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Scammer v. 23.1
Call it Ocean’s 65+…instead of Ocean’s 8 or Ocean’s 11…but it doesn’t have a caste of Hollywood stars, and...
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March 7, 2023
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Another Side to the Story
It was just a year ago that Bruce Willis’ family disclosed that the actor would be retiring from acting...
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February 27, 2023
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Ain’t No Sunshine…
…When She’s Gone.” Or how about, “You are My Sunshine, My Only Sunshine?” or “Here Comes the Sun?” or...
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February 21, 2023
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How to Say ‘NO’ to Dementia
It was about two and a half months ago that we posted about the diagnostics telling Chris Hemsworth he...
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February 14, 2023
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Long COVID’s Long List of Symptoms
The COVID pandemic is not yet done with us in the United States, and the story certainly is different...
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February 7, 2023
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Happiness is a Long-Term Investment
If I were to ask you to make a New Year’s Resolution for your own happiness, what would your...
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January 17, 2023
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To Sleep, Perchance to Dream
No, this isn’t a refresher course on Shakespeare and the famous Hamlet soliloquy. (Spoiler Alert – Hamlet was ranting...
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January 2, 2023
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A Viral Trifecta?
To get to the question in the email first, the Spanish flu of 1918 did not get its start...
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December 13, 2022
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One More BIG Addiction?
If you’re old enough to remember 1969, then you are old enough to remember this bold addition to the...
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December 6, 2022
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Would You Want to Know?
National Geographic has a new documentary series, Limitless with Chris Hemsworth, starring, of course, Chris Hemsworth of Disney’s Marvel...
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November 29, 2022
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In the Caregiver's Words

Recent Client Praise

As a caregiver for an older adult you cannot prevent a medical emergency, but you can prepare for one. Even if you are a distance caregiver, you will find that you can have your elderly parent help in preparing an "emergency kit" just in case. As a provider of geriatric care management services, I help families with whom I work to customize their preparations to the particular health needs of the loved ones. For starters, both a caregiver and an older adult should have what I refer to as the "grab and go list." Should there be an emergency, both of you should have a list which may include the following information or photocopies of important documents:
- identification like a social security card, passport or drivers license
- health insurance cards, both Medicare and any secondary carrier
- recent medical summaries or immunization records
- a list of current records or prescriptions
- a list of important contacts with phone numbers
- veterinary records if your loved one has a pet
- wills, advanced directives or powers of attorney
Because the emergency may not be medical, but instead may be a natural disaster, it is a good idea to have the grab and go kit in a waterproof container and/or fireproof safe. For the same reason, if you are a distance caregiver, it is a good idea to also have on hand the names and phone numbers of neighbors or friends who could be called to check on your loved one. If you have not met these individuals, use your next trip to see your loved one as an opportunity to also introduce yourself to these friends or neighbors. It will make any later, long distance communication a lot easier. Again, thinking about a natural disaster, help your loved one devise a home escape plan should they have to leave home quickly. And have at least two escape plans should the reason for escape be the sort of disaster that can damage the structure of a home, like a tornado, hurricane or earthquake. Help your loved one also to have a plan for sheltering in place for emergencies like a tornado or hurricane. Especially in the case of the latter, you should also have a set aside cache of fresh water, dry goods, a flashlight, battery-operated radio, whistle and crowbar in the event the emergency lasts for more than a day. For more details about specific responses to natural disasters, go to the FEMA web resource (http://www.ready.gov/). For more advice on preparing for - and facing - medical emergencies, this is a good resource (http://emergency.tufts.edu/guide/medical-emergency/). 