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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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:
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.
This is the third in a series of posts on dementia in advance of the release of my new book, How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia. It will be released through Family Solutions Press of Los Angeles and available from Amazon the week of July 17. We will keep you up to date on details. Who are the experts on dementia? There are some incredibly useful on-line resources that families with an older loved one suffering from dementia can turn. We offer a lot of wide-ranging resources in our book, but here are the links on a couple of the more outstanding among them. Consider these national resources available to support the individuals who may need help when dementia rears its head. In these and other resources, there also are local or regional chapters that can be that personal touch that makes such a difference.: 1. Alzheimer’s Disease and Dementia Caregiver Center is an arm of the Association that has done the most to help patients with the disease as well. The Center provides training and other resources to caregivers as well as a 24-hour telephone hotline. http://www.alz.org/care/alzheimers-dementia-support-help.asp 2. Aging Care offers answers and support from those caregivers who also are facing the challenges of caring for a loved one with Alzheimer's or Dementia. The site allows you to “ask your questions and get helpful answers from caregivers, and memory care experts.” They also offer a free guide, "Life as an Alzheimer's Caregiver". The guide draws upon the experiences of elder care experts, caregivers to those with AD and patients themselves https://www.agingcare.com/Alzheimers-Dementia/Questions-1 In my book, we cover what we know about dementia, what can be done to stave off the effects of dementia and most importantly what caregivers can do for their loved ones with dementia and for themselves. We also offer a lot of resources, amny of them accessible on-line. 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.
If you are a caregiver to an older, qualified loved one who has not yet applied for Medicare, then December 7 is looming large for both of you. Or if you are a caregiver whose deadline is not this year, but is next year, then it is time for a crash course in what Medicare covers and what parts do what for your older loved one. You can refer to the basics as the ABCs, but you also need to add a D. The rest gets easier. Medicare Part A very simply is the part of the federally-sponsored plan that covers hospitalization for those enrolled. For all those over age 65, this is the longstanding part of the coverage that has no premium to be paid and covers what Medicare will pay to providers for inpatient stays. This is the easiest part, because you will not find too many hospital providers who do not accept Medicare's inpatient coverage. These outsiders are pretty much just military or VA hospitals along with the Shriners' Children's Hospitals. Medicare Part B covers generally the doctors' billings and outpatient care for those who are age-qualified and have enrolled, and it costs about $104.90 a month to enroll. But - and this is a critical but - the providers in these settings have to "accept Medicare assignment." In large part, because Medicare has such strong negotiating power, not every provider wants to accept what they will pay for services. These doctors and others who most likely will be holdouts on Medicare assignment typically are psychiatrists or some specialties. With some exceptions, the Mayo Clinics will not accept Medicare patients, so it is important that you help your older loved one check to be sure the providers they use are on the list. You can do this by going to WWW.medicare.gov and clicking on "Find doctors and other health professionals." Medicare Part C was originally called Medicare Advantage. It is available through private insurance carriers who create panels of physicians in Independent Practice Organizations or Preferred Provider Organizations and more to cover what Part B does not cover. They also will charge a premium. There is an alternative sometimes referred to as Medigap, and you will want to check out which offers the best coverage and access to the providers your older loved one will want. Medicare Part D is an optional plan that offers prescription drug coverage which none of the first three offer. Your loved one will have to "opt in" to this plan as offered by private insurers. Some of this will be changing under Affordable Care Act, so stay tuned for changes that will help to close what often is referred to as the "donut hole," the part that the covered person must pay after the initial coverage is exhausted and before the next threshold of coverage kicks in. So that is your crash course in getting your older loved one enrolled in Medicare, but you need to be alert to some potential landmines along the path: • Just because your loved one's doctors or hospitals are in the covered network this year does not mean they will be in the network next year; • Not every carrier's prescription coverage will be the same - be alert to language about coinsurance versus copays, step therapy and prior authorization, all of which will impact the out of pocket costs of medicines; • Make sure that when your loved one is hospitalized that it is an "inpatient stay" (covered) and not "observation" (not covered); • Know the rules on how you can appeal decisions on coverage. 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.
In the past two postings I have been talking about the warning signs of caregiver burnout as well as what caregivers can do to care for themselves. At the center of a lot of what can be done for the caregiver is a very simple philosophy: “Don’t try to do it all alone.” As a Geriatric Care Manager, this is where I often get the call. The caregiver or someone close to the caregiver needs somebody to help make decisions, take over some of the workload, stand up for an elder or other individual with special needs or counsel the caregiver on self-care.

