Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • home care servicesChicago's Geriatric Care Manager Center of Excellence

COVID’s Other Deadly Toll
During this pandemic, over 13,000 more Alzheimer’s and other dementia patients have died than expected from these cognitive disorders,...
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September 22, 2020
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Hold Your Friends Close and Stangers Closer
Miss your friends, your older loved ones and those summer get togethers in the backyard? We can get together...
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August 11, 2020
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Dementia: We’re Not Post-COVID Yet
If you have a family member or loved one with dementia, this pandemic and its restrictions have been exponentially...
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May 26, 2020
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Distance Caregiving Through a Wall
I’ve written numerous times about distance caregiving, and one of the observations I have offered is that distance is...
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May 19, 2020
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Caregiving During COVID: Four Tips for Reengagement
You may recall that I have recommended limiting your news consumption, because it really does add to our stressed...
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May 12, 2020
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Tips for Distance Caregiving: Up Close and Personal at a Distance
If you think being a caregiver to an older loved one is hard–with all the trips to help them...
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February 4, 2020
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Mittens Before the Frost
I was asked today about the “mitten test.” It was one of our colleagues who had remembered something I...
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September 18, 2018
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GOOD NEWS FOR CHRONIC CARE
Associate Care Manager Gregory is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP), and Medicare Counselor, whose work...
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August 6, 2018
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Long-Term Doesn’t Mean Put It Off Until Later
Gregory Peebles is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP), and trained Medicare Counselor, whose work focuses...
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June 24, 2018
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A House is Not a Home (Part 3)
At CCM, home and safety are as important to us as to you, so it’s no surprise that it’s...
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June 18, 2017
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In the Caregiver's Words

Recent Client Praise

We all know that an object at rest tends to stay at rest, and that is as true of older adults as it is younger ones if you look at the frightening statistics on the obesity epidemic in America. Habits developed over the long run tend to be harder to break, but the fact is that appropriate exercise for older adults can get easier and easier just by the simple fact of dong it. Because the corollary to my first scientific law is that objects in motion tend to stay in motion. And exercise gets easier. Doubtful?

Here are nine reasons:
1. Starting a new exercise routine may feel clumsy at first, but so did dancing, riding a bike and a lot of other physical work we have all gotten better at with time. Muscle memory will help, because your body will make new nerve pathways to make your exercise easier with time.
2. Blood flow improves when you exercise at any age. The smallest vessels actually can increase in number fueling all parts of your body as your heart rate routinely increases with practice.
3. We all have seen body builders grow muscles into sculpted works of art. Well, we do not see the heart, but it gets stronger also with workouts that are even modestly strenuous. This is true of older adults as well as college athletes.
4. With the muscle memory and greater cardiac capacity comes increased confidence among elders who exercise. Physical confidence, in turn, creates greater overall confidence and a sense of “can do.” Older adults with a regular workout routine also will sleep better.
5. We have heard from too many fanatics about “no pain-no gain.” The opposite is, in fact, true. As an older adult works out over time, the body raises its threshold for working. With time, an older adult can do more and more without that shortness of breath or even the soreness afterwards.
6. Take that last one to a higher level, and if the older body begins a regular regimen of moderate exercise, the body’s hormone system will reward it with cocktails called endorphins. Endorphins are basically a homemade version of morphine to help the body feel better and better.
7. The power plants in your cells also will begin to grow in number with exercise over time. You cannot see them, but the mitochondria, as these power plants are called, become more numerous so that your body can burn more carbohydrates and fat to create more energy.
8. Exercise will encourage better eating habits. It is true, because a lot of those bad habit foods – comfort foods – are linked to stress, anxiety or even depression. Since exercise works against these negative emotions, some of the craving for the junk food will ebb as well.
9. Exercise actually makes a person happier. Tied to some of what I mentioned in #8, exercise really lifts the spirits, and it does it in part through releasing chemicals called serotonin, dopamine and norepinephrine. These chemicals can be as effective as some of the drugs often prescribed for depression.
Before you exercise or encourage an elder to exercise, see a doctor to sign off on your fitness to exercise.

