Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • Alzheimer’sChicago's Geriatric Care Manager Center of Excellence

Geriatric Care Management News: Possible Alzheimer’s Breakthrough
Most of you probably know that Alzheimer’s disease is the most common form of dementia among younger and older...
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July 29, 2013
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The Other Costs of Alzheimer’s
As a geriatric care consultant, I field a lot of questions from people concerned about memory issues in an...
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June 20, 2013
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Understanding Dementia from the Inside
In my last posting I shared geriatric care management services for caregivers communicating with a loved one who may...
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May 23, 2013
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Nine Geriatric Care Management Tips on Caregiver Talk for Dementia
If you are a caregiver to someone with dementia you may have found that communication can be frustrating, but...
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May 20, 2013
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Forgetfulness-A Caregiver’s Warning Signs
There are an estimated 30+ million cases of dementia worldwide according to the latest statistics. That amounts to a...
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April 11, 2013
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Talking with Dementia or Alzheimer’s
There are a lot of misconceptions about Alzheimer’s Disease or dementia in general, and these misconceptions can make simple...
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December 20, 2012
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Four Tips for Managing the Cost of Alzheimer’s Medication
Recently, I had the good fortune to speak with the chief executive of a national specialty, Monarch Specialty Pharmacy,...
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December 3, 2012
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4 Reasons to Raise Awareness about Alzheimer’s
As November (National Alzheimer’s Awareness month) is winding down and we continue to see efforts to educate people about...
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November 28, 2012
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4 Tips about Preparing a Meal for a Person with Alzheimer’s
As we prepare for more holiday cheer even after Thanksgiving, we truly understand how caring for a person with...
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November 27, 2012
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Accommodating Dementia at Thanksgiving
I’ve talked about being on the lookout for signs of early onset dementia as we all begin our holiday...
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November 15, 2012
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In the Caregiver's Words

Recent Client Praise

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..
We have all heard the phrase and it usually is a reference to someone who is just a little less on top of their game. Just last week, however, The New York Times released data on staffing in nursing homes that showed a tremendous variance in staffing levels on their units based on time of day and time of week. These staff levels are not inconsequential, because when we talk generically about “nursing homes,” we may be making reference to assisted living or skilled nursing or other supportive living facilities. This is all a way to say that the residents need help with any number of their key activities of daily living like toileting, dressing, bathing, eating and walking, etc. The New York Times reported variances from fully staffed to the understaffed weekends to be as much as a 100 percent difference. That is to say that the number of nurses or aides covering the residents on weekends was as little as half the number as during weekdays. Before the Affordable Care Act, nursing homes self-reported their staffing levels to the government watchdog agencies. Whatever they said was what was on record, so less ethical organizations could easily game a system where no one was minding the store. Since the ACA in 2010, these numbers are now verified. While ACA now more closely monitors staffing, there can still be day to day variances that may elude detection. Some defenders of the status quo claim that on weekends more family are visiting their loved ones allowing thinner staff to keep up with what is alleged to be lower demand. Maybe? How many visiting sons are comfortable helping mom to the toilet? If your older loved one is one of the 1.4 million Americans who are a resident in a nursing home, you can check on their staffing variances. The New York Times actually published a map on line that allows you to hold your cursor over a specific facility on the map to see how they rate from “much above average” to as low as “much below average.” They also will note for you the low and high resident to staff ratios of both nurses and aides. I have in our inset a picture of a facility in Nebraska as an example. So, do three things if you are helping a loved one move to, or have one already in, a nursing home…or may have one moving anytime soon:
1. Go to the map to get the data and also those of competing facilities around the region where your loved one may move;
2. Get references on facilities from care managers or other health care professionals from your locale; and
3. Once your loved one moves in, drop by as frequently as you can, but do so at different times of the day or week.
Consider all of these as steps toward catching a facility in the act of doing things right. If not, don’t be afraid to make a change of venue and a change for the better for you and your loved one. 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.
Medicine today is full of miracles. But Aging Well magazine (Jan/Feb, 2009) reports that although the over 65 set in America constitute only about 13% of the population they account for about 30% of all prescriptions filled. Their share of over the counter (OTC) drugs is estimated to be closer to 40%-50% of all retail meds sold. The report goes on to say that nearly two in five hospitalizations each year are a result of medication issues associated with elders. The elderly are fully half of all prescription drug-related deaths annually.

Let me tell you about a list you should know about. If some drugs have added baggage beyond the healthy effect sought by a prescriber and a patient, a doctor named Mark Beers, MD, and his associates have been the “baggage handlers” since 1991. That is when they first came out with the “Beers List.” Beers and his associates were concerned that certain commonly prescribed as well as OTC drugs were causing what are referred to as adverse drug events (ADEs, sometimes shortened to just AEs). Beers, a doctor specializing in geriatric care, found that the elderly were particularly susceptible to many of the undesirable effects of these drugs because their older bodies tend to have less water content and more fat content than younger individuals. This, coupled with their bodies’ diminished efficiency in metabolizing or processing chemicals through their systems helped to account for the disproportionately high rate of AEs and associated hospitalizations and deaths among the old.

