home care services

Respite Care – The Holiday Gift to Yourself
Be honest if you’re a caregiver and you can answer YES to more than one of these questions. Sit...
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November 23, 2015
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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

April is what most realtors consider to be the beginning of the "market season." Winter has nearly - I did say nearly - left us, and everyone's houses and yards begin to look like showcases. I have shared a lot of postings in the past about the kind of residential options that may be right for your older parent who is ripe for the move. But the fact a growing trend may be that a lot of older adults may not move or make a transition to new housing.

Have you had this conversation with your older parent, leaving contact information for a residential facility, but they never made the phone call? Or has your older parent confided that they would really be fine with moving, but they want the new home to be just like the present one? Or do they simply state, point blank, that they cannot leave the home where they raised their children, entertained their grandchildren or even said goodbye to their lifelong partner? All of these point to an emotional bond that makes it difficult, or perhaps even impossible, for mom or dad to ever leave their residence.

You are not without options, but remember that it has to be their choice, and patience is important. But try this approach. Offer to make a scrapbook with pictures of all the rooms that can be captioned. You might even include vintage pictures of the same rooms from when the kids were younger or when a holiday was celebrated. A memory book of home is transportable no matter where mom or dad lives. You may even take this up a notch and create a literal home video with mom's or dad's narration to make all the memories and rooms come alive.

And moving experts whom I know suggest exporting your parent's "nest" to a new residence. The nest is the place with all the family photos looking down, or the magazine rack or the most comfortable chair which may be home to the remote control for the TV. Take photos of that spot so that you can take the furniture and the pictures and yes, the remote, to a new residence that will give the feel of home.

There are other strictly financial reasons why your older parent may not move. Mortgage and property tax debt is rising among adults 75 years of age and older. It is their fixed incomes which explain why 75+ year olds have had a higher foreclosure rate in the recession and post-recession era than the 50+ year olds. In fact the foreclosure rate among the 75+ year olds has been 23 times higher in 2011 than it was as recently as 2007. And it no longer is a given that older adults will have "burned their mortgages" before they retire. Add to this what Forbes Magazine has called the "Greatest Financial Crisis for Older Adults" - a lack of retirement savings. The average older adult today has only about $25,000 in their 401-K, hardly enough to move to a senior residence anywhere... let alone one on a golf course.

So, as you speak with your older parent about residential options, be listening for the cues. They may not be willing to move. But even more sobering, they may not be financially able to move from their house. Be sensitive. Ask questions. Make no judgments. Explore all the options ... including intergenerational living accommodations.

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.
…and when to not say anything…read further. It seems like such a waste of talent…the energy and brains that scammers invest in finding new ways to bilk people of their money, and older adults are more susceptible than others. Let me start with that part first. Older adults more often get scammed, because they answer their phones, they tend to be more trusting and they have more liquid assets. Let me share the short version of a number of relatively new scams targeting seniors. For more details, please also go to the U.S. Federal Trade Commission web site (https://www.consumer.ftc.gov/scam-alerts ). 1. A Government program that will pay bills. The scammers have been selling this “government program” at places of worship. The scammers at first appear legitimate as they take enrollment information from enrollees. The first bills appear paid, but the scammers cancel the transactions and keep the funds. When the bill comes the next month, it will have late fees, and the scammers will have the credit card and personal identification and financial information of the enrollees. 2. The “good-looking” bad check. This one actually seems to go back to the faxes that used to come across from a Nigerian prince, but it is still being used. The scammer asks you to deposit a check for a substantial amount of money because they do not have access to their own local bank. But could you please write a check for a much smaller amount in the meantime? Well, by the time the check bounces, so does the scammer. 3. More taxing issues. With the tax filing deadlines approaching, some people will be approached by email or even conventional snail mail with notices that the government demands more. If the email has a link, do not click it; it may have malware or worse. If the written letter asks for a wire transfer, prepaid debit card, gift card or other form of payment than a check, it also likely is a scam. If the request is to make payment to I.R.S., that also is a scam, because Uncle Sam asks for checks to be made payable to the U.S. Department of Treasury. 4. I cannot hear you now. Sprint used to famously ask, “Can you hear me now?” Well, there are robocalls going out with the same question…do not say yes! Scammers will be recording your answer to be used later as confirmation in what may sound to be a legitimate solicitation that has your “yes” answer as the reply and that now will have a price tag associated with it. Don’t say anything! How do you help protect your older loved one? Well, for phone callers, you can still request that their numbers be placed on the “no call” registry: 888/382-1222. To report suspicious activity, the Federal Trade Commission can be reached at the site I listed at the top of this post or called at 877/382-4857. 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.
Free White Paper: Exercises for Seniors, Depression Prevention for Seniors
Cases of depression are increasing in people who are 65 and over. Any number of factors can cause this as we age, including more medical complications, the sense of loss, and isolation. Additionally, many who aren't diagnosed with depression simply feel down about life. We've compiled a series of senior resources to help you or a loved one stay upbeat and positive.

