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

Prescription Risks for Elders-part 1
Within the past two weeks the Food and Drug Administration (FDA) has issued a number of warnings that concern...
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July 6, 2011
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Preventing Unnecessary Hospital Readmissions
According to research reported in the New England Journal of Medicine, approximately one in five Medicare beneficiaries discharged from...
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June 24, 2011
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Hospital Discharge Needs of Elders
Elders have more health care issues and have more doctors’ office visits and more hospitalizations than their younger counterparts. ...
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May 9, 2011
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Finding Caregiver Resources
In the past two postings I have been talking about the warning signs of caregiver burnout as well as...
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January 27, 2011
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In the Caregiver's Words

Recent Client Praise

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.
So last week, the turkey turned out really great, the pumpkin pie was awesome, the home football team prevailed, and most of the family showed up for the annual feast. Everybody ate, laughed and played together nicely, but you feel like crying. It just was not the same without mom or dad or some other loved one in the picture. You're not alone if you have this feeling of being let down or even depressed as you try to put on a happy face and enjoy the holidays that used to be so wonderful.

Psychologists call these responses to holidays or other special times of the year "anniversary reactions." The holiday itself may bring back memories of a time when there was a lot to enjoy - which makes holidays without a loved one all the more empty now that they are gone. Or the holiday may be the time when your loved one passed, and it is hard to find the good times in what now is a memory of profound loss.

It is not just about dates on a calendar. There are other potential triggers that bring on a sense of grief and loss almost as fresh as the moment of the initial loss itself. Certain places when we come "home for the holidays" can be triggers for melancholy. Certain smells like those of a favorite dish or of the frost in the air or the candle smoke as the Chanukah candles burn down or the Christmas tree that may soon stand in the corner. And there may be the sounds that open the flood gates as we all shift to the holiday music that will be with us until the day after Christmas. But you don't have to simply resign yourself to the blues; here are some ways to reconstruct a more positive version of your holidays.

1.    Crying gets the sadness out. It's okay to be honest about how you feel by simply letting the emotions out. Crying can be a great emotional release and a relief that will let you then get back on with more positive holiday emotions.

2.    Reflect back on the positive activities that you had enjoyed with your deceased loved one. Find someone - children or grandchildren - with whom you can share the activities, and you may find they begin to give you a new satisfaction.

3.    Memory of loss can stand in the way of other positive experiences that preceded the loss. Talk with close friends or relatives, some of whom may have shared those positive events. By reconstructing the positive, you re-experience moments you had cherished with your loved one.

4.    Collect some of the photos of the good times you have enjoyed with your loved one. Or maybe it is a letter written or other memorabilia that you can place in a special box or album so that you can have stimuli that help to re-experience the moments that have been special.

      These suggestions are not intended to take the place of professional counseling if your depression weighs heavily on you, but they are steps that may help restore the "happy" in your holiday.

