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

To B or Not to B12?
I have written a lot about dementia over the years as well as other issues that can mimic the...
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May 11, 2021
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Three Milion More Victims…
We see the numbers on a daily basis. How many have died from COVID, to date, we all probably...
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April 27, 2021
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Everything to Lose
Not a day goes by that the sun does not linger a bit longer, that the landscape gets a...
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April 20, 2021
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Not Just Spring…
We’ve heard of Spring Training for those who follow baseball teams like the CUBS or the SOX, and we...
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April 13, 2021
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Three Steps to the Now Normal
Yes, it has been a long year, maybe in part because it has been more than a year of...
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April 6, 2021
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As If COVID Were Not Enough
We’ve all heard about COVID’s symptoms…the GI upset, the shortness of breath, the fever, the added symptoms of the...
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March 30, 2021
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Diseases that Mimic Dementia…But Are Treatable-part 3
As you can tell from now a third installment about other medical conditions that can mimic dementia, it’s not...
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March 22, 2021
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Diseases that Mimic Dementia…But Are Treatable – part 1
Dementia is the condition that adult Americans fear the most, and tragically there are conditions that can give a...
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March 9, 2021
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Can I Have A Hug?
I doubt there is anyone who does not have something that they have not been able to do during...
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March 4, 2021
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A Game Where Everyone Wins
Pick your metaphor. If you want your knife to slice easier, you sharpen it. If you want to improve...
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March 2, 2021
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In the Caregiver's Words