Inside "Caregiver Counsel for Taking the Old out of Aging"

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Senior Home Safety
Having a safe home is a large part of senior health that is often overlooked until it’s too late to prevent an accident and serious injury. According to the National Institutes of Health, six out of ten falls happen in the home where we feel safe and secure. Our elder care management plans place an emphasis of senior home safety for just that reason. Small details like dim lighting, loose carpeting, hard to reach items or an uneven driveway, become safety hazards for aging adults.
Common Safety Hazards
As we grow older, we become more limited physically. Eyesight, strength and agility deteriorate, and we need to be more careful with our bodies as years progress. Addressing physical limitations by making changes around the home before an accident happens, can keep an older adult safe and comfortable at home. Be aware of clutter on the floor, inconveniently placed furniture, slippery or uneven flooring and area rugs that could cause a problem. Bathrooms and kitchens are often the most hazardous rooms. Add extra railings for support in the bathroom and on the stairs, improve the lighting in dim areas and place items at an easy to reach height to keep your older family member safe.
Are You At Risk?
If you are concerned about safety hazards in your home, review our Home Safety Checklist for common hazards and solutions to keep your loved ones from harm, and contact us for an assessment of both the condition of your loved one and their home as well as further recommendations for geriatric care services in Chicago.
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Recent Client Praise

