Geriatric Care Manager

I have written about Alzheimer’s disease…a lot, its warning signs and caregiving probably more than any other topic.  Even in this time of COVID, I still come back to it.  This time it is about the warning sign that may be COVID causing confusion instead of Alzheimer’s disease.  If you are a caregiver to an older loved one, you probably have become very astute about listening for signs of the onset of this virus: changes in taste or smell, persistent cough, fever, all the usual suspects. A study recently published by health care providers at Northwestern University Health System has reported that a disproportionate share of 65+ year old COVID patients also had what they refer to as “altered mental function.”  In short, these COVID patients may be confused or have some difficulties performing some activities of daily living.  This may not be surprising, because delirium also has been a harbinger of infections.  And what is COVID, except a life-threatening infection? The doctors who authored this study explain that this confusion is a result of inflammation that has spread to the brain causing encephalopathy.  It may happen in the disease’s early stages, so this another warning sign for caregivers, and it is a serious sign, because the COVID has spread to the brain.  And even patients who do not show these signs prior to hospitalization may develop the cerebral inflammation once they are in the hospital.  And encephalopathy makes for a poor outcome in the course of COVID’s infection.  Patients with encephalopathy stayed three times as long in the hospital and were seven times as likely to die from COVID. It’s always important to watch for any changes in our older loved ones as potential alerts for COVID, but now delirium is also one of those signs.  So, how does one know?  Here are some warning signs according to the experts:

1. Misplacing the keys…Misplacing the keys or other “forgetfulness” may be signs of potential delirium; get your loved one checked for COVID.
2. Losing longstanding skills…The loved one who was always good at math forgetting how to multiply should be concerning.
3. Just plain confusion…look for smaller signs as basic as their steps begin to more resemble a shuffle as this may be a sign of a more fundamental uncertainty.
4. Changes in personality…The loved one who used to be the animated conversationalist, but now is more subdued may be responding to their own confusion in trying to follow what everyone is saying.
5. Agitation…in a person who was once a cheery individual a short temper also can be a sign of changing mental abilities.

Caregivers should be alert to these, but not jump to the wrong conclusions.  Take a temperature, offer hydration, ask about taste or smell capacity, and all the rest.  So, raise your awareness, and then be prepared to raise your hand. 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.

            Once every 67 seconds.  Every 67 seconds someone in the United States develops Alzheimer's Disease, and among the adults over age 65 in the U.S. about one in nine have the condition.  That is about five million older adults, one in ten of whom will die from this disease each year.  There are about three caregivers for every one of the older adults with Alzheimer's Disease, and they provide about 17.7 billion uncompensated hours of care each year.  But there is help for those with Alzheimer's and their caregivers.             As a professional geriatric care manager, I am certified and a member in good standing of the National Association of Professional Geriatric Care Managers.  Earlier this month they did what they are calling an "InstaPoll" of those of us who are members.  The results from the poll of we care managers, it turns out, offers some very practical advice from those of us who work with clients with this condition every day.  The feedback from the nearly 300 NAPGCM members who responded to the poll distill down into six recommendations for caregivers:

1. The most common recommendation revolves around the fact that dementia develops in stages, and that is important that a caregiver be attuned to the capabilities that a person with AD will retain versus lose so that communication is appropriate.
2. Test for a response to such communications as reminiscing.  If the care receiver responds positively to talking about the past and long term memories, it can be very positive and affirming to break out the scrap books and memory boxes.
3. To guard against social isolation, try to keep up the old routines and engagements as your care receiver enjoyed before.  With less social engagement comes the risk for depression and even further isolation.
4. For those of you who may have raised children, the game of "Mommy and daddy always come back" was important at a young age.  It will be that way also with some AD patients for whom an absent caregiver is just gone.  Reassurance is key.
5. Don't rush with change, especially the disruption of moving to a new residence.  While it is important that an AD patient be secure from wandering, it also is important they be given time to adjust to the concept and an upheaval of house and home.
6. Where there is loss, especially that of a spouse, it is important that a care giver monitor the AD patient for signs that the stress is overwhelming.  Their capacity for processing grief will be compromised by the Alzheimer's.

            If you would like more information on NAPGCM's InstaPoll or on professional care manager advice as well as a care manager locator, just go to our association's web site: http://www.caremanager.org .               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.

I have spoken with Matt Margolis, an Elder Law attorney with Heartland Law Firm recently about VA benefits to which people may not know they are entitled. In this posting, he shares some valuable insights that may expand your options for care cost coverage.

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            One very common question that comes across my desk on a daily basis is “Are there any benefits, other than Medicaid, to help pay for the care of my ___________ (insert: mom, dad, husband, wife, brother, sister, etc.)?”  Typically, this is being asked because Medicaid is only available for someone in a Skilled Nursing Facility.  Because of this, we refer to Medicaid as “nursing home financial aid.”  My follow up question to this prospective client is usually asking whether the person they are calling about or their spouse was a Veteran.

            The Veterans Administration (VA) Aid and Attendance Benefit program is the benefit I will discuss with them.  In the overwhelming majority of situations, the prospective client has never heard of this benefit.  This benefit is actually classified as a “pension” by the VA and is a great source of funds for financially constrained wartime Veterans and/or their surviving spouses to use for their long term care costs such as living at home with a caregiver, adult day care, independent living with a caregiver, assisted living, and/or skilled nursing.

            While family income is one of the determining factors of eligibility, it is important to be aware that the VA allows individuals to deduct their unreimbursed medical expenses, which includes their health insurance premiums, home care, assisted living, adult day care, caregiver, and nursing home costs from their income. As a result, many Veterans who may not have previously qualified might now qualify if long term care has become necessary for them or their spouse.

