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

Advice from the Perspective of 100
This marks the 100th posting on our blog since its inception October, 2010, and it gave me pause to stop and...
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April 16, 2012
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Caregiving to Older Workers
It may surprise you to learn that as many as one in five caregivers are lending their help to...
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December 28, 2011
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Four Ways a Caregiver’s Nose Can Help
I have written in past blogs about some of the inevitable decline of physical capabilities associated with aging, and...
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October 14, 2011
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Four Ways to Fight Dementia
What do hearing aids, exercise, support groups and travel have in common? They all are ways that individuals suffering...
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October 2, 2011
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Four Tips for Making Long Distance Caregiving Work
With a lot of talk these days about children moving back in with parents and intergenerational homes, it is...
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September 19, 2011
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Three Ways to Advocate for Elders
Everyone who is a caregiver to an elder or other person with special needs has to be an advocate...
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September 15, 2011
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Five Things to Know about Kidney Disease
It’s a disease that affects about 26 million Americans. If untreated it will kill these people. And more than...
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August 24, 2011
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Not Just Dementia
I have written in earlier blog postings about dementia: “preventing” Alzheimer’s Disease, Alzheimer’s from the inside out, maternal genetic...
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August 17, 2011
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Caregiver Training and Certification
In my experience as a geriatric care manager, I field a lot of questions from people who are suddenly...
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July 25, 2011
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AARP’s Annual Report on Family Caregiving
In many of my postings on family caregivers I have talked about the really hard job of caring for...
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July 18, 2011
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In the Caregiver's Words

