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February 22, 2011
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In the Caregiver's Words

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Family life crises don’t make appointments; they just show up. For most people that means tackling a crisis with no experience and no plan. (Hope is not a plan!) So, if you are one of the estimated 109 million Americans who have an older loved one in your orbit, what do you need to do to make a Plan? Here is my “short list” of the documents you need to have and be able to put your hands on… sometimes with no notice: • Medical Release – the document you need so your loved one’s medical providers to speak with you about your loved one’s health status, medications and prognosis. • Power of Attorney (POA) for Finance - a legally binding document that gives a person (referred to as the “agent” or “attorney in fact” permission or power to act on behalf of an individual in matters of property or finance. • Power of Attorney (POA) for Healthcare - a legally binding document that gives a person power to act on behalf of an individual in matters of medical treatment. The “power” typically is in force when it is deemed the person in question can no longer act for themselves or if they are not conscious. • Practitioner Orders for Life-Sustaining Treatment (POLST) – a document (varies state by state) that specifies in advance what measures an individual wishes to have in the event they cannot expressly grant permission themselves. These orders typically revolve around life-saving measures; they are sometimes referred to as advanced directives and are placed in a patient’s medical files. • Health and Life Insurance Policies – the health policy will help everyone involved understand what is covered and which physicians and other providers are available to your older loved one. The Life insurance policy should be in a safe place so that it can be readily accessed should that become necessary. • Estate Plan – is (potentially) a wide-ranging document that let’s everyone know how any real estate or other holdings are titled and what the “plan” is for when a will is executed. • Trust documents – help to identify how one’s estate is to be transmitted to beneficiaries. Trust names need to be consistent with life insurance, will and holdings in order to be in effect. • Last Will and Testament – the legal document by which a person expresses his or her wishes of how property is to be distributed at death, and names one or more persons, the executor, to manage the estate until its final distribution. • The Grab and Go – This is a list that typically is sealed in a plastic bag. It includes medical insurance documentation, a list of allergies, a list of medications, primary care physician contact details and in case of emergency (ICE) contact information. Please email (info@creativecaremanagement.com) me with any questions on any of these…as well as how to take the next steps which is your plan. Do yourself a favor…don’t wait for a crisis. 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.
I have written a number of blog postings on safety in the home, and most of them have focused on how to make the home environment safer for an older loved one or other person with special needs. But something we all may not think about as much is making home safer for the caregiver – especially in regards to health safety. As a certified geriatric care manager visiting clients in hospitals, I cannot avoid seeing all manner of hygiene steps that providers take so that they do not transmit disease. They will wash or use hand sanitizer each time they enter the hospital room, they will never sit on the patient's bed, and if they use gloves, they are very careful in how they remove their gloves when they complete an exam. If you are a caregiver to a loved one in the home, here are four tips for bringing that same hygiene to the home to make it safer for both you as the caregiver and your loved one:
1. Immunizations - This is not just the annual flu season immunization; it really covers a range of opportunistic bacteria or viruses that pose a risk to the health of your loved one as well as to you as the caregiver. Talk to your loved one's provider about the specific vaccinations you should have such as tetanus, pneumococcal vaccine, hepatitis B, measles/mumps/rubella and varicella (chickenpox). You want to avoid giving or receiving these bugs, and your loved one's provider will help you to identify what you need to do.
2. Hand Washing - You cannot see the germs, but you absolutely must wash your hands often and thoroughly. You should wash before and" hands-on" helping with your loved one and after. And, just as with restaurant workers, wash your hands after using the bath room as well.
3. Protective Gloves - As an extra precaution, consider using rubber or latex gloves as an extra layer between your skin and the skin of your loved one, especially if you are charged with assisting in bathing or toileting your loved one. And as you remove the gloves start with the wrist and peel them off so that they are totally inside out as you dispose of them. And wash your hands after for good measure.
4. Disinfecting - Cleaning surfaces or clothing and bed clothes that come in contact with your older loved one is a very good idea, and it is easy. Use some amount of bleach in your washer loads, and for surfaces one teaspoon of bleach per gallon water will make an effective disinfectant. This solution can be used in the kitchen as well as the bathroom. As with all cleaning products, read the label for any special precautions.
Charlotte Bishop is a certified 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.
