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

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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Spring Tips for the Holiday Caregiver
We all know that that Spring in the Midwest isn’t on a straight line from Winter toward Summer, but...
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March 28, 2023
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How (NOT) to Worry, Stress or Be Anxious
It’s not so much whether you’ll have worries, be stressed or feel anxious…it’s how you’ll manage your worries, your...
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March 21, 2023
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Another Side to the Story
It was just a year ago that Bruce Willis’ family disclosed that the actor would be retiring from acting...
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February 27, 2023
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Ain’t No Sunshine…
…When She’s Gone.” Or how about, “You are My Sunshine, My Only Sunshine?” or “Here Comes the Sun?” or...
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February 21, 2023
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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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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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Passing on Personal Possessions is Perplexing for People: 6 Pointers
As you gathered with loved ones over the holidays, you may have realized it’s time to start discussing how...
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January 10, 2023
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One More BIG Addiction?
If you’re old enough to remember 1969, then you are old enough to remember this bold addition to the...
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December 6, 2022
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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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In the Caregiver's Words

Recent Client Praise

One of the big challenges of the holidays can be all the hype about "over the river and through the woods..." along with all the mandatory "holiday cheer." If that is the way reality works, why is it that when you visit Grandmother or Grandfather, they appear more blue than merry? Depression during the holidays is very real, but it also is different from "clinical depression." And when you visit your older loved ones, you may see the signs of holiday depression. So, what will you be walking into and what can you do about it? What is holiday depression? First, of all, there are a lot of expectations for "jolly holidays" that simply do not square with reality, and we can thank the popular press as well as Hollywood for some of that. But there is more. Holidays are times when we all come together to celebrate family. For older adults, some of those people who used to be such important parts of the family celebration may now have died. So instead of holiday cheer, there is a real sense of holiday loss. This is all the more acute for the "firsts." The first holiday without mom or dad is really poignant just as the first anniversary of their passing or the first of their birthdays without their being present can really bring a person up short. A holidays this year also will be framed by all the holidays that have preceded this one and all the people that were part of the earlier celebrations. Christmas or Hanukkah or Kwanza have been defined by the people who were present then, but absent now. Some do's and don'ts. If you have an older loved one who seems to be feeling the seasonal blues, encourage them to be socially involved where they can. Do not let them fuel the depression by being isolated as well. Also, pay attention as we move through and beyond the holidays If the blues last months instead of weeks, the depression may be clinical. Clinical depression should be addressed by a professional who can help a person get back to a better path. And an important "don't" - don't tell the -person they should not be depressed or tell them to simply "snap out of it." The blue feelings they have are valid, and people do not choose to be depressed. Ask if there is anything you as a caregiver can do to help. Talking can help to get some of the sadness out. And getting back to that potential for social isolation, offer to take an older loved one who is depressed out. They may enjoy some "shopping therapy," or the preparations in the kitchen or other venues where people are gathering to prepare for or to celebrate the holidays. Simple physical activity can be part of the catharsis to help combat the holiday blues. So, celebrate the past, but let go. Encourage your older loved ones also to engage in helping others, in giving to others. The reaching out will do much for helping them to feel integrated as well as offer a sense of validation of self. 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.
Legal trusts can help a disabled individual get added help beyond what government programs like Medicaid offer and without sacrificing what these programs do offer. You may recall Gordon Gault, a Chicago attorney who specializes in trusts, wills and probate among other legal areas, who spoke with me some time ago about guardianship. Recently we also talked about trusts available for elders or others with special needs. Gordon explained that the concept behind a special needs trust is that a person can qualify for Medicaid, Social Security and other government programs while at the same time having money set aside for supplemental services or benefits. In Illinois a trust can be handled in one of three ways.

A special needs trust means that the benefits are not for room and board, but for special, or supplemental, needs. This trust is established by some one other than the disabled person so that the disabled person can receive government benefits to which they are normally entitled, but can also obtain extra health services not provided by the government, clothing, vacations, a television, or educational benefits. Gordon offered the example of someone with serious disabilities – mental or physical - where they qualify for government benefits. If the disabled person has a relative with a significant amount of money to be gifted to the disabled person and grantor does not want the money to prevent the disabled person from receiving government benefits, he can set up the special needs trust. The trust basically says that the trustee, whoever is selected by the grantor, can oversee the use of the trust funds. Upon the death of the disable person all of the remaining trust funds pass to whoever is selected by the grantor.

