senior care services

Medicare Doesn’t Cover WHAT?!
Gregory Peebles is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP) and trained Medicare Counselor, whose work focuses...
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June 18, 2018
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In the Caregiver's Words

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Osteoarthritis (OA) is the most common source of disability in older adults. Specifically, it is OA centered on the knee that debilitates more older adults than any other single condition. Why? OA takes time to develop and those adults who make it to an older age have had the time to get there.

We are all born with shock absorbers on the bones that have articulated joints - that is, the bones that connect to other bones. Those shock absorbers are the soft tissue at the ends of joints that keep the long bones of the leg, for instance, smoothly joining together as we walk, run, jump and more. With the passing of years and the mileage we all accumulate the cartilage begins to wear down and perhaps entirely erode away. When that finally happens we have bone on bone instead of the formerly soft tissues meeting soft tissue, and the resulting friction causes inflammation and ultimately debilitating pain.

While there may be no cure for OA, there are steps short of knee surgery that can help the older adult you may know who has that popping, grinding, painful knee. They should see a provider, typically their primary care physician, who then likely will refer them to an orthopedic surgeon for definitive diagnosis with an XRAY. If the referral physician determines that surgical intervention may not be needed there are options that can be explored.

The treatment options that can be discussed with the care provider include:

1.    Exercise - in cases where building up the muscles surrounding a joint may take some of the pressure off the bone, this may be one of the easy fixes.

2.    Physical therapy - it may be helpful to have a professional who specializes in the mechanics of the body put your older adult through the paces and/or introduce other interventions like heat, cold or more.

3.    Diet - if a person is sufficiently above ideal weight, simply losing some of that excess weight (I know "simply" may be a stretch) can make a dramatic difference in how much pressure the joint receives.

4.    Injectable medications - using any one of a number of anti-inflammatory agents injected into the joint can sufficiently reduce the inflammation and a patient will see a marked relief in pain.

5.    Assistive devices - in some cases a different shoe or a modification to the shoe may make a huge difference in how walking transfers (or does not transfer) its impact up the leg or using a cane can help.

6.    Oral medications - There are prescription and over the counter (OTC) medications that can provide relief from the pain by reducing the inflammation; these are called non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, naproxen sodium and others.
So, if you have noticed the older adult for whom you are a caregiver gives that telltale wince when they stand or climb stairs, it may be time to accompany them to a visit to their provider; bring your list of options with you. 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.
I did not start out as a geriatric care consultant although I have been one for nearly 20 years. I actually started in care management helping injured workers, but it seems that life has come around full circle with an increasingly older work force. Larger percentages of workers are staying on the job beyond what had customarily been the "retirement age" of 65. Yet, today's older worker does not fit some of our historic expectations. The National Council on Compensation Insurance (NCCI) has offered some new research that may surprise a lot of people, especially those who claim that older workers will be more prone to costly injuries. The research showed, for instance, that workers under age 35 had more finger cuts than those over age 35. But workers over age 35 reported more cases of carpal tunnel syndrome or neck injuries than younger workers. This generalized to a lot of what are referred to as repetitive stress injuries like rotator cuff injuries. Even so, the differences were not very great in these latter categories. There also has been a pervasive notion that older workers' injuries will be more expensive than those of younger workers. Well, that depends on what you term "old." It turns out that workers under age 25 do have less expensive injuries with less time lost from work than those older, but it would probably be a stretch to suggest that a 30 year old employee is an "older worker." Moreover, once a worker hits age 35 and up, the costs of their injuries and the time lost from work are very much on par with much older workers. The researchers also found that the best way to reduce injuries and their costs is not to hire 30 year-olds, but to train workers in safety and to report injuries immediately when they happen. And there is one more similarity between the older worker and their younger counterparts, and it has to do with family responsibilities. We all expect younger, married workers to have family responsibilities they juggle with their workplace commitments, but older works are also jugglers. In their case, however, they are trying to manage caregiving responsibilities for older parents along with their maintaining on the job performance. And, of course, some of the "younger, older workers" are sandwich generation workers with kids at home or in college as well as parents who need help. No surprise, then, that an increasing number of our clients are not just the individual caregivers, but also the employers for whom they work who are looking to take some of the stress from their "older workers" by offering our services as a resource and support. Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric care consultants, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
Everyone's abilities and needs change as they age, but home may still be the same physical space it was twenty or more years ago. It's important not to wait until there is an accident to make changes that can help accommodate an older person's changing needs. It is easy to get ahead of where you need to be by presuming that the decision is about whether the best place for a loved one is home or an assisted living facility, a skilled nursing facility or some other new residence. I wrote in my last blog about the basic categories of "activities of daily living" (ADLs) that help us evaluate how a person is caring for themselves. The ADLs are hygiene, continence, toileting, dressing, eating and transferring. As a GCM, I often do what you might call an audit of the older adult's home while they are there. In that audit I look for signs of what they can and cannot do for themselves and what may pose hazards given their abilities.

