Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • geriatric care ChicagoChicago's Geriatric Care Manager Center of Excellence - Since 1991 | Page 3

Medicaid Changes to Affect Seniors
Because health care – particularly long term care – can be expensive for elders and others with special needs,...
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June 10, 2011
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Summer Visits for a Senior Care Check-up
In this posting, I have invited Julie Northcutt, President of Caregiverlist.com, a company that uses new technology to deliver...
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June 3, 2011
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Making Home into a Gym
I have written in other postings about how “staying active” can be tremendously important for older adults or others...
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May 27, 2011
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Geriatric Care Management is Catching On
We may not be hearing QUITE as much about health care reform of late, now that the political debate...
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May 17, 2011
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Special Needs Trusts for Elders and Others
Legal trusts can help a disabled individual get added help beyond what government programs like Medicaid offer and without...
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May 14, 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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Continued Insights into Guardianship
I started in my last posting with a Q and A with John Wank, President of the Illinois Guardianship Association. He...
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April 27, 2011
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Seniors and Depression and a Fix
One of the most common health issues that seniors deal with is depression. According to the National Institutes of...
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April 18, 2011
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Safer Senior Living – The Kitchen
In my last posting I spoke to ways to improve the safety and accessibility of the bath for seniors...
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April 10, 2011
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Safer Senior Living – The Bath
I promised in my last posting to talk more specifically about what can be made safe for seniors who...
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April 5, 2011
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In the Caregiver's Words

Recent Client Praise

In my past two blog postings I have talked about some recent warnings from the Food and Drug Administration (FDA) that concern me as a geriatric care manager, and they should concern caregivers and the elders in their charge as well. This most recent and third warning was about some of the dosing for drugs that are used for people who may be anemic or suffer from chronic kidney disease or be on chemotherapy of some sort. As you may suspect, this is a relatively smaller segment of the adult population, and as you will see here, it gets even smaller as we are mainly talking about people with chronic kidney disease. But one of these medications has been part of one of my client’s standard monthly routine for some time, so it struck closer to home.

You may know these drugs by their brand names if you or a loved one has one of the conditions. The brand names are Procrit, Epotin or Aranesp, and they help the body increase the red blood cell count for people with some types of anemia. These drugs, referred to as erythropoiesis-stimulating agents or ESAs, are also now known to increase patients’ risk of cardiovascular events. As with the other two warnings I have posted, these risks only became known over time as more and more people were given these medications. This is because the actual cardiovascular events they can cause are still fairly rare.

All of these drugs already had had warnings of one sort or another on their packaging, so doctors have been aware of those. The new warnings, in fact, are most particularly a danger for patients whose medications move their hemoglobin levels above a given point. These drugs were intended to replace the need for certain patients to have red blood cell transfusions which also pose their own risks. The new guidelines have been made clear to doctors in new warnings on the package inserts of these drugs, and they specifically make it clear that patients with chronic kidney disease and on dialysis should be treated differently from patients who are not on dialysis.

As with any warning from an agency like the FDA, this may call for a conversation with your provider. If you or an elder or other special needs person for whom you are a caregiver have chronic kidney disease, you should talk with your specialist about steps that may be taken to minimize any unnecessary heart risks.

