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

How Old You Really Are
One of my staff worked with a senior community in upstate New York near Elmira a number of years...
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August 8, 2023
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Follow Your Gut…You’ve Got No Choice
It was back in the sixties and seventies that so many folks embraced the mantra: “You are what you...
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April 11, 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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Long COVID’s Long List of Symptoms
The COVID pandemic is not yet done with us in the United States, and the story certainly is different...
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February 7, 2023
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Planning for the Holidays is More than a Menu
The latest news reports suggest only about 10 percent of American Adults have received their seasonal booster for COVID. ...
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October 24, 2022
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Stranger Things: Step up Your Diet with New Options
If I were to ask you what you or an older loved one had for dinner yesterday, the chances...
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October 4, 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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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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The Will To Do the Right Thing
This whole idea to write up a legal document to give surviving loved ones clarity about how to take...
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August 9, 2022
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Before or After the Fall
I came across an informative piece in the Washington Post about a week ago, and it brought to light...
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July 26, 2022
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In the Caregiver's Words

Recent Client Praise

Perhaps you’re thinking about ways to make caregiving easier in the next coming year. You may have read tips and advice about caregiving and creating care plans, especially if you follow this blog, but don’t know exactly what care managers do on a task by task basis. An elderly care plan should encompass all facets of a senior’s life. In days of old, care plans merely addressed pressing health concerns. Today, caregivers design care plans that include health, lifestyle and social dimensions, improving their residents’ quality of life across the board.

As a care manager, one of the goals I try to instill through CCM is providing assistance within the context of a senior resident’s accustomed environment. If the resident lives in a nursing home or care facility, the care plans should allow for home-like routines. A reliable Chicago senior care provider must also encourage healthy lifestyles that fit the resident’s beliefs and personal preferences.

Before actually preparing a care plan, we first observe the senior resident’s daily routine. We try to find out if there are tasks the resident prefers to avoid, e.g., picking up clutter, cooking a meal or bathing, and why the person avoids them. We also might prepare an ADL (activities of daily living) questionnaire for the senior and loved ones to fill out. The resident’s daily needs, lifestyle choices, hobbies and interests will be explored as well. In addition, we’ll about activities the resident would like to pursue, but currently cannot, because of a constraining physical or mental condition.

Once we have all the pertinent data from observation and needs assessment, we’ll go over these findings with the senior resident. They decide whether certain devices would be of help, especially in the performance of ADLs. Identified care needs, however, should be administered in such a way as to preserve the dignity of the resident and promote his independence as much as possible. Appropriate ways to encourage the patient to engage in a hobby and interact with others are considered too.

When the assessment is completed, they start identifying together short and long-term goals for the resident to work toward. Goals are written by both the care manager and the senior, and should have the patient's strengths and needs in mind. Throughout the entire process of goal setting, the senior gets the ultimate vote over specific objectives he or she deems worth striving for. After all, a geriatric care plan helps ensure that an aging individual continues to enjoy life. This is why it is so important to find reliable Chicago senior services only from established managers. Creative Care Management also makes sure to link seniors and their families with the appropriate local resources in Chicago for care providers and other needs.

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.
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As seasoned and experienced professionals in geriatric care management, we work to improve the quality of life for caregivers, their loved ones, friends and family. Through consultation and in depth, personalized assessment, we will develop or improve care plans in ways that will release the stress and strain family caregivers often face. We intuitively prepare for a range of care challenges, unravel complex problems, and answer difficult questions. In essence, we are a lifeline – a place you can turn to for short or long term support and a resource that connects you to the best care options. As creative problem solvers, we have one goal – empowering you and your loved one to make informed decisions toward a more comfortable and secure lifestyle. Get guidance »

