Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • Alzheimer’s diseaseChicago'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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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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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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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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Become a Dementia Detective by “Talking the Talk”
Today we have a guest Post from Christina Padilla, a speech-language pathologist and Certified Dementia Practitioner living and working...
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September 27, 2022
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Treatments for Alzheimer’s Disease
September is Alzheimer’s Awareness Month, and this is the third of four posts we’ll offer on the subject. I...
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September 20, 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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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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Burn Calories to Reduce Dementia Risk
We most often think about exercise as a way to work off the calories that we may have consumed,...
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August 30, 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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In the Caregiver's Words

Recent Client Praise

As November (National Alzheimer’s Awareness month) is winding down and we continue to see efforts to educate people about this disease, it is easy to lose sight of why it is so important to build awareness year round. For some, it may seem like people are generally aware of the damage Alzheimer’s can cause, the fight for a cure, and the advancements for treatment that could be made. However, there are many things people may not know about the disease and assumptions that could be debunked by those who experience Alzheimer’s in their daily lives.
1. Most cases of Alzheimer’s aren’t detected until its late stages – meaning people usually either don’t spot the symptoms or they ignore them to be a sign of old age. In some cases, people feel like Alzheimer’s cannot be treated so they bypass medical assistance all together.
2. There are treatments for Alzheimer’s – in that you can delay its progression significantly. Medical advancements have helped patients live longer when they maintain healthy habits and keep careful track of their condition.
3. Certain practices earlier in life can increase a person’s risk for Alzheimer’s disease, such as not eating right or not getting enough exercise.
4. In some cases, people who have experienced Alzheimer’s – sufferers, their families and friends - are afraid to talk about the disease. Sufferers may feel they might be treated differently.
Of course, there are more reasons to educate people about Alzheimer’s and participate National Alzheimer’s Awareness month. There are also even more reasons to continue after November is over - as often and as much as possible – for families, sufferers, and caregivers.

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.
Yesterday, we talked about dealing with stress and melancholy during the holidays. Here are even more tips that you can use to cut down on stress and post-holiday blues while caring for a loved one. Remember, it is okay and understandable to feel down during and after the holidays. But the more you are prepared, the better your holidays may be.
1. It’s okay to say no. When it comes to holidays, if you feel the need to cut down on the amount of gatherings you’ll be able to attend this year – there’s no need to worry. Pace yourself – you’ll have a much better time, especially you tend to feel overwhelmed when running around place to place.
2. Keep gatherings small. You may find that scheduling festivities with smaller groups is much easier to manage as well as much more comfortable for you and your loved one.
3. Communicate. If you plan to host a gathering or go to one, be sure to talk to your loved one about it often so he or she is able to anticipate being social. In addition, talk to your guests beforehand about your loved one’s condition if they haven’t visited in a while.
4. Give yourself and your loved one a break. Realize that it is okay to take time out for yourself as a caregiver. You may find that setting aside a bit of time to relax is just what you need to reduce stress levels. Recognize that your loved one may need some quiet time too.
Last but not least, monitor how you’re feeling as you go through the holidays. If you’re feeling melancholic during festivities because you’re remembering how things were in the past, understand that this is okay and you should let yourself feel them. However, it may be a matter of focusing as much as you can on positivity, your loved ones, your happiness, and the present moment. You can find more these tips at Caregiver.com.

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.
We are knowledgeable in a wide range of elder care services. Below you will find just some of the things we do to make the life of your elder loved one more complete and your life just a little simpler. If you are not sure what exactly you need, please don't hesitate to contact our Geriatric Care Management team.
Geriatric Care Plans
A direct product of a careful assessment, geriatric care plans act as a roadmap for health care options and living arrangements of an aging individual. Learn about geriatric care planning.

Assisted Living Consultations
Based on a careful evaluation of your loved one’s needs, we help review and select the ideal assisted living facility. We also assist with paperwork and legal matters. Learn about assisted living consultations.

Retirement Communities Consultations
We find the ideal retirement communities that match your aging loved one’s lifestyle preferences and then take care of the transition for you. Learn about retirement communities consulting.

