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

Saying “No” May be the Right Answer
Saying “yes” when someone asks you to do something can be like eating candy. It feels right or good...
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November 15, 2022
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Become a Dementia Detective by “Talking the Talk”
Today we have a guest Post from Christina Padilla, a speech-language pathologist and Certified Dementia Practitioner living and working...
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September 27, 2022
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Diagnosing Alzheimer’s Disease
September is Alzheimer’s Awareness Month, and this is the second of four posts we’ll offer on the subject. A...
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September 13, 2022
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Food Fight
When you hear the word cancer a lot can come to mind such as “cancer survivor,” “living with cancer,”...
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August 23, 2022
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Before or After the Fall
I came across an informative piece in the Washington Post about a week ago, and it brought to light...
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July 26, 2022
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What You Can and Cannot Change About Dementia
Let me start with the short answer to a question we raised in the email announcement of today’s post. ...
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June 21, 2022
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Age and “Long Covid”
There seems to be a cliché for everything, so we’ll start with this go-to for COVID: “We’re not out...
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June 7, 2022
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When Being in Demand Isn’t Healthy
If you’re a musician, you want to be busy, because gigs represent a better living. If you’re an actor...
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May 17, 2022
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HDL Graduates from “Good” to Better
You may have had the conversation with your physician about your cholesterol levels during your annual physical; there are...
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April 26, 2022
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Heavy Drinking Helps?
Let’s take a short quiz. Question: Who prefers coffee…and who prefers tea? Which is healthier for you? Answer: ...
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April 19, 2022
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In the Caregiver's Words

Recent Client Praise

First, I want to thank everyone who helped get the word out on our recently-orphaned therapy dog, Annabelle. I am happy to report that Annabelle has found a new, adoptive home and that dog and master are doing great. Thank you for making our internet community work. Now, shifting gears… Hospitalization seems to figure prominently in most of the new clients we see. It is either a recent trip to the hospital that triggers the call to a care manager, or it also can be a surprise discharge from the hospital that sets everything in motion. You may ask, why should a discharge be the urgent situation? Well, the practical side of health care as we know it these days revolves around a big push to discharge patients “sicker quicker.” It can happen with the nurse or an aide walking into the hospital room and simply announcing to the patient and whomever is at their bed side that it is time to leave…often for a nursing home. Most patients and their families will scramble to comply. Nobody really wants to be hospitalized, but how prepared is the patient or the family for a return home or a quick departure for the nursing home? The fact is you need to know your rights. A family in this circumstance can file what is called a “fast appeal” of a pending discharge with a Medicare Quality Improvement Organization. Make that telephone call on the spot, and the patient can stay in the hospital until an independent physician reviewed the circumstances. Every 65+ year old adult admitted to a hospital as an inpatient has the right to challenge a discharge if he or she feels unprepared to leave. But few people understand the process that’s involved. In fact, all Medicare patients upon admission should receive a written notice of their rights. It will be labeled: “Important Message from Medicare” and in it you will be supplied with the name and a phone number for your Medicare Quality Improvement Organization (QIO). These are the people who handle fast appeals and other quality of care issues. Once you make a call, you or your loved one may be asked to fill out a form that allows the QIO to act on their behalf. Once that fast appeal has been filed, the hospital cannot transfer the patient. But you don’t necessarily have to be surprised. Ask on a daily basis what the expected departure date may be. Now, there is fast and there is really fast. Make sure that if a patient is to be discharged under the 24 hour mark, the stay may not be considered an inpatient hospitalization. It may simply be labeled as “observation” and therefore may not be covered as a hospital stay. Make certain of your rights here so that you are not billed inappropriately. Make sure that your primary care physician and possible also a care manager are in the loop so that you will have an advocate. 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.
Gregory Peebles is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP), and trained Medicare Counselor, 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 This is the final installment in a three-part series to help clear up some common misconceptions about Medicare that are more important for Caregivers than your older loved ones. We started our series with the structure of Medicare [link], and moved last week to surprising omissions of coverage [link], chief among which is long-term or “custodial” care. When folks discover that Medicare does not cover residence in a Skilled Nursing Facility (used to be called a “nursing home”), it can be startling. And if they are waiting until they need this residential care, it is too late to prepare. Managing the options available requires a little planning, though, and the sooner it starts, the more effective it can be. Several insurance companies provide long-term care packages, and some options are even provided through employers and may be available to you now —provided you know what to ask for. Individual policies are also available, but, if initiated later in life, premiums can be quite high. These premiums also potentially increase with age, and this can make the option less viable for some. Important to consider, too, in your planning, is that income typically goes down with age, and the premiums must continue to be paid so long as the beneficiary is receiving care. This means that the earlier you invest in long-term care, the more likely it is to be affordable for as long as you need it. Important services covered by long-term insurance usually include:
- SNF, or “nursing home” stays;
- Assisted Living;
- Adult Day Care Services;
- Home Care; and
- Home Modification.
As none of these services is covered by Original Medicare, the benefit of having a long-term care policy is clear. In fact, home care and home modification services increase the amount of time adults can age-in-place, which is the preferred option for most. So, wherever you are in your journey, consider putting methods in place that bolster the existing benefits of Medicare and increase your options for quality of life while maintaining your hard-earned savings. It is never too early to plan! 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.
We all know that an object at rest tends to stay at rest, and that is as true of older adults as it is younger ones if you look at the frightening statistics on the obesity epidemic in America. Habits developed over the long run tend to be harder to break, but the fact is that appropriate exercise for older adults can get easier and easier just by the simple fact of dong it. Because the corollary to my first scientific law is that objects in motion tend to stay in motion. And exercise gets easier. Doubtful?