      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 a suggestion for the perfect gift for those of you who may be visiting with family during the holidays, perhaps with family members whom you may have begun to notice have cognitive abilities that are slipping a bit. I joined a group this past weekend who annually goes holiday caroling to those who are unable to get out or who are in memory units at a number of facilities here in our home town. It really helps me each year to share a bit of joy with those who are no longer able to just jump in the car and head out to a holiday show or a family gathering. It also reminded me of a significant therapy for people with many types of dementia. It is not a therapy that restores memory, but it is what is termed “reminiscence therapy,” and it restores a calm to people with cognitive impairment by “taking them back” to a place in their memories that they can still access…a place that is a good memory to savor. Therapists in the Netherlands have created small villages as settings for people with dementia so that they can return to some of the familiar looks, smells and music of an earlier time that is still within reach in their minds. It takes them back. There has been success with this concept in a village called the Glenner Town Square outside Baltimore as well. It is complete with pictures of a generation ago on the walls, period music emanating from the speakers and even a vintage Ford Thunderbird parked outside a vintage diner. Think of such places as comfortable and safe environments which are structured to be soothing memories of a time that becomes clear in their minds. And as with all pleasant sensations, the mind rewards the body with a boost of “feel good chemicals.” It brings a smile to participants’ faces and a better night sleep following. All of that makes their tomorrow a bit better as well. So I thought about this while we sang to people who immediately beamed when they heard our familiar refrains…and yes was even in a room playing a rerun of It’s a Wonderful Life…but who doesn’t do that during the holidays? And as we sang another old standard, I watched many of them singing along without using the songbooks we were provided. No troubles with their memories as I followed the words in my own book rather self-consciously. So here is something you all can take home for the holidays in the form of a little experience that will be a real “feel-good.” Bring along some classic music, add to that some of the vintage photos you may have and follow where your older loved one wishes to go. Please don’t correct them if they happen to talk about the older relative who died ten years ago as if they just couldn’t make it to the family dinner. Go with their flow and you all will get to a happier place that will have some really nice memories for you along with the “feel good” for you all. 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.
"It has been forever! You look so different!" Joyful cries of greeting such as these are so common at the holidays that we don't notice them. However, if someone has changed but we don't feel comfortable mentioning it, that's a very important change. Modern families see each other less and less. Work and/or geography get in the way, and the most face-time many of us get with our extended families is at the holidays. We all want to keep an eye out for the ones we love, and the line between wanting to honor the autonomy of adults and wanting to prevent problems is difficult to walk. However:
Did you notice anything like this over your holiday visit?
1. Are there bruises? Signs of a fall? Noticeable loss of weight?
2. Are they wearing messy, baggy clothes? Poor hygiene? Smell of urine anywhere?
3. Is the refrigerator full of spoiled or moldy food?
4. Do they have trouble finding words used regularly in conversation?
5. Are they moodier than you remember them? Not interested in their hobbies anymore?
If you did, you're not being nosy. These are real signs of decline, and you need to address them with your loved one with respect and care. They could be fixed as easily as adjusting medication, but they could also be real indicators that it's time to sit down and have a serious talk. It's never easy, but change rarely is. The good news, is that we've done all this before, and we're here to help if you want to talk. If you just found out that this is your life, and you suddenly need answers, I can help with a consultation. If you don't know what to do, just call. We'll figure it out together.
This week is National Women’s Health Week. The reason I mention “caregiving” in the title to this posting can probably be summed up in one word: Stress. If we were all together in a room, I would see a lot of heads nodding, because those women who are caregivers know what kind of stress this is…but you may not all be accepting that it is also costing your health to be that stressed caregiver. One woman with whom I spoke some time ago said it best when she remarked that she didn’t think twice about canceling her own physician appointment in order to accommodate a medical appointment for her father for whom she was a caregiver. There are more than 65 million caregivers in America today, and two out of three of them are women. But that is not all. The majority of these caregivers are married and have full-time jobs. And 37% have a child or grandchild under 18 years of age living with them. No surprise that caregivers’ health care costs are significantly higher, because caregivers are sicker. And they don’t practice good wellness habits. Caregivers smoke more, drink more alcohol and get fewer preventive screenings. Ditto that “good wellness habits” thing. There is not a quick fix to this health risk that women caregivers seem to uniquely have. There is no one size fits all, but there are some steps that all women – not just the caregivers – should take:
1. Find what makes you happy and go there…frequently.
2. Schedule a wellness visit with your primary care physician - now.
3. Ask about what preventive screenings or vaccines you should have on your calendar.
4. Get active…walk more and farther, and do it five days a week.
5. Eat healthy…which is not to say you cannot still have your guilty pleasures, but you do need good sources of protein and lots of greenery in your diet.
6. Get enough quality sleep…most experts talk about eight hours a night.
7. If you smoke, quit; if you text and drive, quit; if you drink, monitor your alcohol consumption.
8. Find what makes you happy and go there…frequently. I have repeated this for a reason.
And I probably need to add that you should starting working on this list now, because procrastinating on your health is not an option. 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.
Because health care – particularly long term care – can be expensive for elders and others with special needs, it is critical that anyone looking for Medicaid qualification take action before June 14, 2011. As a geriatric care manager, we help elders and special needs individuals as well as their caregivers to navigate Medicare, Medicaid and the other entities that provide safety nets for those who qualify.

There are changes in store for Medicaid that may affect who qualifies and how they qualify after June 14 of this year. I had the benefit of sitting in recently on a presentation by an elder law attorney in the Chicago area, Janna Dutton, who helped shed some light on the subject.

Medicaid is mandated by the federal government, but the details of how it applies and how it is financed are the domain of state government. I will be talking in this posting about what we know now about Illinois law as well as what we do not know. So, let’s start with an individual who is seeking to apply for Medicaid in Illinois.

First, of course, that person must be a legal resident, but that part is simple. For Illinois, a resident simply is someone in Illinois (for no specific duration) with no intention of leaving. There is no duration of residency required. To qualify for Medicaid, however, an individual cannot own a home outside Illinois, not even a vacation home. And the individual must be over age 65 or be eligible for Social Security Disability benefits.

Presently, a person will qualify for Medicaid only if they have no more than $2,000 in liquid assets, but this does not include a home (which can be valued at no more than $750,000 if the applicant plans to return home after their stay in a nursing home). State government has a “look back” period of 36 months prior to application. That is, they will “look back” three years at an applicant’s finances to see if there were any expenses or “gifts” that may appear to be efforts to deplete funds for the sake of qualifying for Medicaid. Any suspect monies expended will be added back to existing assets. Anything over the qualifying amount then will be spent before Medicaid contributes to the person’s care.

Exceptions may include “gifts” that have been a longstanding pattern of giving by the applicant (for instance, dollar amounts consistently given to grandchildren upon marriage, graduation, etc.) The date from which the spend-down starts presently is the date of the gift that forced assets to exceed the $2,000. Asset qualifications for applicants may be what will most change after June 14. After June 14 it may be as much as a 60-month look back, and the ineligibility may start at the date of application rather than the gift.

The financial scrutiny also extends to accounts that may be held jointly with a caregiver or relative. The joint account will be considered the exclusive asset of the applicant unless there have been regular deposits to this account by the non-applicant. For this and all accounts, the responsibility for documenting paperwork is that of the applicant.

This is some of what we know, but it is what will change after June 14, 2011, that we cannot fully know. I recommend you seek counsel from a qualified Illinois attorney, and I particularly recommend you go to Janna Dutton’s website for helpful information and advice about this and other elder law issues.

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 Charlotte Bishop.