Recent Client Praise

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At CCM, home and safety are as important to us as to you, so it’s no surprise that it’s a prevailing topic of our discussion. I have asked Gregory Peebles to talk about this topic from the vantage point of his experience. 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 life - at home. An Associate Care Manager, Gregory has been a part of my team for over a decade. - Charlotte
Home. There’s no place like it, but it’s also very conveniently located wherever you hang your hat. As nice a thought it is that “home” is a physical place we can go, when we look at that thought more closely, it turns out to be not nearly as nice as we first imagined. Our insistence on home being an actual place isn’t just silly misstatement; it’s a false belief that can easily get in the way of our ability to discover new happiness. We imagine “home” existing as it always has in our memories: strong, immovable, untouched by time. It holds us safe inside, protecting us while we watch the world transform at a dizzying speed into a place we no longer recognize. It’s easy to see why we yearn for such a harbor against change. That place doesn’t really exist, though. Even if there remains a physical house from childhood where parents still live, “home” is not a physical building: it is a mental place, constructed not of wood or stone, but of our memories and feelings. Consequently, when we visit the mental place we call “home”, safety is usually one of the first feelings to come to mind. When folks say, “I want to go home,” what they’re really telling us is that they want to feel safe again. We feel safest when we know. Not surprisingly then, where we once lived for a long time feels the safest. But, like the false idea that “home” is a literal place, is it possible that we could also be wrong about being safe in our own homes? Absolutely. In case you can’t tell yet, this post is gently getting us ready to talk about denial: denial that change is a necessary part of living; denial that our circumstances are ultimately beyond our control; denial that we are at last, mortal. As we age, inconveniences in the home can turn into safety hazards. As we watch our parents age, we begin to feel deeply our own mortality and—if we’re not careful—to slip into a pattern of denial, the manifestation of which is the attempt to keep life as it exists in our memories perhaps longer than is advised. However, while this may feel psychologically safe, it may also be physically the most dangerous choice to make on behalf of our loved ones. Yet we rightly want to keep our lives free of disruption for as long as we can. So how can we strike the balance and keep our loved ones safe and in that special place we call “home”? In our next blog, we’ll talk about what makes a home a safe place for aging adults, including how to continue to ensure protections for the loved ones who depend on you. Be sure to come back and we’ll give you what we know. 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.
There is no doubt that being a caregiver to an older loved one can be a positive and rewarding experience and it may be a way to give back. But the caregiving demands can become onerous, and the caregiver can feel stretched between their obligations to their own children and their partners. Or the day job can be demanding in and of itself without the "extra shift" that caregiving heaps on a person. As a certified geriatric care manager, I have seen caregivers who are stressed, but not nearly as often do I see a caregiver who talks about this burden. It brings up too much guilt, or they feel they just need to "get through" the next week or month, but the weight of the added responsibilities can be huge to the point of breaking. It is important to find relief before the caregiver reaches that point, and there is a way to measure caregiver burden before one reaches a breaking point. Consider the following and rate each on a scale where 0=never, 1=rarely, 2=sometimes, 3=quite frequently and 4=nearly always - be honest:
1. He/she needs my help to perform many daily tasks.
2. He/she is dependent on me.
3. I have to watch him/her constantly.
4. I have to help him/her with many basic functions.
5. I don’t have a minute’s break from his/her chores.
6. I feel that I am missing out on life.
7. I wish I could escape from this situation.
8. My social life has suffered.
9. I feel emotionally drained due to caring for him/her.
10. I expected that things would be different at this point in my life.
11. I’m not getting enough sleep.
12. My health has suffered.
13. Caregiving has made me physically sick.
14. I’m physically tired.
15. I don’t get along with other family members as well as I used to.
16. My caregiving efforts aren’t appreciated by others in my family.
17. I’ve had problems with my marriage (or other significant relationship).
18. I don’t get along as well as I used to with others.
19. I feel resentful of other relatives who could but do not help.
20. I feel embarrassed over his/her behavior.
21. I feel ashamed of him/her.
22. I resent him/her.
23. I feel uncomfortable when I have friends over.
24. I feel angry about my interactions with him/her.
Add up your score, and if you are close to or above a 36, it is time to consider help. At least consider help with some of the supportive activities you do for your loved one. You will find senior residential communities or centers who provide respite care to give you the break you may need. Also, look to what you rated "quite frequently" or "nearly always." If you have a cleric, a counselor or therapist, these may be good points for your conversation. Also, do a search of my blog here using the keyword, "caregiver." One of the topics I have addressed a lot is Caring for the Caregiver. Take care of you! For more on this scale (and there are others as well) go to: http://www.fullcirclecare.org/caregiverissues/health/burden.html 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 ccbishop@creativecasemanagement.com.
42 million is a big number. That is how many caregivers to older loved ones AARP estimates there are in the United States, and no surprise, the number of sons and daughters and husbands and wives of older adults with needs is growing. We do not see this mushrooming segment of the population, but it is changing the lives of the caregivers in fundamental and often unhealthy ways. One of the reasons we do not readily see caregivers is that the AARP survey reported that 44% of the caregivers simply do not talk about the unpaid job they do. No one, it seems, wants to look like the unloving family member who is having difficulty performing their caregiving tasks. As a result, about one third of caregivers report they are either sad or just plain depressed. Another third avoid any decisions that might give them a break or better leverage their time with their loved one. And another third simply go it alone, isolating themselves from their friends, colleagues or any support networks. Fully 38% report they are sleeping less, and nearly a quarter are eating more on top of that. Caregiving can be bad for the caregiver's health! Most of this symptomatic profile of the stressed caregiver owes to the simple fact that caregiving is their "other job;" more than six in ten caregivers age 50 or older also have a full-time salaried job. As geriatric care managers (GCMs) caregivers are the people with whom we work in support of their care receivers, and the services we provide to the caregivers can be every bit as important as those that we offer their older loved ones. If you or someone you know is a "stressed caregiver," please consider the following from a professional "stress reliever" to stressed caregivers:
1. Ask AARP. The AARP website is a veritable wealth of information for caregivers to older loved ones, and they have a dedicated portion of their web site devoted to caregiver resources.
2. Involve the Family. Don't try to go it alone if you have siblings or other family members. Not only can many hands make fast work, but fresh perspectives and energy can help the caregiver doldrums that arise from too much solo stress.
3. Catch a Break. If you do not have siblings, check your community for respite care services. If there is a senior residential community in your locale, they often have drop off facilities for non-residents...which gives everyone a break.
4. Talk to Your Employer. This is in step with not going it alone. If you are stressed with caregiving it will show at the workplace. Rather than be judged as a suboptimal producer, talk to human resources about possible flex time or a leave.
5. Call a GCM. To more fully explore your options, call the option-makers for the decision-makers. You can find a GCM in your locale by going to the association web site.
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@cr eativecaremanagement.com.
Geriatric Care Management
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