Here are nine reasons:
1. Starting a new exercise routine may feel clumsy at first, but so did dancing, riding a bike and a lot of other physical work we have all gotten better at with time. Muscle memory will help, because your body will make new nerve pathways to make your exercise easier with time.
2. Blood flow improves when you exercise at any age. The smallest vessels actually can increase in number fueling all parts of your body as your heart rate routinely increases with practice.
3. We all have seen body builders grow muscles into sculpted works of art. Well, we do not see the heart, but it gets stronger also with workouts that are even modestly strenuous. This is true of older adults as well as college athletes.
4. With the muscle memory and greater cardiac capacity comes increased confidence among elders who exercise. Physical confidence, in turn, creates greater overall confidence and a sense of “can do.” Older adults with a regular workout routine also will sleep better.
5. We have heard from too many fanatics about “no pain-no gain.” The opposite is, in fact, true. As an older adult works out over time, the body raises its threshold for working. With time, an older adult can do more and more without that shortness of breath or even the soreness afterwards.
6. Take that last one to a higher level, and if the older body begins a regular regimen of moderate exercise, the body’s hormone system will reward it with cocktails called endorphins. Endorphins are basically a homemade version of morphine to help the body feel better and better.
7. The power plants in your cells also will begin to grow in number with exercise over time. You cannot see them, but the mitochondria, as these power plants are called, become more numerous so that your body can burn more carbohydrates and fat to create more energy.
8. Exercise will encourage better eating habits. It is true, because a lot of those bad habit foods – comfort foods – are linked to stress, anxiety or even depression. Since exercise works against these negative emotions, some of the craving for the junk food will ebb as well.
9. Exercise actually makes a person happier. Tied to some of what I mentioned in #8, exercise really lifts the spirits, and it does it in part through releasing chemicals called serotonin, dopamine and norepinephrine. These chemicals can be as effective as some of the drugs often prescribed for depression.
Before you exercise or encourage an elder to exercise, see a doctor to sign off on your fitness to exercise.

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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When you were young, you may have dreamed of being like Superman or Wonder Woman. They both had remarkable powers that made them more than just better than the average person or even the best among the average humans. They had powers that came from something very special about their makeup, in the former case, well, “super powers.” Scientists at Northwestern University’s School of Medicine are using similar language now to refer to a rather small subset of people who live to be not just over 90 years of age, but some to be old enough to celebrate their 120^thbirthday. They are “Super-Agers.” Are you a super-ager? Well that depends. The physicians involved in the research are looking at a lot of factors that may help make a superager like psychosocial factors, education, family history, genes, physical health and the brain. And they are looking at people over 80years of age who have the memories of those 30 years younger as well as a control group of “average” people. For instance, they have found that super-agers have a thicker cerebral cortex, the important outer layer of the brain responsible for memory, attention, language and thinking. It was thicker than the normal agers, about the same size as members of the younger, middle-aged control group. There were other exceptional facets of the super-agers’ brains such as that part of the brain that controls social behavior. The scientists also have taken blood samples to further assess the DNA of the superager. So, if it is all based on the genes we receive, or as some say the parents we have chosen and that these people may be less numerous than only one of every hundred within the overall population, what’s the point? Well, one of the researchers points out that you don’t have to be the one who has the right genes to live longer. If they find that the superager’s’ genes turn off a certain protein or turn on a certain metabolic process that contributes to longevity, then you don’t have to have better genes to live longer. You just have to have some help to adjust the proteins, the metabolic processes or whatever it is that works the magic. So, there may be good news for us all. If you have an older loved one in your orbit who shows signs of being a superager, encourage them to reach out to NU’s medical school…today. 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.
According to research reported in the New England Journal of Medicine, approximately one in five Medicare beneficiaries discharged from a hospital will end up back in the hospital within thirty days. It usually is for the same reason they were admitted originally. This means that it not only is bad for the patient who has to go back to the hospital, but it typically represents an expense that could have been avoided. And it is these sorts of statistics that give me a chance to talk about a question I get asked a lot: “What is it that geriatric care managers do?” Let me explain.

