in home care for seniors

  • At CCM, home and safety are as important to us as to you, so it’s no surprise that it’s a common topic of our discussion. I have asked Gregory Peebles to talk about this topic from the vantage point of his experience. Gregory is both a Certified Senior Advisor (CSA) and Certified Dementia Practitioner (CDP) whose work focuses on helping aging adults and folks with limited independence by providing resources and support to help them discover and lead their best life. An Associate Care Manager, Gregory has been a part of our team for over a decade. – Charlotte Home. Not only is there no place like it, conveniently located wherever you hang your hat, that fits--like an old, comfortable shoe, but it’s also a place that once we leave, to which we can never return. While most find this very stressful, some are secretly happy for a new chapter. Indeed, lots of people confirm they like adventure, but small is the number who enthusiastically embrace major residential change. So what’s the difference?  Well, for one, the direction of action: people elect to go on adventures, but change just seems to happen to us. This is a major life change, and those inclined deserve the opportunity fully to grieve their loss of home sweet home. However, once the initial grief has been addressed, we’ve got work to do!  Change isn’t the end, and there’s plenty of life and happiness yet to be found no matter the location. Where that happens is up to you. The diversity of the experience of aging can be exciting, and, with the number of Americans joining the group of aging adults, the kinds of communities that now exist will only become more varied. Right now the kinds of accommodations available generally fall into a few groups.
    • Active Adult Communities – Often neighborhoods with individual bungalows, these communities are based on the model of so-called “snow birds” who opt to transition to such a residential community rather than maintain a larger space. Living in one of these communities requires a high level of independence (and income). Individuals or couples with highly social personalities thrive in this setting.
    • Independent/Congregant Living – Facilities of this type, while slightly less luxurious than an Active Adult Community, feature many of the same accommodations with a denser population. In an urban setting, they are often high-rise apartments indistinguishable from nearby housing, with dining, health care, and leisure activities on the premises. If considering this type of facility, be sure to keep nearby entertainment and accessibility in mind.
    • Assisted Living – A senior for whom it has become difficult to care for themselves either because of physical limitations or decreasing independence will often find an exciting new life in such a facility, either through public assistance or private pay, where skilled staff are present to provide diverse care. If the care receiver is also living with cognitive decline, such a facility with a “Memory Unity” may be advisable.
    • Skilled Nursing – On average, aging adults who become residents within skilled nursing facilities – SNFs - are those who have health problems, who require 24-hour care, and whose ability to manage the Activities of Daily Living is severely impaired. Nursing home care, too, is expensive, but public assistance programs such as Medicare or Medicaid relieve the cost.
    Change is difficult, but not unmanageable. New identities await us and are only limited by our willingness to embrace them and the imagination we bring to our experiences. Change is scary, and rightly so, but when we weather even the most difficult transitions together, and our lives are no longer recognizable from before, we may--if we choose to--learn that home is something that we take with us wherever we go, and that it is recognizable not by its address, but by the love shared and the people with whom we share it, common to both our memories and our futures. One final thought: This is when people often reach out to Aging Life Care Professionals to help smooth the transition to a new residence and to ensure ongoing care. CCM has helped countless families like yours succeed in this new chapter. Contact us today and let us assist you. 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
  • geriatric care manager and older womanIn my last posting, I gave a checklist of the preventive health touchstones for men over age 65, and you will see some fairly predictable parallels to women's health as they hit 65 as well.  But take note of the differences if you are a caregiver to an older woman.  I am going to start             Bone Health - all women need to have their bone density tested even before age 65, and it is largely because of the hormonal changes that are associated with aging.  the bone density test is called a DEXA scan, and if you are a caregiver to an older woman, you should approach her doctor about having it done as well as ask about what amount of calcium supplement will be a helpful part of her daily intake.  Again, exercise will be important as well.             Breast Health - there are risk factors that every woman ought to know, but on average, a mammogram every year or other year depending on their risk factors.  All women of any age should learn self-exams as part of their monthly ritual as well.             Pelvic Health - once a woman stops ovulating, and 65 is well beyond that, PAP smears are no longer part of the annual routine unless they have had a positive test result at some point along the way.  The rule is that three negative tests within the past decade makes for a safe future but check with the physician.             Blood Pressure - women should have their blood pressure documented annually as with men. With diabetes or heart disease, this maybe more frequent.  If blood pressure is above 135/80 blood sugar levels should be tested regularly.             Oral Hygiene - as with men an annual cleaning and exam is a must. Again, oral health tracks with heart health, so twice a year has more benefit that just a great smile.             Cholesterol Levels - if cholesterol has been within normal ranges, a check about every three to five years is adequate.  With heart disease or diabetes, this should be more frequent.             Colon Health - up to age 75 a "virtual colonoscopy" every five years.  A stool test every year, a sigmoidoscopy every five years and a colonoscopy every 10 years without a history of family colon issues or cancer.             Eye Health - again, a vision exam is recommended every two years as a screen for glaucoma and visual acuity.  If the older patient has diabetes, more frequent testing.             Immunizations - as with older men, keeping current with all immunizations is important.  For pneumococcal vaccines, every five years; flu shots annually.  And the shingles vaccine if she has had chicken pox when younger.  A tetanus booster every ten years is recommended, and talk to the primary care provider about anything else.             Everything else - as with men annual exams are a time to weigh in, record height and test hearing.  And women as much as men are prone to depression as they age.  A physician can offer an assessment as well as a consult on all medications and any possible interactions .                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
  • With all the talk of risk mitigation amid this COVID pandemic, home improvement may seem low on your list of things to do.  But after we all have self-quarantined, maintained our “physical distance” (I don’t call it “social” distancing.) and stocked up on comfort food, please allow me to give you five insights into getting through this and coming out of this a better, more balanced and healthy person.    