The second is an Omnibus Budget Reconciliation Act 93 payback trust, and it is federally-created. It allows an individual to create a first party trust, that is the individual for him-/herself. This is only for people under age 65. That person can take whatever money they have if they have become seriously ill, and do not want to lose all their money to health care costs. If they have a parent or grandparent alive, they can hand the money over to them with a trust document that has the same special needs language as the first option. If it is someone other than a parent or grandparent, they need a court order…a relatively simple procedure. There must be a regular accounting to the sate as trustees, but it is very straightforward. The balance of whatever remains in this trust after the beneficiary dies goes back to government to pay back whatever the government has expended. If there is excess, it goes wherever the trust says it will go.

The third is a pooled trust for a disabled person under age 65. Control does not go to a family member; it goes to the pooled trust, a non-profit organization monitored by the state. The organization provides the advantage that they are 100% trustworthy and they are professionals who know what they are doing. They know the rules and regulations are, and the money is well-protected. They provide the paperwork to the state oversight agency. The disadvantage is that it is not family making decision for the trustee; it is an agency. Upon the death of the disabled person, 15% goes to the non-profit and 10% goes to charities. Four percent of the overall pooled trust is taken on an annual basis for operating costs.

These are all specific to Illinois. Gordon Gault is available for consultations about Illinois trusts, and he encourages individuals to check with counsel in their own state if the expected beneficiary is not a resident of 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.

