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Four Things a Geriatric Care Manager Is
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December 8, 2011
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In the Caregiver's Words

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I have to believe that you’ve heard the one about the patient who shows up at the doctor’s office. The doctor walks into the exam room and asks what has brought the patient in today. Patient says, “Doc, it hurts when I do this.” …Pause… The doctor replies, “Well, don’t do that.” Case closed. It seems that in many cases that approach to health and wellness has taken a backseat to more prescriptions for more pills. Yet, if you dig deep enough on line beyond all the classes of medications, you will find the following recommendations:
- Engage in at least 150 minutes of physical activity per week,
- Stop Smoking,
- Limit sodium and alcohol intake
- Enjoy a healthy diet with lots of vegetables and fruits
- Get to a healthy weight
- Manage your stress.
All of these are good ideas, but a person has to search for them with all the other medications that are available for a medical provider trying to see more patients per day. It’s not all on the health system. A majority of patients also seem to want an “easy pill” which may account for the high demand for the current wave of weight loss drugs originally intended for diabetes, but very much in demand for those who want to lose weight more easily than dieting may afford. And then there’s the Toby Keith song about a conversation he had had with Clint Eastwood about his “secret” to living well and long. The lyrics go like this: Don't let the old man in…I wanna leave this alone…Can't leave it up to him…He's knocking on my door And I knew all of my life…That someday it would end…Get up and go outside…Don't let the old man in Many moons I have lived…My body's weathered and worn…Ask yourself how would you be…If you didn't know the day you were born Try to love on your wife…And stay close to your friends…Toast each sundown with wine…Don't let the old man in Many moons I have lived…My body's weathered and worn…Ask yourself how would you be…If you didn't know the day you were born When he rides up on his horse…And you feel that cold bitter wind…Look out your window and smile…Don't let the old man in Look out your window and smile…Don't let the old man in But to get to the real point, if you really want to live longer and live well, don’t look for another pill or procedure. Look for a chance to take a walk, a chance to get up from your couch or to step away from your desk or to push back from the dinner table. This may take more than a day, but it will reward you with many more days and a happier life. It’s part of my “Live Well Blueprint.” Charlotte Bishop is an Aging Life Care Advisor, Retirement Lifestyle Coach and founder of Creative Care Management, LLC, 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.
The discussion about whether home is still the right or safe place for an aging parent should start with whether an older adult wishes to stay in their lifelong home or not. Some older adults are ready for a move, whether it is just to downsize the responsibilities of home ownership or to move to a warmer climate. But if they really want to stay where they are, the next conversation can then focus on what can be done to allow that to happen, but only if the choice is to stay and age in place. This is going to be the first in a two-part series about helping an older parent maintain independent living within their own homes. I have talked about some of the hardware-related issues in earlier posts, but this is more about lifestyle changes.
Emergencies Just Happen. There are a lot of options to make an elder’s home safer from falls. But, a fall or some other medical emergency can occur no matter how hard we try to prevent one. Make sure you have copies of all the important phone numbers in case of a medical emergency, especially if you live in another town away from your parents’ home. And be sure that this includes the local hospital, the primary care physician, any medical specialists and even the phone number of a neighbor or two who can step up if called upon. Also, keep current with any diagnoses or medications that your older parent currently takes.

Unheard of Problems. Hearing loss is typically a slow process of degradation. It may not be noticeable to those whom your parent sees everyday. But you take care of a Chicago senior living some distance away, note any change you may notice since your last visit. It is not just that you want your parent to benefit from optimal hearing – when one loses hearing, it is harder to even talk on the phone. Add up the difficulties in social situations and the inability to reach out with phone calls, and an older adult is at risk for becoming isolated which ultimately fuels melancholy and depression.

Vision Too. Older adults who have progressively lost visual acuity also are at risk for the same isolation that deafness can produce. If it is hard to see the buttons on a telephone it becomes just as hard to reach out to others as when one loses hearing. But if your older parent does have a decline in seeing or hearing, it does not mean that they cannot be socially active, but you may have to get help in the way of transportation, organization social venues and the like.