The typical picture of an older patient who is readmitted is one without a lot of social support locally, and this older patient:
- May not fully understand their discharge instructions.
- May not be taking their medications as instructed.
- May have complications they cannot handle.
In most of these cases, if the patient had had someone to be the information processor, interpreter and implementer, the readmission would not have been necessary. A geriatric care manager would be available to make sure the discharged patient understands any limitations on activity that the medical professionals have stipulated or understands how active they should be to recover from being in bed for the number of days they were in the hospital. A care manager can help to make sure that all the patient’s medications are organized or that a new prescription gets filled and its dosing gets integrated into the daily regimen. (Remember that seniors are about 13% of the population, but they represent about 30% of all the prescriptions written.

The National Transitions of Care Coalition offers a checklist your care manager or you as a caregiver can use with an elder for whom you are responsible as they leave the hospital:
1. Have a method in place to assure safe use of all medications.
2. Have a plan to facilitate the big change from hospital to home.
3. Engage all members of the family and personal network of the patient.
4. Share important information with all care providers and caregivers.
5. Find and read any educational materials about the patient’s condition.
6. Facilitate any follow-up provider visits, therapy, etc.
As a caregiver (or through your care manager) advocate for the patient to physicians, discharge planners or other providers responsible for the continuity patient’s care.

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.
I came across an informative piece in the Washington Post about a week ago, and it brought to light a useful perspective on falls and injuries and recoveries. I’ve talked a bit in earlier posts about preventing falls, especially with your older loved ones. Preventing a fall is arguably the best place to be, but as the more recent article highlights, how we recovery from a fall is also critical. What do you think?
Before the fall. If you have an older loved one, don’t wait for the phone call; here are some simple steps you can take to assess your care receiver’s risk as well as help bolster their safety:
- Assess your loved one’s risk for falling using the CDC’s questionnaire.
- Make certain your loved one gets an annual eye exam, and keep their glasses (if needed) current with their vision.
- If you accompany them to their doctor visit, ask about their feet, posture, leg strength and agility.
- Help assess and address any clutter or other safety issues in your loved one’s “space,” and remember that a lot of this revolves around lighting and ease of access.
This last one has a lot to it. If you would like, we have a home safety checklist that you can use to identify potential trouble spots in your loved one’s house. Just email me at info@creativecaremanagement.com , and I will send you a copy. You may have noticed that I have nearly 600 postings in this blog. Please just type in “home safety” or “fitness” in the search box on the Blog…or any other keywords that are top of mind for you about your loved one’s safety. After the fall. The author of the recent piece, Elizabeth Heath, quotes a “mental recovery expert” on what to acknowledge post-fall: “Decreased confidence and fear of reinjury are two common side effects of any injury.”
- Appreciate that the mind has to recover from a fall just as the body does…and it may take longer; consider counseling to help with constructive self-talk and “baby steps.”
- Set realistic goals…you don’t need to get back on the proverbial horse right after being thrown; the same is true for falls while walking…start with an easier path.
- Age is an important consideration, so engage a personal trainer for your older loved one so that they can be re-trained in “getting their nimble back;” that’s “trainer talk” for using multiple ways to work the muscles to keep them responsive to surprises on their path.
- Don’t battle through the pain; your older loved one’s body will show remarkable resilience in recovery if they are allowed to give the body the time it takes…which may be a bit more time than it would have decades ago.
Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of, 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.