In the Caregiver's Words

Recent Client Praise

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How many times have we all seen the commercial with the plaintive actor on the floor crying, "Help, I've _____ and I can't get up." No one would ignore a plea for help from an older person who has fallen and cannot get up. But a lot of caregivers may be ignoring a similar plea with all of the health threat that a fall can represent. It is just that this fall is in slow motion. And it goes like this: "Help, I am so fatigued that I don't feel like getting up." Tired often does not get enough attention in medical circles, but it is a common symptom reported by people age 65 and older. We tend to discount fatigue, because we cannot accept that a person who has retired and now enjoys six Saturdays and a Sunday every week could not be well-rested. And if you are a caregiver to an older loved one, you may find it a bit challenging to muster the sympathy for your older loved one when you already are stretched across your responsibilities for your children, your partner, your job and... Yet, we should all pay attention to the subjective complaints of fatigue in our older loved ones, because tired can be a symptom of more serious medical conditions and because tired can lead to serious physical decompensation. Let's start with the other medical conditions for which fatigue can be a warning sign. Perhaps the most common clinical condition that presents with fatigue is depression, itself one of the most common comorbidities of aging. Depression often can arise from the hallmark aspects of getting older - loss, diminished physical capacity and social isolation to name a few. Chronic fatigue also can be a symptom of sleep apnea, restless leg syndrome, fibromyalgia, chronic obstructive pulmonary disease and any number of heart conditions. Poor quality sleep may also be indicative of musculoskeletal conditions or pain. If your older loved one is consistently tired, it may be time to accompany them on a visit to their physician for an assessment and a conversation. Sleepiness can also be just one more step along the slippery slope to frailty. Fatigue can be a strong disincentive for your older loved one to be as active physically as they once may have been. Fatigue also puts a damper on appetite which in turn reduces the quality of the fuel the body consumes to run the body's engine which leads to increased tiredness and low motivation for physical activity. And all of this translates into decreased mobility and frailty. Medical professionals refer to frailty as a "pre-disability." So, if the tiredness has gone on for an extended time, begin to look for signs of genuine frailty. No surprise, the signs include exhaustion ("hyper fatigue?"). Frailty also is predicted by weakness in grip and slower walking pace. And by weakness, we mean a quantum reduction in ability to grasp, and by slower we are talking a fraction of former strides. All of these point to diminished physical activity. Think of frailty as one step away from a permanent reliance upon a walker or wheelchair. The next time you are speaking with an older individual who reports being consistently tired, it may be time to wake up and take stock of their overall health. 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@cr eativecaremanagement.com.

It’s a disease that affects about 26 million Americans. If untreated it will kill these people. And more than a third of patients who have been diagnosed with it and counseled about it do not even know they have chronic kidney disease; it's a disease that nobody sees. That is not a typo; I did say they do not know they have the disease, at least according to research recently conducted at Vanderbilt University and reports from the specialists who treat kidney disease. Kidney disease is a concern to me as a geriatric care manager, because it affects disproportionately more older adults and because it can be an outcome of poorly controlled of diabetes or high blood pressure and just more birthdays.

A research team headed by Dr. Kerri Cavanaugh of Vanderbilt surveyed 401 patients with various stages of chronic kidney disease. The patients were being treated at the university’s nephrology clinic, and the majority had actually seen a nephrologist within the past year, and many had even attended “education courses.” Yet, when they were asked if they had chronic kidney disease, more than one in three said “no.” This speaks to my top two rules about visits to a health care provider:

Always take along a prepared list of questions and get answers from your provider;

Always take a caregiver, friend or family member along to ask questions,

listen and take notes along with you.

I mentioned in my title to this posting that this is “the disease nobody sees.” Now, the five things you should know if you or someone for whom you care may have chronic kidney disease, because the end stage of chronic kidney disease is renal failure which leads to dialysis as your kidneys simply stop doing their clean-up job on your blood:

If you have diabetes, hypertension, a family history of the disease or are over

60 years old, get a kidney function test every year.

Maintain good control of your blood sugar and cholesterol levels and keep your weight down.

If you have even stage 1 kidney disease, stay away from acetaminophen, ibuprofen and aspirin as well as laxatives, antacids, ulcer medications, certain decongestants and even enemas.

Stay away from foods that are high in salt as well as anything that may contain magnesium or aluminum.

Be alert to changes in urination, swelling of the extremities and face, fatigue, a metallic taste, dizziness, shortness of breath, nausea, leg or back pain or feeling cold even when it is warm.

For more information on what to be alert to as well as how to preserve kidney function, I recommend the website of the National Kidney Foundation.

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 we age, our bodies give us feedback we’re not used to. Activities that never required a second thought suddenly take some planning. Sometimes it’s hard to know if a new pain or sensation is something that we should worry about, or just a natural part of the aging process. We’ve compiled a list for you. If you or someone you love experiences any symptoms on this list, take them seriously and consult a physician immediately.