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.,geriatric care manager Chicago, geriatric care Chicago

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Too Good to Be True
With over 300 clinical trials on vaccines for COVID19, it perhaps is not a surprise that at least two are very close to emergency authorization by the Food and Drug Administration this month. Where are you in the line...
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December 1, 2020
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Every 44 Seconds
That was on November 19th this year…the pace of COVID-19 deaths in the United States…one every 44 seconds, or 1,971 in a 24 hour period. They have tallied “only 956 deaths for yesterday so far, but that figure will...
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November 24, 2020
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The Other Global Health Crisis
Wearing a face mask is the new front line of defense against the spread of the war on COVID-19, but it does little to protect against the other public health crisis that is hitting people around the globe. Scientists...
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November 17, 2020
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You’re Bringing What for Thanksgiving?
Remember Thanksgiving just a year ago? It was that family gathering when you prepared the turkey and someone brought a vegetable and someone else brought dessert and someone else brought cranberry sauce. But mostly it was the people coming...
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November 10, 2020
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Connecting the Dots Means Early Detection in Dementia
One of the other casualties of this extended quarantine is the cognitive consequences of less social interaction and less intellectual stimulation…what we call the “Activities of Daily Living.” If you have an older loved one with whom you still...
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October 27, 2020
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Online Shoppers Beware
We all think that we could never get scammed, right? We all think that only other people can be fooled into giving away personal financial information of access, right? Well, this week I came as close as I want...
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October 20, 2020
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If You Can’t See Something…
If you see something, say something. We have all heard this about everything from neighborhood watch programs to announcements in airports…that is, back when people actually took flights to somewhere. But what if you can’t see “something”… something like...
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October 13, 2020
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October 9, 2020
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Earlier this month, Kaiser Health News published an update on what the Centers for Medicare & Medicaid Services (CMS) is doing to reimburse for more services that may not be strictly medical…but offer a health benefit. With Kaiser’s permission we are releasing their summary of these changes here. Air conditioners for people with asthma, healthy groceries, rides to medical appointments and home-delivered meals may be among the new benefits added to Medicare Advantage coverage when new federal rules take effect next year. Earlier this month CMS expanded how it defines the “primarily health-related” benefits that insurers are allowed to include in their Medicare Advantage policies. And insurers would include these extras on top of providing the benefits traditional Medicare offers. “Medicare Advantage beneficiaries will have more supplemental benefits making it easier for them to lead healthier, more independent lives,” said CMS Administrator Seema Verma. Of the 61 million people enrolled in Medicare last year, 20 million have opted for Medicare Advantage, a privately run alternative to the traditional government program. Advantage plans limit members to a network of providers. Similar restrictions may apply to the new benefits. Many Medicare Advantage plans already offer some health benefits not covered by traditional Medicare, such as eyeglasses, hearing aids, dental care and gym memberships. But the new rules, which the industry sought, will expand that significantly to items and services that may not be directly considered medical treatment. CMS said the insurers will be permitted to provide care and devices that prevent or treat illness or injuries, compensate for physical impairments, address the psychological effects of illness or injuries, or reduce emergency medical care. Although insurers are still in the early stages of designing their 2019 policies, some companies have ideas about what they might include. In addition to transportation to doctors’ offices or better food options, some health insurance experts said additional benefits could include simple modifications in beneficiaries’ homes, such as installing grab bars in the bathroom, or aides to help with daily activities, including dressing, eating and other personal care needs. “This will allow us to build off the existing benefits that we already have in place that are focused more on prevention of avoidable injuries or exacerbation of existing health conditions,” said Alicia Kelley, director of Medicare sales for Capital District Physicians’ Health Plan, a nonprofit serving 43,000 members in 24 upstate New York counties. Even though a physician’s order or prescription is not necessary, the new benefits must be “medically appropriate” and recommended by a licensed health care provider, according to the new rules. Many beneficiaries have been attracted to Medicare Advantage because of its extra benefits and the limit on out-of-pocket expenses. However, CMS also cautioned that new supplemental benefits should not be items provided as an inducement to enroll. The new rules “set the stage to continue to innovate and provide choice,” said Cathryn Donaldson, of America’s Health Insurance Plans, a trade group. “CMS is catching up with the rest of the world in terms of its understanding of how we keep people healthy and well and living longer and independently, and those are all positive steps,” said Ceci Connolly, chief executive officer of the Alliance of Community Health Plans, which represents nonprofit health insurance plans. Some offer non-emergency medical transportation, low-cost hearing aids, a mobile dental clinic and a “grocery on wheels,” to make shopping more convenient, she said. 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.
We do a lot of postings on dementia, in no small part because adults rank it as their number one concern, just above running out of money or dying. I have again asked our Vice President, Steve Steiber, Ph.D., to talk to us about what we may not know - but should know - about the evolving science around Alzheimer’s disease and treatment options. Steve has over twenty years of experience as a consultant to the pharmaceutical and biologic industry prior to joining us at Creative Care Management. He reports in this post on what may be a "light at the end of the tunnel we call Alzheimer's disease. What is the first thing you learn when you are admitted to a hospital, and this can be for outpatient or inpatient procedures? ONE SIZE DOES NOT FIT ALL! That applies to Alzheimer’s disease as well. There has been no blockbuster fix for Alzheimer’s, to date, but on closer examination of how people with different genes or with different make-ups respond, scientists are finding they react differently to medications. We already have seen this in cancer treatment, and it is a broad and promising side of medical care called genomics…sometimes called pharmacogenomics when referring to medicines and nutrigenomics for foods or supplements. When physicians look to a person’s specific genes, they can find people who may respond a lot better than someone without those genes. They call it “personalized medicine,” and it is showing some real promise. Let's start with a clinical failure that may actually be something else altogether: tramiprosate (an antiaggregation of amyloid agent). Earlier this year results from a phase 3 clinical trial (this is the final phase for a drug to be up for possible approval by FDA) for tramiprosate showed no appreciable improvement, on average, for Alzheimer’s subjects in the trial versus those on placebo. I said, “On average.” When scientists later looked more closely at the genetic makeup of patients in the trial, they found that those patients with two copies of the APOE4-gene had markedly better results than those with only one or no copies of this gene. Scientists are reassessing how these patients and those with the APOE3 gene respond, especially since these latter are at greater risk for developing Alzheimer’s disease. Worth a second look, for sure. I also mentioned nutraceuticals. In a European study some time ago, there seemed to be some promise for vitamin D as a protective agent against Alzheimer’s. As scientists looked specifically at the patients with two copies of the APOE4 gene and taking vitamin D, they found those patients had better memory scores than those on placebo or without the gene. Vitamin D in the absence of the two gene copies did not seem to do as well. Scientists are also looking more closely at omega-3, what we sometimes refer to as fish oil (it is only in the fish oil, because that is where it is stored after fish eat the algae that contain the omega-3). And there are multiple types of omega-3, two of which are particularly “brain-healthy.” Scientists have a couple challenges here. One, the brain’s absorption of the healthy omega-3 takes a few years, and there also is a difference in the genes I mentioned above. This may take longer to get good evidence, but it also is promising. There also is research into limiting environmental risk for developing Alzheimer’s that is linked to both the APOE4 gene and the presence of pesticides like DDT and its metabolic cousin, DDE. While DDT has been banned in America for some time, its metabolite, DDE, is still around. Preliminary research suggests that it is not just the DDE or just the APOE4 gene, but the presence of both that is associated with higher incidence of Alzheimer’s. While these early findings will not tell you what to ask your physician about diet or medications, it is a cautionary note for all who live in or near agricultural regions. The lesson learned again is that we likely have just begun to tap the genotypic profiles that may lend themselves to less versus more risk or less versus more success. The oncology field has begun to get better and better results in their fights across a number of cancer types by paying attention to genes that can predispose individuals to either greater risks or to better outcomes. It just may be that Alzheimer’s disease can follow the same model. 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
Did you have a great Thanksgiving Holiday or do you find yourself totally exhausted from all the preparations and clean-up and dreading (at least) four more weeks of the same? If you can see something of your experience in that description then you may be a caregiver who has not followed my "prime directive" for caregivers: You will always take better care of others if you are taking care of the caregiver first! I have said it somewhat differently on numerous occasions, but those charged with taking care of an older loved one along with everyone else in their orbit also need to care for themselves. Don't burn the proverbial candle at both ends.

