in home care for seniors

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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In the Caregiver's Words

Recent Client Praise

I was asked today about the “mitten test.” It was one of our colleagues who had remembered something I had said about how to use mittens to facilitate a better test of how well home is still working with their older mom…not against her. Most of us look at our childhood home and our parents’ present home as the same place we grew up, but the difference is that mom or dad have grown older and maybe less able to negotiate the same space as they used to do. I call it the “mitten test.” If you live in the upper portions of the U.S., your winter mittens may just about be ready to come out of the storage closet. Besides keeping you warm, your mittens have another useful purpose that can help you make home an easier place for your older loved ones. You can use them to identify spots in your loved one’s home that can be adapted to fit their changing capabilities. As our bodies age, certain of our nerve pathways begin to fail, and the human anatomy uncannily reroutes many of the circuits as they stop firing. But with age, more and more of those pathways may slow or fail for a variety of reasons, and it just makes it harder for older adults to do the simple manual tasks they used to do without even a thought. Turning a door knob, turning on a lamp or taking the lid off a jar become challenging, maybe even impossible. It is hard for those of you who may be in the prime of your lives to really get this, no matter how empathetic, so I recommend an easy exercise to help you experience what this erosion of manual dexterity and fine motor skills feels like. In doing so, you can also help identify challenging hardware or activities that can be more easily managed with a bit of creative help. With a pair of mittens, walk through each of the rooms in your elder loved one’s home and go through the normal activities of the person who lives in those rooms. As you enter a room, it is may be more challenging to flip a light switch or twist the switch on a lamp with your hands in mittens. These can be remedied by retrofitting wall switches with the larger rectangular switches that one merely presses on and off. Likewise, the lamp twist switches that are challenging with mittens can be replaced with wider winged grips. And even before you enter a room, the door knob may be your undoing if the knob is too small or too slippery. Handles may be an appropriate replacement. The mittens are effective barriers to everything from opening the ketchup bottle to a twisting the lid on a jar of apple sauce or beverage bottle and more. And if a key itself is hard for an older loved one to grip when opening a door, hardware stores have over-sized sheaths to make gripping easier. With your mittens still on, try tying your shoe laces or buttoning a shirt or blouse. It may be time to get creative with Velcro-equipped shoes or other substitute hardware for buttons. And go through the motions of other self-grooming activities to determine what challenges are manageable and which are just out of reach. The number of what are called “assistive devices” will amaze you as you look to television remote controls, computer access and more. Check out the Department of Health and Human Services Assistive Technology site. 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.
It ended with almost uncontrollable laughing. That’s how one of our team describes his conversation with his mother about making her funeral plans one day not long ago. Yes, you heard that right…they talked about her memorial service and had a great laugh together. My take on that is that once the incredible stress around a topic that no one wants to talk about is addressed, the relief is almost giddy. We laughed too when he relayed the part about Googling funeral hymns and singing along with his mom the ones she particularly liked. Trust me; this is not a unique story, and it is only one of the “difficult conversations” families can have. According to AARP, 70 percent of Americans say they feel that it is important to have an end of life conversation with their family members, but only 30 percent have had that conversation. The younger generation in the family may not hear the conversations that older adults have among themselves about death and dying, and parents may not want to “burden” their adult children with talk of end of life. But that will not change the fact that death is a universal event for all of us. If you are that adult child who would like to help your parent with the conversation, there are some ways to “break the ice” in order to have a productive conversation. First, you don’t have to start with end of life questions; you can start with some of the more mundane issues about health or medical issues. Every professional painter will tell you that there is a whole lot of prep work before they even put the brush to the paint. Start with mentioning perhaps a friend whose parent had a medical episode, and the adult children were not even aware that their parent had a problem with their (fill in the blank…heart, lungs, etc.). So those same children could not even supply their parent’s physician’s name or the medications they were taking or any of the other details that the paramedics or emergency room personnel had asked. Or you may even point out that your significant other has all the details on your medical health “just in case.” Would your parent also wish to have you in the know about their health…just in case? And there may be certain circumstances…
- Mom, if your medical professional makes any kind of new diagnosis, do you want to know every detail, treatment options, prognosis, or just the big picture stuff?
- Dad, if the doctors have treatment options for a condition, do you want to know all the details, or just what your doctor recommends?
