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

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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Dementia, Distraction, Delirium and Depression
September is Alzheimer’s Awareness Month, so we’re going to be sharing four posts that will help everyone with what...
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September 7, 2022
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Why Mister Rogers Was Right
Mr. Rogers Told You…but were you listening? And it wasn’t just once that he shared the message; it was...
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August 2, 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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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...
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June 7, 2022
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Dementia from a Pet’s Point of View
Fetch! Come! Sit! Stay! Remember! So, I’ve given away that I’m a dog owner rather than a cat or...
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March 1, 2022
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If It’s Not Happy or Merry?
I explained in an earlier post about why we refer to Holidays in the plural, and how we are...
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December 14, 2021
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Can You Hear Me Now?
From 2002 to 2011, actor Paul Marcarelli was the voice for Verizon pitching their cellular communications with the simple...
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September 28, 2021
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In the Caregiver's Words

Recent Client Praise

If you are a distance caregiver who will be home with an older loved one during these holidays, it is a great chance to have great conversation and to do a caregiver check up with your older loved one. You may beneficially find it helpful to raise some questions in your catch-up conversation to get a clearer sense of how well your elder is caring for themselves. Try these: 1. How are you sleeping? It is common knowledge that as we age, we simply need less sleep, but there is a real health difference between needing less sleep and actually suffering from insomnia. Consistent loss of sleep can be a real health risk in itself. Medical researchers find that as the hours of lost sleep pile up, blood pressure also rises. With rising pressure, there is rising inflammation or even weakening of blood vessel walls. People with genuine insomnia have twice the chance of suffering a stroke. Recommend end of day habits that will be less stimulating...like less television and more reading. It may be helpful to even suggest a white noise machine or some sound devices that mimic wave action or light rainfall to soothe your loved one to sleep. 2. Do you enjoy a good cup of coffee? At the opposite end of the sleep continuum, don't discourage your older loved one's coffee during the day. At the same time you can encourage decaf or a switch to non-caffeinated teas after the lunch hour to avoid stimulation that can fuel sleeplessness. But coffee actually imparts measureable health benefits. It has been demonstrated to reduce the risk of type 2 diabetes, heart disease and even some forms of cancer. 3. Do you have a place for safe walking? Walking just half an hour daily - or even six days out of seven - has had a demonstrably beneficial effect on reducing belly fat. And the effect is more than cosmetic. Walking or even jogging can reduce the middle and at the same time lower the risk of the three above: diabetes, heart disease and cancer. With any exercise, always encourage your loved one to consult their physician and to get comfortable and supportive footwear. 4. How are you feeling? This sounds like a vague question, but it is a chance to talk about anything that has changed lately. Research shows that unusual chest or arm pain are common precursors for heart issues in men. In women, it is not so clear. In fact, fewer than a third of women report discomfort before a cardiac event. But nearly all women have symptoms like indigestion, pain, anxiety or other cues before a heart attack. Listen for what may be brushed off as "nothing." If you are a caregiver to an older loved one, enjoy family and the holiday, and take the conversational opportunity to make it a healthy holiday and new year. 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.

I have been in a discussion lately with some of my peers about how to describe the care management that we do as our calling. In the internet age, most of what defines us all comes down to what you find or where you look on the Web for help. One of my colleagues refers to Care Managers as “the search engine that offers only the best options.” Another of my associates refers to our job description as the “care navigators” who help people with older loved ones find their way. And a third refers to us as “the life and logistics planners for individuals 65 and older....we take care of EVERYTHING so they don't have to.” Okay, we may not be quite there yet. Because most people say they found us after a web search brought them to the Aging Life Care Association, our national society. They have a page where you can then just enter your zip code and find a qualified professional close to you or your loved one. Yet, when I ask people what they were searching for when they came upon the ALCA site, they offer a wide range of needs or issues. And that should come as no real surprise. Our team interviewed three dozen professionals involved in care management for older adults and their families in 2016 and 2017. This is what those professionals reported to us when we asked them to tell us what percentages of the families they serve had what needs:

TYPE OF CASE	%
Alzheimer’s Disease, “Dementia”	66.2
Home Safety	66.2
Medication Questions, Complications	58.2
Acute Medical Crises	50.3
Inadequate Self-Care	48.0
Chronic Medical Condition	46.8
Family Support	45.5
Residential Transition	39.9
Patient Discharge, Home Care	38.6
Financial Challenges	33.7
Other	34.5

We all looked at how things ranked and had to agree that the top issues where we help families pretty much follow this national sample of care manager experience. Notice that this table totals to nearly 530%. Talk about multi-tasking! This says that a typical family with a crisis surrounding their older loved one is trying to handle five or more crises…not just one. Maybe that is why you may want the help of a professional when life begins to change for mom or dad or any other older loved one in your orbit. Maybe that is why you want a care manager to be that search engine that can uncomplicate your life with the best solutions to all of life’s complicated moments.

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.

