Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • In Home CaregiverChicago's Geriatric Care Manager Center of Excellence

A Happy – And Well – Holiday for All
It’s the season of holidays. We started with Thanksgiving and then Channukah, and we have yet to tackle Christmas...
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December 19, 2023
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Why AND Is the Most Important Word
Do you recall the 1991 movie called City Slickers? It was another great role for Billy Crystal, but it...
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July 19, 2022
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Making Your Holidays Happy Again
Yes, “holidays” is a plural word here. Please allow me to digress on this plurality and simply point out...
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November 16, 2021
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Not Just Spring…
We’ve heard of Spring Training for those who follow baseball teams like the CUBS or the SOX, and we...
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April 13, 2021
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Can I Have A Hug?
I doubt there is anyone who does not have something that they have not been able to do during...
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March 4, 2021
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COVID’s Other Deadly Toll
During this pandemic, over 13,000 more Alzheimer’s and other dementia patients have died than expected from these cognitive disorders,...
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September 22, 2020
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Dementia: We’re Not Post-COVID Yet
If you have a family member or loved one with dementia, this pandemic and its restrictions have been exponentially...
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May 26, 2020
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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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Caregiving During COVID: Four Tips for Reengagement
You may recall that I have recommended limiting your news consumption, because it really does add to our stressed...
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May 12, 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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In the Caregiver's Words

Recent Client Praise

You remember the Tom Hanks movie where he is stranded on a Pacific Island and how he learns to adapt. Unfortunately, Hollywood does not offer a role model for us, because we are not suggesting you resort to a diet of raw fish or having heartfelt conversations with your volleyball. But there is some good advice available to us all to help us lean into this situation and get through it. It comes from our own government’s Substance Abuse and Mental Health Services Administration. Let me give you the short version:
- Minimize News Exposure – I find this one particularly hard to follow, but think of it as sunshine. It can be illuminating, but over-exposure can cause burning. And since we don’t have “news screen” as we have sun screen, limit your exposure to 30 minutes or so.
- Stay Informed – This may seem to contradict the first suggestion, but getting the facts is important for understanding how this pandemic is affecting everyone, how it can be contained and the progress we are making toward containing it. It’s a fire presently out of control unless we contain it. This means to not get glued to opinion media – see number one. Opinion “newscasters” are to the pandemic what gasoline is to a fire.
- Sitting is the New Smoking – Take regular breaks from whatever it is that is occupying your time. If you are working from home, take periodic walks around the block, make a call to a friend, anything to put what occupies you on pause. Try to fill your pause with something good for you: walking, meditating, praying, whatever renews you.
- Reach Out – I mentioned in an earlier post how my family gets together each Sunday on ZOOM. Helping them know how you’re feeling is good for them, and it is equally gratifying for you to know they are holding up as well. I participate in a phone tree to check up on people we would normally see, but are unable to see now. With ZOOM dinners we actually are making better friends of existing acquaintances and new acquaintances on top of that. We are a social species, so don’t cut yourself off.
- Become Stronger – How many times have commitments or work gotten in the way of doing what we should to sustain ourselves? Getting enough sleep has no excuses anymore. There are no excuses to not take time for long walks or working out. For this latter, you may have to get creative, but pushup-ups and sit-ups need no equipment…or leg lifts, etc.
- Ask for Help – If all of the above still leave you feeling depressed, mentally fatigued or just out of sorts for a reason you cannot quite put your finger on, reach out. The SAMHSA that I referenced in my introduction has a help line, so don’t be afraid to ask: 1-800-985-5990.
We at CCM want you all to remain safe and follow the rules so that you all will get through this health crisis. It has been only 37 days so far. Be safe and be healthy. 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.
More than seven million Americans are balancing the demands of a full-time job along with caregiving to a family member, typically an older parent. For many, they daily choose between work and family as they try to juggle each job's demands, and what usually has to give it their free time, their time with their own kids or this time with their spouses.

