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

A House is Not a Home (Part 3)
At CCM, home and safety are as important to us as to you, so it’s no surprise that it’s...
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June 18, 2017
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Drugs and Birthdays May be Bad Chemistry
Most of us have grown up with the faith that when we have a medical issue, there is likely...
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October 10, 2013
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4 Geriatric Care Manager Tips for Preventing Falls in Older Adults
We as certified geriatric care managers all hear about older adults falling. Caregivers often do not expect their own...
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October 9, 2013
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Four Caregiver Health Safety Tips
I have written a number of blog postings on safety in the home, and most of them have focused...
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September 10, 2013
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Caregiver (Sibling) Rivalry
Raise your hand if you ever had a disagreement with a brother or sister as you were growing up. ...
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September 5, 2013
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Nine Geriatric Care Management Guidelines for the Caregiver
About one in ten American adults, or approximately 44 million people who provide unpaid care to another adult, are...
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September 3, 2013
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Five Geriatric Care Manager Tips for Helping Your Elder Remember
When we as geriatric care managers talk about memory loss and aging, it seems inevitable that the discussion turns...
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August 29, 2013
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Caregivers Need to Prepare for Medicare Too
I recently spoke with one of the financial advisors we list on our Geriatric Care Management Support Tools page,...
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August 28, 2013
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It Is Never “Just” Diabetes
I have again asked our vice president for geriatric care manager services, Steve Steiber, Ph.D. to share his insights,...
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August 21, 2013
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Caregivers Cannot Ask Doctors This Question
I have talked in a lot of my postings about advanced directives and how we all need to prepare...
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August 15, 2013
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In the Caregiver's Words

Recent Client Praise

We all know of someone who has received that call out of the blue that a mother or father has fallen and fractured a hip or has had some other unexpected medical emergency that demands a caregiver response. We don't always hear about a adult child of an older parent who actually has been really prepared for the emergency. I would like to offer some advice here about how everyone with an older parent - whether there has been a crisis or not - can benefit from having some sort of plan in place to make being a caregiver a less frantic and more thoughtful transition.

1.     Have the Conversation. Think of this the same way you would in a business setting. If you have an older parent, call a meeting of the siblings and your parent(s). This could be when everyone already is going to be together for the holidays, and make it like any other meeting. This meeting may be easier to have without the older parents present as a first step so that all the kids in the family can openly and honestly express their concerns and questions. Have an agenda, and circulate it ahead of time. You should ask if there is a will, are there advance directives, a power of attorney? Find out who is best able to provide what kinds of caregiver support in advance of an emergency.

2.     Know Your Family. You all grew up together, and most or all of you now have families of your own. Yet, you still are brothers and sisters and some of the family dynamics that may have been vexing when you were very young will still be challenging. Having some of this conversation early will give everyone a chance to see who can be counted on and for what. It also will give you all a chance to sort out some of the challenges without the added stress of a medical emergency at some later date.

3.     Interview Your Parent(s). Set a time when you can talk with or without a recorder going about their memories of home and the family as you all were growing up. They may like speaking "for the record" about their memories of their own parents as they grew up and older. You can also use this as an opportunity to talk about how their see their futures. You may have had your own experience like this as your kids have gone off to college and they want to know what you will do when they leave home. And if your parents want to move to a new, more manageable place, this is a chance to explore that as well as the options.

