senior home care services

Mittens Before the Frost
I was asked today about the “mitten test.” It was one of our colleagues who had remembered something I...
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September 18, 2018
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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...
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June 18, 2017
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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...
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June 5, 2017
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In the Caregiver's Words

Recent Client Praise

It’s not just about being lonely. Isolation may be a bigger senior health issue than even dementia – never mind that research has shown a clinical link between these two. I had a client a few years back who responded to a question from an attendee at her 100^th birthday about how it feels to be 100 by saying simply, “Not so much peer pressure…” Now, this individual was surrounded by friends and family, but what she highlighted was the attrition of social connection that accompanies aging in most individuals. As one ages, one loses friends and loved ones and one also loses the ability to physically get out and about. As one becomes increasingly isolated, there are mental, physical and emotional correlates of the loneliness:
- Research published in 2012 showed a clear relationship between social isolation and death among adults 52 years of age and older. One cannot say that isolation kills people, but one’s chances of dying from any cause are greater if living alone.
- Research from the University of Chicago has found a clear link between levels of loneliness and poor cognitive function and even dementia risk. In other research reported in 2016 older patients with the amyloid markers of Alzheimer’s were 7.5 times as likely as those without the markers to report feeling isolated or lonely.
- The National Center on Elder Abuse adds to the bad news by reporting that socially isolated seniors have higher rates of physical or financial abuse. Are they easier targets for predators or do predatory caregivers isolate them to take advantage?
- Isolated seniors also report more of just about every chronic medical condition from COPD to heart disease, poor mobility and, of course, depression. Loneliness is even linked to high blood pressure. This, after taking into account gender, ethnicity and other factors.
Most of these can give rise to the proverbial chicken and egg arguments about loneliness as a cause of the problems or the problems themselves giving rise to loneliness. So, let’s turn it around and look at what you can do if you are one of the circle of caregivers for an older loved one. Loss of a spouse leads to isolation. Be present in the weeks and months (not just days) following such a loss to help an older loved one re-integrate into a new social support system. Transportation challenges can lead to social isolation. If you have a loved one without transportation, look for alternatives like para-vans, carpooling and volunteers. Caregivers are at risk for social isolation. Find respite care resources, lay volunteers from religious organizations and home care options to give these caregivers a break. And don’t forget the isolation of that caregiver’s care receiver. Loneliness can be contagious. Volunteering can go the other direction also. Encourage your older loved one to engage in community activities, take a class or seminar, join a club, etc. And appreciate that with these added social activities you are helping to prevent a slide into unhealthy behaviors for your older loved one, such as smoking, drinking or just poor diet. Now is the best time of all to engage an older loved one in new activities. It is, after all, the New Year. And it is the season of long and cold nights. Encourage activities that can be part of the good habits of the new year. 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.
As geriatric care managers, we provide advice, counsel, advocacy and support for older care receivers or other people with special needs of any age. Care managers, however, also provide support to the front line caregivers to these care receivers by adding our CMs eyes and ears when the caregiver cannot be present, our advice based on the experience we have that first time caregivers just cannot have and support for the caregivers themselves. This last is important, because the person most often neglected by the caregiver is they, themselves. They do not sufficiently care for themselves while they are involved in caregiving. That said, there are different kinds of caregivers, and the care they need will be different. We can make a lot of distinctions about kinds of caregivers, but one important dimension that I see a lot very simply is defined by the relationship to the care receiver. By that I mean, the difference between intra-generational caregiving and intergenerational caregiving. Let me explain. Intra-generational Caregiving. According to all the surveys I have seen, one of the most common caregiver relationships is that of one spouse caring for the other. But it also can be siblings who care for one another as one falls ill, or it can be friends, cousins, neighbors and more. These intra-generational caregivers could benefit from the greater knowledge of community resources that GCMs have, the correct questions GCMs can ask at a medical appointment, the help GCMs can bring to the caregiving to avoid harm to the caregivers. This last is especially true when both the caregiver and the care receiver are older and frail. I have seen cases in which the caregiver is injured in a fall while trying to attend to their fallen care receiver. Yet, such accidents can be avoided if a care manager is brought in to "leverage" the good intentions of a caregiver. But a caregiver may feel guilty about asking for help when they perceive they should be taking care of everything. The family needs to talk about helping the caregiver. Intergenerational Caregiving. The other common caregiving relationship is the son or daughter (most often the daughter) who is trying to be the caregiver for mom or dad. This same daughter or son, however, are also responsible for a spouse, or their own children or a job. These are the truly stressed caregivers who would benefit from a trained care manager to attend the medical appointments and to ask the right questions that will get the best care for mom or dad. They also would benefit from a very subtle form of counsel on just how to establish the new ground rules for caregiving. I hear some caregivers say something to the effect that the roles have been reversed, and now mom (or dad) is the child and they are the parent. Wrong! The roles have changed, but they have not reversed. When a child to an older parent steps up to the caregiving role, there need to be some difficult conversations about everyone's expectations and about the older loved one's dignity. A third party like a GCM can be an invaluable arbitrator, not to mention a great resource about all the options in the community that can make caregiving much less stressful and much more rewarding. As I have said in other postings, just as it may take a village to raise a child, it also takes that same village to care for all our older loved ones! 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@cr eativecaremanagement.com.
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I started in my last posting with a Q and A with John Wank, President of the Illinois Guardianship Association. He continues this second with his answers to our questions in this the second in a three-part series.

