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

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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Caregivers and their Medicare?
Yes, you read it right. I am posting this one about what caregivers should know about their Medicare. But...
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September 12, 2013
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In the Caregiver's Words

Recent Client Praise

I have spoken with Matt Margolis, an Elder Law attorney with Heartland Law Firm recently about VA benefits to which people may not know they are entitled. In this posting, he shares some valuable insights that may expand your options for care cost coverage.

            One very common question that comes across my desk on a daily basis is “Are there any benefits, other than Medicaid, to help pay for the care of my ___________ (insert: mom, dad, husband, wife, brother, sister, etc.)?” Typically, this is being asked because Medicaid is only available for someone in a Skilled Nursing Facility. Because of this, we refer to Medicaid as “nursing home financial aid.” My follow up question to this prospective client is usually asking whether the person they are calling about or their spouse was a Veteran.

            The Veterans Administration (VA) Aid and Attendance Benefit program is the benefit I will discuss with them. In the overwhelming majority of situations, the prospective client has never heard of this benefit. This benefit is actually classified as a “pension” by the VA and is a great source of funds for financially constrained wartime Veterans and/or their surviving spouses to use for their long term care costs such as living at home with a caregiver, adult day care, independent living with a caregiver, assisted living, and/or skilled nursing.

            While family income is one of the determining factors of eligibility, it is important to be aware that the VA allows individuals to deduct their unreimbursed medical expenses, which includes their health insurance premiums, home care, assisted living, adult day care, caregiver, and nursing home costs from their income. As a result, many Veterans who may not have previously qualified might now qualify if long term care has become necessary for them or their spouse.
As a general rule, to qualify for the Aid and Attendance benefit, a family's total assets (excluding their primary residence and vehicles) cannot exceed $80,000. Fortunately, many clients I meet with have assets in surplus of this number. The good news is that with the right strategies and planning, we can still position them to qualify.
            A few things worth mentioning:
In the end, the VA Aid and Attendance pension is a heavily untapped, but much deserved, benefit for those Veterans and/or their surviving spouses who served and fought for our country.

Heartland Law Firm is a holistic elder law and estate planning firm. Heartland Law Firm concentrates in assisting seniors and those in transition with understanding the landscape they are in and what protections and benefits are available to them and their loved ones. Visit their web site at: Heartland Law Firm.

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.
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 info@creativecaremanagement.com.
The beginning of a new year is certainly a time for resolutions, but it also can be a time to take stock of the "big picture" if you are a caregiver to an older loved one. Your older loved one may be "doing well." But the following are brief descriptions with links to postings of their own on some of the dimensions you should track along with resources you may find helpful if you are family member or caregiver to an older adult.

8 Tips to Prevent Senior Home Fires. The question of how an older parent is doing physically is as much about their residence as it is about their personal health and well-being. Last year I devoted some time to talking about how to make an older adult's home safe from fires.

3 Tips to Avoid Scams Targeting Seniors. In the past I also have devoted some time to talking about the inevitable predators who may look to scam older adults and how to be financially vigilant on behalf of your loved one.

Making the Most of Medical Face Time. Caregivers are not expected to diagnose or prescribe unless they are a health care professional. But as caregivers, I have talked about ways to make productive use of medical face time to get answers to important questions about your loved one's health.

3 Elder Care Suggestions for Depression. And of course, health and well-being are not simply how well a person's body is functioning. It also is about their mental health. Rates of depression escalate as individuals age and they face losses and physical decline, and a caregiver should take note of how mom or dad may be doing psychologically.

Independent Living for Your Parents. While for some, being active is about physically getting out and about, being socially active can be every bit as important for aging parents or other loved ones. Caregivers may benefit from a two-part series I had posted last year about considerations in independent living.

Watch For Signs of Elder Abuse. Caregivers along with all the family members also need to be advocates on behalf of older adults who can be victims of physical, psychological or financial abuse. Here are some tips.

What is a Geriatric Care Manager? Finally, I had started this blog about two and a half years ago talking about what a geriatric care manager (GCM) is. Please check out that first post as it talks about GCMs as elder advocates and care coordinators, or as I like to describe the profession: "GCMs are the Option-Makers for the Decision-Makers."

