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

I Miss the Scams That Used to Be Easier to Spot
It was probably ten years ago that my husband’s mother was caught up in a telephone scam on her...
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September 26, 2023
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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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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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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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Planning for the Holidays is More than a Menu
The latest news reports suggest only about 10 percent of American Adults have received their seasonal booster for COVID. ...
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October 24, 2022
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What’s Scarier than Halloween?
The short answer to this question is cybersecurity breeches. First, how do you know if that spam in your...
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October 18, 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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Burn Calories to Reduce Dementia Risk
We most often think about exercise as a way to work off the calories that we may have consumed,...
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August 30, 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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The Will To Do the Right Thing
This whole idea to write up a legal document to give surviving loved ones clarity about how to take...
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August 9, 2022
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In the Caregiver's Words

Recent Client Praise

In my last post, I gave you some tips on distance caregiving that arguably could be called the 30,000 foot perspective on distance caregiving. But even from afar caregiving is deeply personal and the caregiver needs to be as much a focus as the care receiver. You might call this my “do unto yourself as you do unto the other” post. I’ll start with the “other:”
1. Caregiving is a team sport – to be successful you have to be part of your care receiver’s team. Most health care providers, especially the residential ones, have what they call a “Care Team.” That could include a nurse, a physical therapist, a social worker, and a physician, and this last could include any number of specialists. You are part of the team, and you do not have to have power of attorney to be a team member…but you do need your care receiver’s written permission for the rest of the team to talk with you.
2. Successful teams bond with one another – you need to have a relationship with key members of the Care Team. And everyone needs to own their position on the team. Regular check-ins happen…well…regularly. Everyone keeps notes and lists of “to do” items. You also need to get into that habit.
Now, about you.
1. Take care of you - If you know anyone who is a therapist or social worker seeing clients in an office, they do not work all their hours in one-on-one therapy. They take time to process, and they take time to recover. In short, they take care of themselves. The lesson here is that self-care is very important to successful “other-care.” I recall an individual who confided in me that he had gone from six hours of uninterrupted sleep a night caring for his mother to six hours of interrupted sleep a night caring for mom. That is not good self-care.
2. Avoid burnout - When you have a call with your care receiver or members of the care team, set a time limit as you begin. Make notes following the calls, and these include assessing how you feel about what you have heard. Have the local care team take care of what happens locally…you cannot.
3. Set loving limits – I followed this advice when I was raising my children as well. You have to recharge your batteries. Some people workout, others write in a journal, some people go to the art museum, and some listen to their favorite music. Do what feeds your spirit so that your spirit will be there for both you and your care receiver.
In the end, everyone on the team wins. If you are a caregiver, it’s important to be part of a winning team. 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.
Earlier this month, Kaiser Health News published an update on what the Centers for Medicare & Medicaid Services (CMS) is doing to reimburse for more services that may not be strictly medical…but offer a health benefit. With Kaiser’s permission we are releasing their summary of these changes here. Air conditioners for people with asthma, healthy groceries, rides to medical appointments and home-delivered meals may be among the new benefits added to Medicare Advantage coverage when new federal rules take effect next year. Earlier this month CMS expanded how it defines the “primarily health-related” benefits that insurers are allowed to include in their Medicare Advantage policies. And insurers would include these extras on top of providing the benefits traditional Medicare offers. “Medicare Advantage beneficiaries will have more supplemental benefits making it easier for them to lead healthier, more independent lives,” said CMS Administrator Seema Verma. Of the 61 million people enrolled in Medicare last year, 20 million have opted for Medicare Advantage, a privately run alternative to the traditional government program. Advantage plans limit members to a network of providers. Similar restrictions may apply to the new benefits. Many Medicare Advantage plans already offer some health benefits not covered by traditional Medicare, such as eyeglasses, hearing aids, dental care and gym memberships. But the new rules, which the industry sought, will expand that significantly to items and services that may not be directly considered medical treatment. CMS said the insurers will be permitted to provide care and devices that prevent or treat illness or injuries, compensate for physical impairments, address the psychological effects of illness or injuries, or reduce emergency medical care. Although insurers are still in the early stages of designing their 2019 policies, some companies have ideas about what they might include. In addition to transportation to doctors’ offices or better food options, some health insurance experts said additional benefits could include simple modifications in beneficiaries’ homes, such as installing grab bars in the bathroom, or aides to help with daily activities, including dressing, eating and other personal care needs. “This will allow us to build off the existing benefits that we already have in place that are focused more on prevention of avoidable injuries or exacerbation of existing health conditions,” said Alicia Kelley, director of Medicare sales for Capital District Physicians’ Health Plan, a nonprofit serving 43,000 members in 24 upstate New York counties. Even though a physician’s order or prescription is not necessary, the new benefits must be “medically appropriate” and recommended by a licensed health care provider, according to the new rules. Many beneficiaries have been attracted to Medicare Advantage because of its extra benefits and the limit on out-of-pocket expenses. However, CMS also cautioned that new supplemental benefits should not be items provided as an inducement to enroll. The new rules “set the stage to continue to innovate and provide choice,” said Cathryn Donaldson, of America’s Health Insurance Plans, a trade group. “CMS is catching up with the rest of the world in terms of its understanding of how we keep people healthy and well and living longer and independently, and those are all positive steps,” said Ceci Connolly, chief executive officer of the Alliance of Community Health Plans, which represents nonprofit health insurance plans. Some offer non-emergency medical transportation, low-cost hearing aids, a mobile dental clinic and a “grocery on wheels,” to make shopping more convenient, she said. 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 have all heard someone this season say, “It’s just a cold,” or “I have a touch of the flu,” or similar expressions that pretty much write off a lot of what is going around. And nobody gets pneumonia, right? Wrong! It may sound like a small number, but about 6 of every 1000 people in American will have a bout with what is termed “community-acquired” pneumonia this year. Still sounds small, but the rate triples for 65 to 69 year old people…18.2 per 1000. And for 85+ year olds, the number skyrockets to 52.3 cases per 1000 people. So, if you have an older loved one in your orbit, be vigilant to signs and symptoms that can tell you they have graduated to pneumonia. There are six signs that should alert you to something that deserves a visit to the doctor or emergency facility:
1. Productive cough – the kind that almost rattles with the mucous as a person coughs to clear their lungs.
2. Fever or not – Fever with a pneumonia infection is common among younger individuals, but pneumonia actually can suppress body temp in older cases.
3. Chest aches – While we are most often concerned about heart issues with chest pain, breathing with pneumonia can give similar symptoms.
4. Tired – While the immune system fights pneumonia, it takes energy away from the rest of the body resulting in fatigue.
5. Fuzzy head – The lungs are not the only congested organ; the brain gets a bit muddled with pneumonia also.
6. Breathless – With congested lungs, it should be no surprise that a patient with pneumonia may also be short of breath with even modest activities.
The rules of engagement with pneumonia are simple.
1. Doctors’ orders - especially with completing the full course of antibiotics…be sure your loved one takes all the pills prescribed.
2. Sleep – give the body a chance to devote its undivided attention to fighting the bug by resting and getting help around the house.
3. Fluids – think of it as “flushing” out the system, and it also helps get rid of the congestion in the lungs.
And remember that the risk may be lower for younger people, but the operating rules are pretty much the same. Give all the support you can to help your body fight the invaders too! 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.
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.
More than seven million Americans are balancing the demands of a full-time job along with caregiving to a family member, typically an older parent. For many, they daily choose between work and family as they try to juggle each job's demands, and what usually has to give it their free time, their time with their own kids or this time with their spouses.

