Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • senior home care servicesChicago's Geriatric Care Manager Center of Excellence

Hold Your Friends Close and Stangers Closer
Miss your friends, your older loved ones and those summer get togethers in the backyard? We can get together...
Read more
August 11, 2020
0
0
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...
Read more
May 19, 2020
0
0
Mittens Before the Frost
I was asked today about the “mitten test.” It was one of our colleagues who had remembered something I...
Read more
September 18, 2018
0
0
A House is Not a Home (Part 3)
At CCM, home and safety are as important to us as to you, so it’s no surprise that it’s...
Read more
June 18, 2017
0
0
A House is not a Home (Unless You’re There)
At CCM, home and safety are as important to us as to you, so it’s no surprise that it’s...
Read more
June 5, 2017
0
0

In the Caregiver's Words

Recent Client Praise

Raise your hand if you ever had a disagreement with a brother or sister as you were growing up. It may sound like an odd question, but it highlights of the "iron rules" of family dynamics that I have seen in my years as a certified geriatric care manager. Most families tend to play out a lot of the family dynamics that had characterized them during the formative years of the family. They simply are older now that they were when mom and dad were raising them as children. We also still find that caregiving to mom or dad as they age generally falls to the daughter in the family and not the son. According to sources woman (daughters) caregivers outnumber men (sons) about two to one. SO what can one do to manage the family dynamics so that the caregiving actually is productive instead of combative. In part because caregiving can be demanding and stressful, it can bring out some of the family's old tensions or unresolved issues. Some siblings may be the optimists and others the pessimists, but quite often the tension that already exists is exacerbated because the duties are not seen to be shared equitably. Here are some guidelines that can help to diffuse a tense predicament and hopefully move things to a more productive plane:
- Make it a point to appreciate all points of view, and be open to compromise; as I often say, "Would you rather be right or happy?"Recognize that not all siblings can contribute equally; everyone comes from a different place with different abilities and different constraints.
- Don't forget "please" and don't forget "thank you;" show appreciation for everyone's contribution to caring for mom or dad.Make it a point to share all the information; if one of the siblings does not know their help or input is needed, it is not going to be forthcoming.
- Remember to frame your suggestions and actions around what mom or dad would have wanted, not what you specifically may want.
- You may not be required to "forget" a perceived wrong from a sibling, but you do have to "forgive" the slight so that you all can move forward.
- If you are the caregiver who is not getting sufficient help from the siblings, you still need to find professional (or otherwise) respite care.
- Be open to seeing when you need to call in help just to work together as siblings; seek the facilitation of a therapists, counselor, social worker other third party.
- Remember one of my other iron rules, and that is "Care for the Caregiver;" you cannot be an effective caregiver if you are not caring for yourself.
This may seem like a lot, but productive resolutions of issues will in the end be better for your older loved ones. The lessons you learn in working through your sibling tensions also can be tremendously illuminating as you look to prepare your own children for roles that they will one day face. Charlotte Bishop is a certified Geriatric Care Manager and founder of Creative Care Management, 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.
I started in my last post talking about older loved ones and “aging in place.” That first post was about the aging part and Activities of Daily Living. In this installment, I have a tip on how to assess the “place” part of aging in place. I call it the “mitten test.” If you live in the upper portions of the U.S., your winter mittens may just about be ready for the storage closet. But your mittens have another useful purpose that can help you make home an easier place for your older loved ones. You can use them to identify spots in your loved one’s home that can be adapted to fit their changing capabilities. As our bodies age, certain of our nerve pathways begin to fail, and the human anatomy uncannily reroutes many of the circuits as they stop firing. But with age, more and more of those pathways may slow or fail for a variety of reasons, and it just makes it harder for older adults to do the simple manual tasks they used to do without even a thought. Turning a door knob, turning on a lamp or taking the lid off a jar become challenging, maybe even impossible. It is hard for those of you who may be in the prime of your lives to really get this, no matter how empathetic, so I recommend an easy exercise to help you experience what this erosion of manual dexterity and fine motor skills feels like. In doing so, you can also help identify challenging hardware or activities that can be more easily managed with a bit of creative help. With a pair of mittens, walk through each of the rooms in your elder loved one’s home and go through the normal activities of the person who lives in those rooms. As you enter a room, it is may be more challenging to flip a light switch or twist the switch on a lamp with your hands in mittens. These can be remedied by retrofitting wall switches with the larger rectangular switches that one merely presses on and off. Likewise, the lamp twist switches that are challenging with mittens can be replaced with wider winged grips. And even before you enter a room, the door knob may be your undoing if the knob is too small or too slippery. Handles may be an appropriate replacement. The mittens are effective barriers to everything from opening the ketchup bottle to a twisting the lid on a jar of apple sauce or beverage bottle and more. And if a key itself is hard for an older loved one to grip when opening a door, hardware stores have over-sized sheaths to make gripping easier. With your mittens still on, try tying your shoe laces or buttoning a shirt or blouse. It may be time to get creative with Velcro-equipped shoes or other substitute hardware for buttons. And go through the motions of other self-grooming activities to determine what challenges are manageable and which are just out of reach. The number of what are called “assistive devices” will amaze you as you look to television remote controls, computer access and more. Check out the Department of Health and Human Services Assistive Technology site. 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.