Beers' most recent list of 48 drugs and drug classes has been published in the Archives of Internal Medicine and has been embraced by the Centers for Medicare and Medicaid Services (CMS). Beers and his associates have established a set of criteria for determining if a drug poses a risk, that is, is it a potentially inappropriate medication (PIM) for the elderly. Using an expert panel of internationally-recognized experts, Beers and associates were able to find consensus on the drugs that are part of their list of potentially-hazardous medications. It is an important elder resource you should know.

The Beers list has a number of “old friends” as well as exotic medications of which most of us have never heard. You will find the likes of over the counter Naprosyn or Aleve (generically known as naproxen sodium) as well as Benadryl (diphenhydramine) and Chlor-Trimeton (chlorpheiramene). There are also household names like Valium (diazepam), Tagamet (cimetidine) and Prozac (fluoxetine). It is important not to take the Beers list as a blanket generalization that these are simply drugs to avoid. It is not quite that black and white. Some agents are on the list because they can cause complications among specific groups such as diabetics, asthmatics, or insomniacs. Others are contra-indicated for individuals with balance or gait problems because they become prone to falls, some for individuals who have bladder outflow compromise or still others who suffer from chronic obstructive pulmonary disease, emphysema.

The list goes on, and in some cases it is simply a dosage or extended release formulation warning that justifies being included on the list. Check it out: Beers 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 throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.
Earlier this month I had a chance to talk about some of the questions I most often get asked as a geriatric care manager. In Chicago, there is a radio talk show on Chicago senior care and other topics that are relevant to elders. It is called – appropriately – AgingInfoRadio, and the program airs every Thursday. You can actually listen to our give and take by going to the archives of this program at AgingInfoRadio

Some of the questions we discussed in that 25-minute conversation included:
- What should I look for in a geriatric care manager?
- Is there a central directory to help find a geriatric care manager?
- How would you sum up what a geriatric care manager does that people cannot already do for themselves?
- When is home no longer the best place for an aging family member/loved one?
- What elder resources are available to help an older adult in their home?
- What can be done to make home “secure” for an older adult?
- What services can be brought home to maximize independence?
- How do I guard against an accident at my parent’s home?
- What are the best alternatives to home?
- What is the difference between independent living and a nursing home?
- What is a Continuum of Care Facility?
- What questions should a family member ask to get the right facility for a loved one?
If you would like to hear the answers I shared on the air, please check out the conversation I had with the host Sue Zawacki at Radio Talk with Charlotte Bishop

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.

Copyright ©2011
In the first posting of this two-part series, I went no further than the hallway in our tour of the home. I certainly appreciate that everyone's kitchen or bath is going to be a different starting point, so I'll stick with some of the basic fixes that can be introduced to make an older adult's home easier to navigate - and safer.

Kitchen. The first rule is to have ample clearance under all working surfaces such as sinks, stovetops and counters so that an adult in a wheelchair can access those surfaces. Even in homes where the older adult is not yet confined to a wheelchair but may use a cane or walker, this can be a forward-looking refit to enable greater independence longer. New kitchen innovations also make it possible to elevate dishwashers for easier access among residents who have difficulty stooping to conventional machines' levels. Microwaves and ovens can also be brought down to more accessible levels. And make sure there is enough storage or pantry access at levels that a resident in a wheelchair can reach.

Anticipating the same accessibility throughout the house, engage an electrician to lower all switches and outlets to a height of 36-40" off the floor. And as with the light switch I had mentioned in my last blog, using rocker switches makes them much easier for an older adult to manipulate. Also a general recommendation: make halls, doorways and room spaces wider for easier maneuverability. Appreciate also the poorer visual acuity of an older adult, and be sure to have ample lighting throughout the house.

Bath. Some of the same principals for the kitchen also apply in the bath room. Make sure cabinets can be accessible by lowering them on the walls, and create clearance under sinks to enable wheelchairs to maneuver. Lower the mirror over the sink so that a seated adult can see themselves. Showers and baths ideally should have flat thresholds for easy access for a wheelchair or walker. In the shower, consider either multiple shower heads at different heights or a shower head that can slide up and down along a vertical bar. Grab bars also should be strategically installed near commodes and alongside bath tubs.

Bedroom. Here is another place to have less clutter for the resident using a wheelchair or walker to have easier maneuverability. Rocker light switches all round at 36-40" again will be important as will having a light switch within easy reach of the bed to avoid accidents when an older adult might otherwise be forced to get out of bed in the dark. In closets, have hanging bars at levels that are reachable from a wheelchair as well as the conventional higher level.

All of these recommendations revolve around what is in the home or its access points. Don't forget to adapt the garden areas for the older adult who still wishes to tend their flowers. Elevated planter gardens make it easier to reach the ground. These suggestions and those in my first post have at their center a focus on helping older adults to remain at home and independent. Check this web site for more examples and resources: http://www.ageinplace.org/
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 have had the opportunity to work with Charlotte Bishop on several cases in recent years. She always goes the extra mile for my clients. (more…)
Eric Parker, Stotis & Baird Chartered