You are General Counsel and Director of Program with the Illinois Guardianship and Advocacy Commission.

What does the Commission do?

As the largest public guardian in the United States, the Office of State Guardian (OSG) handles personal or financial decisions for more than 5,000 disabled adults. Nearly all OSG wards are indigent persons, with costs of care paid by public entitlements. Nearly all OSG front-line staff are Registered Certified Guardians (RCG) under the program administered by the Center for Guardianship Certification.

Legal Advocacy Service (LAS), is the statewide public agency that provides court-appointed legal counsel and representation to vulnerable children and adults with mental illness or developmental disabilities in judicial proceedings involving their commitment to, retention in, enforced treatment in, and release from mental health care facilities.

The Human Rights Authority (HRA) ensures rights protections for persons with disabilities by conducting investigations of alleged rights violations committed against persons with disabilities by agencies that serve them.

How are our laws different?

Illinois has two kinds of public guardians. In addition to the Office of State Guardian, every Illinois county has a county-based public guardian's office. The county guardians serve in cases where the ward has more than $25,000 in assets. The Office of the Cook County Public Guardian is especially notable in advocating for its wards. See their website: Public Guardianship.

What challenges would out of state children of an older parent in Illinois for whom they seek a guardian face?

Guardianship is instituted by the filing of a petition in which the petitioner requests the appointment of a named party as guardian. Section 11a-8. If the suggested guardian is an out of state child, the court may wish to know how the child would execute an active and suitable program of guardianship, as described in Section 11a-5(a). Consequently, conducting a guardianship petition and then, serving as guardian, on a long-distance basis, may be complicated. Securing local assistance could be a desirable alternative.

What is the benefit of a private guardian vs. a professional guardian?

There are no particular benefits. Most guardianship involves family, with one family member caring for another, often with fees waived. In these cases, a family membership may be desirable, particularly where there is a long-established caring relationship and no suggestion of financial or emotional misconduct on the part of the family member. In cases where the family is unavailable or unwilling to serve, public guardians are available. Private, for-profit guardianship also exists in Illinois. In both public guardianship cases and for-profit guardianship cases, fees are generally paid from the estates of the ward, if there are any.

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 Charlotte Bishop
If you are a caregiver to an older loved one, I'll bet that one thing you probably watch closely is their behavior or demeanor. Do they remember important facts from yesterday or are they tracking what is said in a conversation? In an age when most people worry about dementia more than mortality itself, everyone is rightfully vigilant for signs of an slip in cognitive function. But what about when the caregiver cannot be there to watch? Our caregiver clients often refer to our geriatric care managers as their eyes and ears. Let me share with you two real life examples of memory issues, but when things were really not what they may have appeared to be after all. And a geriatric care manager's eyes and ears could make the difference.
1. The Dementia that was an Infection. It started like this. The distance caregiver gets the phone call that the mother was found on the floor of her apartment in an independent living facility. She seems confused and has difficulty with word formation, all signs of classic post-stroke confusion or even dementia. The patient is rushed to the nearest hospital and initial tests rule out stroke. So, perhaps it is dementia? What would you do? A care manager on the scene likely would start with dementia as a consideration, but dementia typically is not a sudden onset predicament. It progresses over time...often a long time. A care manager would ask the medical providers if they have run blood and urine tests? Have the providers done a full body check. Why? to rule out any toxic exposure or an elevated white cell count. In this case, the tests found the woman had an infection that went systemic and dramatically and quickly affected the woman' mental abilities. So, this turns out to be delirium. The principal difference between dementia and delirium is that the latter is more sudden and often transient. Antibiotics within a matter of days brought her back to normal..
2. The Renal Failure that Wasn't. This one starts with the caregivers in an independent living center noticing that the man seems very tired and does not track what is going on very well. Delirium? A care manager suggests a trip to the physician's office for a blood test. The test shows renal function that is at virtually zero. No urine is being produced. None. The physician pronounces renal failure and ships the gentleman to the hospital for dialysis, but what does the nephrologist do? The patient is put on an IV drip and quickly given a large quantity of normal saline solution, and kidney function begins to return. Within three days of the start of this rehydration kidney function is returned to near normal. In this case, the patient was a sparse water drinker, and when the condition worsened, the body's response was to turn off the thirst sensation resulting in real dehydration and renal failure. With the renal issue resolved, the care manager enlists a caregiver who will help the gentleman keep to his medication schedule AND drink four cups of water in the presence of the caregiver each day. Both of these examples came from distance caregivers, siblings whose older parent lived in another state. Both of these cases also represent one reason that a care manager can be engaged before a crisis. In both cases, had there been a trained professional routinely just "dropping by" to be the eyes and ears for the adult children of the older parent, the infection might have been caught earlier and the renal issues may have been avoided. Geriatric care managers often get the call in an emergency, and they can make a difference in how well the older adult recovers from the emergency. But if you are a distance caregiver to an older adult, you should also consider having a GCM be the eyes and ears present when you cannot be. You might just find that having a sister in Chicago is a great addition to the family. 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@cr eativecaremanagement.com.

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