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.
Associate Care Manager Gregory Peebles returns with a series on the Internet and aging. Gregory is both a Certified Senior Advisor (CSA) and Certified Dementia Practitioner (CDP) 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 lives. Gregory has been a part of CCM, Inc. for over a decade. – Charlotte Since one of the primary uses of the Internet is to find things, it was inevitable that we would turn to it when looking for love. The “market” responded, and these days it seems thereare as many web sites and apps as there are people looking to date. Older adults, not wanting to be left out of any opportunities, now have match-making services that cater exclusively their cohort’s desire to connect, or to reconnect after loss. What advice can we give to aging adults and those who support them in living their fullest lives?
1. Be ready. Trying to start a relationship at any stage in life is complicated. It’s especially tough to get “back in the swing” after profound loss. Even caregivers and family should leave space for lots of complex feelings, staying ready for extra conversation. If you or your loved one is experiencing more difficulty than is comfortable, talk therapy can be of great assistance working through grief or even into “learned loneliness.”
2. Get creative. A good profile shows personality and flair, while also being honest and accessible. Anyone looking to create an online persona should ask friends to take new, current pictures, brainstorming with confidantes about what makes the relationship-seeker unique. We know only the subjective portion of ourselves. Outside perspective can really help us understand what others experience when they encounter us.
3. Avoid clichés. Lots of people like “long walks on the beach,” but if someone has a special knowledge of tides, or shells, that’s a point of connection or interest. Potential dates know then that the walk won’t be just aerobic awkward silence.
4. Stay safe. Online dating isn’t dangerous, but successful users of the service know that precautions are necessary. They start by having conversations on a mobile device, as landlines can be traced to an address. When it’s time to meet, they make sure to do so in a very public space - best for coffee or lunch - transitioning to more privacy or less daylight only once trust has been established.
5. Stay safe, the sequel. If the relationship becomes physical, intimacy should be safe. (Please note that if you are the adult child to an older loved one that intimacy can span everything from holding hands, so be sensitive, and don’t assume.) That said, the numbers regarding disease transmission among older adults continue to rise at alarming rates. Yet, intimacy is natural, and everyone has a right to enjoy it. You thought “that talk” was awkward when you were an adolescent child to your parent! Appreciate that everyone also has a right to stay healthy through conversation and proper precaution.
6. Remain positive. It would be great to meet Mr/Ms Right immediately, but the old saying about kissing frogs remains true at any stage of life. It’s also true that a positive connection of any kind—even if not potentially romantic—is preferable to self-isolation. Meeting folks with open-ended mindset is a healthy way to begin any relationship any
Charlotte Bishop is a best-selling author , 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.
As November (National Alzheimer’s Awareness month) is winding down and we continue to see efforts to educate people about this disease, it is easy to lose sight of why it is so important to build awareness year round. For some, it may seem like people are generally aware of the damage Alzheimer’s can cause, the fight for a cure, and the advancements for treatment that could be made. However, there are many things people may not know about the disease and assumptions that could be debunked by those who experience Alzheimer’s in their daily lives.
1. Most cases of Alzheimer’s aren’t detected until its late stages – meaning people usually either don’t spot the symptoms or they ignore them to be a sign of old age. In some cases, people feel like Alzheimer’s cannot be treated so they bypass medical assistance all together.
2. There are treatments for Alzheimer’s – in that you can delay its progression significantly. Medical advancements have helped patients live longer when they maintain healthy habits and keep careful track of their condition.
3. Certain practices earlier in life can increase a person’s risk for Alzheimer’s disease, such as not eating right or not getting enough exercise.
4. In some cases, people who have experienced Alzheimer’s – sufferers, their families and friends - are afraid to talk about the disease. Sufferers may feel they might be treated differently.
Of course, there are more reasons to educate people about Alzheimer’s and participate National Alzheimer’s Awareness month. There are also even more reasons to continue after November is over - as often and as much as possible – for families, sufferers, and caregivers.

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.
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As we once again come together with family and face tough decisions for the start of the coming year, it may not be so much the caregiving tasks that leave you down and out after the holidays. What may worry you the most is facing family members who don’t particularly get along, have differing opinions about how to care for a loved one, or have a hard time working together when it comes to caregiving. In fact, this can be one of the main sources of stress and holiday blues. It is tough to tackle all the duties that come along with caring for someone while trying to keep the peace at the same time. There are elder care services and resources that can help you with these issues through mediation.

As a geriatric care manager, I’ve found that mediation is extremely important and something that can sometimes be glossed over and overlooked. While there are people who specifically specialize in mediation, it is a necessary and crucial part of care management as well. Developing and overseeing care plans as well as finding the right options for families who need it requires participating parties to communicate and work together. In fact, any care decision for an elderly loved one or a person with special needs warrant proper cooperation from everyone involved with that person’s care. This not only creates a healthy environment for the loved one but it allows for a smoother outcome when disagreements happen. This environment may also allow the loved one to have an easier time voicing their input on important decisions in their lives.

The mediation process can help families work out disputes that hinder care progress, resolve fights about how to care for their loved one, and mitigate arguments about important care issues such as the possibility of an elder moving to an assisted or independent living community. The important word here, however, is “help.” Geriatric care managers and mediators do not make decisions for the family. They themselves don’t resolve conflict. But instead, they serve as a lifeline and a resource for families who need another person involved, navigating through all the arguing and guiding all parties in the direction that is right for them. They facilitate and ensure that everyone listens to each other and that all voices are heard. As simple as that sounds, communication can be hard to repair if it has been broken for quite a while or if the family is settled into their usual ways of handling disputes.

During the holidays, one wish from many caregivers might be for their family to simply get along for the sake of their loved one. It is the one key that will prevent significant amounts of unnecessary stress and worry.