Home Care Management
We manage the process of selecting and placing your loved one with the right kind of home care service from a reliable and trustworthy provider. Learn about home care management consulting.

Nursing Home Consultations
We evaluate healthcare needs of your loved one and assist in selecting the most appropriate nursing home. We then carry out periodic reviews of your loved one’s condition. Learn about nursing home consulting.

Senior Home Safety
Complete assessment of safety of your elder loved one’s home, and subsequent retrofitting to ensure comfortable and injury-free environment. Learn about senior home safety services.
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Recent Client Praise

Although Alzheimer’s disease is the most common type of dementia, there are over 100 different causes of reduced brain function and cognition…dementia. Although we are all hopeful for a cure...or should I say cures. So, it is huge when we begin to learn what factors predispose someone to reduced cognition and how we can modify behavior or the environment to reduce the risk and that cognitive outcome. Let’s take them one at a time:
1.Dementia has been statistically tied to high mid-life blood pressure
Longitudinal research recently reported in the British journal Lancet Neurology statistically linked higher and rising blood pressure in early to middle age with a higher incidence of dementia in later life. In this research “middle age” was defined as 36 to 53 years of age, and “later life” was defined as 69 and older.1.Dementia is linked to decreased brain size This is where it is all linked. The higher blood pressure or rising blood pressure in early life is also linked to a smaller brain volume. In the British study they followed people from birth to older age with 20 measurement points along the way. The link between brain size adjusted for early life cognition is not necessarily a direct one. We talk about “adjusted for early life cognition,” because people who have cognitive issues early in life tend to have more as they get older. But those with smaller cranial size have an even great incidence of cognitive impairment. The researchers speculate that it is the clear link between reduced brain mass and the development of white matter brain lesions that gives rise to the dementia, not just a matter of brain size.
2.White matter brain lesions are linked to the later onset of dementia
Here is where the link becomes really concrete. The researchers showed that a given increase in blood pressure yielded quantifiably more white matter lesions. Back to brain size, the same sort of trade off was demonstrated with brain size…more pressure yields smaller brain mass. The bigger the increases in blood pressure the greater the incidence of white matter and the smaller the brains.
3. 30% of dementia cases are modifiable
Yet, blood pressure alone was not directly associated with cognitive function at any given point in time. It was the early rise and sustained high blood pressure that created the brain size and white matter problems later. These were tied to diminished cognitive abilities. And this now gets back to modifying risk factors for dementia, and it is pretty clear. Everyone gets their blood pressure check early and regularly…and gets it under control if it is elevated!
4. All of the above
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.
Associate Care Manager Gregory Peebles returns with a talk about hidden signals of aging that need our attention. 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 my team for over a decade. – Charlotte Call it self-reliance, gumption, stick-to-itiveness, or fierce independence, but most of us are very proud of this aspect of our national character. We manage ourselves and try to not bother our neighbors. We may need help, but we try to not ask for it. There’s plenty to be proud of in taking care of ourselves, but no matter how hard we try to remain staunchly independent, we ultimately need each other, and most of us don’t get much practice asking for help. Consequently, when we do need to ask, we can feel like a failure (we’re not!) and don’t want to reveal our vulnerability. Please allow me to share three signals that your older loved one may be in need of help but not be able to ask. Older adults embrace their independence and hate admitting they need help as much as anybody else. More often, they are told they need help. After some type of health scare (statistically, an in-home fall), a doctor or loved one gets tasked with “The Talk”. Life will be different. There will be more physician visits. There will be more caregiving. There will be less self-rule. The defining incident, which has usually been a long time coming, may register as a shock to the adult children or other loved ones of an older adult who may be focused on their hectic lives. After the life-changing incident has occurred, everyone’s eyes are opened to what they couldn’t see before. Here are three warning signs your loved one may need your help but hasn’t asked.

