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

Five Things You Need to Know about Coronavirus
Okay, there may be more than five things you want to know about the coronavirus, but these five basics...
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January 28, 2020
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If you are a caregiver, you probably know that the number of hours this job demands is onerous. According to a recent AARP survey, caregivers report an average of more than 20 hours a week taking care of an older loved one. This is on top of the "day job" they already have as well as any other family duties they may have for a spouse or children at home. So who is taking care of the caregiver? One person who probably is not caring for the caregiver is the caregiver him/herself. If you are a caregiver for an older adult or someone else with special needs, try out these suggestions so that you can survive and even thrive your caregiving responsibilities.
1.    Remember to laugh. It is no surprise that caregiving is stressful, and one of the casualties often is one's sense of humor. Laughter is a great stress-reliever that we have to give in to regularly, because it will make everything else a lot easier.

2.    Remember to be "normal." Caregiving can be demanding and often unpredictable in ways that tend to take over one's life. Perhaps you used to have a favorite television program or you enjoyed going for brisk morning walks or some other habit that gave you pleasure. Indulge yourself with one of these returns to normalcy and you will be more refreshed to return to your caregiving after.

3.    Remember your friends or colleagues. Caregiving can squeeze one's social life tremendously, and isolation can only make the weight all the heavier. Take time for a lunch or coffee with people you like, and some of the stress will go down a notch or two.

4.    Remember to get help for the emotional demands. This can be in the form of a support group or perhaps a counselor or your cleric. Talk with someone who will help give you some coping tools and understand why you need them.

5.    Remember to check up on your health. You probably attend all the doctor's visits for your loved one, but when was the last time you had a check-up yourself? It is not just emotional health that can suffer under the stress of caregiving, so keep healthy.

6.    Remember to forget some things. You may have a whole list of "must dos" on a weekly basis, and it is really acceptable to drop some items from your list. Hire someone to do your housekeeping or shoveling the walk or mowing your lawn.
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
Most of us have grown up with the faith that when we have a medical issue, there is likely to be a drug to take to alleviate the problem. Yet, we as geriatric care managers have found that more than 700,000 hospitalizations each year result from adverse events or side effects of drugs or because patients are over-medicated. Most of these patients are older adults, despite the fact that those over age 65 years of age represent only about 13.5 percent of the population. If you are a caregiver to an older adult or other person with special needs, you should pay particular attention to the following to keep your loved one out of the hospital:
- It is not just prescription drugs that should concern you. Most of the medicines that we all purchase over the counter (OTC) were once prescription medicines. They can represent potentially harmful side effects like Tylenol with its potential for liver toxicity. And don't forget that even aspirin is an acid; but it was on the drug store shelf before there was an FDA to protect us from its stomach slide effects.
- Keep track of all the medicines your elder may be taking (and include the OTC meds). Most doctors' offices are getting very good about asking what medicines are being taken with each visit, but be prepared with your loved one's lists at each visit. And ask if any can be dropped; you may be surprised at how many prescriptions handle the side effect of another medication.
- Be careful about how a medication is to be taken. Make sure your older loved one and you both understand the time of day a drug is to be taken, with or without food or how it might interact with another medication or even certain foods.
- Read the fine print. Every prescription has something pharmacists call the package insert or PI. Read the indications and usage section of this long page and call your provider with any questions. Also read the adverse events to make note of anything that has a greater than 5% incidence - and what steps to take should that event happen.
- Make sure you watch for anything out of the ordinary and ask your loved one how they feel. It may be just a dry mouth, or it may be hard stools or other side effects they may not volunteer. Everything is important to monitor. And if your loved one suddenly has any difficulty breathing or feels anxious, call your provider.
Underlying all of these caveats, appreciate that your older loved one has less fluid per pound than a younger adult. Their metabolisms also function more slowly. And most drug trials are conducted only with younger and healthier adults, so side effects may be minimal and less consequential. Birthdays and drugs may have bigger side effects than the pharmaceutical companies may have found in their trials. Charlotte Bishop is founder of Creative Care Management, a team of geriatric care managers, certified professionals, advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecasemanagement.com.
There are an estimated 30+ million cases of dementia worldwide according to the latest statistics. That amounts to a new case diagnosed about every 7 seconds, and the prevalence is projected to increase to more than 100 million people by the year 2050. This represents all the manifestations of dementia, not just the most dreaded dementia, Alzheimer's Disease. With this rising prevalence, you won't be surprised to hear that one of the more common questions I get from the people with whom I work as a geriatric care manager goes something like this: "Is it dementia in my parent or is it just forgetfulness?"