Let’s take a short quiz. Question:      Who prefers coffee…and who prefers tea? Which is healthier for you? Answer:        Both together are better for your cardiovascular health than either alone. We see a continuous stream of nutritional information about what colored food is best for us (hint: brightly colored) or that flavonoids are healthy or that high fiber is key to any diet or how many calories should be consumed daily. Yes, the list is seemingly endless. And there can be a lot of accumulated data that are used to support a given position on any of these sources of nutrition, but we don’t always see really large population studies over very long spans of time. Well, in Britain where the government picks up the tab for people’s health care, they invest in broad-based studies to improve health, and what better place to start that with what people eat or drink. Tapping into an existing panel of nearly 366,000 study participants who are part of a panel of the UK Biobank, scientists were able to follow these individuals’ tea and coffee consumption as well as their health statuses for a median of 11.4 years. What they found may be rather surprising, and the statistical significance of the results was even more startling. The researchers found that of these nearly 400,000 people, 2.8% experienced a stroke and 1.4% developed dementia (the vascular, not the Alzheimer’s dementia) over those 11.4 years. These health outcomes were tied to tea or coffee consumption. Those who consumed two to three cups of tea or coffee showed a 30% reduction in strokes and 28% reduction in dementia. Those who drank less than two cups of either beverage had much smaller reductions in either health outcome. The greatest benefit came to those who drank two to three cups of both tea and coffee daily, and the difference from the non-drinkers was slightly better, 32% and 28%, respectively. The odds that these 32% and 28% reductions could have occurred by chance alone were between one and two in a thousand! The researchers continued to follow patients who had strokes and found that the coffee and tea consumption protected them even more from vascular dementia.   Again, there was no discernable benefit for Alzheimer’s disease or for that matter hemorrhagic stroke. As a final note, if you were to peruse the 600+ posts to my blog over the years you will find a theme. Paying attention to our diets and exercise are the two best things we can do to live both well and longer. The next time a friend suggests you meet for a cup of coffee or tea, you now have one more reason to say yes…and maybe ask for a refill. 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.
Caregivers tend to be very dedicated to caring for others, typically an older parent or disabled member of the family, but they often do not do so well in caring for themselves. It is not that caregivers do not need at least a bit of help themselves, but it can be a very conflicted issue for a caregiver to ask for help. It may stir up guilt about not caring for mom or dad or inadequacy at not being able to do it all. And it is not that caregivers are alone. They have other siblings, they have friends or neighbors, and they also have respite care available to help. Respite care is not just one type of service, it is a whole continuum of in home care services as well as out-of-home services available in most communities. For at home care, respite care can provide a needed break for the caregiver who needs to also work a day job, run their own personal or household errands or simply have some time to recharge. Family, friends or other volunteers can be crucial in giving this time to the caregiver as well as providing stimulation, conversation or some fresh energy to care for the receiver of care. Personal care or skilled care providers also can assist with the "heavy lifting" like activities of daily living (ADLs) such as bathing, dressing, toileting and more. Area residential care facilities can provide an even wider range of support where caregivers can drop mom or dad for short breaks, overnight care, or short intervals to cover vacation time. For more comprehensive needs of those who need help with ADLs, there are facilities in most communities for adult day care that may be a full 9 to 5 or 7 to 7 to help with caregivers who also have work responsibilities. If you are looking to recruit an individual who will be coming to assist in senior care for mom or dad in the home, be sure to ask for references. Also be clear about services you expect, make certain of compensation (and no prepayments), and even consider a background check so that everyone has peace of mind. If you are going though an agency, go through the same process as well as ask about bonding and other assurances you and your loved one will be secure. If you will be looking to a facility with its own personnel, you should ask about:

their hiring criteria,

skill levels, certifications, training of personnel,

how hands on caregivers are supervised,

how emergencies are handled and who the providers are,

any other services (e.g., meals, transportation, entertainment, etc.), and

payment terms.

And you may ask to spend an afternoon or a day at the facility to observe how well they deliver on their promises. Don't be afraid to ask questions of caregivers in order to really assess if the people in place are engaged in the service they provide. People who like what they do will do a better job than those who just have a job. 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. Read more about Our Story and Charlotte's mission.
One of my staff worked with a senior community in upstate New York near Elmira a number of years ago, and he tells the story of their “brand signature.” It was a silhouette of a hand against a similarly dark outline of a tree branch with a caption: “In my mind I still climb trees.” This was a very high-energy community, but they did not have a rock climbing wall in their gym or a tree to climb for that matter. What they realized is that age is about how you feel about yourself more than it is about your birthdays. How old are you? You’ll find different formulas for this, but it seems that we humans, on average, feel about 12 years younger than our drivers licenses may say. It’s fewer years for very young adults, and the gap widens with age, but the feel versus real gap tends to be about twenty percent. Why is that? To some extent it’s cultural. The gap is much wider in western European countries and America. Not much gap at all in Asia, and the difference virtually disappears in African countries. I think it breaks down to three categories: wanna do, won’t do and can’t do. Admittedly, these are culturally defined, but it’s a lot about cultivating a spirit of potential versus handicap. The wanna do category of people who are aging have a list of things they have yet to do and want to do (I do not use the term, “bucket list”). They want to run a marathon in every major city, they want to climb a mountain, they want to play a round of golf at St. Andrews. You don’t hear them talk about their list of health issues…in fact, they may even show you pictures of the xrays that suggest they can’t do what they, in fact, are doing! The won’t do is straightforward, but still hard to explain. Many of these could do if they wanted to do, but they don’t. It may be a perception of this is how mom or dad was at this age, or it could be a plea for attention or even role-playing the “victim.” And maybe they just are not convinced of the benefit of getting up and getting out or exercising as it could apply to them. The can’t do have genuine issues, often defined by genetic heritage or a diagnosis or a tragic accident. But if you peel back the veneer of that “label” you likely will find a wanna do or a won’t do under the surface. Michael J. Fox has Parkinson’s Disease. Yet, he has helped raise $1.5 billion for research to find a cure, or short of that ways to mitigate the challenges of this neuro-muscular condition. Mr. Fox even maintains a strong sense of humor about the constant assault of his diagnosis. So, how old are you? What do you see when you look into the mirror? And, finally, how old do you want to be? Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of, 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.
Any discussion of hygiene - whether in an older adult or anyone else for that matter - is an admittedly subjective discussion. It is not just about taking a daily bath or shower. In fact, in many other parts of the world, a daily cleansing is considered a bit excessive, and some people of earlier generations did not necessarily grow up on the daily dousing we call personal hygiene. Everyone potentially has their own take on how frequently they wish to bathe, but hygiene also can be an indicator that something else is not quite right in an older adult.