Presentation.– “Keeping Up Appearances” isn’t just a show on BBC. This is how individuals and families signal health and success in all aspects of their lives. When self-presentation declines, something is wrong. It’s that simple. Look for changes in housekeeping habits. Lack of interest in hygiene or grooming can signal depression, or a change in body mechanics. Weight loss can be because meals get forgotten, or because they are just harder to prepare. It doesn’t matter which one.

Mood and Memory. – We’re not talking about minor lapses of judgement or awareness. Everybody has a bad day or two in a row. Everybody forgets stuff. If, however, your loved one is more irritable than usual for longer than usual, or is more emotional than usual, that’s a signal of change. Losing one’s glasses or forgetting the day of the week are not necessarily causes for alarm. Even procedural memory loss (temporarily forgetting how to do something) is more common than we think. It’s always time to talk, but it’s probably not time to call a doctor until your loved one moves from forgetfulness to inability to process events into memories…instead of where are the car keys…what are the keys for?

Mobility.– It’s hard to ignore a body that has slowed and become harder to maintain. So don’t. When offering an elbow on the stairs just isn’t good enough anymore, it’s time to talk about the logistical changes necessary to keep your loved one as independent as they can be. Walkers, chair lifts, in-home caregivers, ride services, and a host of other options can facilitate.

Seeing these signals gives you an advantage for continued health and high quality of life for your older loved one. If your loved one lives at distance, services like those CCM, Inc. can identify and coordinates can help ease your mind and provide your loved one with just enough support to preserve their independence and their safety. 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.
Associate Care Manager Gregory is 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 Lots of people play simple games on their phones while waiting. On this blog, we’ve often mentioned that any game play encouraging cognitive and spatial orchestration is great for the player’s cognitive future. But what if there were a fun game whose results also helped doctors learn more about dementia? That would be especially helpful, keeping our own brains sharp while we contribute to research. That sounds like double duty! Well, set sail at full mast, because that game exists. At first glance, “Sea Hero Quest” [iOS/Andriod link] is a fun mobile game like any other. It is special, however, because it exists to provide researchers with more data on 3D spatial cognition, often a first casualty to a dementia diagnosis. In the game, the child of a parent suffering from dementia sets out on an odyssey to recover their parent’s lost memories. On the path to discovery, there are navigation, orientation, and chasing adventures. The ways that the players advance levels is precisely the kind of valuable information hoped for; and the more people that play the game, the more information to help. Alzheimer’s Research UK is a major player in supporting the data obtained from gameplay, and it is hoped that the information gathered will make inroads towards early detection and consequent treatment. In addition to the regular mobile version, there is also a Virtual Reality (VR) release which combines the game with scene immersion. It tracks head movement and provides even more data to researches about how players obtain information about their environment. So, if you’re a mobile game player of any sort, consider the introductory video below, download, and start gaming! You just might have a great time helping your future self.

Illinois long term care has been ranked at about number 24 out of the 50 United States on a number of dimensions by AARP, The Commonwealth Fund and The Scan Foundation. So, does that mean that Illinois’ long term care glass is half full or half empty? Let me share my perspective as a geriatric care manager on some of the details of this national study so that you can be the judge not just about the national study, but also about facilities you may be investigating for an elder or other special needs individual in your orbit.

The report is enlightening in how it rates and ranks what it refers to as long-term services and supports (LTSS) on four important dimensions. And this is the first of its kind multi-dimensional scorecard on state-level performance. When I mentioned that Illinois ranks number 24, that is an average across all four dimensions. In reality, the state ranks:

Number 12 in affordability and access which they calculate based on a numberof indicators such as the private pay cost of nursing home or home health care, other measures of insurance coverage and just how easy it is for those who need LTSS to receive them ;

Number 33 in choice of setting and provider which is based upon the diversity and number of provider options available for both public and private pay individuals with needs;

Number 24 in quality of life and quality of care which recognizes that it is not just the quality of care, but also how individuals who need LTSS can still preserve their safety, freedom from abuse and human dignity; and

Number 27 in support for family caregivers which recognizes that there has been a decline in recent decades in non-family care and services such as respite care that help preserve quality of life for the caregiver as well as the elder or special needs individual.