Confusion/Speech Difficulty. Call 911. These two symptoms are the most common manifestations of stroke. As the difficulty recovering from stroke depends heavily on the speed of attention to the event, it is wise to take this very seriously. Other reasons to suspect stroke include numbness, weakness, paralysis on one side of the body, or further difficulty with balance.

Vision Issues. Blurry, double vision? This is also a potential warning of stroke. Additionally, if you experience pain in your eyes, you should seek urgent treatment.

Chest Pain. This is a big one. If you have pain that lasts longer than a minute or two, it’s no time to wait. Treating a cardio event in the early stages is key.

Shortness of Breath. Any sudden difficulty catching your breath for longer than a few seconds should be your cue to get to the emergency room.

Stomach Pain. If it’s sudden, intense, and lasts longer than 30 minutes, a visit to urgent care is called for. Unresolved pain needs dealt with, and abdominal pain could need special attention. Don’t take the risk.

High Fever. If an adult has a fever that has reached 104 degrees, they need to be seen by a physician. The same is true for a newborn (up to 3 months) with a fever that reaches 100.4F. Excessive fevers need to be brought down. Let the professionals help.

Unusual Vomiting. When abdominal pain is unrelieved after vomiting, or if there is blood in the vomit, the situation needs caution and monitoring. If the unusual vomiting is accompanied by a high fever and lasts more than a few hours, children should be seen immediately. Adults should be seen if the episode lasts longer than a day.

Seizures. If seizures are part of your medical history, follow your doctor’s orders for managing; however, if seizures increase in occurrence, this is call to revisit your care plan. A first-time seizure requires immediate attention, as does a seizure experienced by anyone who lives with diabetes, or who is pregnant.

Head Injury. Take even a head bump seriously if you have a lingering headache. Head injuries can cause seizure, difficulty with speech, and confusion. Loss of sensation, strength, and coordination are also key indicators that any issues with head injury should be taken seriously.

If your symptom is something not listed above, be seen sooner than later. Aging happens differently to everyone, and health is high priority. Finally, trust your instincts. If something feels “off”, check it out. You’re right that it probably is nothing, but it’s much better to know than to worry. 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.
You don’t have to be a meteorologist to know that winter can be particularly challenging for older adults in the upper Midwest. So, I am not going to talk about slipping on ice or hypothermia; I think most of us and our older loved ones get those. I am going to talk about four of the more subtle and insidious hazards of a protracted cold spell.

Winter Depression: Isolation is bad for the soul…or more medically speaking, the mind. Being trapped inside their house or apartment, older individuals may be protecting themselves form frostbite, but they also may be setting themselves up for depression. If you have an older loved one who lives alone…or even if it is a couple…make a wellness check to bring a bit of cheer to them. Social engagement is one of the best remedies for winter blues.

Power Outages: When the power goes out in the summer, it may mean we have to eat the ice cream before it melts. But in the winter a power outage can mean frostbite can be happening under their own roofs, not just outside. Make sure your older loved one has flashlights and back-up batteries, warm blankets and a battery-powered radio. The CDC has a longer checklist.

Dietary Variety: Help your older loved one not just have enough food, but have enough variety to get ample quantities of vitamin D. That includes milk and cheeses, seafood, leafy vegetables and fresh fruits. You do not have to be a culinary wizard; it is the variety and freshness that count.

Carbon Monoxide: For homes with gas fireplaces or furnaces that vent from the side of the house. Be aware of leaks in the apparatus inside the house as well as blocked exhaust ports that may become blocked by snow. Check on the carbon monoxide detectors in the hour to see that they are working and have back-up batteries for those as well.

And between trips to visit your older loved ones, please give them a call as well. All of this will help take the chill as well as some of the bleak off their winter. 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.
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Creative Care Management has helped:

The adult child and their parent who is suffering from an illness

The family looking for quality senior home care in Chicago

The caregiver who lives away and needs extra eyes and ears to oversee care procedures

Someone who needs help handling doctors, hospitals, and paper work.

The daughter who isn't sure that her mother's medicine is working.

The caregiver who is juggling work and children of their own and may find it difficult to care for their loved one as much as they'd like.

The son who is unsure what steps to take now that his parent has been diagnosed with a mental illness.

