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

When Being in Demand Isn’t Healthy
If you’re a musician, you want to be busy, because gigs represent a better living. If you’re an actor...
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May 17, 2022
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Heavy Drinking Helps?
Let’s take a short quiz. Question: Who prefers coffee…and who prefers tea? Which is healthier for you? Answer: ...
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April 19, 2022
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Gaining More than Birthdays
We’ve all heard someone explain…typically referring to that paunch around our middle…that their “metabolism has slowed” from what it...
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March 22, 2022
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Making Your Holidays Happy Again
Yes, “holidays” is a plural word here. Please allow me to digress on this plurality and simply point out...
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November 16, 2021
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Not Just Spring…
We’ve heard of Spring Training for those who follow baseball teams like the CUBS or the SOX, and we...
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April 13, 2021
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Can I Have A Hug?
I doubt there is anyone who does not have something that they have not been able to do during...
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March 4, 2021
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A Game Where Everyone Wins
Pick your metaphor. If you want your knife to slice easier, you sharpen it. If you want to improve...
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March 2, 2021
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No Vaccine for the Other Plague
You’re fortunate that you haven’t contracted COVID, and you may even have received your first dose of a vaccine,...
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February 16, 2021
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Until the Vaccine?
We have all been following the news on vaccine rollouts, and frankly you may have been as disappointed as...
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January 26, 2021
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How the COVID Vaccines Work
If you’re like me, you have been following too much news on the pandemic, but hopefully you also have...
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December 15, 2020
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In the Caregiver's Words

Recent Client Praise

If you are a caregiver to an older loved one or a person with a disability who may be sent to physical or occupational therapy, you need to know about Medicare's new rules on medical necessity. For the past decade Medicare spending on outpatient therapy has been increasing at a rate of more than 10 percent a year, but the number of patients receiving therapy has been growing at less than three percent a year, so there have been about 1300 pages of changes.

       It really all comes down to the physical therapist. Even if your physician writes a prescription for outpatient therapy, it is up to the physical therapist to determine if the therapy satisfies the Medicare requirements. So that your loved one does not end up paying for service (because they can have therapy on demand), understand what the therapist looks for:

1.    Therapy must be aimed at addressing a functional deficit (such as the patient being restricted in some vital activity of daily living).

2.    The therapy has to be something that actually requires a therapist - that is, it could not be a self-improvement home effort.

3.    The therapy is not for maintaining good function; it has to be directed to - and make progress toward - improved function.

4.    Therapy must focus on improving something that makes a difference in the patient's daily life; Medicare will pay for efforts aimed at self-care around their home, but not for training for a marathon.

5.    Therapy has to have a chance of succeeding; the therapist must determine that there is a strong likelihood of achieving goals that have been set forth.

       The guidelines are fairly clear and the therapist's documentation must speak to these issues for the program to be covered. And it is important to appreciate that Medicare's governance will not object to any legitimate use of therapy; they just set the standards so that physical therapy is more than simply "going through the motions." You don't have to read the whole 1300 pages of Medicare's guidelines to appreciate how the revisions will affect therapy. Check out what the American Physical Therapy Association says about making the guidelines work for the beneficiaries (click the link).

