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

COVID-19 Scams: The Insult to the Injury
What national emergency would be complete without scam artists taking advantage of the vulnerable? Community health experts are telling...
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March 31, 2020
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Listen to an Astronaut about COVID-19
A small percentage of us may be coping with symptoms of COVID-19 or we know someone who is, but...
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March 24, 2020
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Trusted Voices on COVID-19
The news cycle calls the COVID-19 crisis a rapidly developing story. It unfortunately also has been one with a...
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March 17, 2020
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One is Number One Threat to Seniors
We’ve all had times when we desperately need our own space…time to ourselves, just ourselves. And it’s good to...
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March 10, 2020
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Helping Your Older Loved One – AND You – Avoid COVID19
All of us here know how to prepare for a blizzard, people in the South know how to prepare...
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March 3, 2020
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Part 2: Five Important Tips for Caregiving and Self-Care
In my last post, I gave you some tips on distance caregiving that arguably could be called the 30,000...
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February 18, 2020
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Five Things You Need to Know about Coronavirus
Okay, there may be more than five things you want to know about the coronavirus, but these five basics...
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January 28, 2020
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How to Spot and Fight Pneumonia
We have all heard someone this season say, “It’s just a cold,” or “I have a touch of the...
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January 14, 2020
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Number One Cause of Stroke…and the Other 8
The number one cause of stroke is unavoidable, but the next eight are not. Number one is birthdays, and...
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January 7, 2020
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Not Just Pride Before a Fall
Birthdays are a leading cause of falls that can result in an emergency room visit, and every year this...
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December 17, 2019
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In the Caregiver's Words

Recent Client Praise

With a lot of talk these days about children moving back in with parents and intergenerational homes, it is easy to overlook the huge growth in “distance caregiving” in America. In 1997 the number of distance caregivers - family who are caring for an older parent in another location – was about 7 million; it has since doubled to an estimated 14 million today. I came across a study on distance caregiving by a nurse oncologist, Polly Mazanec, that addressed a lot of the issues I see as a geriatric care manager with my own clients.

We often get a call from a son or daughter (and yes, it is more often a daughter), because they are concerned about some life issue of an older parent who still resides here where we work. It can be a change for the worse in a chronic medical condition, a sense that the parent is “confused,” a progression of a cancer, a fall or a home security concern. But almost without exception, the distance caregiver clearly sounds stressed. When I talk about “distance,” there is no magical number of miles to be distant, if it is perceived as distance then that becomes stressful. Distance can be measured in miles, but if the caregiver has a strenuous workload or is the sole wage earner in this recession or has family obligations in their own home, the ability to make frequent trips to help mom or dad is limited.

Caring for an older parent from distance is stressful, because there can be a long interval between visits or a most recent visit has shown visible changes in mom or dad or there has been a change in treatment regimen that the distance caregiver does not understand. And the medical change actually can be more stressful for the distance caregiver than for the patient. The stress comes as much from anxiety and guilt than it does from concern for the elder’s well-being, a stress owing to having “not been there to help."

Based on our experience, I offer some suggestions for long distance caregivers:
1. Help with the things that can be done at distance - arrange for meals to be delivered, housekeeping details to be attended, a checkbook balanced, in-home help to be present, or a neighbor to look-in at intervals.
2. Appreciate that being an adult yourself may not release you from the way you related to your parents back when you were a child at home - give yourself permission to help as you can without feeling guilt about not being there.
3. Enlist the help of a local advocate - this can be a nurse clinician at the doctor’s office or a geriatric care manager, but it is helpful to have someone to monitor and manage and then inform you.
4. Acknowledge that hands-on is not the only kind of care; distance caregiving can be a very important part of the village it takes to care for an elder or other person with special 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 throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.
While speaking with Matt Margolis (Elder Law attorney with Heartland Law Firm) recently, he mentioned a common question he receives often: “Why do I need a Health Care or Power of Attorney?” The short answer, he offered, is because only YOU can make a health care decision on your behalf or sign your own name. And he offered to expand on this in our blog with this post:

It is important to differentiate between a Power of Attorney for Health Care (HCPOA) and a Power of Attorney for Property (PPOA). If a doctor or other medical professional cannot communicate with you about your health care needs, whether it is because you are mentally incompetent or physically incapacitated (i.e. in a coma), a HCPOA allows someone else that you appoint to talk to the doctor and make a decision on your behalf. This authorized person is called your “agent.” A key component of the HCPOA is that the agent is making YOUR decision for you. It is not the agent’s decision or based on how the agent feels about a certain situation; rather, it is based on what you noted in your HCPOA and what you discussed with your agent (hopefully) prior to your incompetency or incapacitation.