4.     Know Your Resources. Become familiar with the hospital where your parent(s) may be admitted in the event of an emergency. Get to know the social workers at the hospital, because they will know what you also should know about how they manage emergencies and discharges subsequent to hospitalizations. Have your parent(s) sign a disclosure document so that you will be able to speak with a health care provider. Make sure you also have phone numbers and names of neighbors who may be called upon should there be a medical emergency.
          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.
Stan Lee, the 95 year old co-creator of The Guardians of the Galaxy and the rest of the Marvel Comic Book series was in the headlines of the Hollywood Reporter this past week. But the story was not about Spiderman, Hulk, Captain America or the Guardians of the Galaxy. It was alleged this past Tuesday that he was the victim of elder abuse! A radio station in Orlando, Florida, amplified this by calling it a “captive situation” and that unnamed people were keeping him under lock and key to control his assets. Mr. Lee, who is a co-creator of one of the most successful comic book franchises, a franchise that has also spawned a hugely successful box office sensation, lives in an LA neighborhood where houses go for tens of millions of dollars. He has a net worth of about $50 million and has Miros, Picassos and more hanging on his walls…amid some empty hooks with faded shadows where something used to be. That’s not all that a recent visit from a New York Time reporter found to be missing. There are reports of more than a million dollars in wire transfers and a designer bag of cash and other valuable items seem to have “walked away” from the house. Some of this is under investigation. If you are thinking that because your older loved one is not worth millions that you have less to worry about, think again. Kerry Peck, a Chicago-based elder law attorney, famously states that we should all have someone looking out for us who loves us more than they love our money. I have five suggestions for those of you with older loved ones as well:
1. No matter where your older loved lives, you or someone you know should drop in frequently...and sometimes unannounced…and at different times to see how mom or dad is doing and who is visiting;
2. If your loved one requires home care or home health be sure that it is with a bonded and insured agency…and check references;
3. Know your loved one’s friends and be wary of “new friends” in their lives…especially friends for whom mom or dad may be doing financial favors;
4. Either personally or through a bonded professional monitor your loved one’s financial transactions, credit card and bank statements…look for changes;
5. And this is really #1, start the conversation early with your loved one…the conversation about how they want to live and where they want to live and whom they trust to help them.
It’s never too early to be a guardian of your loved one’s galaxy. 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.
As many as seven million Americans, in fact, probably had a pretty “blue” Christmas this past season according to estimates from the Centers from Disease Control and Prevention. I have written before about how many chronic conditions disproportionately affect the over 65 crowd, and depression is high on the list. In fact, 65+ year olds comprise about 16% of all suicides in America, so to label their Christmas blue is a bit of an understatement. Depression, often associated with loss, finds older adults to be something of a perfect storm as an age segment. As one ages, there are the inevitable losses in terms of just not being able to do what one used to do easily. And the job that used to define a person’s success and image is now history. And any number of physical illnesses can rob a person of their vitality. Cognitive decline also warps the lens through which older adults may view the world around them …a far cry from the proverbial “rose-colored lenses” of an optimist. Older adults are more likely to have suffered the loss of a loved one such as a spouse, friend or even son or daughter. That, combined with the other physical losses both shrink their social circles and reduce their desire to even get out of their homes. They become isolated which only reinforces any depression they may already have from their losses. And the losses accumulate. But it is crucial to remember that depression is not just an inevitable part of growing older. It is not a “normal” part of the aging process. When you gathered with your older loved ones over the holidays or spoke or Skyped with them did you notice any signs of:
- Crankiness or nervousness
- Fatigue
- Lack of focus or concentration
- Too much or too little sleep time
- Too much or too little appetite
- Vague digestive issues or pains
- Suicidal thoughts or comments?
Act now on any of these signs and symptoms of depression. Most depressed people don’t speak up…they simply accept the way they are feeling and slip another notch into their malaise. There is, in fact, a stigma that many associate with “mental illness” of any sort that may fuel their resistance to help. Insist that they see a professional, perhaps their clergy if not a professional trained in mental illness. Giving them a happier new year would be a wonderful belated gift for the holiday just past. And since this is the 21^st century, there is a text hotline. Just text 741741 for help. 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.
Family life crises don’t make appointments; they just show up. For most people that means tackling a crisis with no experience and no plan. (Hope is not a plan!) So, if you are one of the estimated 109 million Americans who have an older loved one in your orbit, what do you need to do to make a Plan? Here is my “short list” of the documents you need to have and be able to put your hands on… sometimes with no notice: • Medical Release – the document you need so your loved one’s medical providers to speak with you about your loved one’s 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 behalf of an individual in matters of property or finance. • Power of Attorney (POA) for Healthcare - a legally binding document that gives a person power to act on behalf of an individual 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 an individual wishes to have in the event they cannot expressly grant permission themselves. These orders typically revolve around life-saving measures; they are sometimes referred to as advanced directives and are placed in a patient’s medical files. • 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 your older loved one. 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 a will is executed. • Trust documents – help to identify how one’s 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 a person expresses his or her wishes of how property is to be distributed at death, and names one or more persons, the executor, to manage the estate until its final distribution. • The Grab and Go – This is a list that typically is sealed in a plastic bag. It includes 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 for a crisis. 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.
