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

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

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.
Caregiving is not like a switch that we turn on or off, that we are either caregiving for an older loved one or we are not. What I have found in my work as a geriatric care manager working with family caregivers is that there is a line that is crossed at some point. That line distinguishes what I would term the occasional caregiver from the immersed caregiver; a line that distinguishes the younger daughter or son who routinely looks in on mom or dad from one that suddenly is thrust into a role of scheduling and coordinating care for their loved one. Any caregiver can be caught by surprise when they get the call that mother has fallen and fractured a hip, that dad has had a stroke or that their loved one is hospitalized for any of a number of acute conditions than are suddenly life changing events. But for most caregivers, there are not-so-subtle signs that it is time to become more involved. Note that I said more involved with, not more in control of your loved one's life. One of the reasons that even a loving caregiver may not see the signs that they should be stepping up is that their parent wants to still be in control. The fact is that they can always be in control, but they may need more help with some of life's day to day tasks that are becoming a challenge.
1. Look into the Details. I have talked in other postings about activities of daily living as a number of facets of what we all may take for granted until we begin to lose some our abilities to take care of ourselves. For instance, are there bills that have not been paid on time, are there signs that mom or dad has not been preparing regular meals, do you notice that your older loved one is not keeping up their personal hygiene? Is there slippage? Gently ask to help with some errands or to bring in groceries or cook a meal - perhaps their favorite dish? Remember that you are not taking over; you are just helping out.
2. Become Part of the Conversation. Mom or dad might appreciate a ride to their next doctor's visit, and ask if they have any questions the doctor has not addressed. They may or may not have raised the questions, but they did not track with the answers. And you may have some questions about how well they are managing a chronic condition like diabetes, congestive heart failure or chronic obstructive pulmonary disease. Again, you are not usurping control; you are simply participating because you also care.
3. Everybody Has a Role. As you are seeing what else can be done to help your older loved one, remember to listen for what they want to control and what they are happy to relinquish. Find out from the provider what the larger goals are, and then work with your loved one to devise a game plan in which they actively participate. If they are not an active participant, they will not own the goal. You already have made it possible for them to understand the changes in their health; now make it possible for them to participate in their success.
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.
This is the second in a series of posts on dementia in advance of the release of my new book, How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia. It will be released soon through Family Solutions Press of Los Angeles and available from Amazon. We will keep you up to date on details. Who is at risk for dementia? The simple answer is that in only about one in twenty cases is there any leading indicator or marker for Alzheimer’s in the form of a specific gene, and these are the early onset (before middle age) cases. There also is the ApoE4 gene variant. Individuals with one copy of this variant can have as much as four times the risk as others in developing the disease, and two copies of ApoE4 increase the risk to tenfold. Women also are at somewhat greater risk than men. And sadly, not only are women more likely to be diagnosed with the disease, but they also are more likely to be a caregiver to someone with the disease. For all other cases, it is simply a matter of increasing risk as one ages. The risk factors in general across all the dementias tend to revolve around birthdays, poor diet, poor exercise, poor intellectual/ social engagement as well as diabetes, high blood pressure or depression. For the dementias that are specific to either Parkinson’s or Huntington’s, the cognitive compromises simply accompany the physical progressions of these diseases. 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. We don't mean to sound the alarm about sugar, but we 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 professional care managers, we 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, poor diet in general and lack of exercise that have resulted in what doctors call "insulin resistance," the pancreas' inability to keep producing enough insulin to process all the carbohydrates or sugar. 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 has been referred to as "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 a 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 more likely than others to also develop insulin-resistant Alzheimer's disease. Type-2 diabetes does not cause Alzheimer's disease, but type-3 diabetes is caused by the same poor diet 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. In related research scientists have found that one of the more common medications used to treat type 2 diabetes, metformin, has a neuroprotective benefit as well as its indicated benefit in addressing blood sugar levels and pancreatic function. The research coming out of a close analysis of Veterans Administration data by a doctoral candidate at Tulane University suggests that metformin can have a long term neuroprotective effect that can stave off the brain deterioration of Alzheimer’s and Parkinson’s. In my book, we cover what we know about dementia, what can be done to stave off the effects of dementia and most importantly what caregivers can do for their loved ones with dementia and for themselves. 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.
Raise your hand if you are a caregiver and have never misplaced your car keys. Raise your hand if you are a caregiver and have never been concerned that the forgetfulness of an older loved one might be a sign of Alzheimer’s or some other form of cognitive impairment. I am thinking that we went from no hands up to nearly all hands raised. But the practical fact is that for those of you with care receivers of a certain age it is common that there will be keys misplaced or names forgotten and more. Yet, that is not necessarily an indication of anything organically wrong with your loved one’s memory. So, how does one know? Here are some warning signs according to the experts: 1. Experts talk about the differences between “retrieval” and “storage” problems in memory. Forgetting someone’s name is retrieval and it is not a warning sign of Alzheimer’s. Forgetting that you know the person at all, however, is a storage problem, and it can be a sign of a more serious brain issue. Or misplacing the keys is a retrieval issue, but forgetting what the keys are supposed to do is a storage problem that should prompt closer attention. 2. There also is a difference between losing the car keys and losing the ability to do something that always came pretty naturally. Misplacing the keys, according to the experts, can happen to just about anyone, but forgetting how to start the car and put it in gear can be cause for concern. Or the loved one who was always good at math forgetting how to multiply also may be concerning. 3. Just plain confusion with normal daily activities also is a potential sign, according to the scientists who study these things. If your loved one gets confused on the way back to your table from the restroom while dining out, that may be cause for concern. You should also look for smaller signs as basic as their stride. If their steps begin to more resemble a shuffle this may be a sign of a more fundamental uncertainty…or the unexplained fall likewise can be a precursor of cognitive decline. 4. Finally, look for what may be as subtle as changes in personality. The loved one who used to be the animated conversationalist, but who now is more subdued may be responding to their own confusion in trying to follow what everyone is saying. Agitation in a person who was once a cheery individual also can be a sign of changing mental abilities. Against all of these potential warning signs, be careful about a hasty judgment. A change in mental acuity that is rapid in its onset is better classified as a delirium – not dementia. These episodes can arise from urinary tract or other infections, dehydration or even some hormonal imbalances. Certain medications like steroids or combinations of medications can precipitate short term mental imbalances. Caregivers should be alert to these, but not jump to the wrong conclusions. And beware of your loved one’s healthcare provider who prescribes any of the Alzheimer’s agents for “organic dementia” or “delirium” or anything short of a definitive Alzheimer’s disease diagnosis. So, raise your awareness before you raise your hand. 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.
As a geriatric care manager, I work with court-appointed guardians. You may recall from a blog last December, Caregiver or Guardian, we talked about guardianship. I had the really good fortune to speak with John Wank, President of the Illinois Guardianship Association. Mr. Wank also is General Counsel of the Illinois Guardianship and Advocacy Commission, a state agency. He answered a lot of the questions I have heard from our clients. This is going to take a few postings to get through them all. Here are some questions and his answers for a start.

