at controlling costs for the most expensive, chronically ill patients in the Medicare program. We wouldn’t be surprised if CMS pulls the plug on the demonstration and rolls out the program nationwide. We are happy to share this guest posting on Charlotte’s Blog. For subscriptions to Darwin’s regular weekly information, just click here. 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.
Associate Care Manager Gregory Peebles returns with a series on the Internet and aging. 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. Gregory has been a part of CCM, Inc. for over a decade. – Charlotte We think of the Internet as a place that caters to young people. While this is mostly true, it remains so only because that’s the way our culture trends--not because virtual reality becomes suddenly indecipherable to those of us who have crossed the threshold of middle age (or older). As we mentioned in this topic’s introductory post, recent data tell us that at least two-thirds of Americans 65+ have a reason to be online. So what are they doing? Where are they? Let’s take a quick look.
1. Email. This is still top of the game for our older community. In fact, the older a person is, the more likely they are to view email as a way of sharing information. This is the way the Silent Generation prefers to use the Internet: by staying in touch, more casually even than by using the telephone.
2. Shopping. Silver is where the gold is. Online marketers have figured out that aging adults spend more money online than any of their generational counterparts, and that the same people are more than twice as likely to spend on products that report improved quality of life, and vendors are taking note. Amazon recently developed the 50+ Active and Healthy Living Store, and its initial success will doubtless inspire more, similar online shops from already successful providers.
3. Socializing. Seniors are on Facebook, too! (And at a growing rate … a little more than half of folks surveyed; other social platforms don’t register anything close to these numbers.) Facebook has become the virtual town square to many Americans. More and more folks get some version of news media from the social giant. Facebook, which integrates new, non-social features, seems to be positioning itself to become The Only Internet Anyone Needs.
4. Dating. Online dating has taken a swift upturn in the last few years, and adults 60+ are the most rapidly growing group in the pool. While services like SeniorMatch are geared specifically to those looking for love later in life, Match.com reports 4.5 million active users in the demographic!
Now that we know where they are and what they’re doing, we can start to address issues of safety. Next week we’ll be talking about the security dangers that our older loved ones can face on-line. 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 and Amazon Best Selling author of a new guide for caregivers to older adults with dementia: How Do I Know You: A Caregiver’s Lifesaver for Dealing with Dementia
In my experience as a geriatric care manager, I field a lot of questions from people who are suddenly faced with caring for an older parent or spouse. For people who become caregivers overnight after a parent has a fall or experiences a significant medical setback of some sort, it can be an overwhelming responsibility. Where does one go to learn how to be a caregiver for an older adult or someone else with special needs? It is easy to tell a person how to become certified as a geriatric care manager (not as easy getting certified) or even a paramedic (again, not as easy getting certified), but how do you become a caregiver right away?

As much as some folks may have a predisposition for being “good with people,” being a caregiver poses some unique challenges and an aspiring caregiver can benefit from some special training. One of the resources I featured last month, Julie Northcutt – President of CaregiverList.com, talked about using summer visits as a time to take stock of the needs of aging family members of other with special needs. She has a new training module that has come to my attention, and I am sharing it with you here, because it may give a lot of you a jump start to caring for older family members or others in your orbits.

In her 10-hour on-line program, CaregiverList.com offers training that meets the requirements of state licensing boards for caregivers, and it also may offer peace of mind. I was impressed with its topical coverage:
- Communicating with Others
- Observation, Reporting and Recording
- Providing Personal Carburetting and Maintaining Good Mobility
- Elimination and Toileting
- Infection Control
- Environmental Hazards and Safety
- Basic First Aid
- Understanding Elder Abuse
At $49 it seems to be a reasonable investment in care for an elder and peace of mind and confidence for 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 throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.
If you have a family member or loved one with dementia, this pandemic and its restrictions have been exponentially worse than for the rest of us who have “just” sheltered in place. Depending on where you and your loved one with dementia may call home, you may be seeing the beginning of a relaxation of the more stringent measures to stop the spread of this virus. But dementia – and this may differ a bit depending on type of dementia – has presented and continues to present some added challenges to your safety and the safety of your loved one. I’d like to offer these suggestions for you or anyone you may know who is caring for a loved one with dementia at home:
- If you have professional home care help that comes to your home, don’t wait to be surprised by any changes in their protocols – call and ask when or if protocols for hygiene may be changing;
- Changes or not in agency protocols, it is your house, and you can set your own rules for hygiene and face masks;
- With your caregiver (and other visitors to your home), do your own contact tracing – ask about any exposures to others with the virus and where and when;
- You probably had implemented some reminders about hygiene for your loved – keep the post-it reminder noted in the bath about hand washing, etc.;
- Continue to be patient with your loved one if they forget about hand-washing or wearing the mask outside – your patience will be tested as much by your own anxiety as your loved one’s forgetfulness;
- If your family or community has lost a loved one to COVID-19, don’t remind your loved one about the loss if they ask about this individual again – it only makes them relive the grief as if it were new.
I’ll make this last one separate from those first five you do for your loved one. Be sure to make taking care of you a daily investment. As I have always said, you can only take care of someone else if you are also caring for yourself. Be safe and be well. 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.