When I get a call from a client who is concerned about their older loved one's hygiene, I start by simply asking if this is a recent change from old habits or if it simply the way they always have been. If it is just the way the habit has always been, then it will not be easily changed...if, in fact, it even should be changed. Old habits are deeply ingrained. But a change in personal habits can be the sign of something else at work.

In an earlier post, I had pointed out that loss in appetite can be a warning sign of depression. The same holds for an older adult who has lost interest in how they look or how they smell. Depression is a bigger issue than hygiene, and in fact, if the older adult addresses the depression with talk therapy or medication, if indicated, they may find a renewed interest in self-care and hygiene.

And as with appetite as I addressed in the last posting, a change in hygiene can simply be a product of the older adult's diminished ability to smell what you as a caregiver may find offensive. Conversely, you may find that your older loved one has dumped excessive amounts of cologne on themselves, because they cannot tell that they have given themselves an overdose of the good smelling stuff. Regardless, any discussion you may have with the older adult about something as personal as how they smell should be a very sensitive discussion.

Your older loved one also may also be finding it difficult to navigate the bath like they used to because of their diminished agility. And modesty may preclude them from asking for help. So if this is the case, consider enlisting the help of third parties like home care aids who will not be as threatening to their sense of propriety.

Forgetting to shower or bathe can also be a sign of a larger pattern of forgetfulness, so try to assess hygiene against the "big picture." Does your older loved one also miss appointments or forget to pick up their clothes from the cleaners? Maybe suggesting a calendar with dates filled-in with the "things to do" can be an assist, because we all can forget things. If the forgetfulness, however, is part of a greater disorientation, be alert to early onset dementia. Even if this forgetting is part of a dementia, don't immediately push the Alzheimer's panic button. Mild dementia can be exacerbated by poor sleep or even a medication that has a side effect of confusion. Diphenhydramine (branded Benadryl), an ingredient in a lot of over the counter medications, can precipitate some amount of forgetfulness in a person of any age.
            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.
Family crises don’t make appointments…they just happen whether you are ready or not. In fact, our clock is ticking: • Every 67 seconds another person in America is diagnosed with Alzheimer’s, and that is just one of the nearly 100 types of dementia; • Every three minutes an individual 65 years of age or older is taken to an emergency room; 14% of the subsequent admissions are for broken hips. The list goes on. You wish mom or dad could have the life they want…to stay in the home you grew up in … to stay independent. In fact, they may have made you promise that you would see to it. But dreams and promises can’t always come true. Are you ready? The clock is ticking. Do you dread the phone call that may come in the middle of the night- or during the work day? The call that tells you something out of the blue has happened to someone you love? I got that call- I was working full time with school age children at home when I got the call that my mother was diagnosed with cancer. Right then and there I had to deal with my mother’s medical needs, her health crisis, her finances while caring for my family and running my business. One of our employees got the call that his mom had to be out of her independent living facility within 30 days…she was no longer “independent.” How many of you have had a similar experience- or are hoping you never get the call? Well, hope is not a strategy for your inevitable family crisis - you need a plan. A plan starts with having the necessary documents for your older loved ones, and the basics are: a POLST, a Living Will, a Power of Attorney for Healthcare and a Power of Attorney for Finance. Some of our clients also have found that mom or dad wanted to lay out their plan for a funeral, but that may be getting a bit ahead of things. You also need to know their physicians – that’s right, it’s plural; there likely will be more than one. You also want to know their preferences…which hospital in the event they need to go to one, a document to inform any medical interventions. And, of course, where their health insurance card is, their will, and who their lawyer is. You may get some resistance, so just remember that resistance is just fear putting up a wall. Empathize with their fear. Imagine now your next step. Imagine what it would be like to have the peace of mind that a plan can give. The possibility of sleeping at night. The possibility of having more time with your family. The possibility of being able to do your job. The possibility of feeling more in control of all the chaos. Check out what I had to say about planning for the crisis that doesn’t make an appointment on ABC News. Watch it below (after a brief commercial).
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.