Let me start by reassuring you that we all forget some things some of the time, so just forgetfulness is not the cause for alarm we may think. But at the same time, the forgetfulness or other early manifestations of dementia can be hard to spot, because loving caregivers tend to cover for their partners so that outsiders will not know. Let me share some of the signs that your older loved one's memory may deserve some attention by a professional.

1.     Is the forgetfulness obvious in the form of an accumulation of unopened mail or newspapers and magazines piling up, seemingly unread? Does your loved one miss appointments with increasing regularity or have prescriptions that have gone unfilled? While no one case like this should be a huge cause for alarm, a pattern can suggest the beginning of something more serious that just forgetfulness. Be careful to look for larger patterns, not just the occasional slip.

2.     If you are at all involved in your loved one's finances such as helping to pay bills or to balance the check book, do you notice irregularities? Have they paid a bill more than once or missed a recurring bill entirely? Are they losing money or hiding stashes of cash? Beware, because some of these may also be signs that your loved one is being financially exploited.

3.     Do you notice telltale burns or bruises that show some lack of attention to kitchen duties or other work around the house? Yet, don't make a lot of a little as these may also be signs of weakness that are just part of getting older.
          If you have noticed any of these warning signs, please appreciate that they may be warning you of something other than dementia. Has your loved one's alcoholic consumption changed recently, or are their medications manifesting some side effects or interactions? Something as basic as your loved one using diphenhydramine (Benadryl) can cause forgetfulness the day after using it for allergies or as a sleep aid. And alcohol consumption can exacerbate this fuzziness. One of the more common ailments of older individuals is depression which can distract them from the attentiveness they may have shown when they were younger. Be alert to recent losses or changes that may have precipitated the blues as an explanation for forgetfulness or absent-mindedness. 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.
Associate Care Manager Gregory is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP), and Medicare Counselor, whose work focuses on helping aging adults and folks with limited independence by providing resources and support to help them discover and lead their best life. Gregory has been a part of CCM, Inc. for over a decade. – Charlotte Lots of folks are worried about the future of Medicare and Medicaid. In February, the Senate passed the CHRONIC Care Act which is called “Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care” in full, and is specifically designed to promote improved assistance to the millions of older adults with multiple medical issues. It expands care at the same level of funding and seeks to assist those whose chronic illnesses are not efficiently managed by the hospital model. As adults age, some health concerns can be resolved with treatment, but some, like dementia, emphysema, heart and kidney diseases, and arthritis, are permanent conditions that need a great deal of medical attention. For these conditions, though, hospitalization is not the best way to provide care. Still, many patients with chronic conditions find themselves in multiple, unnecessary office and hospital visits due to the current treatment climate. This legislation, which also seeks to end the lack of coordination between Medicare and Medicaid, will be a boon to folks living with chronic conditions, especially those whose chronic illnesses are auto-immune, as one of the primary objectives of the bill is to reduce hospital visits and provide more in-home care. What does the bill say it will do? What improvements can Medicaid or Medicare Advantage beneficiaries expect? The bill:
- Expands coverage for “non-medical” services and equipment– Funds are now freed for more in-home care for patients who need service, but do not need skilled nursing, and more funds are available for Durable Medical Equipment (grab bars, wheel chair ramps, etc) for the chronically ill.
- Expands telehealth coverage– Medicare Advantage members will have more access to telephonic health management and digital services where before barriers made these services more difficult to receive. This includes telehealth services for stroke no matter the geographic location of the call.
- Includes Telehealth with In-Home Dialysis– Kidney patients already on in-home dialysis will find it a great convenience to be able to use telehealth as a clinic visit.
- Frees Acountable Care Organizations (ACOs)– These organizations will be free to assign chronic status and utlilze their resources to provide care at a greater rate of their own discretion.
The bill, which will provide better care at the same level of funding, eliminate unnecessary hospital visits/stays for chronic patients, while drastically reducing cost of care provided, looks to be a win-win situation which will positively impact many aging adults. If you or someone you love is dealing with chronic illness and on Medicaid or a Medicare Advantage plan, your life just got a little easier, and your care just got a little better. Reach out to us at Creative Care Management or your providers and find out how this change in care model can best benefit your situation. 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.