But sometimes even that is not enough to fit everything into the 24 hours of a day, and the working caregiving confronts the tough decision of one job or the other. According to the MetLife Mature Market Institute:
- Almost two-thirds of working caregivers have to make some sort of real adjustment in the demands of their job or their career plans to accommodate their caregiving.
- One out of every three workers will cut back on their hours to make room for caregiving duties like trips to the doctor or actual hands on care for an incapacitated loved one.
- One out of ten have moved from full-time to part-time employment in order to accommodate their caregiving responsibilities.
- One in twenty opted to leave the workforce entirely and nearly as many left their jobs by retiring earlier than they otherwise would have.
If you are one of these workers juggling two responsibilities, here are some tips:
1. Set clear boundaries with your loved one so that calls to work are only in case of emergencies.
2. Divide your day into "work hours," "caregiving hours" and also time for yourself - "my hours."
3. Get some help from outside agencies for the tasks that do not require you to be hands on.
If you are looking to downsize your workload or quit your job, you should:
1. Do your homework by reading the employee manual or talking with human resources about their guidelines or employee assistance programs to accommodate caregiving.
2. Know your rights under law by reading the Family Medical Leave Act (FMLA) http://www.dol.gov/whd/fmla/
3. Prepare for your conversation for the meeting with your manager before you meet with your ideas for reduced time, flex time, job sharing or other solutions and above all, be honest and open.
4. Recognize that if you love your job that this will be a tough move, and let your employer know how committed you are to your job and the company and that your really do plan to return to the workforce.
For more information on what the MetLife Mature Market Institute can tell you about caregiving in America, go to their web site: https://www.metlife.com/mmi/research/index.html?WT.ac=GN_mmi_research

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 Visit our For The Caregiver page for more information and resources..
Everyone who is a caregiver to an elder or other person with special needs has to be an advocate also. In my first blog posting, I spoke about what a geriatric care manager does on behalf of the elder or their families, and one of the principal duties is to advocate on behalf of our clients. In this posting, I offer a few of the ways that all caregivers can advocate on behalf of their loved one to assure the best healthcare and quality of life.

As an advocate for an elder, you need to be more than just the person who gets an older parent to and from a provider’s health care appointment. As long as the elder confirms that you can attend the appointment, you can be present, and you should use that opportunity to take notes and ask questions.
1. As an advocate, you will want to be as knowledgeable as
  
  possible about any medical issues that affect your loved one, and that includes
  
  asking questions of physicians and others as well as doing searches
  
  on-line. And be organized. Write your questions down before an
  
  appointment, and don’t be shy about asking them. If you don’t understand
  
  the answer, ask for clarification. It is the responsibility of a caregiver
  
  to be a “knowledge partner” in the health care of a loved one.
2. As an advocate, another important function you can provide is
  
  continuity of care. On an ongoing basis, attend all visits to the elder’s
  
  primary care physician as well as any specialists they may see. Ask
  
  questions when a health care provider observes something or makes an assessment
  
  that may conflict with what another physician has said or is at odds with what
  
  you have observed day to day. And this latter part is key. Because a
  
  caregiver or a geriatric care manager can be there day to day, they will see
  
  things that a health care provider may not observe at an annual or semi-annual
  
  visit. Speak up.
3. As an advocate, the records you keep may not be medical files like a health care provider’s office keeps, but as a caregiver you become the central depository of everyone’s information and inputs. Keep current on all prescriptions as well as over the counter drugs your loved one may be taking. And have that information – or a distillation of it – available when you meet with providers. And you may also have to be the one to discreetly let a provider know if your loved one is unable or has been unwilling to comply with prescriptions or other directions.
The common thread here for all of this advocacy is that a caregiver should not – and a geriatric care manager – will not keep quiet. Ask questions, provide information and be persistent if you feel you are not being heard.

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.