Dr. Oliver Sacks explains neuroplasticity in his editorial, “This Year, Change Your Mind,” in the New Year’s Day editorial page of the New York Times. As a geriatric care manager, I have encountered clients whose injuries have induced deficits of some sort from which recovery plans are designed and executed. Physical injuries such as lost limbs, vision, hearing or others have fairly clear rehabilitation trajectories, and the injured individual can learn and work through them to recover as much of a productive life as possible.

Neurological injuries like those Dr. Sacks offers as examples require remolding an organ that we do not see from injuries that also may be invisible.  As Dr. Sacks explains, neuroplasticity offers the means by which the brain can remold itself to overcome a deficit. For a geriatric care manager, the deficits do not have to be as dramatic as a spinal cord injury, the onset of blindness or even a stroke. We see every day the consequences of older adults’ inactivity and the cumulative deficits that can grow out of the under stimulated life. The brain does lose some of its pathways through natural attrition, and it is critical for a vibrant life for the aging individual to keep working in order to maintain the pathways they already have as well as to create new ones as some of those may become unavailable. A colleague likens it to commuting in the brain. There may be detours and rerouting, but an active individual will always find a route home.

There is a case of a 70+ year old client whose spouse is suffering from Alzheimer’s inexorable progression. While there is little to do to forestall that condition, he takes it upon himself to exercise at his facility’s gym three times a day, he is a voracious reader and he is an active participant in his wife’s care team so that he can be both physically and mentally able to care for his wife to whom he is entirely devoted. Or the 90+ year old woman who will keep up with her grandchildren when they come to visit – as exhausting as it may be. She is a brilliant conversationalist, she rarely repeats herself and she completes the New York Times crossword puzzle. What do they have in common? They both push the boundaries of the envelope.

They both are pushing the plasticity of their brains.

Dr. Sacks exhorts us to “change our mind” this year as part of our 2011 resolution. I would expand that to include all of those on whom an elder or person with special needs depends, and encourage those caregivers to help push the envelope for those in their care in order to effect a change of mind and a robust life in 2011 for all.

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.

Copyright ©2011

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Dental health and mental health are linked. That’s right, dental and mental well-being are medically linked. I have posted a lot about dementia and how consuming too much alcohol, living in polluted air, sustaining a head injury, diet and a lot of other factors influence whether you will someday develop one form of dementia or another. In fact, the consensus among health care professionals is that two of every five cases of dementia could be prevented or delayed by lifestyle and healthstyle changes. But one healthstyle change that you may not be aware of is basic dental hygiene. In research recently reported in the journal Neurology scientists linked oral health to memory health. Scientists followed a group of 8,275 men and women whose average age was 63 at the study’s outset for almost two decades. Nearly one in five of the study subjects developed Alzheimer’s disease or some other form of dementia over the 18 years they were followed. The scientists were measuring and carefully tracking a whole host of demographics and health characteristics. They recorded age, gender and education and tracked cholesterol levels, blood pressure, cardiovascular health, body mass and oral health. Teeth health, it turns out, provided a significant marker for dementia. Those with severe gingivitis and tooth loss increased their risk of dementia by 22% over the other people with healthy gums and teeth. Among those who had lost all their teeth for whatever cause over the years they were followed had a 26% increase in their risk of developing dementia over those with healthy teeth. The researchers cite the fact that the bacteria that can cause gingivitis can travel from the mucous membrane of the mouth along nerves to the brain. But the link between dental health and mental health could be more general. Inflammation also is a factor in developing dementia. When a person’s mouth becomes infected as it does with gingivitis that inflammation can spread to other parts of the body like the brain. That inflammation can affect the cardiovascular system and the pancreas (resulting in diabetes), and both of these also have been demonstrated to have links to dementia. I have to point out that this is not proof that dental disease causes dementia…but the dental disease does precede the dementia. If dental disease which is caused by poor dental hygiene does cause dementia, there is trouble on our collective horizon. Half the population has severe enough periodontal disease to be in the higher dementia risk category! With the “extra time” all of us may have during this pandemic, may I suggest we spend a bit more time brushing our teeth? 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.