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.
As a caregiver for an older adult you cannot prevent a medical emergency, but you can prepare for one. Even if you are a distance caregiver, you will find that you can have your elderly parent help in preparing an "emergency kit" just in case. As a provider of geriatric care management services, I help families with whom I work to customize their preparations to the particular health needs of the loved ones. For starters, both a caregiver and an older adult should have what I refer to as the "grab and go list." Should there be an emergency, both of you should have a list which may include the following information or photocopies of important documents:
- identification like a social security card, passport or drivers license
- health insurance cards, both Medicare and any secondary carrier
- recent medical summaries or immunization records
- a list of current records or prescriptions
- a list of important contacts with phone numbers
- veterinary records if your loved one has a pet
- wills, advanced directives or powers of attorney
Because the emergency may not be medical, but instead may be a natural disaster, it is a good idea to have the grab and go kit in a waterproof container and/or fireproof safe. For the same reason, if you are a distance caregiver, it is a good idea to also have on hand the names and phone numbers of neighbors or friends who could be called to check on your loved one. If you have not met these individuals, use your next trip to see your loved one as an opportunity to also introduce yourself to these friends or neighbors. It will make any later, long distance communication a lot easier. Again, thinking about a natural disaster, help your loved one devise a home escape plan should they have to leave home quickly. And have at least two escape plans should the reason for escape be the sort of disaster that can damage the structure of a home, like a tornado, hurricane or earthquake. Help your loved one also to have a plan for sheltering in place for emergencies like a tornado or hurricane. Especially in the case of the latter, you should also have a set aside cache of fresh water, dry goods, a flashlight, battery-operated radio, whistle and crowbar in the event the emergency lasts for more than a day. For more details about specific responses to natural disasters, go to the FEMA web resource (http://www.ready.gov/). For more advice on preparing for - and facing - medical emergencies, this is a good resource (http://emergency.tufts.edu/guide/medical-emergency/). 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. We provide geriatric care management services to those in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
Legal trusts can help a disabled individual get added help beyond what government programs like Medicaid offer and without sacrificing what these programs do offer. You may recall Gordon Gault, a Chicago attorney who specializes in trusts, wills and probate among other legal areas, who spoke with me some time ago about guardianship. Recently we also talked about trusts available for elders or others with special needs. Gordon explained that the concept behind a special needs trust is that a person can qualify for Medicaid, Social Security and other government programs while at the same time having money set aside for supplemental services or benefits. In Illinois a trust can be handled in one of three ways.

A special needs trust means that the benefits are not for room and board, but for special, or supplemental, needs. This trust is established by some one other than the disabled person so that the disabled person can receive government benefits to which they are normally entitled, but can also obtain extra health services not provided by the government, clothing, vacations, a television, or educational benefits. Gordon offered the example of someone with serious disabilities – mental or physical - where they qualify for government benefits. If the disabled person has a relative with a significant amount of money to be gifted to the disabled person and grantor does not want the money to prevent the disabled person from receiving government benefits, he can set up the special needs trust. The trust basically says that the trustee, whoever is selected by the grantor, can oversee the use of the trust funds. Upon the death of the disable person all of the remaining trust funds pass to whoever is selected by the grantor.

The second is an Omnibus Budget Reconciliation Act 93 payback trust, and it is federally-created. It allows an individual to create a first party trust, that is the individual for him-/herself. This is only for people under age 65. That person can take whatever money they have if they have become seriously ill, and do not want to lose all their money to health care costs. If they have a parent or grandparent alive, they can hand the money over to them with a trust document that has the same special needs language as the first option. If it is someone other than a parent or grandparent, they need a court order…a relatively simple procedure. There must be a regular accounting to the sate as trustees, but it is very straightforward. The balance of whatever remains in this trust after the beneficiary dies goes back to government to pay back whatever the government has expended. If there is excess, it goes wherever the trust says it will go.