Take for example, hygiene. Even a cursory observation can tell you if the older person has bathed or shaved recently, if their clothes are clean, etc. It can be as easy as securing the services a home care aid who can be present in the mornings or evenings or even just a few times a week to help with personal grooming or showering. Dressing is linked to this, and it may be that more frequent visits may prove necessary, because the older individual's range of motion may be limited making it difficult to get easily in or out of clothes.

With continence, it may be the family who may notice that there has been "an accident." Remember, however, that this is highly embarrassing to the older adult. They may even be embarrassed to purchase adult diapers at a store. The fix may be as simple as making the purchases discreetly for them. Toileting itself may become difficult owing to diminished dexterity. Grip bars in the bathroom as well as an elevated seat for the commode may be in order. You can also assess how well the older adult is able to feed themselves by either seeing them at the dining table or just look at the front of their clothes for evidence of spills. Or are they not eating or losing weight? They may need someone to prepare nutritious meals, because it is a real pain to cook only for one.

Finally, if just getting around the house has become a challenge to the older adult, watch their gait. Do they shuffle or are they unsteady? Get rid of scatter rugs in the house; they are a fall waiting to happen. Consider grip rails along hallways or a walker for getting around. I have an 84 year old client who had broken a hip, made it through rehab, but did not want to be seen using a walker. What won her over was finding a sleek machine in hot red that looked like it belonged in the Tour de France. She is not using a walker now; she is showing off.

We have resources listed on our site, but think about calling on a local home care agency for personal care, Meals on Wheels for food preparation or look for a durable medical equipment distributor for a walker. Hire a handyman to refit the bathroom or halls with grip bars, put bigger handles on kitchen cabinets, build a ramp for the stairs and more. You don't hire a Geriatric Care Manager to do this, but we can spot solutions to needs you may not see and know the resources that you may not know.