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. We provide geriatric care management services to those in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
For a pandemic and quarantine that has lasted about 18 weeks, it is safe to say that most of us are really feeling just a bit ready to be done with it, right? One would think that also means that by now, we will have heard it all, seen it all and know it all, right? Sorry to say that the answer is “yes” to the first one and “no” to the second one. Let me share some facts that are part of what I would call the emerging story of COVID-19. Test – We are still faced with limited testing for COVID-19 in most parts of the country. But if you are looking to be tested because you feel symptomatic or are worried that you have been exposed, be prepared for potentially very long waits and know that you likely will have to have authorization signed by your provider. And check with local Public Health officials for free testing sites near you. Model – Some of the evolving opinion on how we need to handle this unprecedented pandemic suggests that an example that can guide us is how we eventually came to manage HIV/AIDS: testing, contact tracing, treatment and changes in behavior. We are hopeful to add to this a vaccine for COVID-19, but without one, the first three are key to bring the numbers down. ZOOM – is a great way to keep in touch while maintaining safe distance, but treat this also like phone calls or home visits when it comes to family. Set loving limits on the time you spend, especially if you already are aware boundary issues with a parent. It’s complicated. Read – We are not plugging a specific retail source here, but consider supporting the local bookstores still remaining who are suffering from no foot traffic or browsers. Go to their web sites. There are also great sources for e-books such as your local public library or a site called Book Bub. Move – More important than ever get your daily step quota in…and more. Set yourself new goals for upper body strengthening or perhaps consider a diet. I heard some good advice from a professional I know recently. Don’t think of it as losing weight, because you will be tempted to quit the diet and go find the weight again later. Think of it as “releasing the weight.” Health – Don’t skip your medical appointments, even if they call it an “elective procedure.” Also contact your provider to see if they offer telemedicine alternatives. You ZOOM family and friend; why not get face time with your provider? Treatment – We are not there yet. Hydroxychloroquine still does not have much support for efficacy, and it can increase QT Prolongation, a heart abnormality that is dangerous. Kaletra, an anti-retroviral used to treat AIDS, shows no efficacy yet and can cause pancreatic inflammation, liver problems and bradycardia in the heart other side effects. Remdesiver offers a better picture with very recent clinical data showing a 62% greater chance of survival than current standard of care treatments. The BCG tuberculosis vaccine also shows some promise in helping COVID patients survive. You. I write often about how important it is for the caregivers to care for themselves. That’s another way of saying “it’s okay to care for you.” Put yourself at the top of each of your “to do lists.” Because – as I have said also – if you do not take care of you, who will? So, please move this one to the top of this list also! 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.
With a lot of talk these days about children moving back in with parents and intergenerational homes, it is easy to overlook the huge growth in “distance caregiving” in America. In 1997 the number of distance caregivers - family who are caring for an older parent in another location – was about 7 million; it has since doubled to an estimated 14 million today. I came across a study on distance caregiving by a nurse oncologist, Polly Mazanec, that addressed a lot of the issues I see as a geriatric care manager with my own clients.