You may be familiar with the statistics on breast cancer in America. One in eight women will develop breast cancer in their lifetimes, and even some men develop breast cancer. You probably also know that early detection is really key in order to combat the disease and there are even genetic markers that can help to detect breast cancer in its earliest and most treatable stages. And you probably also know that there is a risk for breast cancer to resurface even after a seemingly successful treatment regimen. What you may not have known is that once a patient has been diagnosed and even successfully treated for breast cancer that they are now at greater risk for cardiovascular disease. That just seems wrong, but the facts are there and in fact, the breast cancer survivors will potentially develop a more difficult cardiovascular problem than the heart patients who did not have breast cancer. So, scientists set out to determine how breast cancer survivors can catch a break. They carefully matched two groups of women who had managed to beat breast cancer. The women in the two groups were similar ages, had undergone similar treatments and had approximately the same BMI, a measure of weight and fat. One group, however was introduced to a fairly aggressive program of weight training, aerobic exercise and stretching. They exercised with an instructor for 60 minutes twice a week and exercised on their own for two more 60 minute sessions for a total of 240 minutes a week. The other group just had their normal activities of daily living. Both groups were tested at baseline in a way that competitive athletes often are by measuring how efficiently their bodies use oxygen, a test call the VO2 MAX test. The VO2 MAX for the group getting physical training was up only .3% at the end of a year, but the less active group was down by 3.8%. The difference was even more pronounced in women who were continuing on chemotherapy. Comparing exercise with the non-exercise groups using a standard cardiac risk measure that cardiologists call the Framingham Risk Score (takes into account blood pressure, LDL cholesterol and more), the exercise group did 11% better than the non-exercise group in reducing their risk. The odds of that happening just by chance are one in one thousand. So, if a woman beats the odds on breast cancer, the smart money on getting a healthier heart in the deal certainly favor exercise. 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.
Remember the ads that started with a plea: “Help, I’ve fallen and I can’t get up?” That is so twentieth century. Today, it is Alexa, please turn off the lights in the living room. Alexa, please play Guns and Roses…you get the point. Now, Alexa is making house calls for your older loved one. This past week, Amazon rolled out new software tools that are Alexa-compatible to help people at home communicate with their providers. Think about mom or dad now able to let their doctor know that they are able to get up and about at home following their surgery. Or they can report that they are having very little post-op recovery pain or that the infection seems to be under control today. That is all well and fine, others would say, but that patient feedback is strictly confidential. The good news is that Alexa communicates with your loved one’s health care provider … just like a healthcare provider. That is, the communications from home to hospital are HIPAA-compliant. The software developers have built in protections so that what is communicated by way of Alexa or Siri or Amazon or Google stays confidential. Amazon specifically is keeping tight control on who can use the platform with only six companies so far having received access. It used to be that “telemedicine” was via phone connectedness…and then via computers, but now it is just a voice away with an in-home set of ears sharing everything with a health care provider. Soon enough, those who cannot ambulate as easily or drive can order their prescription refills through Alexa. Developers are also at work to develop software that can understand medical records as well as ask the right questions of patients at home to help keep medical status current for the humans at the clinic who wish to check up on patients in their homes. There is more:
- Cigna has a system available to its large national clients so that they can better manage their health and wellness goals;
- Express Scripts allows for prescription renewal as well as tracking progress as the pills get delivered home.
- Another health system enables a home device to enable residents to identify the nearest provider with appointment availability when needs arises.