With our own state ranking about the middle of the pack, the scorecard tells us that there is tremendous variability in the quality of care available to elders and others with special needs in Illinois. It is also important to appreciate that when the need arises for long term care, it usually is following an accident or sudden event like a stroke, a fall with hip fracture, etc. So, when you are looking for a facility or home service for someone in your orbit, remember the key dimensions in this report as guidelines. Check out the full report to get a better sense of the details of how they measure these attributes at Raising Expectations. If you are looking to evaluate nursing homes in Illinois, you also will find a great web resource that will help you facility by facility in Illinois.

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.

As a geriatric care consultant, I field a lot of questions from people concerned about memory issues in an older loved one. Alzheimer's Disease is a condition currently affecting over 5 million people in America, and it is estimated that one in three seniors will die with either Alzheimer's or one of the other forms of dementia. It is the sixth leading cause of death in the U.S. Now comes the cost part. The Alzheimer's Association estimates that the disease will run up a $213 billion dollar bill this year, and that figure will climb to $1.2 trillion by the year 2050. So who is going to foot the bill for this frightening condition? Even among those over 65 years of age, Medicare does not come close to covering the entire bill for Alzheimer's care. The best estimates are that about 60% of the costs associated with the care of an Alzheimer's patient will be paid by the patient of family of the patient. And the total annual cost for the typical Alzheimer's patient will come to about $57,000 each year. Here are some costs that you need to watch:

- Conventional medical insurance or Medicare will not cover adult day care or in-home caregivers. If you as the caregiver have a day job, that can get complicated and costly.

- Doctor's visits and most outpatient services are covered, but there will be co-pays. Be careful of which providers may be in-network (and covered) and out of network (not covered)

- Drugs tend to be covered, with the exception of the "donut hole," but coverage may be limited to only those medications on a plan's formulary. Be sure you understand what drugs are covered and prior authorizations are required.

- Nursing home care is covered up to a point, but this does not include "custodial services." Medicare will pay for short term nursing home care (up to 100 days), but only following a three day inpatient hospital stay.

- Make sure you understand what status your loved one is being hospitalized. They may be staying overnight, but it may be labeled "observation" instead of inpatient.

Don't pull out your hair; there is help. You can call 1-800-MEDICARE or you can go on-line for answers. You will find answers at Medicare.gov. There also is a group called the Medicare Rights Center. Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric care consultants, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
I have talked in the past about making home safer for seniors as well as geriatric care management services for those considering a move to residential communities. But the financial and practical fact of the matter is that owning the family home may prove to be less affordable as well as less livable for adults in retirement. Never mind that classic picture of older adults whose kids have graduated college. They have burned the paper of a paid-off mortgage and can now live for free! Well, a lot of seniors were hit by the Great Recession just like other homeowners, and the house is not really free and clear. For virtually everyone, the cost of the house still includes real estate taxes which continue to rise even though housing values have declined in most markets. And the costs to maintain a house tend to come in big chucks like the cost to replace roofing or a new furnace or a hot water heater and more. Some older adults never got to the point where they could buy their own home in the first place. A study issued by the Joint Center for Housing Studies of Harvard University found that older adults make up about 13 percent of the rental market in the U.S. That is precisely the share of the U.S. population that is 65 years of age or older, and the percentage is expected to grow with the baby boomers adding to the number of renters. Finances and age are just a part of the decision to rent or buy; also important are health and lifestyle. Regarding health issues, if you are a caregiver to an older adult you may find that they can maintain their independence longer in a rental property that in a conventional home. Rental properties typically can offer a residence all on a single floor for any older adult with difficulty getting around. More current housing also will offer elevators to make getting from the ground floor to their apartment unit easier. And don't overlook the convenience of having a landlord taking care of the heating and cooling systems, the laundry machines and the roof. They also will maintain the lawns and walks. Regarding lifestyle issues, older parents may wish to have the added security of being able to be away from home for extended trips without the worry about safety of their homes. The added safeguard of two front locking doors and nearby neighbors can make it easier to take a vacation or a trip to visit the kids and grandkids in another part of the country. And don't forget that lifestyle also can include the freedom that may come from not having the added weekend duties of a lawn and grounds. That extra time back in the week can be a real bonus for an older adult who really does have something better to do. 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.