Copyright ©2011 Charlotte Bishop
The processed food consumption that has been linked to our global epidemic of obesity is also tied to the rising rates of Alzheimer's Disease world-wide. I don't mean to sound the alarm about sugar, but I came across an article recently that tied together a number of facts and trends that we all may have seen. And we all should be very alarmed! As a geriatric care manager, I often work with older adults who have developed medical conditions that reflect a lifetime of poor health and nutrition habits. We see the elevated blood pressure and the obesity that can arise from sedentary lifestyles and poor diet. One of the more common developments we see is the onset of type-2 diabetes resulting from a lifetime of too many sweets that have resulted in what doctors call "insulin resistance," the pancreas' inability to keep producing enough insulin to process the large doses of sugar it confronts. What you may not know is that the brain also produces insulin, and that when faced with a prolonged assault from more sugar than it can process, its ability to produce insulin may falter and then fail. The result is "type-3 diabetes." The research has been piling up. For instance, people who suffer from type-2 diabetes (type-1 is the form that people are either born with or develop as an immune response) have deposits of amyloid-beta in their pancreas. Sound familiar? Yes, amyloid beta deposits in the brain are the signature marker for Alzheimer's Disease. And this also begins to explain why type-2 diabetics are estimated to be anywhere from 50 percent to 100 percent as likely to also develop insulin-resistant Alzheimer's Disease. Now, it is important to point out that type-2 diabetes does not cause Alzheimer's Disease, but type-3 diabetes is caused by the same over-consumption of sweets that causes type-2 diabetes. This may begin to also explain why the rates of the two conditions both have tripled in the United States in the past forty years. This, along with a lot of other inflammatory conditions related to the heart and the circulatory system. You may have thought that the extra care required for the estimated 5.4 million obese Americans with type-2 diabetes was costing us a lot - $150 billion annually? It is estimated that care for that many Alzheimer's patients is even higher at about $200 billion, the reason being in part because the close supervision for the safety of a cognitively-impaired patient is so much higher than for an obese individual. This is probably one of the situations where I don't have to connect the dots for any of you who are caregivers to an older adult...or attending even to your own well-being. My advice can best be summed up with two words: diet, exercise. Ironically, these are considered first line treatment for people who are obese or who have begun showing the signs of type-2 diabetes. Of all the advice I have digitally-shared these many years, this may be the best for a whole host of reasons. Please pass it on. Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.
Today we have a guest Post from Christina Padilla, a speech-language pathologist and Certified Dementia Practitioner living and working in Evanston, IL. Let’s face it: nothing about dementia is easy. It’s as hard on the individuals with dementia as it is on the people who love and care for them. But you can still maintain a rewarding relationship with your loved one by learning some communication strategies to improve your daily interactions throughout the progression of this disease:
1. Focus on the relationship. It is better to be in relationship than it is to be right. Your loved one is going to say things that hurt or upset you, possibly even accusing you of things that are not true. It’s important to understand that this is part of their disease and does not reflect reality. Arguing or correcting them with a “reality check” will only lead to anger and agitation but attempting to enter their reality and understand the true origin of their feelings will deepen your relationship.
2. Identify the underlying need. Given the communication difficulties people with dementia are experiencing, the words they say often don’t reflect the real message they are trying to convey. They may not be able to adequately verbalize when they need to go to the bathroom or feel hunger, pain, cold, loneliness, or sadness. They may feel they are living in a different time of their lives, as many people with dementia regress to an earlier time over the course of their disease. With a few well-placed questions and a little detective work, we can identify the need within their message and help meet it.
Having these two as a general grounding, use these tactics as you communicate:
1. Apologize sincerely. This is not admitting to wrongdoing, but rather offering an apology for the distress they are experiencing. It is important that you be sincere if you use this strategy.
2. This does not mean pretending something is true when it is not, but rather entering your loved one’s experience instead of denying it. If they are having an hallucination, you can ask them about what they see without pretending you see it too. If they accuse you or someone else, you can acknowledge it by saying, “You’re thinking I…” and then try a transition phrase such as, “Let’s figure this out.”
3. Ask simple questions. Yes/no questions are too narrow and will often end the conversation but offering either/or choices (Are you hot or cold? Are you hungry or is it something else?) or asking simple open-ended questions (Can you tell me more about what you see?) is a good way to get more information. Often acknowledging your loved one’s feelings/experience is all they need, and you can gently redirect them by suggesting an alternative activity or segueing into a new conversation. If they feel heard and seen, they will usually follow your lead.
Here are a couple of examples of situations and ways to respond that can help give you more information about what might really be going on:
1. Situation 1: “Someone stole my purse!”
Response: “You’re thinking your purse has been stolen! Let’s figure this out. Where do you usually keep it? Do you need something inside it or did you want to go somewhere?” In this situation, you are not only acknowledging your loved one’s feelings, but also gently helping them to find the lost item while at the same time investigating why they need it. Maybe they are looking for a tissue, want to go for a walk, or are living in a past where it’s their job to do the weekly shopping. Once you figure it out, you can follow their lead or redirect (e.g., why don’t we take a walk to the corner store).
1. Situation 2: “Help, I’m covered in ants! They’re crawling all over me!”
