Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • in home care for seniorsChicago's Geriatric Care Manager Center of Excellence

Distance Caregiving Through a Wall
I’ve written numerous times about distance caregiving, and one of the observations I have offered is that distance is...
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May 19, 2020
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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

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.
This is one of the most emotionally-charged questions I hear when I am called by a family member who is concerned for the well-being of their older parent/s living alone at home. There is a lot of emotional attachment to "home sweet home," "home as castle" and more that has been learned over time. The question of whether home is still the best or safest place for an aging loved one is not just about the physical space. When invited to evaluate a situation, we look at both the individual's capacity to reside in a space and the environment's capacity to accommodate their needs. In this posting I talk about how we help explore the individual's capacity to get around in their home.

If you as a family are unsure about a loved one's ability to safely live independently, you can start with an assessment of how that person handles the basics of what we call activities of daily living (ADLs). Here is a checklist of the six basic categories of ADLs and how you can make an initial assessment yourself:

Hygiene: Do you see signs that they are not bathing, brushing, grooming as regularly as they once did?

Continence: Are there signs of "accidents" that they or their spouse may be trying to hide?

Toileting: Very simply, can they manage the bathroom on their own?

Dressing: Do they have the balance or strength to change in and out of clothes?

Eating: Do they have the dexterity to bring a utensil from the plate to their mouth, cut their own meat, etc.?

Transferring: Can they get from a chair to the bed, from the bed to another location, in and out of a car, etc.?

Take the example of one of my client's; I'll call Rose. Rose was living alone and independently. The first sign she might be having trouble was when she "forgot" to turn off her gas stove (fortunately it was lit); the kids bought her a microwave. When she consistently burned toast, they took away the toaster. It wasn't until she flooded her basement three times by leaving a kitchen sink running that the family accepted that either moving out or 24/7 in-home care would be their only recourses.

If your loved one is having difficulty with any of these, they may still be able to live independently, but some accommodation may be necessary. A GCM can help with an objective assessment of these functions as well as recommendations for accommodations. We are objective, because we don't represent a retirement home, a home health agency, etc. Also, a GCM can help with assessing the more nuanced or complex activities, what are termed instrumental activities of daily living (IADLs). These are more of the cognitive issues that may either be accommodated by outside assistance or be the red flags that home no longer is a safe or secure environment. Examples of these activities can include looking up phone numbers, cooking meals, doing housework, managing medications, etc. Here again a GCM or social worker can help assess if these are insurmountable shortcomings or if outside accommodations can provide the right level of assistance.

Just because a person does not always remember to take their meds or does "not get around" as they once did are not necessarily reasons to move them from their home. Accommodations, particularly those that can be brought to the home, will be in my next blog.