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.
Ask any caregiver to an older loved one, and they most likely will admit that it is a stressful – but rewarding – job. But did you know that caregivers over age 65 are 63% more likely to die than people of the same age who are not caregivers? And for reasons that researchers do not fully understand caregiving is an even bigger mortality threat for women than it is for men. This rather alarming introduction is to underscore how serious it is to care for the caregiver. And there are some steps and some options that can take a lot of the crunch out of caregiving and allow all parties to focus on mutual care. If you are a caregiver to an older loved one with a chronic condition, here are some tips on how to take care of yourself along this journey: 1. Recognize your Depression – The estimate ranges from 40% to 70% of caregivers show signs of depression. It is not just “having a bad day.” Watch for your signs of irritability, heavy drinking and difficulty sleeping. Then, get professional counsel or talk with friends who “get it.” 2. Go Easy on Yourself – There are many aspects of your loved one’s condition that you simply cannot make better. But you can help to make your loved one more comfortable, and you can be there to listen. Just showing up is huge; give yourself credit for all of those efforts you make. 3. Take a Timeout – You must keep places on your calendar for “your time.” For some caregivers, that means a workout, for others just a long walk or a hot bath. To do these, you also need to enlist the help of other friends or family who can substitute for you or you can engage respite services from a local agency. 4. Make Your Health a Priority – Do not skip a doctor’s appointment, do not delay an annual physical or routine diagnostic procedure, and stay current with your medications. Be alert to other physical manifestations of your stress like pains, acid reflux or poor sleep. Get help for you so that you can help your care receiver. 5. Make a Plan – Engage the services of professionals who can help you explore your options. When home is no longer an adequate setting for caring for your loved one, get help to investigate the options that can be brought into home or where the new home is going to be. Remember, hope is not a plan and that there are professionals like care managers who know things you need to know. It is entirely possible to give until it hurts. But that does not really help your care receiver or you as the caregiver. Put yourself in your loved one’s place, and consider what you would expect of a caregiver. And at the end of each day, recognize that you have done all that you can, and that is more than enough. 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.
For how many years have women been told they need to take some sort of calcium supplement even before they advance in years to avoid osteoporosis? Okay, it’s a big number, but that’s not the point if you have an older loved one in your life. It’s more than calcium that is needed in a person’s diet to get the benefit of bone density that the calcium is credited with preserving. Calcium intake throughout a person’s life is needed to grow or maintain bone mass. It was the early sailors that understood that a person also needed fruits containing citric acid in order for the body to actually put the calcium to use maintaining serum calcium levels. They didn’t worry about osteoporosis’ they worried about scurvy. So this is another part of the more complicated calcium story and what the body really needs. First of all, food is the preferred way to access calcium, because foods containing calcium also contain other nutrients. Getting your calcium through food also avoids the mega doses of the mineral that can be associated with cardiac risks. In addition to calcium, vitamin D is needed to help the body absorb calcium. Vitamin D has the added benefit of improving muscle performance and balance. It keeps your bones strong and your muscles nimble. And vitamin D is activated by sunshine, so it is not just eating food with sufficient vitamin D and calcium, it is getting out in the sunshine…although there are nutrients that can help the body utilize the vitamin D in the absence of sunshine. Researchers also have shown some benefit of phytoestrogens, some of which are found in soy products, with women. Omega-3 fatty acids that you have heard about in conjunction with Alzheimer’s prevention also confer benefit to the skeleton especially in conjunction with calcium because they contain phytoestrogens. Antioxidants like flavonoids found in some vegetables, wines and fruits offer beneficial bone effects as well. Vitamin B12 and magnesium also are being actively investigated for their bone health benefit. On the flip side, researchers advise against fish products like cod liver oil as they can work against bone health. What is the big takeaway? First, calcium is important, but it works best in conjunction with some of these other vitamins and minerals. And all of this works better in association with diet in general, not as pills or supplements. The best dietary supplements are a range of fruits and vegetables, many of them found in your salads or even dinner wine. And what is the best thing about a balanced meal? The good company that can come with dinner can also improve life for your older loved one who may be more at risk for social isolation than malnutrition. It is rarely just one thing! So invite mom or dad to dinner. 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.
“I really appreciate everything [CCM is] doing/can do to serve.”
A satisfied client
In my last posting I shared geriatric care management services for caregivers communicating with a loved one who may be suffering from dementia. If you have a loved one who has Alzheimer's or one of the other types of dementia, you know all too well that they are not the same person they once were. But have you actually spent some time trying to understand who they are? Have you tried to understand what it is like inside dementia? Try this hypothetical situation. As you awaken tomorrow morning, you make note of the time, and you know that the dogs need to be walked because they have been in their crates all night. You have just enough time to walk them and then have breakfast and get to work. As you go downstairs to the kitchen, the crates are not there, the dogs are not there. In a minor panic, you turn to your wife who is there and ask where on earth the dogs and their crates are? If your wife of many years tells you the dogs have been dead for six years and that you have dementia which is making you confused, how do you feel? ...probably confused, anxious, frightened, and then sad - very sad. That used to be what professionals recommended to caregivers of individuals with dementia - a bit of reality-grounding, but today, the more accepted approach is one of empathy or what therapists call redirection and validation. So, this kinder approach to the situation might be to apologize for not letting your loved one know that the dogs are being groomed and that if they wish you can prepare a breakfast for them. A patient with dementia may suffer from delusions or hallucinations, and these can be intense and stressful events. So, affirming their feelings and then helping them to shift to something more soothing can be very helpful. This older adult who just happens to suffer from dementia still is the person with feelings who is just behaving in what they perceive to be a rationale manner. By validating their feelings and then redirecting their behavior, you are helping them to cope with the world as they see it. Some therapists even suggest that this helps to restore a sense of self-worth that will be helpful in avoiding some future episodes or anxiety:
1. First, ask questions that will help you understand what has triggered the response. I had a client who saw little people around the perimeter of the room painting the baseboards. Once we understood that these people did not speak or harm him, we could incorporate them into his world while still interacting with him.
2. Don't think that it all has to be logical. It is more about how your loved one feels than it is about if it makes sense. Just go with it.
3. Especially if your loved one is upset, try to gently find out what makes for the upset. Then, validate by agreeing that you would be troubled also if its happened to you. You will find that the anxiety for both of you will subside.
4. The bottom line for all of this is to gently give your loved one an out and a chance to save their self-esteem.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends who provide geriatric care management services to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
It’s a disease that affects about 26 million Americans. If untreated it will kill these people. And more than a third of patients who have been diagnosed with it and counseled about it do not even know they have chronic kidney disease; it's a disease that nobody sees. That is not a typo; I did say they do not know they have the disease, at least according to research recently conducted at Vanderbilt University and reports from the specialists who treat kidney disease. Kidney disease is a concern to me as a geriatric care manager, because it affects disproportionately more older adults and because it can be an outcome of poorly controlled of diabetes or high blood pressure and just more birthdays.