Chicago Assisted Living Experts

Assisted living residences are housing facilities meant specifically for those with a need for daily supervision and/or assistance. Making a decision to move your elder loved one to assisted living is not easy and comes with so many questions. Is it the right choice? What type of paperwork is involved? Which assisted living facility is best, given our particular situation? Creative Care Management helps you find answers to all these and many other questions about your elder loved one’s care. Our elder care service specialists begin by conducting a thorough assessment of your loved one’s condition physically, mentally and socially. Then, considering every aspect of your needs from level of care necessary to budget concerns, we put together a geriatric care plan and then help find your loved one an appropriate community of the highest quality. We grade our facilities based on three factors below and only recommend the top assisted living care providers.

Responsiveness
Quality of service
Facility and staff qualifications

Contact us today and learn for yourself what makes Creative Care Management, the top-rated Chicago geriatric care management company. We will work together to improve the life of your loved one by finding them the expert care they deserve.

Life in Assisted Living

Assisted living communities are staffed with professional caregivers and healthcare providers, that monitor and assist residents with their personal health needs including assistance with medication management and daily routine as needed. An active, social life is encouraged among residents, and planned activities are often provided by staff members, but residents are not fully independent like those living in a retirement community, nor are they under the 24 hour supervision that nursing homes provide.

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We’ve had a nice trend over the recent years, a trend in which hip fractures in America had been declining. Alas, I said “had been”. According to an international study staffed, in part, by researchers at the Harvard Medical School, we are expected to see the rate of hip fractures reverse what had been a downward trend to what is forecast to nearly double from hip fractures 2018 levels to what they are forecast to be in 2050. And it’s even more pronounced among men. This latter part was a bit of a surprise to me as we have always associated hip fractures with osteoporosis which has been the domain of post-menopausal women. This was an international study, so we can even point to Brazil as the country you would have wanted to be born in to “lower” your risk of hip fractures versus Denmark, the high mark. Hip fracture rates are more than three times as high in Denmark than in Brazil. Post hip fracture treatment was lowest in Germany, but almost five times higher in United Kingdom. Talk about adding insult to injury, fracture rates are on the rise and post-fracture care is going down. The analysts point to men’s overall lower treatment with medications for osteoporosis than women to explain some of the gender difference. But my opinion is that the trend down can be explained also by longer life spans in general as well as poorer dietary habits, fitness habits and obesity in a lot of countries. Calcium intake is important for healthy bones, but so is exercise, particularly the exercise employing work on the load bearing legs like walking or running. Remember sitting is the new smoking. As you consider your options, I encourage you to consider being a leader in “living well.” At your next social gathering when others chime in with all their latest ailments or other medical complaints, try this. Mention that you have taken up daily walking, mention how far and mention how you’re sleeping better and that you may even have dropped a little weight. Ask the group who among them would be your walking buddy, because it’s better for both you and a walking or running buddy. Be radical and start a new trend in your social circle. Be radical and be hip! Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of, 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.
As a geriatric care manager, I have to admit that we are very skilled at not only providing senior care options for those among our clients with medical conditions, but translating medical speak into a language that clients, caregivers and families can process. A lot of these are chronic conditions that progressively impact the caregivers' loved ones, and some have some rather scary names. But one of the medical "conditions" that does not have a name associated with it is every bit as important as those medical jargon labels like chronic obstructive pulmonary disease or congestive heart failure and more. It is called "functional status." If you are a caregiver, you may have seen your loved one's chart at some point, and it has a lot of information on it. A fair bit of it covers the ongoing record of a patient's vital signs, measures like heart rate, blood pressure, temperature and more. But you will not see a measure called functional status, what some in our field these days are calling the "sixth vital sign." The key reason to know your loved one's functional status is because that is a really good predictor of how easily or rapidly they will recover from, for instance, a hospitalization. If your loved one is going through chemotherapy, it will also dictate how aggressively the doctors can treat the cancer. They call it performance status. But for every discharged patient, functional status is also a very important predictor of whether they will be re-hospitalized within the next 30 days. How well one is able to take care of oneself is really critical to a healthy recovery. And functional status is all about self-care like bathing oneself, taking one's medications when they are supposed to be taken, preparing a nutritious meal and more. Functional status is what gets a discharged patient back on their feet, and being up and about is one of the best ways to avoid having other problems like pneumonia or bed sores. Getting back to re-hospitalization, Medicare is starting to take functional status very seriously, at least indirectly. Starting in October they will be monitoring hospitals' readmission rates, and those who are above the national average will begin to pay penalties. So, doctors should start paying attention and recording their patients' functional statuses. Because it will not be the patients' medical condition alone that will put them back in the hospital; it will be that interplay between how they take care of themselves - their functional status - and their medical condition. It is interesting that we, as providers of senior care solutions, have been focused on those two dimensions all along. We call the combination of good functional status and a medical condition to be "quality of life." If you are a caregiver, you can really help your loved one by helping them to be as active and self-sufficient as possible. If they cannot be totally independent, then assistance in any of the activities that challenge them can still improve their net quality of life by leveraging their functional status. It will be better for your caregiver quality of life as well. Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends providing senior care options to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