- Another digital health company interacts with people in their homes to manage chronic conditions like diabetes.
I cannot help but imagine Alexa helping that diabetic patient at home by monitoring their cookie and ice cream purchases…maybe tech gone too far? 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.
Back in May I posted about how May used to be called National Geriatric Care Manager Month, but with a change in our association’s name it has become National Aging Life Care Professional Month. People have asked me what has changed, and I am reminded of a columnist here in Chicago who used to write for the Sun-Times, but switched over to the Chicago Tribune when the Sun-Times changed ownership. When people asked him what he changed with that move, Mike Royko replied, “My socks!” Aside from the fact that “socks” are not my idea of a fashion statement, I would have to echo what Royko said those many years ago. Aging Life Care Professionals – you can still call us Geriatric Care Managers – still deal with the aging person and their families and the challenges of aging. I say families here, because almost invariably the person who gives us a call is the adult child of an older mother or father…or uncle or aunt…for whom they are a caregiver. And what weighs upon that caregiver most heavily is not just a medical diagnosis, but a quality of life issue. So we most often are focused on reducing the worry, stress and time the caregivers must take from their day jobs…or their family lives…or their personal lives. So what does an Aging Life Care Professional actually do? The short answer is: Whatever it takes. But let me elaborate; it is the same as we formerly did under the label Geriatric Care Manager: • Assess and Monitor-does the older loved one’s current home and their current capabilities work together, or are we seeing the kind of rehabilitation from a fall or illness that we should rightfully expect? • Plan and Problem-Solve-if home is no longer a good fit for the older loved one’s capabilities, what can be done to make it so or what are the alternatives to the current environment, or if an older loved one’s medical condition is not responding to current treatment, what are the options? • Educate and Advocate-when an older loved one does not feel they can ask their physician the important questions or when the living facility is not delivering appropriate care or service, who should be informed and who will stand up for that person? • Coach Families-this is most families’ first time down the path of aging, and a professional with training and experience can help everyone find optimal solutions and facilitate the best outcomes. • Option Making-and as I always tell our clients and our staff, we are not the decision-makers; we are the option-makers for the decision-makers. Charlotte Bishop is an Aging Life Care Professional and 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.
There is an epidemic going on, and it involves that butterfly shaped gland in the neck call the thyroid. Since 2002 the prevalence has doubled in the US, but this is not because twice as many people have developed hypothyroidism as it is that the professional society that represents endocrinologists established new standards. The new standards for defining hypothyroidism have reduced the TSH (thyroid-stimulating hormone) range to be .3 to 3.0 from the earlier standard that had been about .5 to 5.0. And this is not just a trivial matter of definitions when what had been about 15 million people with hypothyroidism suddenly becomes about 27 million Americans. This is about one in ten Americans, and the prevalence of hypothyroidism is about twice as high among women over 60 years as it is for their younger counterparts. (Just for what it's worth, this is more people than the number diagnosed as diabetic in America.) Hypothyroidism is important also because there is a big connection between the thyroid gland in your older loved one's neck and their brain and heart. For anyone whose TSH levels are out of range, the impact on the heart would be through the potential for significantly elevated cholesterol levels. It is estimated that this could be as many as 10 million Americans. So, for people whose thyroid condition has not been diagnosed, but they have been put on lipid-lowering agents like the statins, their cure may be even easier. By taking a thyroid supplement, suddenly cholesterol levels may become better managed. Yet, fewer than half the adults with diagnosed elevated cholesterol levels in a recent survey were aware if they had ever been tested for elevated TSH levels. I had mentioned the brain connection, and there are two significant brain manifestations of hypothyroidism. Patients who are out of range on their TSH levels may be depressed or they may display signs of delirium. The former may have led to treatment with antidepressants, treatments that may now prove unnecessary, and the latter may be confused with dementia if the delirium goes unchecked over time. And there are other symptoms of hypothyroidism that you should be looking for if you are a caregiver to an older loved one: • thin, brittle, dry hair or skin • increased sensitivity to cold • fatigue • muscle or joint pains • constipation. You don't need to remember all the signs and symptoms of hypothyroidism, but you should remember to ask your loved one's physicians at the next annual physical what your loved one's TSH level is. If the number is too high or too low, begin advocating for help to avoid the other conditions. Yes, your loved one may take home one new prescription, but they also may get rid of one or more existing prescriptions...and feel a lot better. 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.