A perfect example of what can go wrong when not having a HCPOA in place is the Terry Schiavo case from Florida. In 1990, Schiavo suffered major cardiac arrest, and a few months later was declared to be in a permanent, vegetative state. In 1998, Schiavo’s husband petitioned the court to remove her feeding tube, which was opposed by Schiavo’s parents. After many court filings and appeals to the Florida and US Supreme Court, the court’s decision to remove the feeding tube was upheld in 2005, and she died shortly thereafter. The problem was that Schiavo did not have a HCPOA in place. Therefore, no one had the legal authority to instruct the doctors on what to do without court supervision.

A PPOA allows your legally appointed agent to sign your name on your behalf and to handle your financial affairs. If you were to become mentally incompetent or physically incapacitated, who would continue to pay your monthly bills on time so your mortgage is current and your gas and electricity aren’t shut off? If you do not have a PPOA in place, there is NO ONE else that has the legal right to access the proper accounts and take care of your financial matters for you.

If you do not have a HCPOA or PPOA, a legal guardian will need to be appointed by a court to allow someone to make health care decisions for you or to be able to legally sign your name. A guardianship is a costly and time-consuming process. An attorney must appear in court a minimum of three times before the permanent guardian is appointed. Once appointed, the guardian must file an annual accounting with the court every year showing what money has come in to the estate and what money has been paid out from the estate. This can be a very arduous process when the person whom the guardianship is being sought for is not agreeable (typically due to their mental incompetency). This is called a “contested guardianship.”

To avoid the potential of any costly and unnecessary court proceedings, you should consult with an attorney to ensure that you have valid Powers of Attorney for Health Care and Property in place. This will not only protect you, but will save your loved ones a lot of aggravation and expense in the future.

Heartland Law Firm is a holistic elder law and estate planning firm. Heartland Law Firm concentrates in assisting seniors and those in transition with understanding the landscape they are in and what protections and benefits are available to them and their loved ones. Visit their web site at: Heartland Law Firm.

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.
There is a lot of news about the "older market" or other stories featuring someone who has reached the landmark age of 100 years and more. In my geriatric management experience, while working with elder adults and their families, all of what I see in the news is just snapshots of people at a certain age. What I have found is that who a person is at 80 or 90 is really a product of experiences that preceded the present. A long term study of aging by the Harvard Study of Adult Development followed a cohort of Harvard sophomores along with a group of young men in Greater Boston since the 1930s. My title stretches their findings a bit, because of course no one lives forever, but the study did offer some great insights into living long and living well:
1. Get rid of the cigarettes. The Harvard Study showed that men who did not smoke clearly out-lived those who were smokers. Other research continues to show that giving up smoking is a positive influence on health and longevity at almost any age.
2. Practice competent coping. It is not about the hand that life dealt these study subjects; it is about how they played the hand they were dealt. People who adapted to the events of life overall have lived longer than those who did not.
3. Waistline leads the lifeline. The researchers found that those subjects who maintained a "healthy waistline" and weight fared better than their obese counterparts. It is not about being stick thin, but it is about avoiding the other extreme.
4. Regular exercise contributes. Any kind of regular exercise improved both the physical and mental health of the men the study followed. Exercise also likely contributed to that healthy waistline and positive attitude.
5. Be mentally engaged. It starts with pursuing an educational degree, but those who lived longer also always seemed to have something they were excited to explore whether it was keeping a journal or studying a new subject. Intellectual activity seemed as important as physical activity.
6. Make and keep friends. That also includes the person one marries. The researchers found that those who were the most socially engaged also tended to live longer.
I have not talked about how old one's parents lived or one's cholesterol. These factors did contribute to longevity, but the researchers noted that they contributed less than expected. Even stress in a study subject's life was not a negative predictor of longevity as much as how the subjects coped with the stress. Charlotte Bishop is certified in geriatric management and founder of Creative Case Management, led by professionals who are advocates, resources, counselors and friends to elder adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.

