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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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

We all have heard of coaches exhorting their players to work together by saying “there is no ‘I’ in team.” Let me share what I’ve learned from another coach ata business coaching seminar recently. The coach was very clear in stating that unless you make something a priority, unless you consistently work on it, you will not be successful. This, from a coach who had neglected herself for years, but with the realization that her health and her body needed to be a priority, she was able to not only shed over fifty pounds, but also found her hours working on the business were more productive. The hours spent in physically working her body gave her a much clearer mental grasp of her business priorities and the energy to execute. She had learned that taking care of herself was a huge part of taking care of her business. In our personal and professional experiences, those caregivers who take better care of themselves, whether that is a physical workout, a book club, a long walk or a conversation with a dear friend, also take better care of their loved ones who are their care receivers. In effect, they put the ‘I’ back in caregiver. So starting out with first things first: Who should attend to the caregivers? Clearly, part of the answer is the caregivers themselves. There are external supports that can be as basic as just giving a break to what some have characterized as “the 36 hour day” (book of the same name, authored by Nancy Mace and Dr. Peter Rabins) that many caregivers live. But this taking a break for the caregiver has become so central to care planning that it has gained a name. Residential and other facilities that care for older loved ones call it “respite care.” It is not just taking care of the older loved one; it is giving the caregiver to that older loved one a break from the day to day stressors and responsibilities of active caregiving. Too many caregivers feel guilty if they are not there for mom or dad or for a failing spouse 24/7. We encourage all caregivers to watch for their own burnout symptoms as a caregiver can only be as good for the loved ones who depend on them as they are for themselves. Stress is inevitable; burnout is self-inflicted. Do you see the signs? Are you missing hours or days of work? Are you not able to track and pay all your bills…are you getting late notices? Are you not exercising enough? Instead, are you consuming a lot of unhealthy junk…sweets, fast foods, alcohol? Are you having nightmares or disturbing dreams? Are you feeling lethargic or maybe even depressed? Are you angered by minor issues, or are you impatient with your family or friends? Have you simply “let yourself go?” If you can answer any of these questions with a “yes,” you need to know that you would benefit from a break. There are resources and support systems that can help. Family, friends, volunteers, and care managers are all helpful. Getting your own support system or taking time out doesn’t mean you are unsuccessful, not being a good daughter or son, or losing a battle, but it does mean you are getting through a very difficult and emotionally-charged time in your life. In virtually every community there are resources available to provide respite care. These will be independent or continual care facilities who offer day care for older adults while the adult caregiver/child is at work. Some offer care for periods that may range from days to weeks or even a month or more. If you are a caregiver, check into one of these local resources as a help in getting you through your week or maybe just a test case to see what difference this kind of help can make for both you as the caregiver and your older loved one. To address or prevent burnout, consider:
1. Becoming educated about your loved one’s medical condition in order to be as effective as you can be.
2. Recognizing that you are not superman or superwoman; set some limits on what you and others can expect from you.
3. Not beating yourself up about feeling angry, afraid or even resentful; instead find ways to vent.Feelings are just feelings, no matter how strong they may be. Defusing their energy defuses their power and helps you to be more balanced.
4. Talking to someone, especially to a therapist or counselor or clergy member…even trusted friends as a principal way to vent.
5. Lifting smart. As a caregiver, be smart about not hurting your back when lifting, pushing and pulling; keep yourself in shape and use an assistive belt around your care receiver if your physician recommends it.
Appreciate that caregiving is a job, and that all jobs allow one to “punch out” from work as well as take vacations and breaks. Give yourself permission to take a respite from caregiving. Illinois has an agency that offers support, the Illinois Agency on Aging. Their mission is “to serve and advocate for older Illinoisans and their caregivers.” Put yourself back on your list of “things” to do. 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’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.
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.
Everyone's abilities and needs change as they age, but home may still be the same physical space it was twenty or more years ago. It's important not to wait until there is an accident to make changes that can help accommodate an older person's changing needs. It is easy to get ahead of where you need to be by presuming that the decision is about whether the best place for a loved one is home or an assisted living facility, a skilled nursing facility or some other new residence. I wrote in my last blog about the basic categories of "activities of daily living" (ADLs) that help us evaluate how a person is caring for themselves. The ADLs are hygiene, continence, toileting, dressing, eating and transferring. As a GCM, I often do what you might call an audit of the older adult's home while they are there. In that audit I look for signs of what they can and cannot do for themselves and what may pose hazards given their abilities.

Take for example, hygiene. Even a cursory observation can tell you if the older person has bathed or shaved recently, if their clothes are clean, etc. It can be as easy as securing the services a home care aid who can be present in the mornings or evenings or even just a few times a week to help with personal grooming or showering. Dressing is linked to this, and it may be that more frequent visits may prove necessary, because the older individual's range of motion may be limited making it difficult to get easily in or out of clothes.