But sometimes even that is not enough to fit everything into the 24 hours of a day, and the working caregiving confronts the tough decision of one job or the other. According to the MetLife Mature Market Institute:
- Almost two-thirds of working caregivers have to make some sort of real adjustment in the demands of their job or their career plans to accommodate their caregiving.
- One out of every three workers will cut back on their hours to make room for caregiving duties like trips to the doctor or actual hands on care for an incapacitated loved one.
- One out of ten have moved from full-time to part-time employment in order to accommodate their caregiving responsibilities.
- One in twenty opted to leave the workforce entirely and nearly as many left their jobs by retiring earlier than they otherwise would have.
If you are one of these workers juggling two responsibilities, here are some tips:
1. Set clear boundaries with your loved one so that calls to work are only in case of emergencies.
2. Divide your day into "work hours," "caregiving hours" and also time for yourself - "my hours."
3. Get some help from outside agencies for the tasks that do not require you to be hands on.
If you are looking to downsize your workload or quit your job, you should:
1. Do your homework by reading the employee manual or talking with human resources about their guidelines or employee assistance programs to accommodate caregiving.
2. Know your rights under law by reading the Family Medical Leave Act (FMLA) http://www.dol.gov/whd/fmla/
3. Prepare for your conversation for the meeting with your manager before you meet with your ideas for reduced time, flex time, job sharing or other solutions and above all, be honest and open.
4. Recognize that if you love your job that this will be a tough move, and let your employer know how committed you are to your job and the company and that your really do plan to return to the workforce.
For more information on what the MetLife Mature Market Institute can tell you about caregiving in America, go to their web site: https://www.metlife.com/mmi/research/index.html?WT.ac=GN_mmi_research

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 ccbishop@creativecasemanagement.com Visit our For The Caregiver page for more information and resources..
You may have had the conversation with your physician about your cholesterol levels during your annual physical; there are three of these they follow. Your LDL, the one that can gum up arteries, is the more worrisome, but it can be managed by diet and exercise bringing LDL down as much as 15%. Triglycerides are created by the excess calories your body keeps on hand for building cells and for energy between meals, and the excess are stored in fat cells. There is a role for diet and exercise here as well. High Density lipids, HDL, help to clean up excess cholesterol in our bodies, so it’s often referred to as the “good cholesterol,” and exercise has been shown to elevate HDL as much as 20%. More HDL plus less LDL and triglycerides are the recipe for better cardiovascular health.
Scientists, with funding from the National Institutes of Health, have found that HDL also circulates in another system in your body, your cerebrospinal fluid (CSF). And it is doing good work there as well. The scientists studied 180 patients 60 years of age and older (average was 76.6 years old) to see the effect of HDL in their cerebrospinal fluid. Having measured how much HDL all of these individuals had in their CSF, the scientists also measured performance on three different domains of cognitive function. After controlling for age, gender and even years of education, the scientists showed higher cognitive function was positively associated with higher levels of HDL in these patients’ CSF. In short, better cognitive function was associated with higher HDL just as better cardiovascular function is associated with higher HDL. Because this association was even stronger with individuals with no cognitive impairment, these findings suggest that HDL levels may be an important part of Alzheimer’s disease (AD) prevention. This kind of research is quite remarkable because it begins to reveal what precedes the onset of dementia, not just what the effects of dementia look like with its tau tangles and beta amyloid plaque. It shows that HDL and the chemicals that comprise HDL may at the very least be early biomarkers for the onset of AD. And at the most, the research shows there may be a path to steps that can help prevent or delay the onset of Alzheimer’s disease. And at the very least, the role of HDL encourages all of us to more healthful diet and exercise as part of a program not just toward cardiovascular health, but also toward cerebrovascular health. Charlotte Bishop is a Caregiver Coach, an Aging Life Care Advisor, 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. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
Making decisions on behalf of a loved one is not always easy. Yet the challenge can be eased with information. The most common questions I get as a geriatric care manager revolve around:

1. What should a caregiver do to address their loved one’s need?

2. How does a caregiver make choices among alternatives to help their loved one?

To help with both of these decisions there are a good many free resources available to everyone. Your older family member or someone else with special needs may be in Chicago and you may live in Nashville, but you can get good information from all your own nearby healthcare providers, legal advisers, financial consultants, or other experts. These individuals should be able to direct you to their own national member organizations or associates they personally know in another city. Local hospital discharge planners can be very helpful, because it is their job to get at least medical help for individuals who are preparing to return to their homes after a hospital stay. Just remember that their job ends at the hospital door for discharged patients, so they do have limitations.

You can also do in-home research at the click of your mouse. I have found a web site called senior citizen’s guide to be really helpful. It has city by city listings of health, housing, services, and activities by most major metropolitan areas. Even if your loved one is in a smaller community miles away, one of these metropolitan centers can be very helpful starting places in directing you to allied services within your target geography. Just contact them. Or contact a local public library, and ask for the reference librarian.