And there are some issues that can be clearly laid out in documents for the medical record. Called POLST in Illinois (Practitioner Orders for Life Sustaining Treatment), it is considered a legal document that becomes part of a patient’s permanent record which states what kind of measures they wish to have applied in emergency situations. It is more than a Do Not Resuscitate (DNR) order; it covers the extent to which medical professionals should work to sustain them in an emergency. The Illinois site for this legal document also has suggestions for how to have the conversation. Obviously, the conversation can get into details like the one I started this post with, but it may not be the first conversation. We as Geriatric Care Managers also get the call to help families cover these kinds of issues, and we have made this into a form called the Life Span Care Plan(SM). 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.
Okay, "Grain Brain" is not something that immediately tells you what it is all about. Grain Brain is the phrase that neurologists and other brain scientists are using to describe a link between blood glucose levels from high carbohydrate consumption and dementia. A book by the same name is going into its 15th straight week on the New York Times bestseller list, so the concept is getting a lot of attention. But what does it mean for you or an older loved one in your orbit? In a scientific study recently published in the prestigious New England Journal of Medicine, researchers followed a large group of men and one of women for an average of almost seven years. During this nearly seven years they regularly measured the individuals fasting blood glucose levels. At the end of the study they found that people with higher blood glucose levels were more at risk for developing dementia that those whose levels were not as high. They found this to be true even with people who did not have diabetes. It is true, that this kind of study cannot say that increased blood sugar levels actually cause dementia, but the link is sufficiently clear that the New England Journal would publish the findings. Scientists also find that not all grains have the same negative effect on cognitive ability. Those with the highest gluten content seem to be the worst offenders. This is not the first research to show negative health outcomes associated with elevated blood sugar. Researchers have well-established proof that a high carbohydrate diet and the associated elevation of blood sugar poses a risk to one's heart and to the immune system. And there are other studies. in a 2012 study in the Journal of Alzheimer's Disease, researchers reported that risk for cognitive decline was 89% greater among those on a high carb diet; those on a high fat intake diet saw a 44% decrease in their risk for cognitive compromise. And researchers in another British journal, Lancet Neurology, estimated based on their findings that as many as 54% of the cases of Alzheimer's Disease in the United States could be avoided with exercise, weight reduction and steps to reducing blood pressure. This last study really drives home a great point. If you are a caregiver to an older loved one, you both will see great returns on a few basic investments of time and effort. Increase the daily amount of exercise, reduce the carb intake and the rewards will be weight loss, reduced blood pressure, a healthier heart, a more vigorous immune system and more acute cognition. Sounds like a really great return on investment to me. So, will you and your older loved ones be among those who avoid the "grain brain?" 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.
Over the past couple years on more than one occasion I have talked about what a geriatric care manager (GCM) is. Even though the national association that accredits professional geriatric care managers (NAPGCM )is about 30 years old, the question of what we are still comes up. But there is more you should know about a care manager if you are one of the caregivers or family members looking to engage a geriatric care manager to help with your loved one. Here are eight questions I recommend you ask anyone you are considering for your circle of care.
1. What are your credentials? A GCM should also have other training or credentials like a rehabilitation degree, nursing diploma or social worker license in addition to being certified as a GCM. Ask about that.
2. Are you certified or licensed? Are they a certified geriatric care manager or simply providing services to older adults? Just as you would not want a lawyer who did not pass the bar or an accountant who did not have a CPA, you would not want just anyone who claims they “care for older people.” You can visit the Association web site to see the standards; check the link above and also look for the logo on their web site.
3. How long have you been providing elder care? There is no magical number of years, but you should decide how much experience gives you confidence and comfort that mom or dad will be in good hands
4. What about emergencies? You are not looking for a paramedic when you engage a care manager, but you need the peace of mind that your local resource can help in case of an emergency.
5. Does your company have any “relations” with other service providers? You definitely want someone who knows area resources like home care or senior residential communities. But be careful of anyone who may receive pay for referrals or who may simply steer you to their own services.
6. How will you communicate with me? This really is about what you want. Do you want a regular call, calls after medical appointments, routine e-mails or some other communication that will answer your questions and give you peace of mind?
7. What are your fees? First, you should receive a written document or contract with the fees and billing policies laid out. An article in the Wall Street Journal a few years back said that the national range of $80-$200 provided a “good buy” considering everything a GCM can do for a family.
8. Can you provide references? This will help you to get it in the “customers’ own words” from someone who has been in your shoes. You can also look for certification by the Better Business Bureau.
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 Charlotte Bishop.
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Creative Care Management, Inc.

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