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. CCM is a leader in elder care services. Please email your questions to ccbishop@creativecasemanagement.com.
Geriatric Care Plans
At Creative Care Management, we understand that adjusting your life to provide care for a loved one can be confusing and stressful. Building and managing a geriatric care plan alone is overwhelming, and you may be asking yourself: What sort of care do they need? Are they safe alone? What happens as their condition progresses? That’s where we come in. We are a top rated in Chicago geriatric care management provider, which means we serve as a resource and a guide through the process of developing and managing a senior care plan designed specifically for you and your family.
Developing a Geriatric (Senior) Care Plan
Through our four step process, we personally take you through assessing your loved one’s needs, creating an all encompassing plan for their care and then setting that plan in action.
Step One: Meeting and Assessment
To begin the process, we meet with you in order to fully understand your unique situation and concerns. At that first meeting, we conduct a thorough assessment of the physical, mental and social health of your loved one to determine their current and future needs. We also look into their current living arrangements, and decide which steps can be taken to assure their safety at home. If you are concerned with the safety of your loved one at home, we suggest you take a look at our Home Safety Checklist to identify common hazards in and around their living space.
Step Two: Creating a Care Plan
Based on the assessments in Step One, we collectively develop a Geriatric Care Plan covering all aspects of caregiving in order to suit your specific needs. Although no plan is identical, here’s an example of a Geriatric Care Plan for you to better understand our process.
Step Three: Setting the Plan in Action
Once we have a solid plan, we work with you to set it in action. We facilitate connections with quality elder care service providers to meet your needs. We want the best for you and your family, so we only recommend providers and facilities that meet our high standards. Recommendation of care providers and facilities are based on 3 key factors:

Responsiveness of the provider to a client’s needs.

Reliability and consistency when it comes to the provider’s quality of service.

The established level of training and certification required by the provider for their facility and/or employees.

Step 4: Overseeing the Plan in Action
We understand that elder care is an ongoing and ever changing process, which is why our geriatric care plans always include the option of our continued involvement and oversight. As conditions change, we are there to help you make the necessary adjustments. Geriatric care management is about helping you and your older family member find the best care possible, without the stress of handling everything on your own. If you are concerned for a loved one but aren’t sure where to start, we can help you get organized by creating and implementing a care plan built specifically to meet the needs of you and your loved one.
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Recent Client Praise

As you gathered with loved ones over the holidays, you may have realized it’s time to start discussing how to pass on personal possessions—our “stuff.” From photo albums and china to jewelry and tools, it all needs to find a new home at some point in our lives.

Whether you’re the “giver” of the items or a potential “receiver,” Melissa Warden, owner of Room-by-Room Downsizing, recommends using these six proven strategies from “Who Gets Grandma's Yellow Pie Plate?™”

Recognize the sensitivity of issue. There are a variety of reasons why people don’t plan ahead for passing on personal belongings; many think it’s simply an economic and legal issue. However, decades of family dynamics and memories can complicate the issue.

Determine a goal. For example, protecting family relationships is a goal that’s high on the list for many families. Or maybe your goal is to preserve privacy. You’ll use your goal to help you make decisions through the process.

Decide what's “fair” in your family. When divvying up personal property, fairness issues emerge in both the outcomes (who gets what) and the process (what methods are used to distribute items). Sort out what fair means to your family by talking about the topic now.

Understand belongings have different meanings to different people. Avoid assumptions as to who wants want, especially based on gender and birth order. Again, givers and receivers are encouraged to talk with loved ones, share stories, and pass on family traditions.

Consider distribution options and consequences. There are more options available the sooner you start having conversations about the topic. If no plans are in place or wishes known, state laws will apply.

Agree to manage conflicts if they arise. They’re your things. Conflict is more likely when adult children and others are left to work things out on their own. They’re still your kids, regardless of their ages. If you think there will be conflict without your presence, then do all the allocation in advance or assign a third party to arbitrate later.

There is no magic formula for passing down personal possessions, but employing these six strategies can help your family have a more positive experience.

Melissa is a Certified Senior Advisor and a member of the National Association of Senior Move Managers. She’s a facilitator of the “Who Gets Grandma’s Yellow Pie Plate?” workshop, which she can host for your family over Zoom. For a free 15-minute phone consultation to learn more, contact her at 847-809-1369 or through her website.

And check out the free resources on Who Gets Grandma's Yellow Pie Plate? | UMN Extension.
If you are a caregiver to an older loved one, you likely have heard of it, but maybe you were not sure if it is a real syndrome…or if it is, what you can do about it. I am referring to what is termed “sundowners syndrome,” and let me tell you, it is real. Sundowners can affect anyone with Alzheimer’s or any of the conditions along the dementia spectrum as well as those who may simply have some cognitive impairment or diminishing of their executive function. How do you spot it? Well, you may have noticed that there are times of day when your older loved one is simply less lucid or unable to respond to others in their midst, and it actually does coincide with the end of the day…sundown or late afternoon. Do they become anxious or nervous? Are they more demanding or even fearful of people whom they know? Are they just confused or disoriented or just plain cranky? They may shout or begin to walk about, have a change in mood, talk to someone or about someone who is not there. Okay, so you may see some of these in your older loved one; what can you do? Follow these recommended steps:

Keep to a regular, daily routine with your loved one so that they do not have to process new information late in the day; they simply cannot be intellectually nimble.

