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

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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A House is Not a Home (Part 2)
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 12, 2017
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A House is not a Home (Unless You’re There)
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 5, 2017
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Respite Care – The Holiday Gift to Yourself
Be honest if you’re a caregiver and you can answer YES to more than one of these questions. Sit...
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November 23, 2015
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Caregivers and their Medicare?
Yes, you read it right. I am posting this one about what caregivers should know about their Medicare. But...
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September 12, 2013
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In the Caregiver's Words

Recent Client Praise

I had the good fortune recently to meet Jennifer Muskat, the Director of Client Services for San Diego Home Care Assistance. She shared some helpful perspectives on the importance of geriatric care management services for older adults who need emotional support. "The physical obstacles that your aging parent or loved one encounters in old age are often the most noticeable. While you can easily observe their struggles with walking or daily chores, it is much more difficult to recognize, understand and empathize with the emotions they experience on a day to day basis. Your elderly loved one will be forced to deal with a handful of life-changing events as they age. Retirement, forfeiting the right to drive, and the loss of a spouse, sibling or close friend are just a few examples of inevitable changes that accompany aging. Without emotional support from family members during life’s new and unfamiliar events, seniors become vulnerable to depression and often suffer from a decreased quality of life. As an adult, your sense of worth comes from your ability to provide for your family, perform your job well and most importantly, function as an independent individual. Whether from frailty or age-related illness, seniors lose these abilities, resulting in an increased dependency on their adult children. When this role reversal occurs, many seniors experience feelings of worthlessness and a lack of self esteem. Becoming dependent on their children, who once relied on them for everything, is difficult to cope with emotionally. When neglected, these negative feelings can result in depression in seniors. They feel alone and helpless and that no one understands their situation. To ensure the health and wellbeing of your loved one, it is crucial that you are aware of how your loved one may feel. If they seem withdrawn, upset or have just suffered the loss of a close friend or family member, take the time to talk with them. Listen with patience and compassion and try not to criticize their feelings. By letting your elderly loved one know you are by their side and are available to offer emotional support, you can help combat depression and enhance their overall happiness and quality of life. Also recognize that seniors become socially isolated in their later years and encourage your loved one to pursue new hobbies and stay in touch with old friends. Participation in these activities offers another channel for emotional support. We often do not look beyond the physical ailments of our aging parents and fail to provide the emotional support and encouragement they once provided us as children. However, it is never too late to help. Reach out to your elderly loved one and let them know you are there for them as they enter this new stage of life." Jennifer Muskat is the Director of Client Services for San Diego Home Care Assistance. She offers geriatric care management services as an advocate for senior health and wellness. By constantly developing new programs, she ensures Home Care Assistance caregivers can provide optimal quality of life for senior clients. 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. We provide elder care services to those in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
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.
We as certified geriatric care managers all hear about older adults falling. Caregivers often do not expect their own loved one to have an accident at or around home. The simple fact is, however, that about 20 percent of adults over age 65 will have a fall in any given year. Sadly, most fall can be prevented with some simply safety precautions:
1. The Feet aren't Fit. Yes, it is true that a lot of falls happen because there are hazards all over an older adult's house, but falls are not inevitable. De-conditioning happens in older adults who do not really exercise their balance and their gait. They become less nimble, and you can see it in the "elder shuffle" many of them manifest. You may not be able to help them dance again, but you can get rid of worn carpet or what we call "shatter rugs," or scatter rugs. For an older person who does not lift their feet, these can be a fall waiting to happen.
2. Other Hazards. Anything on the floor and potentially in traffic can be a fall hazard. Look for uneven surfaces, footstools, electrical cords, stairs and similar clutter on the floor. You don't need to make your older loved one's home a sterile and barren place, but you can clear the traffic routes to eliminate risks before they become a broken hip.
3. Line of Sight. If they cannot see it, they will fall on it. Older vision inevitably becomes less acute, but sight also can be obscured by cataracts, macular degeneration or other conditions of older eyes. You can address some of this by seeing that they have annual vision tests and necessary upgrades in their eye wear as well as enhanced lighting throughout the house.
4. Medication Side Effects. Many medicines have side effects that cause dizziness or low blood pressure upon standing. While their main effect may be necessary, the side effects can make navigating an otherwise safe path incredibly difficult. Talk to the health care provider about any side effects and ask about reduced doses or a change in meds altogether.
Charlotte Bishop is founder of Creative Care Management, a team of geriatric care managers, certified professionals, advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecasemanagement.com.
As a geriatric care manager, I often find clients who are on the right medications, but they are overwhelmed by the numbers and schedules of their meds. Older adults consume an average of four or five prescription medications a day along with two more over the counter (OTC) drugs.

While adults over the age of 65 represent only about 13% of the U.S. population, they consume about 30% of the prescriptions written in America today. I wrote about this last November, and talked about the potential for drug-drug interactions and the unique challenges to the health of an older person’s slower metabolism and lower hydration. I also discussed how one of the important tasks for a caregiver is to ask for a pharmacist or geriatric care manager to do a “medication audit” to be assured that the older patient is not at risk for adverse drug events or interactions.