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.
When we speak of dementia, it almost invariably is about Alzheimer’s Disease, but there are multiple types of cognitive decline that fall under the heading of dementia. In fact, the second most common dementia – accounting for 15-20 percent of all dementia cases - behind Alzheimer’s Disease actually has an important attribute that its more common and better known sibling does not have. Vascular dementia actually can be prevented in much the same way that cardiovascular disease can be prevented…through diet. Over the past decades, we have radically improved lifestyle and health style understanding of what causes heart disease. By extension we also have improved our understanding of vascular health which means we are better able to prevent heart attacks/myocardial infarctions as well as strokes. Most people, if asked, can tell you what their good cholesterol (HDL) and bad cholesterol (LDL) numbers are or at least if they are “good” or “bad.” Surgeons have become quite talented at eliminating blockages around the heart and also in addressing some of the potential vascular threats that could become strokes. They have not become quite as good at preventing or removing the threats of mini- or major strokes. But the vascular element that is shared across the types of strokes could be lumped into two categories of diet that we could refer to as “heart healthy” and “head healthy.” But just as there are people who don’t pay much attention to their diet and exercise as ways to live healthier by being thoughtful of their heart health, there may also be a shortage of people who will work to maintain “head health.” Scientists in France examined a large sample of over 1,600 people whose mean age was 72.3 years and 63% of whom were women. They looked for diet differences that could predict “cardiovascular disease burden” (CVD) which, in turn, could predict vascular dementia. People who were under 75 years of age who also consumed two to three portions of fish weekly helped reduce their CVD risk for vascular dementia as much as having hypertension increased the risk of vascular dementia. For people over 75 years of age the effects were not as strong. So, what does this tell us? First, one has to start early in a healthy diet to have a significant effect on brain health. But it likely is never too late to change diet for the better. You just get more return on your dietary investment before age 75. Something for both you and your older loved ones to “chew on.” 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.
Please download our latest white paper "Caregiver Advice about Bad Medicine" by clicking the green button below.

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In the meantime, we invite you to browse more of our FREE downloadable white paper resources - offering both personal and professional advice for those who care for the elderly or people with special needs.

Caregiver Advice on Bad MedicineMany are unaware of the massive scope of the pharmaceutical market and all the ways in which seniors are taking more and more unnecessary drugs because of it. We discuss how caregivers can look out for signs that their loved one’s medication is over prescribed and how to spot warning signs.Get This White Paper

Caregiver Counsel on First Aid for the CaregiverIt is no secret that caregiving can be an everyday challenge, especially when managing a full time job and other family responsibilities. Discover tips about how caregivers can limit stress, boost energy, and stay positive in our latest white paper.Get This White Paper

Caregiver Counsel on Caregiving & the New NormalStatistically, more and more people will become caregivers to an older adult in their lifetime. Becoming a caregiver can be sudden and overwhelming as it is. We offer senior care options for preparing and reacting to different obstacles you may encounter.Get This White Paper

Caregiver Counsel on Taking the Old Out of AgingNo one argues that loss, isolation, or medical ailments may represent genuine setbacks as a person ages, but depression is a significant step beyond just feeling down or blue. Learn how to recognize symptoms of depression and how to be happy even at 100 years old.Get This White Paper

Caregiver Counsel on Senior Living OptionsFinding the best living options for your loved one can be tough. Whether it is picking the right senior living community or making your current family home safer, we help you to prepare for a productive conversation with your loved one about these transitions.Get This White Paper

A Caregiver's Guide Toward a Healthier Senior HeartHeart complications and disease are common issues that older loved ones face. Discover easy and practical ways to give you or the senior in your orbit a healthier heart.Get This White Paper

A Caregiver's Guide for Changes & AgingCoping with change can be difficult. It often involves tough decisions and conversations with the person you care for. Discover strategies to help you and your loved one feel more comfortable with transition.Get This White Paper

A Caregiver's Guide for the HolidaysHoliday stress is tough for everyone but especially for caregivers. Find out how to care for both yourself and your loved ones while managing these hectic seasonal times with friends and family.Get This White Paper

Roadmap to Alzheimer's Learn what to expect when you're caring for someone with Alzheimer's. Inside find tips for detecting dementia, how to best communicate with a loved one with Alzheimer's, and more.Get This White Paper

Making Home Safer Make sure your loved one can navigate daily activities as safely and independently as possible. Read about how to secure the most hazardous areas of the home and what action steps you can take to ensure your loved one is living comfortably too.Get This White Paper

Caring For the Caregiver Learn how to be as good for yourself as you are for your loved one. Are you becoming impatient with your loved one? Are you missing work or finding yourself easily irritated? If so, this white paper can help.Get This White Paper
You may have heard about music therapy, and you certainly have heard the often misquoted: “Music doth have charms to soothe the savage breast.” But does it work? Music therapy, that is. There actually has been a fair amount of research into how music can address some of the issues that trouble people, and some scientists in the Netherlands have scoured the scientific literature to see if music can be of help with patients who have Alzheimer’s. Specifically, they looked to see if a case could be made that music can help relieve the agitation, aggression or depression of dementia patients. In what is termed a “meta-analysis,” they examined a large body of literature to see what others have reported. While they could not control for variables like the size of groups being tested or the therapeutic elements of the settings, they did offer some tentative conclusions:
1. Music does not seem to have a measureable impact on a patient’s agitation. But the researchers suggest that there may be an effect, but since the therapy sessions may have been too long in duration, the effect may have been clouded by patients’ in ability to be stationary for the duration of the tests. The “calm” that was expected also could have been clouded by social interactions among patients in a group setting.
2. The findings were pretty much the same with aggressive behavior. There is no evidence. They could not sort out all the other background noise – not the music – to say with certainty that music reduced aggressive behavior.
3. What did seem more clear is that patients who had been predisposed to depression seemed to have a lifting of their moods with music. While this was a more consistent pattern, it might also have been confounded by the fact that the music therapy took place in a social setting. And isolation is one of the big causes behind depression.
When it comes down to it, we really cannot conclude that one kind of music will always have the same effect on all people. The fact that there were some positive changes across most studies, however, suggests that it is more than a bunch of notes. Music can make a positive difference for people who have cognitive issues…it simply may not be enough. But at the end of the day, we may come back to the traditional rule about not doing harm. If music is not a problem for people, then let the band play on. 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.