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.
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.
Remember Thanksgiving just a year ago? It was that family gathering when you prepared the turkey and someone brought a vegetable and someone else brought dessert and someone else brought cranberry sauce. But mostly it was the people coming together for family time, and the majority would be perhaps college students heading home for the break, but this year’s college-age kids are the majority of the 100,000+ new coronavirus cases each day. They may be filled with expectation and family happiness, but they also may be asymptomatic or pre-symptomatic So, if your family includes an older generation of particularly vulnerable adults, please know that in a recent analysis of COVID surveillance strategies at 1400 U.S. colleges two-thirds either were not testing or only testing symptomatic students for COVID. On top of it all, we are technically entering the traditional flu season. Infectious disease specialists recommend a four step to protect the vulnerable within your extended family this holiday:
1. Students self-quarantine eight days before schedule departure for home. Revert to all on-line learning, wear a mask, socially distance, and wash hands frequently.
2. Test before travel. Experts recommend a molecular test for viral RNA test; have your student ask for student as for an approved nuclear acid amplification test (NAAT). IF results are positive, cancel the trip this year.
3. If safe to travel, have your student mask-up at all times, and be sure they carry an alcohol-based hand sanitizer. Add some sanitizer wipes to disinfect all surfaces with which they will come in contact.
4. You’re not out of the woods yet. While at home, all who have not been living in a “pod” (self-quarantining) at home need to be vigilant about social distancing. And all guests who plan to join you should follow the above three steps also…okay, they may not need to do the on-line learning part. And no buffet style services, no hugs and kisses (sadly), and have lots of hand washing while preparing and consuming meals.
5. I add a fifth step to encourage some optimism. Keep a focus on safety now and also keep a clear focus on next year with the hope that we will all get through this. Just this week, Pfizer announced 90% success with its two injection vaccine.
Maybe it’s morbid to remind ourselves that the early pilgrims also had their viral scourges: yellow fever, small pox, the plague and more. They had no hand sanitizer and no vaccines. We have a lot more going for us this Thanksgiving if we just follow the steps. Have a great holiday, and start with making it a safe holiday. 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.
Our vice president for geriatric care management services, Steve Steiber, Ph.D., brought some startling information to my attention recently, and it concerns the risk we don't often think of when we hear that an older loved one has been hospitalized. He has nearly two decades experience in pharmaceutical medical device consulting prior to joining CCM.
For older adults, who are admitted to a hospital intensive care unit, it would seem that discharge from the hospital means they are out of the proverbial woods. Not so, according to researchers affiliated with Vanderbilt University Hospital. They studied older adults who were discharged from the hospital after a stay in the ICU. What were they were looking for? Complications from what they termed Potentially Inappropriate Medications (PIMs) and Actually Inappropriate Medications (AIMs). Very simply, AIMS are medications whose side effects or likelihood of adverse events outweighed the potential benefits the medications were supposed to confer. PIMs were seen as medications where the jury might still be out. In short, they were looking to see what negative outcomes were associated with the patients' prescriptions separate from their medical conditions. This is a big deal if you are a caregiver to an older adult, very simply because drug-related admissions for 65 to 84 year olds have increased by 96 percent between 1997 and 2008. And approximately half of all drug-related hospital admissions are among adults 80 years of age and older. As we all know the over 65 age group is growing more rapidly than the population at large, so we can only expect this risk to grow. Getting back to PIMs and AIMs, about half of all older adults are discharged with at least one PIM, and four out of five of these older adults are discharged with an AIM. This is all the more exaggerated among patients who have been in the ICU, since 85% are discharged with at least one PIM and more than half are prescribed at least one AIM. The lessons the researchers learned is that some of the AIMs that patients were discharged with were appropriate and useful in the ICU, but should have been discontinued upon discharge. As a caregiver, be aware of the new medications that your older loved one was started on in the hospital ICU, and ask your attending physician if they should be continued at home. The most common AIMs that patients carried home with them on discharge were:
- anticholinergics (37%) - These drugs are used to treat asthma, COPD, incontinence, stomach cramps, and muscular spasms. They can be used to help patients sleep when they are hospitalized.
- nonbenzodiazapene hypnotics (14%) - These are almost always used as a strong sleep aid, but if a patient takes them home beware of their effect with alcohol.
- opioids (12%) - These are indicated for significant pain, most often associated with trauma or in post-surgical recovery. There is significant addictive potential, and these should not be maintained long term.
So, if your older loved one carries home any of these prescriptions, ask the provider why they are appropriate for use at home. If they are appropriate, also then inquire for how long the patient will be taking them safely or for what kind of side effects you should be looking. Please let Steve know if you have any questions about drugs or their side effects or the unique medical challenges faced by older adults or others with special needs. Please email to: ssteiber@creativecaremanagement.com.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends who deliver geriatric care management services to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.