We often get a call from a son or daughter (and yes, it is more often a daughter), because they are concerned about some life issue of an older parent who still resides here where we work. It can be a change for the worse in a chronic medical condition, a sense that the parent is “confused,” a progression of a cancer, a fall or a home security concern. But almost without exception, the distance caregiver clearly sounds stressed. When I talk about “distance,” there is no magical number of miles to be distant, if it is perceived as distance then that becomes stressful. Distance can be measured in miles, but if the caregiver has a strenuous workload or is the sole wage earner in this recession or has family obligations in their own home, the ability to make frequent trips to help mom or dad is limited.

Caring for an older parent from distance is stressful, because there can be a long interval between visits or a most recent visit has shown visible changes in mom or dad or there has been a change in treatment regimen that the distance caregiver does not understand. And the medical change actually can be more stressful for the distance caregiver than for the patient. The stress comes as much from anxiety and guilt than it does from concern for the elder’s well-being, a stress owing to having “not been there to help."

Based on our experience, I offer some suggestions for long distance caregivers:
1. Help with the things that can be done at distance - arrange for meals to be delivered, housekeeping details to be attended, a checkbook balanced, in-home help to be present, or a neighbor to look-in at intervals.
2. Appreciate that being an adult yourself may not release you from the way you related to your parents back when you were a child at home - give yourself permission to help as you can without feeling guilt about not being there.
3. Enlist the help of a local advocate - this can be a nurse clinician at the doctor’s office or a geriatric care manager, but it is helpful to have someone to monitor and manage and then inform you.
4. Acknowledge that hands-on is not the only kind of care; distance caregiving can be a very important part of the village it takes to care for an elder or other person with special needs.
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.
Today’s guest post comes from David Tuggle, a Central Illinois attorney with the firm of Tuggle, Schiro & Lichtenberger. They focus on Social Security Disability law and Personal Injury. In 2004, colleagues ranked him in the top 5% of attorneys practicing in those areas. You might spend most of your life thinking about Social Security as a deduction from your paycheck, a massive government program and a retirement income supplement. When you face the challenges of arranging senior care for a family member, however, you should know there is much more to it. The Social Security Administration (SSA) has two distinct programs designed to help people stay afloat economically when they have disabilities that prevent them from working. Those are the Social Security Disability Insurance Program (SSD) and the Supplemental Security Income Program (SSI). It’s understandable if navigating these programs feels overwhelming. Social Security, after all, is a vexingly large and complex system. The SSA reported granting $883 billion in benefits to 60 million Americans in 2015. But to bring you clarity on what might help a family member with disabilities, let’s break down the differences between the SSD and SSI components of Social Security. Social Security Disability The SSA provides relief to people knocked out of the workforce by the onset of disabilities through its Social Security Disability program. The crucial distinction here is that SSD is for people who have worked and paid into the Social Security trust fund. Having those paycheck deductions means you’ve paid for this insurance. You qualify based on how long you worked and paid into the system. The required length of work varies with your age. You also have to show that your medical condition will last at least a year, or that it will lead to your death. In 2015, the SSA counted 9 million beneficiaries in the program. It also covered 2 million dependents of people unable to work because of disabilities. In total it spent more than $11 billion. The average monthly payment was $1,166. It might not sound like a lot of live on, but it can provide incredible reassurance to someone who can’t work. And that’s a situation the SSA warns many of us could face. In its informational materials, the SSA says, “Disability is something most people don’t like to think about. But the chances that you’ll become disabled probably are greater than you realize.” The agency projects more than a quarter of current 20-year-olds will experience disabilities by the time they turn 67. And a wide majority of the private sector workforce – 67 percent – has no other long-term disability insurance. Supplemental Security Income Program The SSI program, meanwhile, is designed for people with low income and few resources or possessions, so it’s not tied to work history. It includes several guidelines to determine if your income and assets are small enough to qualify. The federal government uses general tax revenues – not those Social Security paycheck deductions - to fund it. SSI provides monthly payments to people with disabilities, people who are blind and those who are 65 or older. It pays a set monthly amount, which currently stands at $733 for an individual and $1,100 for a married couple. The total cost is estimated to be almost $60 billion a year for 8.2 million recipients. Many states also provide supplemental benefits. Those amounts vary by state. Finding your way through the SSA system If you are navigating these programs, it can be daunting. With SSD, for example, most people get denied when they first apply. The SSA has a four-step appeals process that can lead to better results, but it’s not unusual to face months-long waits. If you’re working through this process for yourself or a loved one, having an expert who knows the system can ease your efforts. And along the way, you will learn a lot about how Social Security is much more than a national retirement plan. 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.
Guest post author Gregory Peebles is a team member at CCM whose work focuses on helping aging adults and folks with limited independence by navigating 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 I know I'm not the only one who would rather not talk about abuse. Wanting to avoid difficult conversations is natural. Unfortunately, the social discomfort surrounding abuse makes a space for abusers to thrive unquestioned. So, if you have a dependent older loved one, now is the time to take stock. Since COVID-19 is a part of our daily lives, the physical distancing necessary put in place precisely to protect vulnerable older adults makes abuse even easier to perpetuate. Now, with fewer eyes watching, there's even less fear of consequence than before the pandemic. This article will discuss the nature of abuse and the identity of abusers while offering professional experience across three common abuse scenarios: “The New Friend”, “The Family Secret”, and “The Forgotten One.”

The old slogan holds true: "Hurt people hurt people"...