A research team headed by Dr. Kerri Cavanaugh of Vanderbilt surveyed 401 patients with various stages of chronic kidney disease. The patients were being treated at the university’s nephrology clinic, and the majority had actually seen a nephrologist within the past year, and many had even attended “education courses.” Yet, when they were asked if they had chronic kidney disease, more than one in three said “no.” This speaks to my top two rules about visits to a health care provider:
- Always take along a prepared list of questions and get answers from your provider;
- Always take a caregiver, friend or family member along to ask questions,
  
  listen and take notes along with you.
I mentioned in my title to this posting that this is “the disease nobody sees.” Now, the five things you should know if you or someone for whom you care may have chronic kidney disease, because the end stage of chronic kidney disease is renal failure which leads to dialysis as your kidneys simply stop doing their clean-up job on your blood:
1. If you have diabetes, hypertension, a family history of the disease or are over
  
  60 years old, get a kidney function test every year.
2. Maintain good control of your blood sugar and cholesterol levels and keep your weight down.
3. If you have even stage 1 kidney disease, stay away from acetaminophen, ibuprofen and aspirin as well as laxatives, antacids, ulcer medications, certain decongestants and even enemas.
4. Stay away from foods that are high in salt as well as anything that may contain magnesium or aluminum.
5. Be alert to changes in urination, swelling of the extremities and face, fatigue, a metallic taste, dizziness, shortness of breath, nausea, leg or back pain or feeling cold even when it is warm.
For more information on what to be alert to as well as how to preserve kidney function, I recommend the website of the National Kidney Foundation.

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.