The family concerned about the safety of their home

…And many more cases

How We Can Help

We offer a wide range of elder care services. If you'd like general advice and tips about caregiving, visit Charlotte's blog. At her blog, you can read about physical and mental health conditions, geriatric care, Chicago senior care resources, every day home care tips and more. If you contact us, we'll be able to help you even further with:

Home Care Management

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When I get a call about our geriatric care management services, most people are not asking for a geriatric care manager, per se. They are asking a question about something they have noticed or been told about their older parent or loved one. The question most often is about a change in the older parent that sets off the caregiver alarm that something is just not quite right. In this posting I am going to go through some of the questions I hear and then explore some of them in more detail in later blogs. Please also let me know any questions you may have or any telltale signs you may have seen in an older loved one that give you concern.

Change in eating habits: Have you noticed that your loved one's clothes are fitting more loosely, that they miss meals or that they just don't have the appetite they used to? Losing interest in food or eating significantly less are not normal or inevitable parts of aging. But older stomachs do empty more slowly than a younger adult's, and food may be less appealing because the sense of smell and taste are diminished. Yet, the fact remains that malnutrition is a serious health threat to an older adult. “There’s a fair amount of evidence that suggests if you lose appetite as an older person, in the next six months, you’ll have a higher chance of dying.” This is according to Dr. John Morley, professor at the medical school and Director of Geriatrics at Saint Louis University Hospital.

The cause may not be directly tied to food losing its appeal, per se. It may be that your older loved one simply has poor fitting dentures that just take the joy out of eating; it is actually painful. Loss of appetite is also potentially a sign of depression among older adults.

Older adults also have had a lifetime of losses, such as retirement, debilitating chronic disease, death of a close family member or simply not being as socially engaged as they once were. And these losses can become a huge emotional burden that detracts from appetite.

Any of these causes that lead to a diminished appetite can also ultimately lead to malnutrition which is a slippery slope. Malnourishment can lead to a reduced immune system and the ability of the body to resist diseases or other assaults. Small cuts or bruises will be slower to heal or even be more prone to infection in a malnourished older adult. As the malnourished body looks for nutrition it will feed upon itself, particular muscle. Once an older adult's muscle mass is diminished they will, in turn, be more susceptible to falls or even degradation of bone mass and fractures. And it is hard to put the healthy weight back on.

So, when next you visit the older adult in your life or have a meal with them, take note of the food they consume and what gets left on the plate or not served. Also, check their refrigerator if they are living independently. Look for how well-stocked it is, signs of food well beyond expiration dates or spoiling. It is not just about eating a full meal as much as fueling a healthy, older body.

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.

Be honest if you’re a caregiver and you can answer YES to more than one of these questions. Sit tight if you can affirm more than one per set.

Do you feel depressed? Sluggish? Physically Drained? Have Hopeless thoughts?
Do you feel isolated from your own support system? How long has it been since you’ve been carefree and social?
Do you find yourself mad about “the little things”? Perspective getting tough to keep?
Do you find yourself either punishing yourself more or needing more compassion than usual? Do you feel guilty for being independent?

Here come the Holidays, with stress enough to bowl anyone over, but for caregivers, they can be

particularly exhausting. Lots of stuff to worry about “going right” for the rest of the family while keeping an eye out for the care receiver. You may also be worried about staving off any old, unresolved family tensions. Who wouldn’t be exhausted just preparing? First things first. You’re doing a great job, and I know you don’t want to hear this, I know you’re tired of NOT hearing it, and I know you’re not sure if it’s worth the trouble of telling someone else how to do what you already know how to do. You deserve respite care. And you can have it. Respite care comes in a few packages:

Geriatric Care Managers – That’s us at Creative Care Management. Among many helpful options, we coordinate services using experience and trusted relationships so that you can relax when someone else is taking the wheel. We’re happy to help, but you should know your options, and you can start by searching for GCMs in your area here.
Adult Day Care Centers – These facilities provide a safe environment either for a few hours at a time, or for a full day while a primary caregiver is elsewhere.
Home Care/Home Health Agencies– These non-medical service providers make home visits and give care so you can catch your breath. Home health can also manage tasks like meals or laundry, or help with smaller errands, like shopping.

Friends and community can also be great, inexpensive resources; however, as they’re on a volunteer basis, they’re not as dependable as professional resources. If your loved one is independent enough, a senior center can also provide enough respite to rebalance. You deserve to have the best holiday available this year. Your loved one deserves you to be at your best. More than anything, if you think you need the break that respite care can provide, pick up the phone and call someone. I’ve been doing this for more than 20 years, and if I can’t help you directly, I’ll help find someone who can. Charlotte Bishop is an Aging Life Care Professional and a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.