    1. Start with You – It is not time to slink into the recliner chair with the remote in one hand and a bag of chips in the other. Take stock of what you eat, what you drink, how you exercise and how you are sleeping.  Then choose one area for self-improvement, set a goal and work on it.  Then another…all of these steps that make a better you will also protect you from a virus.
    2. Reduce Stress – I know, easy to say, hard to do. Stress may have made our ancestors effective in defending themselves against predators, but they burn up our systems if we get stuck on “high alert.”  There actually is a special web site designed around how to calm ourselves about COVID-19.
    3. Socially Close while Physically Distant – I talked in an earlier post about ZOOM meetings with people who are important like family, friends and folks who just are isolated themselves. This last is important, because it can help us receive the calming benefit of extending our own empathy.  (Key is to ask a lot of questions instead of “dumping” about ourselves.)
    4. Use the Timer – This is not for the perfect three-minute egg, but for setting what I used to call with my kids “loving limits.” You may have your favorite newscaster or channel, but there is too much bad news if you let yourself get sucked into the endless news cycles.  Use your Egg Timer or your app: 30 minutes is a good limit…and stick with it.
    5. Attitude of Gratitude – I know it seems rather cliché, but you cannot tell the important people in your lives too many times just how important they are. You cannot stop to smell too many roses (I know I am rushing that season).  You would be amazed at how cordial strangers can be if you extend the first courtesy.
    We at CCM want you all to remain safe and follow the rules so that you all will get through this health crisis.  And if you follow as many of these guidelines as you can fit into your day, you will be better coming out of this pandemic than you were going into it.  Be safe and be healthier. 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. 
  • drugsdontworkI attended a medical visit along with one of my clients recently, and he was presented with a document on his rights and responsibilities as a patient.  As  geriatric care managers and care professionals, we often accompany our clients to a doctor's office visit so that we can help ask the questions a patient may not consider and assure that the patient understands all the provider's explanations.  Some organizations these days call them their "patient's bill of rights," and they typically contain all the usual information on how they promise to safeguard a patient's privacy and the confidentiality of their records. This particular document spelled out some of the patient's responsibilities, such as asking questions if they don't understand something.  But it also stated that the patient is responsible for taking an active role in their medical treatment and following the instructions offered by the provider.  I thought to myself, "You mean like taking the medication that is prescribed for the patient's condition?"  Well, it turns out that failure to comply with prescription instruction is a really big problem; in fact, it is referred to by policy folks as American's "other drug problem."  Did you know that:
    • more than half of 65+ year olds take five or more meds routinely
    • about 25% take between 10 and 19 pills each day
    • nearly 60% in a recent survey admit that they miss doses
    • among those on five or more meds, the percentage missing doses is 63%.
    The economic impact of all this non-adherence is estimated to be $100 billion annually.  Non-compliance also is the cause for 125,000 deaths in America annually and $290 billion in emergency room visits and other avoidable medical expenditures.  Non-compliance also is the root cause for an estimated 23% of nursing home admissions (estimated to cost $31 billion) and 10% of admissions to hospitals (estimated at $15 billion). The cause can be just plain forgetfulness or cognitive shortcomings like dementia or Alzheimer's.  Some older adults still choose between food and medicines if they are on limited means.  If you are a caregiver to an older loved one, you can help improve their compliance and here’s how:
    1. Communication: If an older adult understands the severity of their condition, they are more likely to be compliant; help to ensure the provider explains this.
    2. Participation: Patients are more likely to be compliant with a regimen if they are engaged as partners in their own care; empower your older loved one.
    3. Pharmacists: It can be easier to order prescriptions by mail, but the engagement with a pharmacist can be very helpful in reinforcing what a provider has said.
    4. Support: There are groups of people with like conditions that can meet and support one another's compliant behavior; birds of a flock feather together.
    5. Memory Aids:  There are more than day of the week pill boxes available; some dispensers are computerized to help track missed doses and avoid over doses.
    All of this reinforces medication adherence, but also remember that as a caregiver you should be on the lookout for drug-drug interactions, some of which can make adherence difficult.  Tell the provider if you see new behaviors or symptoms as soon as you notice. Charlotte Bishop is founder of Creative Care Management, certified professionals and geriatric care managers who are advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago.  Please email your questions to
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