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.
Until quite recently there were rules governing what Medicare will reimburse if a qualified adult was prescribed physical therapy, occupational therapy or speech therapy. Patients needed to show documented improvement if Medicare was going to continue to cover their therapy. As with all insurance rules, a patient or the patient's families could pay out of their own pockets for any services a provider may prescribe, but until this year, the government was not going to pay for therapy without an improved health status. All that has changed now with a federal ruling that it is no longer necessary to show improved status to get reimbursed. If you are a caregiver to an older loved one or someone else with special needs who is covered under Medicare, therapy now will be offered to maintain a patient's present condition or to prevent "backsliding." Translated, Medicare now must recognize and support a patient who is attempting to stay as well and as active as they can be. As a geriatric care manager, this is very gratifying as a large part of what we do is to help our clients to maintain a quality of life, because beyond a certain age improvement is simply not realistic. Many of the old rules are still in place regarding where therapy may be received. It can be received at an outpatient center, a therapist's private office, in a nursing home or in a patient's own home. Authorization simply requires a doctor's order, so make sure your physician knows about the change. The same dollar caps on how much Medicare will cover still remain, and that is $1,900 a year. And even residents of nursing homes who have used up their 100 days can still get coverage for therapy, so long as they do not exceed the cap for the therapy. This, too, can be challenged , in certain cases, so be sure to check in with a local office of the Centers for Medicare and Medicaid Services for the terms. And claims for patients who may have been denied before this year may still be honored retrospectively back to the date when the lawsuit was first filed January 18, 2011. For more information on:
- the outpatient therapy cap limits,
- getting exceptions to the cap limits,
- who can give therapy services under the rules,
- where therapy services can be received, and
- how to find out what the therapy services will cost,
go to http://www.medicare.gov/Pubs/pdf/10988.pdf or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. To find a resource in your own state, just visit: http://www.Medicare.gov/contacts. 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 ccbishop@creativecasemanagement.com.
We’ve all had times when we desperately need our own space…time to ourselves, just ourselves. And it’s good to retreat periodically from the frenetic work pace, the demands of family or just the congestion of living in the 21^st century. But for older adults, being alone can become their way of life with the loss of friends or a life mate, no longer being employed, perhaps unable to move easily about, a lapsed driver’s license…and life becomes very, very small when it is just one. It’s a bigger problem than many people may think. The National Institutes of Health estimate that 28 percent of older adults live alone; that’s nearly 14 million people on their own. Living alone can lead to depression, poor self-care and ultimately an exacerbation of pretty much every other chronic condition that a person can have. A 2010 study found that socially-isolated older adults were 509% more likely to die prematurely. Being alone too much can contribute to other health issues, so much so that some health insurers are developing more comprehensive and holistic models for caring for our older adults. One of the major insurers of Medicare Advantage programs that will offer “enhanced” care, and they have come up with a model that can be imitated by all of us who may be caregivers to and older loved one. We all may look in on mom or dad, make a regular call or accompany our older loved one to their physician office visits, but there is more you can do. Consider:
1. Checking your loved one’s refrigerator for variety of food as well as expired products. Food insecurity is one of the big threats to health and well-being among older adults.
2. Ask about your older loved one’s friendship network, and get specific. Think about how often you make connections – probably daily – and help your loved one to do the same….be creative.
3. Be sensitive particularly to hospital discharges when an older loved one will be lest ambulatory. Help them even get to a “silver slippers” program at a local gym or to respite care so that they not only physically recover, but also socially recover.
4. Use tech. A Miami-based company called Papa connects older adults with local college volunteers that they sometimes refer to as “grandkids on demand.” Check it out to see if a campus near your older loved one can offer that support.
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.
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Yes, you are supposed to ask why being male and over 65 is a medical condition; so what do I mean by cure? The best "cure" at any age is appropriate prevention, and I would like to offer some prevention guidelines for any of you who have a loved one over age 65. I offer 65 because as we all age, what we should be screening tends to change along with the frequency of screening. I am starting with men in this posting, but I will offer a parallel "cure" for women in my next post. Blood Pressure - everyone should have their blood pressure documented annually, and hopefully by the same provider so that they can track any trends. If your older man already has diabetes or heart disease, this monitoring should be at much shorter intervals. Oral Hygiene - a cleaning and an exam once a year is the minimum, and most dentists recommend a cleaning twice a year. Appreciate that oral health is correlated with heart health, so consider your trip to the dentist to have more benefit that just a great smile. Cholesterol Levels - if your cholesterol have been within normal ranges in the past, you may need to check them only about every five years. As with blood pressure, however, if your older male has heart disease or diabetes, this should be more frequent. Colon Health - guidelines suggest annual stool sample screenings, but a flexible sigmoidoscopy is suggested only every five years and a colonoscopy every ten years. The U.S. Preventive Services Task Force has recommended talking with a provider after age 75 and no invasive testing after 85. All of this is much more aggressive for anyone with colon issues or cancer or who has a family history of any of that. Eye Health - a vision exam is generally recommended every other year as a screen for glaucoma or visual acuity, unless the older patient has diabetes. More frequent testing for a diabetic is recommended to watch for diabetic retinopathy. Immunizations - keeping current is the important part of immunizations. For pneumonia vaccines, every five years is recommended. Flu shots are an annual regimen given the variation in strains that are considered the biggest risks. A shingles vaccination may be a one shot matter, but ask your doctor, and a tetanus booster every ten years is recommended. For other immunizations or other infectious diseases consult a physician. Prostate Health - most doctors will test the size of the prostate during an annual exam, and the doctor also is the best one to advise on how often a patient should take a PSA test. Bone Density - although women are more at risk for osteoporosis than men, the risk increases appreciably after age 50. Taking in calcium and some vitamin D along with aerobic exercise will go far in maintaining bone health, but a physician may recommend how frequently to measure bone density. Everything else - annual exams are a great time to assess weight, height and hearing. It also can be a good time to check your 65 year old for signs of depression as well as go over all medications and any possible interactions or contraindications. 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.