In Home Caregiver

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

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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.
Because health care – particularly long term care – can be expensive for elders and others with special needs, it is critical that anyone looking for Medicaid qualification take action before June 14, 2011. As a geriatric care manager, we help elders and special needs individuals as well as their caregivers to navigate Medicare, Medicaid and the other entities that provide safety nets for those who qualify.

There are changes in store for Medicaid that may affect who qualifies and how they qualify after June 14 of this year. I had the benefit of sitting in recently on a presentation by an elder law attorney in the Chicago area, Janna Dutton, who helped shed some light on the subject.

Medicaid is mandated by the federal government, but the details of how it applies and how it is financed are the domain of state government. I will be talking in this posting about what we know now about Illinois law as well as what we do not know. So, let’s start with an individual who is seeking to apply for Medicaid in Illinois.

First, of course, that person must be a legal resident, but that part is simple. For Illinois, a resident simply is someone in Illinois (for no specific duration) with no intention of leaving. There is no duration of residency required. To qualify for Medicaid, however, an individual cannot own a home outside Illinois, not even a vacation home. And the individual must be over age 65 or be eligible for Social Security Disability benefits.

Presently, a person will qualify for Medicaid only if they have no more than $2,000 in liquid assets, but this does not include a home (which can be valued at no more than $750,000 if the applicant plans to return home after their stay in a nursing home). State government has a “look back” period of 36 months prior to application. That is, they will “look back” three years at an applicant’s finances to see if there were any expenses or “gifts” that may appear to be efforts to deplete funds for the sake of qualifying for Medicaid. Any suspect monies expended will be added back to existing assets. Anything over the qualifying amount then will be spent before Medicaid contributes to the person’s care.

Exceptions may include “gifts” that have been a longstanding pattern of giving by the applicant (for instance, dollar amounts consistently given to grandchildren upon marriage, graduation, etc.) The date from which the spend-down starts presently is the date of the gift that forced assets to exceed the $2,000. Asset qualifications for applicants may be what will most change after June 14. After June 14 it may be as much as a 60-month look back, and the ineligibility may start at the date of application rather than the gift.

The financial scrutiny also extends to accounts that may be held jointly with a caregiver or relative. The joint account will be considered the exclusive asset of the applicant unless there have been regular deposits to this account by the non-applicant. For this and all accounts, the responsibility for documenting paperwork is that of the applicant.

This is some of what we know, but it is what will change after June 14, 2011, that we cannot fully know. I recommend you seek counsel from a qualified Illinois attorney, and I particularly recommend you go to Janna Dutton’s website for helpful information and advice about this and other elder law issues.