So you agree in concept. It seems easy to say, but how does a caregiver start taking better care of her or himself? Here are three simple guides that you may find helpful in getting through the rest of the holidays. I think you actually will find that you better enjoy the opportunities for family and friends when you are in better shape yourself.

1.    Delegate! Recognize that when ten people (or more) gather at your house to dine for the holidays that there will be a lot of food to prepare. Don't go it alone. Request the two vegetable dishes from two of the guests, the rolls from another and the dessert from someone else. You may reserve the special dish that only you do for yourself, but share the opportunity to prepare the feast. And keep sharing after the meal. Those who cannot cook will clean! If you find yourself alone in the kitchen with a sink full of dishes after dinner, you did not delegate.

2.    Designate! Set up a schedule with "rest stops" for your days leading up to and including the day of the event. Set aside time for yourself just as you would set aside a break from a long drive in order to get out of the car and stretch your legs. Get out of the house for a nice walk in the crisp air or sneak away to your room with a magazine or book.

3.    Disengage! Don't compare yourself to anyone else. It is easy to set the bar way too high by thinking that "if mom or dad could do all of the work," then so should you. And that goes for recipes also. Be prepared to enjoy the meal in which everyone has a hand in preparing. In fact, it may even taste a bit better if you did not prepare all of the meal. (Refer to rule #1 above.)

      Enjoy the rest of our holiday season, and remember to take care of the caregiver.

      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.