The third is a pooled trust for a disabled person under age 65. Control does not go to a family member; it goes to the pooled trust, a non-profit organization monitored by the state. The organization provides the advantage that they are 100% trustworthy and they are professionals who know what they are doing. They know the rules and regulations are, and the money is well-protected. They provide the paperwork to the state oversight agency. The disadvantage is that it is not family making decision for the trustee; it is an agency. Upon the death of the disabled person, 15% goes to the non-profit and 10% goes to charities. Four percent of the overall pooled trust is taken on an annual basis for operating costs.

These are all specific to Illinois. Gordon Gault is available for consultations about Illinois trusts, and he encourages individuals to check with counsel in their own state if the expected beneficiary is not a resident of Illinois. 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 Charlotte Bishop
Ageism has the strongest cultural hold in the US when it comes to sexuality. Awareness of ageism is increasing, and this is facilitating improvement in some areas while only glacially creeping along in others. Change is constant, but it’s slow and uneven across facets of life. For example, an older woman who takes up body building might be celebrated for her commitment to her health; however, the same folks who cheered before might be visibly embarrassed to learn that her decision translated into an unapologetic and dynamic sex life she doesn’t mind discussing, even as she approaches the age of 80. --- Today’s guest writer is a longtime, valued member of our staff. Gregory Peebles, MA, CSA, CDP. Gregory is an Associate Care Manager. We welcome Gregory’s contribution to the voice of Creative Care Management, LLC. --- Older adults are expected to conform to stereotypes – gentle, domestic, and (most of all perhaps) de-sexed. The major problem with this is that people do not age according to societal expectations. The National Institute on Aging (NIA) indicates that a rewarding sex life is a high priority for aging adults across population; however, a poll from the University of Michigan demonstrates a reluctance (17%) of older adults to discuss sex even with their healthcare provider. This is due in part to limited time with the physician and otherwise to mutual generational discomfort between patients and physicians, often 30 to 40 years distant from each other in age. As difficult as it may seem to discuss it with our older loved ones, breaking the silence about sexuality and aging combats ageism’s dismissal of older adults. The willingness to confront ageism has also illuminated the intersection of ageism with other harmful “-isms” like ableism (which prioritizes able bodies over disabled bodies) and homophobia (which prioritizes heterosexual expression). So, the fight against ageism is also a fight across the board for aging marginalized communities to improve quality of life. Perhaps the most important to note is that health, not age, determines sexual capacity. Speaking generally, a sexually active older adult is a physically healthy older adult. Our perceptions of what aging adults should and should not do must prioritize first person testimonies of happiness and wellbeing – no matter what it “looks like” to traditionalists. Encouraging families, healthcare providers and the community at large to be more accepting of the older adult’s potential for intimate experiences opens the door for stronger communication and enhanced experience across all facets of life. And ultimately this aspect of one’s expression of physical love is connected to the universal human need to be loved, which is an integral part of every person’s life experience. Ageism is the subtle, popular prejudice that a person’s age determines their worth and what behaviors are appropriate. As longevity continues to increase, what was considered “old” before isn’t anymore, and consequently what is considered “old” now depends on whom you ask. Unfortunately, many people only discover that they’ve crossed the threshold when a younger person laughs at, or dismisses, them. In my work as a Certified Senior Advisor (CSA), I have noticed that my clients frequently are treated by healthcare providers and other professionals as if there is a clear age boundary. Once a person crosses it, it turns them into an “old person” who is expected to look and act accordingly. Trouble is, we all know there’s no such boundary. Today’s mature adult typically doesn’t “act their age”. Older adults are actively encouraged to be active, enjoy their “third act”. Sources: https://www.nia.nih.gov/health/sexuality-later-life; https://www.todaysgeriatricmedicine.com/archive/SO19p12.shtml https://ihpi.umich.edu/news/sex-after-65-poll-older-adults-finds-links-health-gender-differences-lack-communication-doctors

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