I have been in a discussion lately with some of my peers about how to describe the care management that we do as our calling. In the internet age, most of what defines us all comes down to what you find or where you look on the Web for help. One of my colleagues refers to Care Managers as “the search engine that offers only the best options.” Another of my associates refers to our job description as the “care navigators” who help people with older loved ones find their way. And a third refers to us as “the life and logistics planners for individuals 65 and older....we take care of EVERYTHING so they don't have to.” Okay, we may not be quite there yet. Because most people say they found us after a web search brought them to the Aging Life Care Association, our national society. They have a page where you can then just enter your zip code and find a qualified professional close to you or your loved one. Yet, when I ask people what they were searching for when they came upon the ALCA site, they offer a wide range of needs or issues. And that should come as no real surprise. Our team interviewed three dozen professionals involved in care management for older adults and their families in 2016 and 2017. This is what those professionals reported to us when we asked them to tell us what percentages of the families they serve had what needs:

TYPE OF CASE	%
Alzheimer’s Disease, “Dementia”	66.2
Home Safety	66.2
Medication Questions, Complications	58.2
Acute Medical Crises	50.3
Inadequate Self-Care	48.0
Chronic Medical Condition	46.8
Family Support	45.5
Residential Transition	39.9
Patient Discharge, Home Care	38.6
Financial Challenges	33.7
Other	34.5

We all looked at how things ranked and had to agree that the top issues where we help families pretty much follow this national sample of care manager experience. Notice that this table totals to nearly 530%. Talk about multi-tasking! This says that a typical family with a crisis surrounding their older loved one is trying to handle five or more crises…not just one. Maybe that is why you may want the help of a professional when life begins to change for mom or dad or any other older loved one in your orbit. Maybe that is why you want a care manager to be that search engine that can uncomplicate your life with the best solutions to all of life’s complicated moments.

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.

We've all used the expression, "Don't lose any sleep over it." Turns out that losing sleep is one thing that can happen a lot more frequently as we age and it often is associated with other serious medical conditions.   The common causes of older adult insomnia are dementia, heart disease, kidney disease, heartburn or reflux, asthma, diabetes, thyroid disease or even prostate issues. So if you are a caregiver to an older adult who has been having trouble sleeping, it is worth paying attention.

And at the same time, insomnia is not always just one kind of condition. Some older adults have trouble falling asleep initially and some have trouble staying asleep. Some insomniacs may wake up several times a night, perhaps because they need to make trips to the bathroom, and some just cannot seem to feel rested in the mornings because they do not get a quality night's sleep.

As we grow older we need less sleep than we did as children or teenagers. Although we as a nation seem to deprive ourselves of sleep by getting up early, staying up late or both, the average adult needs about seven to eight hours of sleep a night to function well. People who say they need less may just have grown accustomed to getting by with less sleep, but they may also have a difficult time focusing during the day or may be cranky or irritable.

Sometimes it may simply be consuming caffeine, nicotine or alcohol, or it can be nutritional supplements or even vigorous exercise too close to bedtime that get in the way of good night's sleep. If you know someone who has trouble getting enough quality sleep, here are some tips that may help without resorting to the pharmaceutical sleep aids we have seen advertised a lot:

1.    It may be the afternoon nap that has to be taken out of the day's schedule in order to feel sufficiently tired to sleep at night...or the dozing off in front of the television after supper.

2.    Make sure the bedroom is dark enough and quiet enough, and move the clock out of sight so that there is not the temptation to keep checking what time it is.

3.    Don't use the bed as place where you eat, watch television or read so much that it is no longer that restful haven at the end of a day.

4.    Try to go to bed at the same time every night, and have some real physical activity each day so that the body will have something from which to be tired.

5.    Encourage your older adult to make a written list of the things they will do the next day so that the mind does not get caught up in the mental list-making that keeps the body awake.

6.    Above all, relax before bed time; it can be helpful to have a calming time that helps to really separate the day's activities from the night's surrender to sleep.
            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.
In the meantime, we invite you to download the below featured FREE white paper - offering both personal and professional advice for those who care for the elderly or people with special needs. Make sure to come back and visit us for more great FREE resources.

A Caregiver's Guide for the HolidaysHoliday stress is tough for everyone but especially for caregivers. Find out how to care for both yourself and your loved ones while managing these hectic seasonal times with friends and family.Download