“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
We have all been following the news on vaccine rollouts, and frankly you may have been as disappointed as I have been with how slowly this mobilization has been progressing. With the exception of West Virginia, the state by state rollouts have fallen short of most experts’ hopes or expectations. Yet, we are making progress. If you live in Illinois and qualify as a category 1B or 1C, it is important to now reach out to your local departments of public health and get on their electronic lists. Once you do that you can expect to receive an email or text of the next opportunity to become vaccinated. The first group to have received vaccinations, category 1A, included healthcare workers and residents of long-term senior living facilities. Category 1b now includes frontline essential workers and 75+ year-olds, but CDC has added 1C to this next tier of availability, which means 65-74 year-olds, younger people with underlying medical conditions and other essential workers qualify. You need to get on a list to be called, so check with your local departments of public health on-line to get on those lists. They will ask how you wish to be notified, text or email, and you simply need to be watchful. A colleague recommends that you may also consider going to vaccination sites at end of day just to see if they have excess vaccine because some who have been called simply did not get to the site. And there is other “good news.” Eli Lilly, the Indiana drug maker, has tested a monoclonal antibody as a prophylaxis against COVID, and the results are promising. In nursing homes, residents and staff showed a 57% lower chance of getting COVID-19 than those who had been infused with placebo. Among the residents specifically, the risk was reduced by 80%. Only four residents died of complications from COVID, and these all were folks in the placebo group. As a result of this in population trial, Lilly has received emergency use authorization for this antibody cocktail. It is not a vaccine, but it can be used to help supplement vaccine where there is simply not enough vaccine to cover all of the populations. What is remarkable is that this infusion was to be used in treatment of infections, but it also seems to have a genuine level of protection against infection as well. Another company, Regeneron, has been authorized for emergency of bamlanivimab, an antibody cocktail to be used in treating COVID in individuals more at risk for severe COVID disease. There is added good news also with one of the approved vaccines. You may have heard of the more virulent variants of the COVID virus that are surfacing. At least Moderna is adapting a second shot of their vaccine to be particularly attuned to this variant. The latest "breaking news" is about a trial using an oral anti-inflammatory called colchicine. In the past it has been used for rheumatoid disorders like gout, but with COVID it seems to tackle the "cytokine storm" you may recall being discussed in the news...particularly with younger patients. In topline data from these early trials on more than 4,000 patients, researchers found that those who received doses of colchicine had:
- 25% fewer hospitalizations
- 50% less need for mechanical ventilation
- 44% fewer deaths.
We will continue to keep you apprised of late breaking news about our global pandemic, and I personally hope we continue to hear promising news as we all look forward to "rounding the bend." Please continue to exercise all precautions and stay safe. Charlotte Bishop is a Caregiver Coach, an Aging Life Care Advisor, 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. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
It was just a year ago that Bruce Willis’ family disclosed that the actor would be retiring from acting owning to a diagnosis of aphasia, a neurological disorder that affects language speaking, hearing, reading and writing. Only recently has the family made the further disclosure that Mr. Willis’ aphasia is actually a symptom of fronto temporal dementia (FTD), the common form of dementia among individuals under 60 years of age and affects about 9 in 100,000 people between age 60 and 70. I often talk about what to look for if you have an older loved one, but with FTD, it can be anyone from age forty and older. There are a good many genetic markers for this relatively rare condition, but individuals with family members who have been diagnosed will have a forty percent greater likelihood of manifesting the condition. Diagnosing FTD. It’s all about “executive-function” in neurologist speak. This covers a lot of territory, but it comes down to losing abilities that a person may have had like:
- Planning ahead, following or formulating recipes;
- Setting priorities or goals;
- Repeating words or phrases again and again;
- Impulsive or inappropriate language or actions;
- Losing interest in what everyone else in the family may be doing.
Treating FTD. As with most forms of dementia, there is no cure or magic bullet to stave off the inexorable cognitive decline of this condition. But there are steps caregivers and patients can take to help delay the degeneration:
1. Encourage regular daily exercise – anything that increases blood flow and cardiac wellness;
2. Promote sleep 7 to 8 hours a night - pretty much as with anyone…in this case because it can help the brain do its nocturnal clearing and cleaning;
3. Go Mediterranean – which translates into heavy reliance on plant-based meals, fish and whole grains as well as healthy fats like olive oil;
4. Flex the brain – apply the daily exercise routine to that muscle between the ears …and mix it up by learning new games and avoiding screen time;
5. Engage socially – encourage civil and community and family engagement to avoid brain decline as well as depression;
6. Lead with the heart – lower sodium, lower blood pressure and lower alcohol consumption while definitely eliminating tobacco.
Now that Mr. Willis has been diagnosed, you can be assured that the press will give this rare condition more attention. Stay tuned to what will be learned and shared. Follow Mr. Willis’ role model of fitness, diet and as with most of his movies … tenacity. 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.
I had the good fortune to speak to a local Rotary chapter this morning. The question they had put to me was simply how does one plan with an older loved one for that moment that no one wants to plan? The answer is simple ... because for any conversation, you just need a place to begin. Here are five tips to BEGIN the work for your older loved one’s (or your own) future... Break the ice. Start the conversation with your older loved one…ask questions about their ideas regarding the ‘What ifs’ of life…ex: if you had to go to a hospital, which one would you like to go to? Does your doctor have my contact information if there were an emergency? Make a list of what those choices are; include them in a Living Will or POLST “Practitioner Order for Life-Sustaining Treatment”. Make sure that your family and your health care providers are aware of the choices. Evaluate the whole person. Use your powers of observation to assess your loved one’s situation and make notes. Think about what they have told you over time regarding their wishes, finances, housing situation, health. Plan follow up conversations to learn more about what they would want in the event of an emergency. Guard against abuse. Begin to gather legal documents including mortgage information, insurance information, bank account locations, account numbers, etc. Ask about finances, investments. Investigate the possible utility of Powers of Attorney. If there are any gaps or documents such as wills that are out of date or non-existent, get new ones drawn up. You don’t have to have everything perfect, but you will benefit if you start the conversations or the personal reflection needed to begin the process. Inside out. Make a list of you or your loved ones health history, get a medical release so that providers can talk to you about your loved one, consult current physicians and create a list of medications, dosing, etc. Nest. Think about the home as safe from the inside out, not just safe from the outside in...If they are living in the house you grew up in evaluate all the years of wear and tear on the infrastructure: stair railing, worn carpet. Take a look around the home for any obvious safety issues that can be easily addressed: since the majority of falls occur at home scatter rugs, poor lighting, expired food in the fridge, extension cords stretched under rugs or in walkways. Also, expired medication or medications that resemble each other…Safety first. 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.

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