Avoid having dinner being a heavy meal, and avoid sweets, caffeine or alcohol.

Limit naps to earlier in the day; make sure they have not had a chance to nap within four hours of their bed time.

Keep the lights on, but close the curtains to limit the shadows they must process or navigate, and limit noisy distractions.

Be calm and reassuring, and if they make an assertion about a loved one who is no longer alive, do not argue – acknowledge and then redirect.

If none pf these work, it may be more than just sundowners; talk to your loved one’s physician.

And take care of you, the caregiver. I had a client who talked about the transition from having six hours of uninterrupted sleep a night to having six hours of interrupted sleep. That is a recipe for disaster – your own. Take naps or breaks during the day for yourself, and do not lose contact with friends and hobbies. Get respite care; reach out to the senior communities within your locale for a place to drop off your loved one or for home care personnel who can come to your loved one. You also will get support as well as good ideas from a local caregiver’s support group; yes, it does take a village. Charlotte Bishop is an Aging Life Care Professional and 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.
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:

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.

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.

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.

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.

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

Everybody eventually learns to accommodate the “empty nest” that inevitably follows the busy days of child-rearing and child-launching. And then – maybe after a rather substantial wait – there is, once again, the prospect of more little ones in the house. This time, however, they are grandchildren, and as much as everyone who raises kids knows how not to drop a baby, the world has changed. It translates into a new kind of child-proofing different from a generation ago. This is advice for seniors who may be hosts to little ones for the first time in a lot of years.

1.    First, it is important to start with an open mind. It is too easy to slip into a mindset of “what was good enough for my kids,” but times have changed and so has safety. So, some of the old toys may still be considered safe, but the old car seat, play pen or infant swing may not be just outdated; they may be dangerous. Defer to the new mom and dad for advice on what will still work and what needs to be replaced by the next new thing. This approach is also politically helpful in empowering the new mom and dad.

2.    Remember also that when you raised your own children, you may not have had any of the chronic conditions you now have. And you also would not have the medications associated with those conditions, so develop a plan to store medications safely and out of reach of kids. While you may not want the nuisance of those safety bottles, you really need to be certain that medications that will be attractive nuisances to little ones on the prowl are locked up. This is especially true if one of the older grandparents uses the “day of the week” pill reminders that often are stored in the kitchen as a reminder for prescription schedules.

3.    For an add layer of safety, go to the source. The Consumer Product Safety Commission has a twelve-step approach to fully kid-proofing your home, and a number of their recommendations like smoke alarms and carbon monoxide detectors which are great safety measures for everyone. They have a downloadable two page brochure to walk you through the steps (click here for brochure).

4.    This last one is making the grandparents house safe from what the toddlers or young children will bring with them. Falls among seniors are often caused by the unexpected, and there is nothing so unexpected as the little dolls, cars or a myriad of other items that you will buy for the kids or that they will bring with them. Make it a habit of picking up after play time, because you may not see the little hazard on the floor…especially after sunset.

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. Read more about Our Story and Charlotte's mission.
According to the Centers for Disease Control (CDC) adverse drug reactions or overmedication result in more than 700,000 hospitalizations a year. And many of these could be avoided by following advice offered by the American Geriatrics Society. The AGS’s Foundation for Health in Aging offers advice for all of us who care for older parents or adults in our orbits. Here is a summary of the six major recommendations.

Ask before taking OTC drugs: Never assume that just because you can buy a medication in a drug store without a prescription that it will be harmless. Most of these drugs started out as prescription meds. Ask the doctor or pharmacist if an OTC drug is a risk by itself or in combination with a prescription your elder may already be taking.

Make/update your List: A lot of medical offices are very good about asking patients on every visit what medications they are taking and keeping it in their records. With every visit the provider needs to add new medications so that everyone is aware of what your elder is taking.

Question your provider: When you or your elder receive a new prescription ask questions about when to take the drug, with or without food, what to do if a dose is missed, is it available in generic form and what are the common side effects?

Read the labels and follow them: There is a fine print insert of patient instructions that comes with every prescription. Don’t be intimidated by the scientific jargon; look for the indications and usage section as well as the adverse events sections. And then take them as directed – don’t add a dose for better effect or stop just because you feel better.

Report any ill effects: There is a saying in geriatric circles that every symptom in an older adult should be considered a side effect of a drug until proven otherwise. Especially if there is sudden difficulty breathing or swallowing, light-headedness or irregular heart beat. If you cannot reach your loved one’s provider call 911.

Review your medications with your provider: At least once a year you should talk with your elder’s provider about the medications, the doses and any changes you may have noticed. And do not leave out vitamins, supplements or herbals.

For more information go to the American Geriatrics Society web site as well as refer to a list of drugs that have known side effects or other issues. This is called the Beers List .

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

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