As a general rule, to qualify for the Aid and Attendance benefit, a family's total assets (excluding their primary residence and vehicles) cannot exceed $80,000.  Fortunately, many clients I meet with have assets in surplus of this number.  The good news is that with the right strategies and planning, we can still position them to qualify.

            A few things worth mentioning:

• Currently this benefit (unlike Medicaid), has NO look-back period as far as gifting/transferring assets is concerned;
• The benefit ranges from a little over $1,100/month (for a surviving spouse) to a little over $2,000/month (for a Veteran with a dependent); and
• The benefit is tax free.

 

            In the end, the VA Aid and Attendance pension is a heavily untapped, but much deserved, benefit for those Veterans and/or their surviving spouses who served and fought for our country.

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.

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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.

I am really, truly, seriously, absolutely in need of good news – heard news and herd news.  Today, I am happy to say that I can share good news about both!  Let me start with the first part  - a quick story for folks who have a harder time hearing, then I'll tell you what I heard about the herd. First, the heard news.  A church-going friend of mine comments on the upside of not being able to attend in person religious services at his place of worship.  Yes, this is someone who has become a Zoom fan!  He talked of so many areas in his place of worship where the sound quality was virtually non-existent, but at his home computer all the speakers and singers were positioned properly with their mikes, and he had control of the volume.  He considered that something of an upgrade. But the upgrade doesn’t hold true for everyone during this time of masks and social distancing where some older adults just are out of reach and out of hearing range.  With the sound quality dampened by masks and distance posing a hearing obstacle, they are at an even greater disadvantage in this pandemic.  But there is a new hearing device that a lot of people are bragging about, and its success owes as much to the ear bud’s popularity as it does to the cool technology of the new device. Oh, sure, there have been cool hearing technologies in micro before, but unless one has as much as $5,000 in discretionary funds, improved hearing is rather out of reach.  Enter the Olive Smart Ear.  The really great part is not only the apps for getting the setting just right for anyone’s hearing needs, but the price is less than a tenth of some of the micro-technological devices previously available.  And everyone wears an ear bud these days for their smart phones and for their music and more.  The Olive Smart Ear blends into the fashion and taste of the 21^st century really well.  If you have an older loved one whose hearing and attitude could use a bit of a boost, please check out www.oliveunion.com. And then there is the herd news.  You may recall early on in this pandemic that there was talk of herd immunity.  Well, it is not the kind where the COVID is going to just disappear, but there was talk about when we would get to the point that about 70% of a community had had the disease with or without symptoms, and then the rate of spread would dramatically drop off.  Scientists had estimated that the magic 70% mark was the point at which any given individual who contracted COVID would spread it to less than one person on average. Now, it seems that the threshold is as low as 45 to 50% of people having been exposed to confer “herd immunity.”  Cities like New York City or London or other European cities or even Mumbai may not see a second wave after all.  And while there still is no guarantee that we will have a vaccine before the end of the year, our herd may be a lot closer to turning the corner on this pandemic than we initially had thought. Until then, keep your distance, wear your mask and practice really good hygiene, and be something that you may not have been for some time…be hopeful! 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.

Perhaps you have now had the chance to once again be together with family and older loved ones for the holidays or maybe the visit is still on your calendar? If so, you may have noticed or soon will notice that some things are not quite the same, and the changes may be subtle. You may notice that your older loved one's reaction time behind the wheel is more than a bit slow or tentative. You may see evidence that your loved one is more than just "behind on housekeeping;" there may be signs that taking care of home is just more than they are up to. Or you may notice that they have some difficulty standing after sitting for a time or that there is a shuffle to their walk. What can you do? Driving. Talking about giving up the car keys may be premature, but the per mile rates of auto accidents escalates rapidly after about age 70. So, you have to ask yourself if you would prefer to have this hard talk before or after a collision. Then, you need to ask how you would want to be approached if you were the questionable driver. Ask them about how safe they feel on the road with "drivers these days." And do not hesitate to reach out to your loved one's primary care provider as someone who may be able to speak with more authority. Housekeeping 101. This one is more than keeping tidy in the kitchen. If you have done a surreptitious check on the quality and quantity of food your older loved one has in the pantry or refrigerator, you may have found limited quantities as well as staples beyond their expiration dates or making their way to a science experiment. This may be as simple as getting a shopper for your mom or dad, and you can offer to help them find someone to help with the "heavy lifting." Another "heavy" may be in the housecleaning category. No one really relishes pulling out the refrigerator to vacuum or to get under the bed to chase out the dust bunnies. Getting your loved one to agree to help with the heavy lifting on this front may be a nice step toward getting more help as needs change. Fall Risks. Housekeeping may help in beginning to eliminate some of the fall risks your older loved one may face at home. Every year about one in three adults over age 65 have a fall, fortunately not all of them serious. But look for worn carpeting whose frayed edges are a trip risk, particularly on stairs. Scatter rugs also are a big risk as are cords for electrical devices that may be blocking walkways. These may be easy suggestions to make, but you may also wish to bring in a professional like a geriatric care manager who can walk through a veritable checklist on what to look for along with many of the easy fixes. With all of these facets of "home improvement," it is important to remember that you do not have to go it alone in the conversations with mom or dad. You may enlist the support of your siblings so that the whole family is trying to lend a hand, particularly if you collectively have a history of working together around the house. Barring that, you also can raise these subjects in a less threatening way, such as in the kitchen while helping with serving or preparing the next family meal...just one on one. Or if it is the older father, a walk around the yard or block may be an easier venue for a conversation. People tend to talk easier if the talking accompanies a task. There is always that family friend of your older loved one who has been like the extra aunt or uncle who can help facilitate a conversation. And here again, talk with a geriatric care manager about your concerns and how best to bring them up to an older loved one. It does take a village. 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.