Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • Finance & LawChicago's Geriatric Care Manager Center of Excellence

Caregivers, Know Medicare’s PT Rules
Until quite recently there were rules governing what Medicare will reimburse if a qualified adult was prescribed physical therapy,...
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July 11, 2013
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Older and Still Working?
I did not start out as a geriatric care consultant although I have been one for nearly 20 years. ...
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June 27, 2013
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The Other Costs of Alzheimer’s
As a geriatric care consultant, I field a lot of questions from people concerned about memory issues in an...
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June 20, 2013
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Managing Geriatric Care Hospital Sticker Shock
Do you know how much a pacemaker costs…fully installed? Well, if you or a loved one have no heart...
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May 30, 2013
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Low Interest Rates Mean More Elder Scams
People 60 and over make up 15 percent of the United States population, but they represent about 30 percent...
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April 29, 2013
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Why Do I Need Powers of Attorney for Mom or Dad?
While speaking with Matt Margolis (Elder Law attorney with Heartland Law Firm) recently, he mentioned a common question he...
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April 18, 2013
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The VA’s Best Kept Secret…
I have spoken with Matt Margolis, an Elder Law attorney with Heartland Law Firm recently about VA benefits to...
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April 15, 2013
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Tough Talks with Parents – Part 2
In the first of this two-part series, I talked about conversations involving changes in life where you as the...
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February 28, 2013
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Tough Talks with Parents – Part 1
In earlier posts I have talked about some ways to broach difficult subjects with an older parent, talks that...
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February 25, 2013
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When Doctors Don’t Define Medical Necessity
If you are a caregiver to an older loved one or a person with a disability who may be...
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January 31, 2013
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In the Caregiver's Words

Recent Client Praise

As a geriatric care manager, I speak with my older clients who wrestle with weight gain as much as anyone younger. No surprise, obesity has become a recognized, global epidemic in the developed world, and it shows little sign of slowing in its progression toward greater individual bulk and poorer health. Yet, recently reported research in the Journal of the American Geriatrics Society summarized in an article in Medscape on Aging and Obesity suggests that overweight older adults may have very similar mortality to normal weight older adults.

In a study of about 9,000 Australian men and women aged 70 to 75 years old, researchers tracked the mortality of individuals categorized by their Body Mass Index (BMI). BMI is a measure of the estimated body fat of an individual based on their height, weight and waistline. What they found shows that overweight individuals who are older do not seem to have worse mortality than their normal BMI counterparts. That said, being sedentary was associated with a greater risk of mortality. Being sedentary doubles the mortality risk among women, but it only increases mortality in elderly men by about 28%. Extreme obesity, however, was associated with significantly greater mortality.

While the researchers acknowledge that BMI is not a perfect indicator of body fat, per se, they did conclude that dieting among this age group does not offer any measureable mortality benefit. Losing weight among older adults may even be harmful to their well-being.

Given the mortality risk associated with extreme obesity and the ill effects of a sedentary lifestyle, the researchers further suggested that very high BMIs may discourage the activity which is beneficial to older adults.

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.,geriatric care manager Chicago, geriatric care Chicago