Gregory Peebles is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP) and trained Medicare Counselor, 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. Gregory has been a key member of the CCM team for over a decade. – Charlotte This is the second installment in a three-part series to help clear up some common misconceptions about Medicare. Medicare isn’t intentionally confusing, but with all the cross-talk surrounding Medicare, even if understanding it isn’t as intuitive as “1,2,3”, it’s at least as easy as “A, B, D.” In the last post, I discussed the structure of Medicare, and its division into two main parts (A & B) and a supplemental part (D). In review, the major portions of the program look like this:
- Part A – “Original Medicare”, covers in-patient stays (including hospital stays, or stays in rehab facilities, etc.)
- Part B – “Original Medicare”, covers physician visits (including Primary Care Provider visits, or referrals)
- Part D – added under the Medicare Modernization Act of 2003, covers select prescription drugs.
Let me start with some of Medicare’s surprising omissions of coverage. Again, the way the public thinks that the service works and how the service functions in practice are not the same. For example, Part A is designed for stays in medical facilities, but not all stays, and not all facilities are covered. The same can be said for Part B, which does not cover all physician office visits. How does this work? While most traditional, scheduled physician visits are covered, you shouldn’t expect to be covered by Medicare Part B for:
- Most dental care
- Eye exams related to prescribing glasses
- Dentures
- Cosmetic surgery
- Acupuncture
- Hearing aids and exams for fitting them
- Routine foot care
Which facility stays are not covered under Medicare Part A?:
- Long-term care
- “Custodial” care
It may come as a shock to many, but Medicare does not pay any part of the cost for permanent residence in a Skilled Nursing Facility (commonly called a Nursing Home). Without long-term care insurance, many aging adults find themselves unsure how to manage to pay for extended, custodial care. Next week, we’ll talk about options to close the “gaps” in coverage and how folks covered by Medicare are planning for themselves with the help of Medicare Counselors. 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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One of my staff worked with a senior community in upstate New York near Elmira a number of years ago, and he tells the story of their “brand signature.” It was a silhouette of a hand against a similarly dark outline of a tree branch with a caption: “In my mind I still climb trees.” This was a very high-energy community, but they did not have a rock climbing wall in their gym or a tree to climb for that matter. What they realized is that age is about how you feel about yourself more than it is about your birthdays. How old are you? You’ll find different formulas for this, but it seems that we humans, on average, feel about 12 years younger than our drivers licenses may say. It’s fewer years for very young adults, and the gap widens with age, but the feel versus real gap tends to be about twenty percent. Why is that? To some extent it’s cultural. The gap is much wider in western European countries and America. Not much gap at all in Asia, and the difference virtually disappears in African countries. I think it breaks down to three categories: wanna do, won’t do and can’t do. Admittedly, these are culturally defined, but it’s a lot about cultivating a spirit of potential versus handicap. The wanna do category of people who are aging have a list of things they have yet to do and want to do (I do not use the term, “bucket list”). They want to run a marathon in every major city, they want to climb a mountain, they want to play a round of golf at St. Andrews. You don’t hear them talk about their list of health issues…in fact, they may even show you pictures of the xrays that suggest they can’t do what they, in fact, are doing! The won’t do is straightforward, but still hard to explain. Many of these could do if they wanted to do, but they don’t. It may be a perception of this is how mom or dad was at this age, or it could be a plea for attention or even role-playing the “victim.” And maybe they just are not convinced of the benefit of getting up and getting out or exercising as it could apply to them. The can’t do have genuine issues, often defined by genetic heritage or a diagnosis or a tragic accident. But if you peel back the veneer of that “label” you likely will find a wanna do or a won’t do under the surface. Michael J. Fox has Parkinson’s Disease. Yet, he has helped raise $1.5 billion for research to find a cure, or short of that ways to mitigate the challenges of this neuro-muscular condition. Mr. Fox even maintains a strong sense of humor about the constant assault of his diagnosis. So, how old are you? What do you see when you look into the mirror? And, finally, how old do you want to be? Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of, 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.
We all lose sleep sometimes, because we all can carry to bed with us the worries about the concluding day or the day ahead. I have been taking an informal poll on what keeps caregivers awake, and some consistent themes emerge. I am going to list out what I have been hearing along with some suggestions to help you get a better night's rest if you are a caregiver to an older loved one or other special needs individual.