Raise your hand if you are a caregiver and have never misplaced your car keys. Raise your hand if you are a caregiver and have never been concerned that the forgetfulness of an older loved one might be a sign of Alzheimer’s or some other form of cognitive impairment. I am thinking that we went from no hands up to nearly all hands raised. But the practical fact is that for those of you with care receivers of a certain age it is common that there will be keys misplaced or names forgotten and more. Yet, that is not necessarily an indication of anything organically wrong with your loved one’s memory. So, how does one know? Here are some warning signs according to the experts: 1. Experts talk about the differences between “retrieval” and “storage” problems in memory. Forgetting someone’s name is retrieval and it is not a warning sign of Alzheimer’s. Forgetting that you know the person at all, however, is a storage problem, and it can be a sign of a more serious brain issue. Or misplacing the keys is a retrieval issue, but forgetting what the keys are supposed to do is a storage problem that should prompt closer attention. 2. There also is a difference between losing the car keys and losing the ability to do something that always came pretty naturally. Misplacing the keys, according to the experts, can happen to just about anyone, but forgetting how to start the car and put it in gear can be cause for concern. Or the loved one who was always good at math forgetting how to multiply also may be concerning. 3. Just plain confusion with normal daily activities also is a potential sign, according to the scientists who study these things. If your loved one gets confused on the way back to your table from the restroom while dining out, that may be cause for concern. You should also look for smaller signs as basic as their stride. If their steps begin to more resemble a shuffle this may be a sign of a more fundamental uncertainty…or the unexplained fall likewise can be a precursor of cognitive decline. 4. Finally, look for what may be as subtle as changes in personality. The loved one who used to be the animated conversationalist, but who now is more subdued may be responding to their own confusion in trying to follow what everyone is saying. Agitation in a person who was once a cheery individual also can be a sign of changing mental abilities. Against all of these potential warning signs, be careful about a hasty judgment. A change in mental acuity that is rapid in its onset is better classified as a delirium – not dementia. These episodes can arise from urinary tract or other infections, dehydration or even some hormonal imbalances. Certain medications like steroids or combinations of medications can precipitate short term mental imbalances. Caregivers should be alert to these, but not jump to the wrong conclusions. And beware of your loved one’s healthcare provider who prescribes any of the Alzheimer’s agents for “organic dementia” or “delirium” or anything short of a definitive Alzheimer’s disease diagnosis. So, raise your awareness before you raise your hand. 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 talked in a lot of my postings about advanced directives and how we all need to prepare for the end of life crisis that will face us ... and our family members. If you are a caregiver, you should have had the talk with your senior loved ones about what care they want under a variety of life's end game scenarios. And hopefully your older loved one has placed in their physician's file or medical chart at the hospital what they would want to happen were they were attached to a respirator or worse. These are those quality of life decisions. That said, you may still face all the questions we all will when we are addressing the mortality of a mother or father. What would mom or dad want? And that is the right question. We all should know with some certainty before the time comes what mom or dad have expressed as their desires should help to avoid the tough decision of life support or end of life. And the one person we really cannot ask is the physician. As a geriatric care manager, I am involved in decisions like this with some frequency, but I always make it clear that my counsel is not based on what I would do in someone else's place as much as it is about honoring the wishes of an older loved one. So, the children of the older loved one can always ask about health care options. What are the likely outcomes of whatever course of treatment and what alternatives does the family have are important conversations to have with your loved one's provider. I recently read of a doctor who was asked by the children of an older patient consigned to the ventilator what he would do if in their situation. Realistically we cannot ask the provider what he or she would do when facing and end of life decision for his or her parent. That is their decision, and it should have been based upon conversations the doctor will have had along the way with the doctor's parents. It is not a medical decision; it is a personal decision. So, the simple point is that if you are a caregiver to an older loved one, you should already have a good idea what the answer is to that kind of ultimate question is. And if you do not have a clear answer, then it is time to restart the conversation. Yes, it will seem awkward at first, but you may be surprised to find that your older loved one already has given this a lot of thought and likely has an answer to help prepare you and them. 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.