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We’ve all seen the ads on television about the lawyers who will stand up for our older loved one if they are abused or neglected in a nursing home or other facility. A bruise, a bed sore or maybe loss in weight can be pretty conspicuous warning signs, but there is another pervasive abuse of older adults in America, an abuse that has no telltale bruises. We know from the statistics that one in nine older adults in America has been abused, but financial abuse specifically is substantially under-reported. Experts at the National Adult Protective Services Association report that only about one in 44 cases of financial abuse of seniors ever gets reported. Exacerbating this under-reporting is the simple fact that senior financial abuse doesn’t leave a mark on the abused victim. But it does raise a flag if you know what to look for. Look for telltale changes in your older loved one such as:
1. Sudden changes in a will or other document that now includes a new beneficiary.
2. The “live-in” caregiver who seems to be “living off” their client.
3. An unexpected increase in credit card debt or an unusually large line item.
4. Money spent that has a wild or outlandish explanation.
5. More frequent withdrawals on a bank account or new accounts with someone else’s name on it.
6. Vague explanations or complaints about a missing credit card.
7. Guarded talking or behavior around a new caregiver that may suggest they are being intimidated.
8. Missing items like jewelry, money, antiques, art or even furniture from their home.
9. That new girl or boy friend…maybe some significant number of years younger.
Older adults are prime targets because they have the money…their savings, retirement accounts, mortgage-free home or other assets. Older adults are also more vulnerable because they may live alone, they may have chronic medical conditions requiring assistance or they are simply weaker than their exploiter. Older women are particularly vulnerable for all of these reasons plus their upbringing was in a time when women were simply taught to defer, to be nice, to be polite. And nearly half of all abusers are family members or friends. Please remember also that the earlier you spot the flags, the easier it is to “fix the problem.” 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.
Saying “yes” when someone asks you to do something can be like eating candy. It feels right or good at first bite, but the “good” feeling doesn’t last very long at all…in fact, within half an hour the sugar crash after the rush may seem so not worth it. If you are a caregiver to an older loved one, you may have found that the more times you say “yes” to the requests for help with mom the less it feels like a “good deed,” and more and more like one sugar crash after another. In fact, over time you will begin to resent the requests and the person asking the favors. It’s called burnout, and burnout is self-inflicted. What’s the solution? Learn to say “no” without apologizing, and learn to set what I have always called “loving limits,” a technique that I learned early in my career as a mother. And it works going up the family tree as well as down. The real sign that you may be approaching burnout if you are a caregiver can be found in the first emotions you feel when the favor is asked. If you find yourself looking forward to that time with mom, doing that errand with mom or whatever is being asked of you, then you are doing fine. If, on the other hand, you immediately feel your gut tighten or you feel resentful that the person is asking of your time…AGAIN or you feel just plain put out, you are on a path to burnout. So, the answer is not just saying “no.” It’s a “no thank you” with context and a bit of nuance, and it takes practice to get it right:
- I am overbooked already, but …
- I appreciate your thinking of me, but…
- That (task) is really not in my wheelhouse…
- No, I’m not a chauffer, but let’s plan on …
You’ll get creative with this language by practicing. Instead of viewing the asking party as mom and immediately feeling obligated, think of it as a request from a volunteer organization with whom you have no history of repeated “yes.” Thank the asking party for thinking of you as you decline. Ask for a delay to check your calendar. Know that you can be assertive while still being respectful…think of it as respect for you and respect for the asking party. Appreciate also that you can reverse course and say no later, explaining that you wished to give them time to find an alternative. Also, appreciate that if you have been the one to always say “yes” out of obligation or habit that you simply have to learn a new habit that honors you and honors the asking party. Think of “no” as the opportunity to reserve “yes” for when you actually have the time or the bandwidth to successfully and positively complete the task. Remember that relationships are a good deal like being good neighbors…boundaries are important for both parties’ success. Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of, 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
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