Recent Client Praise

COVID 19 was not in my calendar for 2020, and I strongly suspect it was not in yours either. I often have said that family life crises don’t make appointments; they just show up. And I am usually talking about how to be prepared for the inevitable call from or about an older loved one in your orbit…AND how to be prepared for your and their next steps. Well, this time, preparing for a crisis could be closer to home, because all of us need to be prepared so that the people who may get the call that we have taken ill can be prepared. What do you need to do to make a Plan? When I have spoken in the past, some people back off from talking about a loved one in a crisis. This list is about you, so please forgive me for getting “personal.” Here is my “short list” of the documents you need to have and make them available to your partner, your kids or other close friend … sometimes with no notice:
- Medical Release – the document you need so your medical providers to speak with your loved one’s about your health status, medications and prognosis.
- Power of Attorney (POA) for Finance - a legally binding document that gives a person (referred to as the “agent” or “attorney in fact” permission or power to act on your behalf in matters of property or finance.
- Power of Attorney (POA) for Healthcare - a legally binding document that gives a person power to act on your behalf in matters of medical treatment. The “power” typically is in force when it is deemed the person in question can no longer act for themselves or if they are not conscious.
- Practitioner Orders for Life-Sustaining Treatment (POLST) – a document (varies state by state) that specifies in advance what measures you wish to have in the event you cannot expressly grant permission yourself. These orders typically revolve around life-saving measures; they are sometimes referred to as advanced directives and are placed in your medical files. The forms are downloadable at your state’s web site.
- Health and Life Insurance Policies – the health policy will help everyone involved understand what is covered and which physicians and other providers are available to you. The Life insurance policy should be in a safe place so that it can be readily accessed should that become necessary.
- Estate Plan – is (potentially) a wide-ranging document that let’s everyone know how any real estate or other holdings are titled and what the “plan” is for when your will is executed.
- Trust documents – help to identify how your estate is to be transmitted to beneficiaries. Trust names need to be consistent with life insurance, will and holdings in order to be in effect.
- Last Will and Testament – the legal document by which you express your wishes of how property is to be distributed at death, and names one or more persons, the executor, to manage your estate until its final distribution.
- The Grab and Go – This is a list that typically is sealed in a plastic bag. It includes your medical insurance documentation, a list of allergies, a list of medications, primary care physician contact details and in case of emergency (ICE) contact information.
Please email (info@creativecaremanagement.com) me with any questions on any of these…as well as how to take the next steps which is your plan. Do yourself a favor…don’t wait. 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.
Only about one in seven adults over age 65 do any kind of routine strength training, according to the experts. Those six in seven who are neglecting their exercise regimens are the people who are hastening nature's unfortunate digression to greater bone and muscle loss as well as decompensation owing to other common chronic diseases. And people with conditions like heart disease, diabetes or arthritis can help delay the worsening of these conditions by regular exercise. Exercise also is a great way to be sure that an older adult can "take care of themselves" longer and along the way, it reduces stress and improves their mood. Engaging in regular physical exercise is one of the healthiest things older adults can do to maintain their health and well-being. If you are a caregiver to an older loved one, encouraging them to be more physically active is good for their bodies as well as their mental outlooks. But some older adults may fear that it will be too hard to exercise or that it may even harm them. The first thing to do is talk to their provider to see if exercise is safe; be sure to note if the provider personally is in reasonable shape before asking their opionions. If you will receive a valid answer, then begin to ask about what kinds of exercise. And remember to encourage your older loved one not to try to get back into great shape the very first day at the gym. If it has taken a few decades to get out of shape, and it clearly will take more than a few sessions to get back into shape; only on the "Biggest Loser" television program will it all happen within one viewing hour. So how to start?
1. Balance - one-third of adults over age 65 and one half of those over 80 will fall each year. Exercises that help to restore the coordination of the muscles that help one walk, stand and stoop will go far in creating a safer self.
2. Stretching - flexibility is as important as balance, so gentle stretches help to make muscles more pliable and nimble. Stretching alone will not improve strength, but they will be a counterpoint to strengthening to avoid injury while the body gets stronger.
3. Strengthening - we see too many ads about low testosterone levels being responsible for men's bodies losing mass (beware of the cardiovascular risk of these hormone replacement therapies). Yet, working on building muscle mass also helps manage weight and blood glucose levels.
4. Endurance - your older loved one should not run a marathon the first day out. Endurance is probably the last of the four goals that one reaches as an older loved one increases their workout time or mileage over a period of months or even years. Taken together these four aspects to exercise will not only make everyone's body stronger, but it also will boost the immune system. Along the way, getting into better shape will also be the best preparation for any bout with any medical condition and recovery from that condition. There is no time like the present to get into shape for getting older, and that goes for your older loved ones as well as you, the caregivers. 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.
It is absolutely great news that Pfizer and BioNTech have brought a vaccine for COVID-19 from discovery to approval by the US Food and Drug Administration just today. We all can see the promise of “normal” on our collective horizon and almost breathe a collective sigh of relief. We have been more than a bit distracted by COVID-19 for how long…ten or more months? And what used to be the major concern of everyone with an older loved one can now get some press. And there may be good news in the Alzheimer’s fight as well. A company called Cassava Sciences has shared results from a Phase 2b clinical trial that show its therapy helps to block a protein that triggers brain inflammation and the loss of neurons. They are moving to Phase 3 trials on patients who have been diagnosed with Alzheimer’s Disease. The drug is called sumifilam, and it is an oral medication that can be taken once a day. The Phase 2b study focused on how oral administration in a range of dosing could block the proliferation of a protein called HMGB1 that causes inflammation in the brain. The same drug also helps to restore both the shape and function of a beneficial protein in the brain called filamin A, and while it is doing that it also is strengthening the natural defenses of brain by blocking access across the blood brain barrier of inflammatory proteins like albumin. In more straightforward lay terms, this tablet can help manage three pathways by which Alzheimer’s disease can negatively impact the brain. Part of the evidence the scientists presented to get approval to move forward with a Phase 3 clinical trial focused on some of these biomarkers of harm to the brain. Simifilam also showed a reduction of Ptau-181, the “tau tangles” that are a physical characteristic of Alzheimer’s as well as improved performance on cognitive tests. As this promising therapy rolls out with a Phase 3 trial across a number of sites in Arizona and Florida among patients with mild to moderate Alzheimer’s Disease who are 50 to 85 years of age, I will keep you informed of findings. You also can follow any reports to the public by going to a government site for clinical trials related to Alzheimer’s. Spoiler alert – there are nearly 1,300 trials currently in motion on some aspect of Alzheimer’s Disease. We will keep you posted on anything truly noteworthy coming from any of these trials so you don’t have to work on your doctorate in biochemistry to decipher what the reports tell us. So, please consider this two doses of good news on the medical front this week. And when it comes to clinical trials, please remember that the two key tests the FDA applies are that a treatment or vaccine is safe and effective…in that order. Please do not be sucked down the rabbit hole of those who suggest otherwise. Just Google thalidomide…FDA withheld approval of that therapy when the European Medicines Agency signed off. 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.
Career Opportunities at CCM

Open Positions:
Creative Care Management is looking for full- and part-time professionals to provide geriatric care management services to our clients. CCM was founded more than twenty years ago and is a team of certified professionals providing answers to older adults in Northern Illinois and their families.