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.
We have all heard that pride goes before a fall. It turns out that feeling down often precedes falling down as well…at least for older adults. For a number of years, there has been a well-founded suspicion among health care providers that some drugs are just bad for a person’s balance. It’s a noteworthy side effect. And, of course, add those medicinal imbalances to an older physical frame, and some unfortunate accidents can happen. Most notably, it is the fall that results in a hip fracture and the difficult recovery that represents to an older loved one. Researchers in Sweden have found that the chances of a hip fracture are about three times greater among 65+ year old patients on antidepressants versus those not on these medications. Closer examination over the period preceding diagnosis through actually receiving a prescription, however, revealed something that came as a bit of a surprise to doctors. The period before a patient actually begins taking a prescription for their depression actually has an even higher risk of a fall, so it evidently is not all about what just the medication can do to the patient. In the 16 to 30 day window while a patient is depressed, but before they are taking a medicine for it, they are nearly six times more likely to have a fall than non-depressed patients. The month preceding that was the second highest risk…about four times that of non-depressed patients. What encouraged this research in the first place was the noteworthy presence of depression in hip fracture patients in hospital and recovery. While getting through the hip fracture and rehab, physicians in Sweden had noticed the relatively high prevalence of depression. This was not entirely uncommon for an older, sometimes frail or isolated population, but as they dug deeper they found that depression may have actually been a contributing factor to the fall. Also important in predicting fall risks was age. The older the patient, the higher the risk. Men also were at greater risk for a fall than women. The researchers also note that there likely are multiple factors at work for any given person, but depression should be a red flag nonetheless. If you have an older loved one, you should be sensitive to changes in mood…as a healthy approach all by itself. Now, you know it is also a way to look out for their fall risk. Please pass on the attached diagram about safe walking…and also encourage anyone who has more than their share of seasonal blues to see a professional. That office visit may be the step that keeps them on their feet. 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.
This month I have been posting exclusively about Alzheimer’s because November is National Alzheimer’s Disease Awareness month. Most of us probably know someone who has been diagnosed with the condition, a condition that sees a new diagnosis in America once every 67 seconds. If you know anyone who is a caregiver to a loved one with Alzheimer’s disease you also know that the caregivers are losing sleep with the stress that Alzheimer’s can represent. But who would have thought that losing sleep itself can be a cause of Alzheimer’s? Researchers in New York have recently published their findings that show a distinct correlation between obstructive sleep apnea (OSA) and the accumulation of plaque amyloid in the brain. At first, the researchers had to seriously question whether the Alzheimer’s promoted the sleep issue or if the sleep disturbance could exacerbate the progression of Alzheimer’s. They divided a group of 55 to 90 year old adults into groups with no sleep apnea, those with mild sleep disturbance and those with pronounce obstructive sleep apnea. They followed these individuals for two years taking regular measures of the amyloid deposits in their brains through PET scanning as well as their OSA intensity through monitoring. They found that those with the more advanced sleep issues developed statistically more deposits of amyloid on their brains over time. The modest good news here is that not everyone who develops amyloid deposits is doomed to cognitive decline…it is not quite so linear. But people with more advanced Alzheimer’s symptoms also tend to have more amyloid plaque deposits. These scientists continue to work on this association, because while Alzheimer’s has no proven treatment to alter the decline in cognitive function, sleep apnea can be treated. And slowing the progression of a disease with no present cure by addressing OSA is a win. It is also important to take sleep apnea seriously, because it is not just the rattling of the rafters for the poor bed partner; it is a medical issue with implications for brain health. Please check my interview with Eric Horng of Chicago's ABC7 Sunday morning, November 12. We discussed what caregivers in the midst of a crisis can do ... for themselves! Please check it out on this link. 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. It is available through Amazon. But if you would like $10.00 off the Amazon price, I invite you to follow this link: and apply the discount code: ZH3VK3U6.
Scientists have long known that Alzheimer’s Disease has a hereditary component, but new research suggests the predisposition is more often passed on from the maternal side than from the dad who has had Alzheimer’s. This, according to research reported in the March 1, 2011, issue of the journal, Neurology.

One of you who are following my blog had asked about Alzheimer’s recently, so the timing could not have been better. As a geriatric care manager, I often counsel sons and daughters of elder parents who have been diagnosed with Alzheimer’s. I now will tell them that in addition to age of onset, gender of the older parent also is a factor when considering one’s own future. But I can also report that there is very good reason for hope.

The researchers whose work was published studied 53 mentally healthy individuals, some of whom had a mother diagnosed with Alzheimer’s, some with a father diagnosed, and most with no history of the illness in their families. These patients had a baseline MRI at the start of the study to measure how much brain atrophy they had in the key areas of the brain associated with memory, areas that Alzheimer’s compromises. The same individuals also had MRIs two years later, despite the fact that none of them showed any outward signs of cognitive impairment at either time point. The researchers found significantly more brain atrophy among subjects who had a family history of the disease, and particularly if it was from the mother’s side of the family.  The researchers admitted that they had to depend on their subjects’ own reports of parents’ medical conditions, and they also acknowledged that they need larger studies to have greater confidence in these results.

So, what does a person with a mother with Alzheimer’s do? Well, with all the research presently focusing on Alzheimer’s these days, the person in this position should be optimistic. The same researchers who suggest a maternal link to Alzheimer’s have reported on the positive effects of cardiovascular exercise on affected patients. Regular exercise, they report, is associated with less atrophy in the areas of the brain most affected by Alzheimer’s. It does not have to be really strenuous exercise to see this benefit, and regular cardio-respiratory exercise is better than the “weekend warrior” version exercise. The researchers also reported that people already diagnosed with dementia had fewer falls and improved quality of life when they followed a caregiver-directed home exercise program.

Results like this and others are promising. They show that clinicians are getting a bit better at predicting and diagnosing Alzheimer’s as well as slowing and limiting the frailty so much associated with Alzheimer’s Disease. I encourage you to go to the Alzheimer’s Association web site for more useful information if you or someone you know is a caregiver to an older adult with Alzheimer’s.

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.

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