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

Nine Geriatric Care Management Guidelines for the Caregiver
About one in ten American adults, or approximately 44 million people who provide unpaid care to another adult, are...
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September 3, 2013
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Caregivers Cannot Ask Doctors This Question
I have talked in a lot of my postings about advanced directives and how we all need to prepare...
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August 15, 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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In earlier posts I have talked about some ways to broach difficult subjects with an older parent, talks that are about life changes, one of the harder among them was giving up the car keys. This is going to be the first in a two-part series in which I will offer perspectives on some of the changes in life where you as the child of an older parent may be required to step up to help your parent or see that proper help is available. The second part will be devoted to conversations about preparations for end of life, life's final transitions. It may surprise you to learn that the former can be a lot more difficult than the latter. Harder because everybody expects to die someday, but many people have greater difficulty in addressing their potential loss of independence along the way.

Power of Attorney. You may want to talk with your family attorney before this conversation so that you can keep the details straight. There are two types of power of attorney (POA): one for health care and one for finance. The legal system has defaults in place to handle decisions for a person's finances or health and well-being if they are deemed unfit to do so on their own. However, those decisions have to go to a judge and the process can be time-consuming and costly. If one of your older parents is unable to make financial decisions - and they own property jointly with their spouse - it becomes difficult to liquidate the house if funds are needed for long term care or other health care issue. Health care POA can offer similar relief in the event your older parent requires some choices in where and how they will be cared for. In both cases, it can be easier to broach the subject if you, yourself, have had the papers drawn up for your own situation and offer your own experience and questions as an example to your parents. At any age, there is benefit in knowing that decisions will be made in our best interests if we cannot make them ourselves.

Long Term Care Insurance. Assisted living or home health care can be expensive, and the right long term care (LTC) policy can make life a lot easier to the bear financially. But be aware that there are a lot of different types of policies with an array of benefits and payout mechanisms. And the cost to buy LTC insurance will depend on the age at which you sign up as well as some other variables. To be sure you are getting your or your parents' money's worth, look for an independent broker who is not captive to a single insurer. But before you talk with a broker about your older parent, check out an authoritative source. The American Association for Long-Term Care Insurance has a consumer information section you may find helpful. And as with the conversation about POAs, you may investigate a policy for yourself as a foundation for having the conversation with your parent. Part 2 will post on Thursday.

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.
You’ve all probably heard the old joke about why a flamingo stands on one leg…and we have all seen these lanky birds if we’ve ever been to a zoo. The answer is simply, “If they lifted the other leg they’d fall down.” Now, why would a person stand on one leg…and do so for 10+ seconds? According to recent research, it is to test their health and expectation for longevity. You’ve seen or heard it in the news that people in their mid- to late-life who cannot maintain this one-legged posture have more than twice the risk of death in the next seven years over those who can do the pose. That’s a very big differential. To fill in the rest of the research that may not have come across on your evening news or in your online news feed, medical researchers have noted for a long time that agility like this is tied to risk for cognitive decline or other cerebrovascular damage. About 13 years ago, researchers took this a bit farther with a panel of 1,702 patients who would be followed from 2009 forward. Their average age at the outset was 61.7 and 68% of them were men. Over one in five failed the test from the get-go, and as you can imagine, the failure rate was higher among older participants. More than half of the 71 to 75 year-olds could not pass the test. These individuals were followed for a median of just over 7 years and 7.2 percent had died by this next measurement date. But mortality was not equal across the board. Just under 5% of those who could do the one-legged stand in 2009 had died seven years later, but more than 17% of those who could not balance earlier had died. Scratching beneath the surface, there were more factors than simply balancing in play. The researchers found that people who could not balance also:
- Were more likely to be obese;
- Were more likely to have heart disease, hypertension or dyslipidemia; and
- Were three times more likely to have type 2 diabetes.
The study cannot say that there is causation between these factors and death, but these are differences worth paying some attention. So, getting more agile is probably a healthy thing to do, but there likely is more. Getting to a lower weight, managing physical activity to burn calories, taking medications to reduce cholesterol and managing other lifestyle factors to bring one’s long term blood glucose levels down are all pretty sound pieces of advice. Chances are that if a person follows these lifestyle management recommendations that it also may become easier to balance on one leg. The payoff for all of these, then, is pretty obvious. And I think we could add one more. The chance of a fall will be greatly reduced if one gets their nimble back as well, so where will you stand on this issue? 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.
I had the good fortune recently to meet Jennifer Muskat, the Director of Client Services for San Diego Home Care Assistance. She shared some helpful perspectives on the importance of geriatric care management services for older adults who need emotional support. "The physical obstacles that your aging parent or loved one encounters in old age are often the most noticeable. While you can easily observe their struggles with walking or daily chores, it is much more difficult to recognize, understand and empathize with the emotions they experience on a day to day basis. Your elderly loved one will be forced to deal with a handful of life-changing events as they age. Retirement, forfeiting the right to drive, and the loss of a spouse, sibling or close friend are just a few examples of inevitable changes that accompany aging. Without emotional support from family members during life’s new and unfamiliar events, seniors become vulnerable to depression and often suffer from a decreased quality of life. As an adult, your sense of worth comes from your ability to provide for your family, perform your job well and most importantly, function as an independent individual. Whether from frailty or age-related illness, seniors lose these abilities, resulting in an increased dependency on their adult children. When this role reversal occurs, many seniors experience feelings of worthlessness and a lack of self esteem. Becoming dependent on their children, who once relied on them for everything, is difficult to cope with emotionally. When neglected, these negative feelings can result in depression in seniors. They feel alone and helpless and that no one understands their situation. To ensure the health and wellbeing of your loved one, it is crucial that you are aware of how your loved one may feel. If they seem withdrawn, upset or have just suffered the loss of a close friend or family member, take the time to talk with them. Listen with patience and compassion and try not to criticize their feelings. By letting your elderly loved one know you are by their side and are available to offer emotional support, you can help combat depression and enhance their overall happiness and quality of life. Also recognize that seniors become socially isolated in their later years and encourage your loved one to pursue new hobbies and stay in touch with old friends. Participation in these activities offers another channel for emotional support. We often do not look beyond the physical ailments of our aging parents and fail to provide the emotional support and encouragement they once provided us as children. However, it is never too late to help. Reach out to your elderly loved one and let them know you are there for them as they enter this new stage of life." Jennifer Muskat is the Director of Client Services for San Diego Home Care Assistance. She offers geriatric care management services as an advocate for senior health and wellness. By constantly developing new programs, she ensures Home Care Assistance caregivers can provide optimal quality of life for senior clients. 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 elder care services to those in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
With this posting, I am introducing a colleague and guest blogger, Pamela Holtzman, who is a therapist I know locally. Pamela is an R.N and L.C.S.W. who combines her medical background with a combination of cognitive therapy, traumatic release with EMDR and EFT and integrative psychotherapy, to facilitate wholeness and wellness, in her clients. Her perspectives on being well while getting older are worth sharing:

“Have you had that birthday yet which made you suddenly realize that you really are getting older? I don’t mean older in a decrepit, breaking down way. I mean older in a wiser, stronger, and more mature way. I had discovered that I had reached that phase during my recent 60th birthday “initiation by storm” as I came face to face with IRENE, the Class 3 hurricane that wreaked havoc at the doorstep of our home in the Bahamas. What followed was a week-long power outage, and a chance to do a lot of soul searching.

As a result of a life-long practice of maintaining a healthy mind and body balance, I was able to remain calm, peaceful, and resourceful throughout this life altering and potentially devastating experience. How can you stay balanced through life’s unexpected challenges:

Be Present – learn and practice living in the here and now, don’t worry about the past or future. No matter what life is offering, take time to do a morning quieting practice. Good options are yoga, Tai Chi, meditation, or anything that includes a level of mindfulness.

Be Healthy – have regular medial check-ups, and use a preventative approach to health. A good place to start is by eliminating the four poisons from your diet: hydrogenated fats, high fructose corn syrup, processed foods, and sugar. Develop and maintain a routine of ample rest, and follow a Mediterranean diet (high in fruits and vegetables, whole grains and cereals, nuts and seeds, oily fish, and olive or avocado oil, keeping red meat and diary to a minimum.) Try some new grains like farrow and quin. Make sure to drink plenty of water, and, of course enjoy a daily treat of dark chocolate.

Simplify – let go of what you don’t need. Clear that which creates clutter and/or complicates your life. This includes identifying and spending less time with ‘maintenance friends’ who rely upon you, but don’t offer reciprocity in your friendship. Decrease or eliminate activities that drain your energy, as opposed to replenishing your reserves. Remember balance.

Get Moving – of course there’s the physical benefits of exercise (increased bone density, muscular strength, endurance, energy, and better posture), but exercise also provides stress relief and improves mood. I have learned as I age –if I want to move, I’ve got to keep moving! It’s fun to mix up your routine and keep learning. Try Zumba, Nia, Barre, go to a dance class, or water aerobics. Keep exercise fun and playful, and do it every day.

Have a Massage – many enjoy getting one. But you don’t need to pay someone to enable your body to relax, detox and stimulate the lymphatic system. You can do reflexology for yourself on your hands or feet (it’s as good as a whole body massage.) Or try “dry brushing” before your shower, which natural detoxifies and is very stimulating.

Embrace Change – and recognize that change is good. It keeps your mind active, challenges flexibility, and opens up new ways of being in the world. Remember to soften into life, rather than contract in fear whenever you’re not familiar with a situation or are uncomfortable in life. Let go of the need to be right, to be heard, or be acknowledged. As you mature, you can learn to be comfortable with who you are without the need for outside validation.

Fill Your Soul and Spirit – learn to have fun. Think about what fills your reserves, what feels cohesive to your sense of self. For me, it is being with my grandchildren, or doing anything in nature. For you, it may be travel, volunteering service work, or just being home with a good book. You will be able to tell you’re being true to yourself because you will feel happy, rejuvenated and renewed.

If you want to continue to improve and grow as part of your aging process, it is necessary to continue working on balance and integration as part of your daily healthy lifestyle practice. Then, no matter what life challenges you face – you’ll be ready for them. For more information and techniques on healthy living, refer to my book Healthy Lifestyle Path of Wellness."

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.
In the meantime, we invite you to download the below featured FREE white paper - offering both personal and professional advice for those who care for the elderly or people with special needs. Make sure to come back and visit us for more great FREE resources.

A Caregiver's Guide for Changes & AgingCoping with change can be difficult. It often involves tough decisions and conversations with the person you care for. Discover strategies to help you and your loved one feel more comfortable with transition.Download