Qualified applicants should have:

a nursing, social work or other degree in the helping professions

experience with older adults or others with special needs is a plus

GCMs will evaluate an older person's situation, identify solutions, and work with the family to design a plan for maximizing an elder's independence and well being. Geriatric care management involves an in-depth assessment, developing a care plan, arranging for services, and following up or monitoring care. A GCM can also assist in the medical management of a client and suggest potential alternatives not considered, and they assure a loved one receives the best possible personalized care and all the benefits to which they are entitled.
Please send a bio and credentials to:

Steve Steiber

ssteiber@creativecasemanagement.com

or call 847-869-5118 x 511.
One of the most challenging conversations I help facilitate as a geriatric care manager is to address the prospect of nursing home care among elders and the family members who care for them. Much of the discussion comes down to point of view and what a caregiver may find important versus what the prospective resident will find important. In future postings I will also talk about timing and when to consider nursing home care as an alternative to independent living and the options in between. Let’s first look just at everybody’s points of view for a moment.

An article that recently appeared in Seniors Housing and Care Journal compared the opinions of residents and families as well as state agencies on the quality of nursing home care across 89 nursing homes. We all appreciate that nursing homes are regulated, and that the state surveyors that monitor the nursing home quality of care in most states use a fairly standard report card. This report card is called the Online Survey, Certification and Reporting (OSCAR), and you access the report cards for any nursing home you may be considering in your own family discussions. Each facility whom you interview should make a copy of the most recent state audit available for your review.

The authors of an article I came across (“Where Allies Part Ways and Strangers Converge: Nursing Home Performance in the Eyes of Residents, Families and State Surveyors”) found some interesting differences and similarities in evaluations of nursing homes as each of these groups looked at quality. First, whether families or residents would recommend a nursing home was highly correlated with the ratings state surveyors gave to the residences. Residents and families also agreed in their relatively high ratings of “staff show respect” and “ensured resident safety.” At the other end of the rating continuum, both families and residents rated “numbers of nursing staff” lower.

The differences came when residents and families were rating what could be termed quality of life versus quality of care. Residents rated quality of life components higher than families did. Families rated quality of care higher than the residents did. I see two lessons here. First, how State Surveyors rate the facilities you or your loved ones may be considering as a future home will be a pretty good indicator of how home will feel to the resident. Second, when having the family discussion about a potential move, caregivers need to be aware that what is most important to them (quality of care) will not have the same importance for the loved one (quality of life). If you as a caregiver want your loved one to “own” the decision, it is important to keep a focus on quality of life in your discussions with them. I will be talking more about this decision process in future postings.

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.,geriatric care manager Chicago, geriatric care Chicago

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In earlier posts I have talked about some ways to broach difficult subjects with an older parent, talks that are about life changes, one of the harder among them was giving up the car keys. This is going to be the first in a two-part series in which I will offer perspectives on some of the changes in life where you as the child of an older parent may be required to step up to help your parent or see that proper help is available. The second part will be devoted to conversations about preparations for end of life, life's final transitions. It may surprise you to learn that the former can be a lot more difficult than the latter. Harder because everybody expects to die someday, but many people have greater difficulty in addressing their potential loss of independence along the way.

Power of Attorney. You may want to talk with your family attorney before this conversation so that you can keep the details straight. There are two types of power of attorney (POA): one for health care and one for finance. The legal system has defaults in place to handle decisions for a person's finances or health and well-being if they are deemed unfit to do so on their own. However, those decisions have to go to a judge and the process can be time-consuming and costly. If one of your older parents is unable to make financial decisions - and they own property jointly with their spouse - it becomes difficult to liquidate the house if funds are needed for long term care or other health care issue. Health care POA can offer similar relief in the event your older parent requires some choices in where and how they will be cared for. In both cases, it can be easier to broach the subject if you, yourself, have had the papers drawn up for your own situation and offer your own experience and questions as an example to your parents. At any age, there is benefit in knowing that decisions will be made in our best interests if we cannot make them ourselves.

Long Term Care Insurance. Assisted living or home health care can be expensive, and the right long term care (LTC) policy can make life a lot easier to the bear financially. But be aware that there are a lot of different types of policies with an array of benefits and payout mechanisms. And the cost to buy LTC insurance will depend on the age at which you sign up as well as some other variables. To be sure you are getting your or your parents' money's worth, look for an independent broker who is not captive to a single insurer. But before you talk with a broker about your older parent, check out an authoritative source. The American Association for Long-Term Care Insurance has a consumer information section you may find helpful. And as with the conversation about POAs, you may investigate a policy for yourself as a foundation for having the conversation with your parent. Part 2 will post on Thursday.

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.