There are other resources that can provide decision-making support, take on some of the caregiving responsibilities, advocate for an elder or caregiver and offer professional counsel on just coping with the responsibilities of caregiving. There are services to help caregivers in most communities, and the cost is often based on ability to pay. Look to programs such as adult day care centers, home health aides, home-delivered meals, respite care, transportation services, and skilled nursing.

Some steps you can take include:

-Find the local Area Agency on Aging. It may go by other names, but a Google search or even government or yellow pages search can give you some options. Check the Illinois AAA .

-If the elder or special needs individual is a Vet, the Veterans Administration is source of a good many support services,some of which are free to a veteran. For a map of service locations, go to VA MAP .

-There are other “affiliation groups” that can offer a range of support services. This can include the Elks, the Moose Lodge, Masonic Lodge and more. We should not overlook what religious denominations also can do along these lines. It may only be telephonic check-ups or meals or companionship, but it can be just the support or respite a caregiver needs.

-Transportation may be challenge for the elder in which case your state or local Area Agency on Aging can again be a resource.

-Just having a reliable agency to call on your elder who is relatively independent can also give piece of mind to a caregiver, and the Area Agency on Aging also offers pre-scheduled calling to homebound elders that can take some of the check-in responsibilities from the caregiver.

-Many local hospitals or long term care facilities offer day care for older adults. Because they already are equipped to meet the special needs of older adults, they often extend day services to area clients at a nominal charge.

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.,geriatric care manager Chicago, geriatric care Chicago

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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.
Too much caregiving can be harmful to your health! I have talked in the past about how important it is for us all to help care for the caregiver and that caregivers deserve to take care of themselves in midst of all the other tasks of caregiving. And if they do not attend to their own needs, what then? Well, they run the risk of becoming the proverbial “toast.” I have never seen an actual case of caregiver burnout, but I have seen a fair bit of toast in my years as an aging life care consultant or geriatric care manager. For instance, the middle-aged gentleman with whom I spoke a while ago about his care giving duties for his ailing mother. He summed up his situation by saying, “I’ve gone from five hours of uninterrupted sleep each night to five hours of interrupted sleep each night.” And he very much looked it. If you are a caregiver to an older loved one or know someone who is, look for the warning signs of the “caregiver toast” syndrome:
- The Joy is Gone: caregivers often report how rewarding it is to “give back” to a loved one, but as the time goes by and grind threatens to wear them down, they tire of it. Getting tired of caregiving is not a reflection on how “good a person” you are. It is a sign of burning out.
- Everyone’s capacity is different: Don’t compare your caregiving capacity with anyone else’s. It is not about a cup half full versus empty question. It is about how big your cup is, and yours may empty faster than another person’s.
- It may be how much care you are giving you. The caregiver is often the last person in line to get a break or a rest. If you are a caregiver, you cannot take proper care of anyone if you are not attending to your own needs.
The symptoms of “caregiver toast” syndrome are really tangible. Look for signs of the following in yourself if you are the caregiver…or in someone you may know who is a caregiver:
- Muscle aches in the neck, shoulder and back, headaches
- Impatience, distraction, irritability, diminished drive, guilt, melancholy
- Tiredness, sleeplessness, susceptibility to illness, memory loss
- Withdrawal from regular engagement like clubs, religion or social circles
What is a symptom or a diagnosis without a remedy? The toasted caregiver needs to start some healthy activities along with perspectives on themselves. Key will be a healthy diet and sleep cycle; acceptance of any shortcomings and credit for the accomplishments; seek help in regaining perspective, insight and even humor; seek out conversation, companionship and just the touch of others. Find resources with whom to share the load and the journey. Turn down the heat to avoid becoming toast. 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.

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Medicare Doesn’t Cover WHAT?!

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