What I did not devote much space to in that earlier blog is how multiple medications very simply present a real challenge to an older patient to keep all those prescription dosing regimens straight. This often results in noncompliance – or failure to take prescribed medicines – of one sort or another. Health professionals tell me that the reasons for noncompliance usually come down to:
- Forgetting – Elderly patients can lose track of all their prescriptions and schedules; it may be cognitive dysfunction or just being overwhelmed.
- Labeling – Labels may be clear to doctors, but older patients on numerous meds may not track dosing times a day or with or without food and more.
- Cost – Rather than admit that they choose between food and medications, some older patients may consciously avoid some doses or split pills.
For patients who forget doses, there are pill organizers that can be set up for a week – or even a month – at a time. The caregiver can step in to organize the medications along with clear instructions on when they are to be taken. There is a whole host of pill organizers, some with alarms. Google “pill organizer” and see.

There is a lot of variance in labeling of pills. In a recent survey of 464 adults aged 55 to 74 years old published in the Archives of Internal Medicine, the patients averaged dosing six times a day for the average of 7 drugs they were taking. While most drugs could be dosed four times a day at most, patients did not understand their labels sufficiently to consolidate their doses. There is regulatory movement on rules to standardize and simply prescriptions with universal medication schedules. You can help an elder by organizing their meds; the fewer times a patient takes medicine (not necessarily the fewer pills), the better their compliance.

Cost is an issue many elders may not bring up out of embarrassment. Caregivers, however, can work on behalf of their elder to ask for generic equivalents to branded medications. Where only branded medications are indicated, question the physicians’ office about manufacturers’ patient assistance programs, especially for patients without prescription drug coverage. Check the manufacturer’s web site for programs to help defray the full retail cost. You may also find much better prices on-line or through mail order houses when the prescription is filled for 90-day doses instead of 30 days.

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
You may not have been following the news in China this past week, but China has enacted what may be the first law governing caregiving to older adults. In a law called the "Protection of the Rights and Interests of Elderly People" enacted this month caregivers are called to task. The law states "Family members living apart from the elderly should visit or send greetings to the elderly persons." This is not what I would consider a very enforceable statute, but it is a sober statement about what caregivers and their older loved ones around the world are increasingly seeing with regards to geriatric care management. AARP and a group called the National Alliance for Caregiving (NAC) have been surveying caregivers since 1997 and an analysis across the years show some interesting trends:
1. the average age of caregivers has been steadily increasing from 46 years old in 1997 to now 50 years;
2. the percentage of caregivers who are women still outnumber men, but the numbers have declined from 73% women in 1997 to the most recent figure of 67% women (this has been generally consistent across caregivers of all ages)
3. the average percentage of older recipients of care is growing - 24% of recipients 85 years of age and older to now 30% being that old or older;
4. the proportion of caregivers who also hold a day job has been quite consistent during the years of these surveys (from roughly three in four to four in five caregivers employed);
5. across all ages of caregivers there is an increasing incidence of leaves of absence from their jobs reported by caregivers
6. "burden of care" measured in hours of caregiving as well as actual activities was measured only in the most recent survey, but it was the older caregivers reporting the greatest burdens;
7. as a counterpoint to this "burden," the older caregivers also were those most likely to use outside services to help in the caring (older caregivers also were less likely to report help from friends);
Getting back to our China example, the law does say "should." But it just may be that the authorities were seeing some of the same trends as we see here in the United States. And this survey’s report pretty much squares with what I see as a geriatric care manager; older caregivers taking care of older friends or spouses shoulder a larger burden, and it ultimately takes its toll on the caregiver. If you know an older caregiver, help them to find resources to take some of the load off; remember also that a large portion of that "load" may be guilt about not going it alone...so be supportive. Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified geriatric care management 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.
Family crises don’t make appointments…they just happen whether you are ready or not. In fact, our clock is ticking: • Every 67 seconds another person in America is diagnosed with Alzheimer’s, and that is just one of the nearly 100 types of dementia; • Every three minutes an individual 65 years of age or older is taken to an emergency room; 14% of the subsequent admissions are for broken hips. The list goes on. You wish mom or dad could have the life they want…to stay in the home you grew up in … to stay independent. In fact, they may have made you promise that you would see to it. But dreams and promises can’t always come true. Are you ready? The clock is ticking. Do you dread the phone call that may come in the middle of the night- or during the work day? The call that tells you something out of the blue has happened to someone you love? I got that call- I was working full time with school age children at home when I got the call that my mother was diagnosed with cancer. Right then and there I had to deal with my mother’s medical needs, her health crisis, her finances while caring for my family and running my business. One of our employees got the call that his mom had to be out of her independent living facility within 30 days…she was no longer “independent.” How many of you have had a similar experience- or are hoping you never get the call? Well, hope is not a strategy for your inevitable family crisis - you need a plan. A plan starts with having the necessary documents for your older loved ones, and the basics are: a POLST, a Living Will, a Power of Attorney for Healthcare and a Power of Attorney for Finance. Some of our clients also have found that mom or dad wanted to lay out their plan for a funeral, but that may be getting a bit ahead of things. You also need to know their physicians – that’s right, it’s plural; there likely will be more than one. You also want to know their preferences…which hospital in the event they need to go to one, a document to inform any medical interventions. And, of course, where their health insurance card is, their will, and who their lawyer is. You may get some resistance, so just remember that resistance is just fear putting up a wall. Empathize with their fear. Imagine now your next step. Imagine what it would be like to have the peace of mind that a plan can give. The possibility of sleeping at night. The possibility of having more time with your family. The possibility of being able to do your job. The possibility of feeling more in control of all the chaos. Check out what I had to say about planning for the crisis that doesn’t make an appointment on ABC News. Watch it below (after a brief commercial).
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.