Here are some WEB resources to start:

AARP

Senior Options

Eldercare Web

National Association of Professional Geriatric Care Managers

You will find some others on our CCM Resources page

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.,geriatric care manager Chicago,geriatric care Chicago
Most of us have become familiar with generic drugs. We now have a new category in your medicine cabinet called “biosimilars,” so I have again asked our Vice President, Steve Steiber, Ph.D., to talk to us about what we may not know - but should know if you are a caregiver to an older loved one - about the evolving federal rules and science around biologic medicines and the new medicines who are enough like them to get FDA approval. Steve has over twenty years of experience as a consultant to the pharmaceutical and biologic industry prior to joining us at Creative Care Management: We all have heard of some of the (mostly) injectable medicines that have changed the lives of people with rheumatoid arthritis, Crohn’s disease, psoriatic arthritis and some other conditions that are part of a larger category called autoimmune diseases. They have been around for about twenty years and have become names many of us know from television and magazine ads. We also mostly know what a generic medicine is. It is the same chemical molecule as one that a drug company brought to market with a “brand name,” but it is manufactured by another company after that brand drug’s period of patent exclusivity expired. All drugs discovered by a company can be patented for 20 years so that no one can make and sell the same drug until that patent expires. Companies apply for patent protection well before they go to FDA for approval, so they do not have a full 20 years alone in the market following FDA approval. For instance, once Aleve’s patent expired, you had other companies flooding the market with naproxen sodium (the generic name of Aleve). And once Motrin’s patient expired you got ibuprofen, and Tylenol gave way to acetaminophen, and so on. Well, one of the provisions of the Affordable Care Act (ACA) was to change the rules for biologics to be like that process. Before ACA changed those rules, any medicine patterned after one of those approved biologics like Humira, Remicade, Cimzia and others had to go through a process just like a new medicine. Now, like the generics, a medicine can apply to be a biosimilar to a brand medicine simply by proving it is as good as that medicine. Hence, the name biosimilar. Don’t ask me why they couldn’t call it “generic,” but it amounts to pretty much the same thing. So, if you are a caregiver to an older loved one on a biologic, you may soon have a cheaper alternative available. Generics and biosimilars inevitably will be cheaper than the brands they are like. It also means that in most states the pharmacist can substitute the biosimilar for the brand medicine if you agree … even if your physician writes the branded name on the prescription slip. Do your research so that you know the clinical evidence on the new biosimilars as you make that decision at the pharmacy or in a conversation with your care receiver’s doctor. Think of it as getting a BMW-performing car without the logo…and without the price tag. But ask your physician for their thoughts. 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.
…which is to say that there is new research that shows exercise can help keep the brain healthy and able to produce and retain memory function! I have had a number of posts over the years on the importance of diet and exercise and their beneficial effect in helping to avoid medical issues or just in being healthy. This one is back to the healthy effects of physical activity in actually reducing the progression of Alzheimer’s disease. Recent research presented at the last meeting of the Alzheimer’s Association showed a direct link between regular exercise and an improvement in blood flow as well as reduction in the amyloid and tau levels in the brain that are the hallmarks of Alzheimer’s erosion of cognitive function. All of this works to not only stave off the debilitating cognitive impact of Alzheimer’s disease, but other forms of vascular dementia as well. Every 67 seconds in America, another person is diagnosed with Alzheimer’s disease, so how can exercise help in warding off this condition? Research reported by scientists in Perth, Australia, followed individuals and their “brain amyloid load,” a measure which increases with the progression of Alzheimer’s disease. They grouped these patients into two types based upon level of exercise. The exercise group was comprised of those who exercised 150 minutes or more a week, and the low exercise group was those individuals who reported fewer minutes of exercise weekly. Overall, there no differences in amyloid between the two groups, but when researchers looked specifically to those who had the genetic potential for Alzheimer’s, they found that those with this genetic marker in the low exercise group were significantly higher in their levels of brain amyloid. As they more closely examined both exercise groups across those with and those without the markers, it appeared that those who exercised more were able to slow the accumulation of amyloid despite having the genetic predisposition. All of this is preliminary information, and it is yet to be seen if exercise can really delay the ultimate onset of Alzheimer’s among people who have the genes that predispose them to the condition…or for how long and by how much. It also is yet to be determined what kind of exercise may be most beneficial, but it appears that cardiovascular exercise may show the most promise. One physician at the conference also adds that so far there are no side effects from exercise which is a lot more than can be said of most FDA-approved medications for cognitive impairment. That this kind of rigorous exercise also manages blood sugar levels is an additional benefit, but the lower blood sugar levels may also be reducing another risk factor for reduced cognitive ability – reducing risk for type 2 diabetes. There is more “lifestyle” research in motion, so please stay tuned…more to come. These early results show real promise. 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.