Abusers: Who Are They? Once a person has made the decision to continue the cycle of abuse, they've relieved us of making excuses for them. Still, the old slogan holds true: "Hurt people hurt people", so it's no secret that many abusers are themselves victims. Unfortunately, there's no such thing as one real "give away" regarding an abuser's personality. The sad truth is that abusers can seem to be very normal people. Even sadder is that abuse often comes from the very people victims love. The statistics tell us that older adults experience abuse from spouses or adult children at a rate at least as high as older adults in institutions experience neglect or deliberate abuse[1]. A Sneaking Suspicion Now that you think of it, maybe an older person you know might be a victim. Something has been off, but you can't quite put your finger on it, and no wonder. You're not an abuser, so you don't know what abuse "looks like" with older adults. Abuse manifests in as many ways as there are abusers, but here are some common warning indicators.
- Physical - bruises, grab marks, sprained or broken bones, skin burns; otherwise, disheveled appearance, poor hygiene, or weight loss
- Emotional - withdrawal, listlessness, lack of interest; conversely, can exhibit increased anxiety or irritability
- Financial - sudden changes in spending, request to change financial guardianship, or request for additional funds for/from caregivers
If that checklist didn't give you any pause, that's great news. However, The Word Health Organization (WHO) reports that as many as 1 in 6 older adults is a survivor of one type of abuse or another², so unfortunately, that doesn't mean that your older loved one is absolutely safe. I mean, surely, they would tell you if something were wrong, right? Well, not necessarily. As frustrating as it might seem, older adults don't necessarily disclose their abusive situations, most often because: As frustrating as it might seem, older adults don't necessarily disclose their abusive situations, most often because:
1. They have compromised agency of some form (i.e., dementia, etc.);
2. They depend on the abuser for care/financial assistance; or
3. They have attempted to disclose and been conversationally redirected.
These three reasons for non-disclosure correspond directly to three fairly common scenarios of abuse:
1. The New Friend (compromised agency);
2. The Family Secret (dependency); and
3. The Forgotten One (redirection).
We're going to look at each of these quickly and consider their specific warning indicators. Let's look at some "real life" examples. (All names have been changed, and some details altered slightly to protect the victims.)

"I mean, surely they would tell you if something were wrong, right? Well, not necessarily."

The New Friend Ed, a 62-year-old retired banking exec in the developing stages of undiagnosed dementia, met Tanya (36) a few months ago on a dating website. He doesn’t mention Tanya to his family at her request. She says she didn't want to cause any trouble for him because of the difference in their ages. Ed, lonely for the last four years since the death of his spouse, falls quickly in love with Tanya, who doesn’t seem to mind the whirlwind relationship at all. In a casual phone call, Ed mentions to his oldest daughter, Susan, that he is happier than he can remember being with Tanya, whom he accidentally calls by his late spouse's name. He has hope for the future, and he wants to marry. Susan, shocked to hear about marriage in the first conversation regarding Tanya, asks to meet Ed's new friend. Tanya agrees, but regularly cancels scheduled virtual meetings; meanwhile, Ed's lawyer calls Susan because Tanya contacted him about changing Ed's will. She wants it done as soon as possible. Susan obviously wants Ed to be happy, but she knows that this is a problem; however, she has absolutely no idea how best to respond. She doesn't even realize yet that this is an example of abuse. Ed is an easy victim, because his abuser has rightly assessed that Ed, who is lonely, is also not entirely in control of his cognition. For Tanya, Ed might as well have been carrying a flashing sign. In the world of the pandemic, new, non-virtual friends may not be as common, but anyone with an Internet connection can continue to socialize virtually, and the Internet is a place where it's easy to be in disguise. Older adults connected to the Web are at as great a risk of this type of abuse as before in non-virtual space. Luckily, Susan already has a relationship with a lawyer, so she can begin the process of securing Ed's estate against the abuser's attack. But it's not going to be easy. This type of relational, emotional, and financial abuse is particularly insidious because it can turn the abuse victim against the people trying to protect them. It's not always easy to talk to older family about love and sexuality, but asking uncomfortable questions can stop this kind of abuse before the grift is a score.

Denise regularly calls her mother names. She also leverages care to control Anne's behavior with phrases like, "If you don't stop complaining, I won't come back tomorrow, and we'll see how much you have to complain about then."