Response: “I’m so sorry, that must be very itchy! Why don’t we move to another chair and put on some of this lotion?” In this situation, your loved one is hallucinating based on a physical stimulus, possibly feeling itchy or even pain. By acknowledging their discomfort and then offering a possible solution, you validate their experience while at the same time calming and redirecting them, and the outcome is much more pleasant than if you had tried to convince them there were no ants. These are just a couple examples of how patience and your “detective skills” can improve your communication and deepen your relationship with your loved one living in dementia … remember that you are living with it and can walk away. They can’t. You won’t always get it right, and every day will present a new challenge, but the more you practice, the more easily you can flow along with your loved one’s experience, and your new understanding may just take you to some wonderful places! Christina Padilla is a speech-language pathologist and Certified Dementia Practitioner living and working in Evanston, IL. She has spent the past 11 years working with adults with neurogenic disorders and disease and their families to improve communication, swallowing, and cognition for a better quality of life. If you wish to ask her a question or wish some help within your own orbit, please email by way of: info@creativecaremanagement.com . 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.
In my first of this two part series, I talked about how Thanksgiving as well as the holidays that follow can be opportunities to give a helpful wellness check on an older loved one's home. A lot of my suggestions were focused on preventing falls around the home for an older loved one who may not be as nimble as they once were, and home may actually be less safe with the natural wear and tear in an aging household. But there are other health risks for aging adults in America, with dementia, depression and dietary insufficiency forming the three D's for caregivers. Starting with dementia, less than 1 percent of adults between 60 and 64 years of age suffer from some sort of dementia. But by the time adults reach age ages 80 to 84, that prevalence is about 12 percent, and it doubles once they exceed 90 years of age. Depression is one of the most common conditions of aging adults with estimates of about one in five adults over age 65 suffering at some point with clinical depression. Diet can be even higher than this with one group of researchers pegging the prevalence of malnutrition among older adults at nearly 23% across 12 developed countries. So, if you are a caregiver visiting an older loved one during the holidays, look for the following signs:
- Dementia...
  - Without being prying, check your loved one's refrigerator; look for how well-stocked it may be as well as signs of decay or mold
  - Take note of their overall hygiene; are they bathing with enough frequency or laundering their clothes regularly.
  - If your loved one owns a pet, how well groomed and fed is the pet; note also, however, that your loved one may be taking better care of Fido than themselves.
- Depression...
  - This one also encourages a trip to the frig to see if the low supply may indicate a loss of appetite; in fact a lot of what may appear as dementia in the list above actually may be masking a depression.
  - Talk to them about their sleep patterns; inability to sleep through the night or difficulty falling asleep may be signs.
  - Get a sense of how active your older loved one is; are they staying active socially, are they still involved in clubs or hobbies?
- Diet...
  - The refrigerator should be a stop on this check-up as well; an older adult may not admit they cannot afford all that they should eat - but an under-stocked refrigerator may be a tell.
  - Share more than one meal with your loved one; sometimes malnutrition can be attributed to lack of appetite (refer to signs of depression here as well as medications that may be suppressing appetite or causing nausea)
  - Note any more pronounced weight loss; clothes that appear to be looser particularly around the collar or waist band.
  - Be alert to bruises or wounds that are not healing well or problems with teeth; regarding teeth, be sensitive to particularly bad breath that may be a clue to poor diet or tooth and gum decay.
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.
If you are a caregiver to an older adult, don't be surprised if your loved one is asked if there is a gun in their home during the next doctors' office visit. In the past. such questioning was usually out of concern for young children in a home who may find a loaded weapon in the house. And we have all seen the reports in newspapers across the country when a youngster discovers a sidearm in a parent's room. Now, as geriatric care managers, our profession also involves talking about gun safety among our clients. Why? In an article published just this past week in the Annals of Internal Medicine, doctors are now being encouraged to ask their older patients about firearms in their homes. Doctors are rightly pointing out that the higher rates of dementia, depression or memory issues place older adults at a high risk for suicidal behavior. According to the latest data available, firearms account for more than seven of ten suicides among adults 65 years of age and older. This is compared with just 51 percent among the population as a whole. For those 65 and older, the suicide rate is 14.6 per 100,000 versus only 11.4 per 100,000 of the population overall. And suicides with handguns outnumber homicides with handguns. There is no denying the second amendment rights of all citizens, but the suicide risk is a matter to address. Physicians are now being encouraged to ask about guns in the home among their older patients, which places this at the level of a national health issue. I recently heard a local official talking to an audience of older, middle-aged and younger business professionals about what we may call geriatric suicide. He asked for a show of hands for all those who at some point in their lives have owned motorcycles. I was a bit surprised by the relatively large number of hands that went up. He asked those that no longer had motorcycles to lower their hands, and it was mostly the older contingent who took their hands down. He asked one of the older folks why they no longer owned a two-wheeler, and then another and another. The answer? It wasn't safe for them anymore. A lot of heads nodded. Some may feel that the same reasoning should be applied to those who own firearms. I am not pro-gun or anti-gun, but I am a professional advocate on behalf of older adults. Give the medical guidelines a read to see if this may be a discussion you wish to have with your older loved one. Also, please comment on this posting if you have an opinion you would like to share. Like so many issues that are important for us to address, there are no easy answers. Charlotte Bishop is founder of Creative Care Management, a team of geriatric care managers and certified professionals who are advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.