With continence, it may be the family who may notice that there has been "an accident." Remember, however, that this is highly embarrassing to the older adult. They may even be embarrassed to purchase adult diapers at a store. The fix may be as simple as making the purchases discreetly for them. Toileting itself may become difficult owing to diminished dexterity. Grip bars in the bathroom as well as an elevated seat for the commode may be in order. You can also assess how well the older adult is able to feed themselves by either seeing them at the dining table or just look at the front of their clothes for evidence of spills. Or are they not eating or losing weight? They may need someone to prepare nutritious meals, because it is a real pain to cook only for one.

Finally, if just getting around the house has become a challenge to the older adult, watch their gait. Do they shuffle or are they unsteady? Get rid of scatter rugs in the house; they are a fall waiting to happen. Consider grip rails along hallways or a walker for getting around. I have an 84 year old client who had broken a hip, made it through rehab, but did not want to be seen using a walker. What won her over was finding a sleek machine in hot red that looked like it belonged in the Tour de France. She is not using a walker now; she is showing off.

We have resources listed on our site, but think about calling on a local home care agency for personal care, Meals on Wheels for food preparation or look for a durable medical equipment distributor for a walker. Hire a handyman to refit the bathroom or halls with grip bars, put bigger handles on kitchen cabinets, build a ramp for the stairs and more. You don't hire a Geriatric Care Manager to do this, but we can spot solutions to needs you may not see and know the resources that you may not know.

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.
“We are what we eat” is an old adage that takes on new meaning with some research recently published by a nutritionist at Rush University Medical Center. According to findings reported by Martha Claire Morris, a Ph.D. nutritional epidemiologist at Rush University, a diet high in the right fruits and vegetables among other foods is a significant deterrent to late onset Alzheimer’s Disease. The researchers in Rush’s Memory and Aging Project followed a group of 954 patients whose average age at the study outset was 81 years, tracking their diets and also monitoring their mental abilities for five years. It is important to point out that with this older age group – unlike younger adults - genetic issues play a very small role in developing AD, but the researchers found that diet did. Participants who followed a “brain healthy” diet reduced their risk of developing AD by as much as 35% to 53%. A brain healthy diet includes vegetables, especially green, leafy vegetables like kale and spinach. It also includes beans, nuts, berries and whole grains. The berries that packed the biggest preventative punch were blueberries. Fish and poultry were the primary meats in the diet, and the diet also included olive oil and wine (sorry…only one glass a day). As important as consuming the good foods is avoiding the “bad diet.” On the list of foods to avoid in order to maintain brain health are red meats and fried or fast foods. And if you have a sweet tooth, you may need to retrain it as sweets and pastries are also taboo. Finally, cheese and butter are unhealthy for cognitive health…at least in amounts that exceed about a tablespoon of butter a day. As the researchers reported, it is not a surprise that the “brain healthy” foods are high in vitamin K, but they cannot say it is vitamin K alone or whether something else in combination with this vitamin that helps brain health. They also caution that this is not a predictive study, but given that the results square with other research on “brain healthy” foods their findings suggest that we can use these foods to good benefit. To learn more about the research and how nutrition is part of your brain health, visit the Rush University Medical Center web site (click here). And then head out to the grocer and grab a bunch of kale. 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.
I did not start out as a geriatric care consultant although I have been one for nearly 20 years. I actually started in care management helping injured workers, but it seems that life has come around full circle with an increasingly older work force. Larger percentages of workers are staying on the job beyond what had customarily been the "retirement age" of 65. Yet, today's older worker does not fit some of our historic expectations. The National Council on Compensation Insurance (NCCI) has offered some new research that may surprise a lot of people, especially those who claim that older workers will be more prone to costly injuries. The research showed, for instance, that workers under age 35 had more finger cuts than those over age 35. But workers over age 35 reported more cases of carpal tunnel syndrome or neck injuries than younger workers. This generalized to a lot of what are referred to as repetitive stress injuries like rotator cuff injuries. Even so, the differences were not very great in these latter categories. There also has been a pervasive notion that older workers' injuries will be more expensive than those of younger workers. Well, that depends on what you term "old." It turns out that workers under age 25 do have less expensive injuries with less time lost from work than those older, but it would probably be a stretch to suggest that a 30 year old employee is an "older worker." Moreover, once a worker hits age 35 and up, the costs of their injuries and the time lost from work are very much on par with much older workers. The researchers also found that the best way to reduce injuries and their costs is not to hire 30 year-olds, but to train workers in safety and to report injuries immediately when they happen. And there is one more similarity between the older worker and their younger counterparts, and it has to do with family responsibilities. We all expect younger, married workers to have family responsibilities they juggle with their workplace commitments, but older works are also jugglers. In their case, however, they are trying to manage caregiving responsibilities for older parents along with their maintaining on the job performance. And, of course, some of the "younger, older workers" are sandwich generation workers with kids at home or in college as well as parents who need help. No surprise, then, that an increasing number of our clients are not just the individual caregivers, but also the employers for whom they work who are looking to take some of the stress from their "older workers" by offering our services as a resource and support. Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric care consultants, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.

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Tips for Distance Caregiving: Up Close and Personal at a Distance

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