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Associate Care Manager Gregory Peebles is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP), and trained 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 This is the first installment in a three-part series to help clear up some common misconceptions about Medicare. Medicare isn’t intentionally confusing, but with all the cross-talk surrounding Medicare, even if understanding it isn’t as intuitive as “1,2,3”, it’s at least as easy as “A, B, D.” As a care manager, I know first-hand that there are lots of people with the wrong idea that Medicare is a cheap, single-payer, universal care package for US citizens who have retired from the work force. There is a fantasy at work in the minds of many Americans that once they have “paid their dues” and transition into retirement that their medical concerns will be easier to manage, and that all care is covered. Unfortunately, folks who have enrolled in a Medicare plan and those helping to coordinate their care already know that this is only partially true. While Medicare, our government-subsidized health insurance program for adults 65 or older, is somewhat simpler to manage because it is a single-payer service, it has changed significantly since its implementation. But the real shock to many is that coverage was never meant to be universal. Medical providers who agree to take Medicare “assignments” agree to maximum prices able to be charged for services. This does keep costs down, and Medicare pays 80% of those contracted prices; however, service receivers are expected to pay the remaining 20% of costs, not including prescription drugs. When the source of payments is a fixed income, that income gets spent very quickly on covering the “gap” that Medicare does not pay. So, while Medicare may be inexpensive in comparison, it is still rarely easily afforded by those who use it. What Medicare was designed to be is a program to help offset medical costs for aging adults. It was consequently split into two broad categories – Medicare Parts A and B – which correspond to two primary methods of treatment. Part D, added later, supplemented Original Medicare as the trend for prescriptions for aging adults increased.
- Part A – [Original Medicare] Covers in-patient stays (including hospital stays, or stays in rehab facilities, etc.)
- Part B – [Original Medicare] Covers physician visits (including PCP visits, or referrals)
- Part D – [Addenddum under the Medicare Modernization Act of 2003] Covers select prescription drugs.
These broad categories do cover the bulk of what we would call internal medicine, yet there are surprising omissions in coverage, which we’ll talk about next time. Another consideration for those about to transition to Medicare is that the program is not one-size-fits-all; rather, it can be individualized (within limits) to the patient’s needs. Much like traditional insurance, if the selected plan is not optimal for the patient, parts of the plan can be modified during open-enrollment periods. We’ll talk about this, too, when we fill in another “gap” and talk about Medicare Part C. 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.
We as certified geriatric care managers all hear about older adults falling. Caregivers often do not expect their own loved one to have an accident at or around home. The simple fact is, however, that about 20 percent of adults over age 65 will have a fall in any given year. Sadly, most fall can be prevented with some simply safety precautions:
1. The Feet aren't Fit. Yes, it is true that a lot of falls happen because there are hazards all over an older adult's house, but falls are not inevitable. De-conditioning happens in older adults who do not really exercise their balance and their gait. They become less nimble, and you can see it in the "elder shuffle" many of them manifest. You may not be able to help them dance again, but you can get rid of worn carpet or what we call "shatter rugs," or scatter rugs. For an older person who does not lift their feet, these can be a fall waiting to happen.
2. Other Hazards. Anything on the floor and potentially in traffic can be a fall hazard. Look for uneven surfaces, footstools, electrical cords, stairs and similar clutter on the floor. You don't need to make your older loved one's home a sterile and barren place, but you can clear the traffic routes to eliminate risks before they become a broken hip.
3. Line of Sight. If they cannot see it, they will fall on it. Older vision inevitably becomes less acute, but sight also can be obscured by cataracts, macular degeneration or other conditions of older eyes. You can address some of this by seeing that they have annual vision tests and necessary upgrades in their eye wear as well as enhanced lighting throughout the house.
4. Medication Side Effects. Many medicines have side effects that cause dizziness or low blood pressure upon standing. While their main effect may be necessary, the side effects can make navigating an otherwise safe path incredibly difficult. Talk to the health care provider about any side effects and ask about reduced doses or a change in meds altogether.
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.
If you are a caregiver to an older, qualified loved one who has not yet applied for Medicare, then December 7 is looming large for both of you. Or if you are a caregiver whose deadline is not this year, but is next year, then it is time for a crash course in what Medicare covers and what parts do what for your older loved one. You can refer to the basics as the ABCs, but you also need to add a D. The rest gets easier. Medicare Part A very simply is the part of the federally-sponsored plan that covers hospitalization for those enrolled. For all those over age 65, this is the longstanding part of the coverage that has no premium to be paid and covers what Medicare will pay to providers for inpatient stays. This is the easiest part, because you will not find too many hospital providers who do not accept Medicare's inpatient coverage. These outsiders are pretty much just military or VA hospitals along with the Shriners' Children's Hospitals. Medicare Part B covers generally the doctors' billings and outpatient care for those who are age-qualified and have enrolled, and it costs about $104.90 a month to enroll. But - and this is a critical but - the providers in these settings have to "accept Medicare assignment." In large part, because Medicare has such strong negotiating power, not every provider wants to accept what they will pay for services. These doctors and others who most likely will be holdouts on Medicare assignment typically are psychiatrists or some specialties. With some exceptions, the Mayo Clinics will not accept Medicare patients, so it is important that you help your older loved one check to be sure the providers they use are on the list. You can do this by going to WWW.medicare.gov and clicking on "Find doctors and other health professionals." Medicare Part C was originally called Medicare Advantage. It is available through private insurance carriers who create panels of physicians in Independent Practice Organizations or Preferred Provider Organizations and more to cover what Part B does not cover. They also will charge a premium. There is an alternative sometimes referred to as Medigap, and you will want to check out which offers the best coverage and access to the providers your older loved one will want. Medicare Part D is an optional plan that offers prescription drug coverage which none of the first three offer. Your loved one will have to "opt in" to this plan as offered by private insurers. Some of this will be changing under Affordable Care Act, so stay tuned for changes that will help to close what often is referred to as the "donut hole," the part that the covered person must pay after the initial coverage is exhausted and before the next threshold of coverage kicks in. So that is your crash course in getting your older loved one enrolled in Medicare, but you need to be alert to some potential landmines along the path: • Just because your loved one's doctors or hospitals are in the covered network this year does not mean they will be in the network next year; • Not every carrier's prescription coverage will be the same - be alert to language about coinsurance versus copays, step therapy and prior authorization, all of which will impact the out of pocket costs of medicines; • Make sure that when your loved one is hospitalized that it is an "inpatient stay" (covered) and not "observation" (not covered); • Know the rules on how you can appeal decisions on coverage. 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. Please email your questions to info@creativecaremanagement.com.
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.

Caregiver Counsel on Taking the Old Out of AgingNo one argues that loss, isolation, or medical ailments may represent genuine setbacks as a person ages, but depression is a significant step beyond just feeling down or blue. Learn how to recognize symptoms of depression and how to be happy even at 100 years old.Download
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