When you are on call as a caregiver so much of the time, it is hard to simply "turn it off" at night. Being a caregiver has been termed the "36-hour day" by at least one author. Everyone needs to be able to clock out of the job to rest and refresh. Set a quitting time for your caregiver duties, and as a way to signal the end of your shift, consider writing a list of what you will do tomorrow as you pick up where you left off. By making the list, you will not be obsessing about it as you try to fall asleep, and you will not have to think about what you will do when you rise. It is ready to pick up, and you need not give it any more thought.

You end up doing everything because it takes more time to explain it to someone else than it does to simply do it yourself. It really is a problem of delegating. Consider partnering with another caregiver. You can take care of their loved one at certain times in exchange for their help in taking your mom or dad along with them for designated times. Caregivers will be quick learners for one another, and they really do understand that it is not "babysitting." Also, make a list of what others can do for you, like shoveling your walkway, cooking a meal or shopping for you.

You always think you should be doing more. Guilt can be a very unforgiving motivator, and I believe that all caregivers have something to learn from Bruno Bettelheim who wrote about "The Good Enough Parent." Turning his advice around just a bit, the caregiver's role is not to make an ideal parent or loved one out of the person for whom you are the caregiver; it is to simply help your loved one be what they wish to be and for you to accept that as "good enough."

Feelings of isolation or even depression can haunt a caregiver. It comes back to one of my principal tenets of caregiving: You will take better care of someone else if you are taking care of yourself. Seek out respite care for your loved one so that you can meet with friends for coffee or just a break from your routine. And do not hesitate to seek the counsel of a cleric or professional if the blues become more than just a down day. You deserve some help in coping with what is a stressful job.

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.

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