What is a guardian?

A guardian is a person appointed by a court to make personal or financial decisions for another person who has been found by the court to be incapacitated (a disabled person, under the Illinois definition) and unable to make decisions. All guardianship in Illinois is governed by the adult guardianship provisions of the Probate Act of 1975, 755 ILCS 5/11a-1, et. seq. Other laws also apply.

Does the individual get to choose his/her guardian?

An individual may state a preference, but the final decision as to the choice of a guardian is made by the court. Under Section 11-a-6, "(a) person, while of sound mind and memory, may designate in writing a person, corporation or public agency qualified to act under Section 11a-5, to be appointed as guardian or as successor guardian of his person or of his estate or both, in the event he is adjudged to be a disabled person. The designation may be proved by any competent evidence, but if it is executed and attested in the same manner as a will, it shall have prima facie validity. If the court finds that the appointment of the one designated will serve the best interests and welfare of the ward, it shall make the appointment in accordance with the designation. The selection of the guardian shall be in the discretion of the court whether or not a designation is made." Illinois law creates no preferences or priorities as to whom is appointed guardian for a person with disability, other than the requirement that the court give due consideration to any preference of the respondent. Section 11a 12(d). The criterion used in selecting a guardian is the prospective guardian’s capability of providing an active and suitable program of guardianship for the ward. Section 11a 5(a).

Can the individual rescind the guardianship?

Only a court may rescind a legal guardianship. Guardianship is terminated when a person under guardianship (a ward) is restored to legal competency. Section 11a-20. Otherwise, the guardianship continues until the death of the ward. The court may also change the terms of guardianship, making it more (plenary guardianship) or less (limited guardianship) encompassing, or by appointing another person as guardian after the removal or resignation of a guardian. Section 11a-12 defines plenary and limited guardianship; Section 5/23-1 sets out procedures for removal and resignation of guardians.

We will pick up with more of Mr. Wank’s Q and A in the next posting.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management; please e-mail your questions to Charlotte Bishop.

Copyright ©2011 Charlotte Bishop