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 Charlotte Bishop.
If today's 60 is yesterday's 40 and 70 is 50 and so on, then today's elder needs to be in shape. If you are a caregiver to an older loved one who may suddenly be bitten by the fitness bug or who finally heeds your advice to get up and out, it will not be like signing up for the cross-country team in high school. As a geriatric care manager, we are every bit as involved in the functional status / fitness of our clients as we are in their medical status. Here are some suggestions for any septuagenarian just getting into the game:
1. Talk to your Provider. The conversation about getting more active can easily be part of the annual check-up or any office visit, and your loved one's provider may have some caveats like avoiding certain types of impact exercise. But also be sure that you are talking to a believer, because there probably are as many out of shape physicians as there are in the population at large. Don't ask a couch potato how to get into condition.
2. Think Small. Your older loved one should have a goal like walking (or running) a 10K, but that is not the distance to start with on day one. Start small. Encourage a walk around the block, or if they already are a walker, start with jogging mixed with their walk. Run a block, walk two, or some other combination that does not defeat your new athlete right out of the blocks.
3. Remember to Enjoy. If you are a caregiver to your aspiring elder, consider part of your job as coach to be making exercise fun. Exercising with a partner is a positive step toward fun, and someone else depending on their being there at the appointed time is extra motivation for your elder. Where there are no smiles, there also likely will be fewer miles.
4. Change the Game. Encourage your elder to try new exercises or games. If jogging is their focus, both their minds and their bodies will benefit from a day with laps in the pool or a ride on a bike. To build up better balance, encourage yoga or Pilates or maybe even weight training under the supervision of a trainer. Cross-training is something all athletes do to tone their bodies.
5. Be Real. On the one hand, don't let your loved one off with the excuse that they don't have the time. The national guidelines recommend about 30 minutes a day to keep the body working well, and everyone can fit 30 minutes into their day. On the other hand, don't let your loved one burn out. If they push too hard, they can injure themselves, and if they do too much of the same thing, they also can cause a repetitive stress injury.
Now that we have reviewed what a caregiver can do to support their older loved one's fitness, there is no excuse for the caregiver either. I appreciate the time constraints a lot of caregivers face, but remember #5 above; you only need to devote 30 minutes a day. And I could add that you don't have to break a sweat to get the benefits from exercise like long walks. 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.
No, it is not a typo. There are some new changes to insurance coverage under the Affordable Care Act that will have a big impact on one of America's often overlooked health care needs: hearing. Did you know that one in five adult Americans have some form of hearing loss according to the National Institute on Deafness and Other Communication Disorders. Yet, only about one in five of the one in five with a hearing loss actually have used a hearing aid in the past. That translates into about 40 million adult Americans go without a device that could re-engage them with the world, and it mostly is because hearing aids are expensive - about $1,000 to $5,000 - and last only about three to five years before a replacement is needed. The implications for the older population are staggering. Among adults between 65 and 75 years of age, the percent with some hearing lost, but this jumps to fifty percent of those 75 and older who have a hearing deficit. In past blog postings, I have talked about two of the major challenges of aging: loss and isolation. Picture those two amplified by the inability to hear the words of comfort from another person or to engage in social activities simply because one cannot hear well. But there are changes afoot. The Affordable Care Act stipulated a requirement for coverage for the ten "essential health benefits" (EHBs). Advocates for hearing health see number 7 of these ten as applying to hearing: "rehabilitative and habilitative services and devices." While this is not a done deal, there are increasing numbers of states and/or insurers who are getting on board with hearing health just as they had in the past with vision or dental health. UnitedHealth Group has introduced a hearing health option in 2011 that can be either a benefit or at least a discount. Closer to home, Blue Cross/Blue Shield of Illinois is now offering a discount benefit to their members through TruHearing. With these giant insurers in the lead, you have to believe that others will follow now that the playing field for health insurance has become more competitive. You should also check your AAA insurance or AARP membership for discounts. And Veterans Benefits and the Federal Employee Benefit Health Program have always included a hearing health benefit for their members. If you are a caregiver to an older loved one who is having hearing difficulties, give one of these entities a call. You may be very pleased at what you - and your loved one - hear. 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.
May is Mental Health Awareness month, and that makes it a good time to talk about America’s Drug epidemic…an epidemic that affects older adults every bit as much as it does teens. It also is a good time to start a conversation with that older loved one in your orbit. Mental health is not just an issue of seniors, but you might be surprised to know that prescription drug misuse disproportionately affects Americans 65 and older. And it is part of an growing trend. In 1988 about one in three Americans had been prescribed three or more medications, but that has grown to well over half the 65+ group now having three or more meds in their bathroom cabinet. And that does not include the rising rate of alcohol abuse among seniors in America. Why the increase? When you talk with public health officials they cite an increasingly fragmented health care delivery system where all of a patient’s physicians may not be communicating with one another. So, the number of prescriptions will rise as a function of the aging complaints and the number of physicians a patient sees. Older patients are receiving an escalating number of anti-depressants, anti-anxiety meds and prescriptions for sleeplessness. And older patients just live long enough to have more pain and more medical issues, and that begins to explain the escalating number who receive prescriptions for opioids…it is not just “take two aspirin and call me in the morning” any longer. And aging has a way of exposing an individual to more of life’s losses that simply take an emotional toll: • Retirement is not always freedom – for many it is an emotional loss • Older adults also can outlive spouses and friends – another emotional loss • Some older adults live in fear of outlasting their money – an emotional strain • Surgery or other life changing medical episodes – an emotional strain • And the list goes on… All of the above can result in that conversation with a physician who attempts to relieve some of the physical or emotional pain medicinally. Or an older adult can self-medicate with alcohol. So, if you are a caregiver to an older loved one or have someone special in your circle, take time for a conversation. You may be surprised by what you learn. You may also find that you can be part of a mentally healthy solution to what may be affecting that individual. Starting a conversation is a great way toward becoming part of the cure. 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.
We all know that an object at rest tends to stay at rest, and that is as true of older adults as it is younger ones if you look at the frightening statistics on the obesity epidemic in America. Habits developed over the long run tend to be harder to break, but the fact is that appropriate exercise for older adults can get easier and easier just by the simple fact of dong it. Because the corollary to my first scientific law is that objects in motion tend to stay in motion. And exercise gets easier. Doubtful?

Here are nine reasons:
1. Starting a new exercise routine may feel clumsy at first, but so did dancing, riding a bike and a lot of other physical work we have all gotten better at with time. Muscle memory will help, because your body will make new nerve pathways to make your exercise easier with time.
2. Blood flow improves when you exercise at any age. The smallest vessels actually can increase in number fueling all parts of your body as your heart rate routinely increases with practice.
3. We all have seen body builders grow muscles into sculpted works of art. Well, we do not see the heart, but it gets stronger also with workouts that are even modestly strenuous. This is true of older adults as well as college athletes.
4. With the muscle memory and greater cardiac capacity comes increased confidence among elders who exercise. Physical confidence, in turn, creates greater overall confidence and a sense of “can do.” Older adults with a regular workout routine also will sleep better.
5. We have heard from too many fanatics about “no pain-no gain.” The opposite is, in fact, true. As an older adult works out over time, the body raises its threshold for working. With time, an older adult can do more and more without that shortness of breath or even the soreness afterwards.
6. Take that last one to a higher level, and if the older body begins a regular regimen of moderate exercise, the body’s hormone system will reward it with cocktails called endorphins. Endorphins are basically a homemade version of morphine to help the body feel better and better.
7. The power plants in your cells also will begin to grow in number with exercise over time. You cannot see them, but the mitochondria, as these power plants are called, become more numerous so that your body can burn more carbohydrates and fat to create more energy.
8. Exercise will encourage better eating habits. It is true, because a lot of those bad habit foods – comfort foods – are linked to stress, anxiety or even depression. Since exercise works against these negative emotions, some of the craving for the junk food will ebb as well.
9. Exercise actually makes a person happier. Tied to some of what I mentioned in #8, exercise really lifts the spirits, and it does it in part through releasing chemicals called serotonin, dopamine and norepinephrine. These chemicals can be as effective as some of the drugs often prescribed for depression.
Before you exercise or encourage an elder to exercise, see a doctor to sign off on your fitness to exercise.

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

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