The Family Secret Denise (52) has cared for her mother, Anne (74) since Anne fell down the stairs leading into the garage, leaving her mostly immobile. If it weren't for her only local daughter, Anne would already be impoverished paying for the required care. Unfortunately, Denise has come to resent her mother deeply for the level of care she needs. Denise regularly calls her mother names. She also leverages caregiving to control Anne's behavior with phrases like, "If you don't stop complaining, I won't come back tomorrow, and we'll see how much you have to complain about then." When other family members occasionally call to check up on her, they notice that Anne, who was quite opinionated before, always carefully chooses her words now. They notice that she is effusive in her expression of gratitude for tiny things like a phone call, or a card. When asked about Denise, Anne quickly says how thankful she is for Denise's help and just as quickly, perhaps even a bit more noticeably, changes the subject. It isn't until Denise makes an accidental call to another family member where she can be heard berating Anne for needing care that Anne's situation changes. To admit to being victimized by a person's own child is a wound to the heart, but unfortunately, Denise and Anne's story is not at all uncommon. The speed with which a family caregiving dynamic can turn abusive is shocking. Either because, like Denise, the caregiver resents their position, or even because a child may find the time ripe for taking emotional revenge from a perceived wrong decades ago, family caregivers of dependent adults must understand that exploiting the power dynamic between the caregiver and care receiver is a recipe for a batch of poison that will sicken anyone it touches. The Forgotten One Tim (60), who is disabled, has been in and out of care institutions his whole life. He's used to "going it alone", and he's used to having to wait long periods of time on someone to help him accomplish something simple, like toileting. The assisted living facility where Tim currently makes his life provides basic assistance for their residents, but the staff regularly verbalize where Tim can hear it that they find Tim's care to be too much trouble. Tim tells the staff director, but he is rebuffed. When the pandemic is announced, facility caregivers feel empowered to decide that they will help Tim as little as possible, the result of which leaves Tim utterly neglected and completely robbed of personal dignity. When Tim alerts the caregiver supervisors, they minimize Tim's neglect and suggest that perhaps the facility is no longer the right fit for Tim. Tim's family, at distance, believe Tim's story of neglect and help arrange additional care for Tim so that Tim doesn't have to add the stress of moving while disabled to the stress of surviving a pandemic. Tim's additional help bridges the gap between the negligent staff and Tim's care needs. Going Forward The necessary physical distancing in time of COVID-19 has turned so many families into distance caregiving situations - even when the loved one is in the same city. Consequently, we see less of our older loved ones now and depend more heavily on care provided by essential workers. While we don't have much choice except to trust in a caregiver's professionalism, we can insist on and help put in place virtual systems to monitor for abuse. Some families may be able to install full surveillance services, but most of us will need more frugal solutions. The quickest way to check on your loved one is using a video call. ZOOM is a popular video conferencing application right now, but most smart phones have a video call option. If your older loved one has a smart phone, you can "FaceTime" whenever you like. Otherwise, you'll need caregivers and others in your loved one's life to help facilitate. My advice is to "switch it up" regarding the calls.
- Pick different times for a virtual visit.
- Choose different people to facilitate.
- Redistribute and reorganize expectation so that you're not helping the abuser with a regular, predictable schedule.
And finally, if anything seems off, ask directly. So many victims are waiting for someone to notice before they feel they can speak. De-stigmatize abuse in conversation so that if it ever happens, your loved one knows that you understand that it's not their fault. Healing abuse is a long process. Preventing abuse and ending abuse happen when we end the silence that comes from shame. Gregory Peebles, CSA, CDP, is an Associate Care Manager with Creative Care Management and a contemplative monastic in Chicago (CMJ). When not studying or coordinating services for clients, Gregory enjoys attending and making music at Liederstube. He looks forward to a time post-COVID when this will be possible again
[1] https://www.who.int/news-room/fact-sheets/detail/elder-abuse [2] https://www.ncoa.org/public-policy-action/elder-justice/elder-abuse-facts/
It has been a long time since we all first saw the television ad for “Help I’ve fallen and I can’t get up.” Technology has since evolved from a lifeline that a senior would wear around their neck to assure that help was just the push of a button away. Now, caregivers can equip seniors with motion sensors that can tell when a person has fallen and make the call before a button is pressed. Remarkable as these kinds of innovations can be – and there are a host of others – the best way to address the potential for older adults falling is to prevent the fall in the first place. In this first of a three-part series, I am going to first offer a checklist of fall hazards outside the home, and this will be followed by a parallel list for indoors and a final post that is about helping assure that your older adult is in the best physical condition to avoid falls. Starting with the outdoor list:
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. Learn more about What We Do and how we can help you support your loved one.