Dementia is a fairly broad category that can include a number of different manifestations and/or causes. But the truth is – as I discussed in my post last week – that a number of other medical conditions actually can mimic Alzheimer’s specifically, or dementia generally. Read on to see the dementia-like symptoms that can come from problems with other organs of the body. The good news is that the conditions in these other organs actually can be treatable, so it is important to get a clear diagnosis from your loved one’s provider if they show signs of dementia. Here are three culprits to investigate if you see dementia-like symptoms in your loved one…

Heart disease understandably affects a person’s circulation, and that, of course, is considered a problem in itself. But when the heart is not pumping effectively, other organs are getting a poor supply of oxygen. Or there can be other vascular issues like severe restrictions in blood flow owing to strokes of varying degrees, and the brain is one of the first organs to respond to the shortages. Be aware of any dementia-like symptoms in your loved one that can be a warning to get them to a cardiologist instead of a neurologist.
Lung conditions also can impair oxygen to the brain as well as the rest of the body. As with the circulatory issues of the heart, impaired oxygen supply can affect cognitive processes and memory, resulting in possible misdiagnoses of dementia. If your loved one has a history of breathing disorders, what appears as dementia could actually be an exacerbation of the underlying lung condition.
Kidney and liver diseases can induce dementia-like symptoms, because the body is not clearing waste from the blood system if one or both of these organs is affected. In such cases, the brain may be the proverbial canary in the coal mine that can alert your loved one’s medical provider to these other systemic malfunctions. Clear up the liver or kidney issues and the brain is back to working order.

Each of these three conditions arguably are problems in their own right, but they also cascade into other issues of which dementia symptoms may be a part. But there are three more in the list I will add next week – there actually are even more than that. If you can guess one of the three in next week’s list, I will send you a free copy of my book on dementia that is linked in the next paragraph. Please send your answer to info@creativecaremanagement.com and I will let you know if you are correct. I’ll ask for your address also so that we can ship the book to you. More to come. 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.

When I say there is no ‘D’ in dementia, it is not that I am Deficient in spelling. Medical research has been accumulating that people with low levels of vitamin D in their bloodstreams are more likely to experience cognitive decline and even develop Alzheimer’s Disease. When I say cognitive issues, it is not all aspects of brain function. The declines associated with vitamin D deficiency are focused on episodic memory loss and deterioration of executive function. Researchers from University of California, Davis and Rutgers University studied 382 adults whose average age was 75.5 years old. These adults received cognitive assessments which categorized them as having dementia (17.5%), having mild cognitive impairment (32.7%) or as cognitively normal (49.5%). Vitamin D levels were lowest for those diagnosed with dementia, but there was only very nominal difference in vitamin D levels for those who were mildly impaired and those who were classified as cognitively normal. All of these adults were studied for nearly five years and then assessed again. During that time the magnitudes of decline in episodic memory and executive function were greater in adults who had been diagnosed as vitamin D deficient or vitamin D-insufficient. The investigators found that regardless of their baseline cognitive assessment, their ethnicity or a range of other risk factors, those who had been vitamin D deficient at the beginning of the five year period were at greater risk of developing Alzheimer’s Disease. Scientists continue to study the association between vitamin D levels and dementia. While there are no studies that suggest taking vitamin D supplements can prevent Alzheimer’s, doctors in practice are not waiting. They are prescribing D for their older patients, especially those who are already at low blood levels of the vitamin. We who live in northern regions should be particularly on top of getting enough sun to activate our natural vitamin D, consuming more dairy products and green leafy vegetables and augmenting our diets with vitamin supplements. Charlotte Bishop is an Aging Life Care Professional and a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.

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Geriatric Care Services

How Old You Really Are

Follow Your Gut…You’ve Got No Choice

Ain’t No Sunshine…

Long COVID’s Long List of Symptoms

Planning for the Holidays is More than a Menu

Stranger Things: Step up Your Diet with New Options

Treatments for Alzheimer’s Disease

Burn Calories to Reduce Dementia Risk

The Will To Do the Right Thing

Before or After the Fall

Chicago Senior Care Experts

Chicago Leaders in Geriatric Care Management

In the Caregiver's Words

Recent Client Praise

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