I would wager that all of you can remember your first crush after you were no longer living at home. For many of you it was in college. That certain someone who caught your eye…or maybe it was they who first noticed you? The next step may have been to go for a coffee together, maybe study together if it was college…and you remember when you first held hands also, right? If you talked to friends or family, they would ask questions and some of the questions focused on was this a good person, trustworthy, kind, etc. As you recounted what you liked about this someone I suspect you didn’t offer that you gave them a key to your home, the keys to your car or a few thousand dollars because they needed it. That is the difference between your early opportunities to meet someone new and your older loved one’s meeting a “new friend.” According to the National Council on Aging, as many as five million adults 60 years of age and older are exploited each year, but only about one in fourteen cases of abuse are actually reported to the authorities. How much does this cost older adults? The estimates range widely from $2.9 billion annually to $36.5 billion; it’s a veritable industry in America. Going to another government source, the CDC, elder financial abuse is defined in this way: “The illegal, unauthorized, or improper use of an older individual’s resources by a caregiver or other person in a trusting relationship, for the benefit of someone other than the older individual. This includes depriving an older person of rightful access to, information about, or use of, personal benefits, resources, belongings, or assets.” What are the signs? Here are a few, but beware, because scammers are very creative:

A withdrawal from your older loved one’s account that they don’t recall, or maybe don’t want to talk about.

Your older loved one’s social withdrawal or isolation is easier for a fraudster to exploit, because no one is watching.

Is someone “looking after” your loved one, but has no other visible means of support?

Is there a substantial age disparity between your older loved one and the person who has taken an interest in them?

And what to do? There are agencies to which you can turn for advice or intervention:

Your community’s elder ombudsperson

The National Center on Elder Abuse

The Financial Industry Regulatory Authority (844.57HELPS)

Your state chapter of Adult Protective Services

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.
My mom died on March 9th with dementia. During the 4 years as her caregiver, I really valued your emails. I learned so much from reading them and tips made my life better.
A satisfied client

As you prepare for the big holiday feast and potentially the big snowfall that may come your way, we at Creative Care Management wanted to take time out to wish you happy holidays, good health, and an encouraging start to the New Year. This past month we’ve explored all the setbacks that might prevent maximum holiday cheer for the caregiver and how to overcome them. However, I cannot stress enough that the best way to overcome all of these obstacles is to remind yourself what these times are all about. It’s okay to be nostalgic about the past and allow yourself to feel what might be sadness and loss. But try to focus as much as you can on the present. Enjoy the time you have with your family and friends. Laugh, smile, and give yourself credit for making it as far as you have this year. Take time for yourself as needed – to breathe, to reflect, to remain centered.

If you know someone who is also a caregiver, here are some gifts you can give them in order to make their holidays easier.

Someone to listen. The best relief for a caregiver might be just having someone there to listen to their frustrations .

Support. The holidays can be more of a hectic time for caregivers. If you’re visiting a caregiver, offering to help around the house or taking care of some of the tasks on the caregiver’s plate might be an excellent present.

“Thank you.” Sometimes caregivers aren’t able to hear or see how much of an impact all of their hard work makes in tangible ways. Letting the caregiver know that their work is appreciated and that they’re doing so much good for their loved one may brighten up their holiday. It will serve as encouragement to keep going well into the New Year.

All of this said, whether you’re a caregiver or friend of a caregiver - take care of yourself and allow yourself a moment to rest during this joyous time.

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.

For this week’s post, Charlotte asked Rebecca Bloomfield, partner at Jerry S. Pearlstein Insurance, to speak to caregivers about long term care insurance. She and Jerry head up a unique agency of trusted advisors, helping individuals and families to take control of their personal financial planning … and more. Please describe the concept of long term care insurance. “Long Term Care Insurance (LTCI) pays for services when more than 90 days of continuous care are required. It’s contingent upon an individual’s inability to do at least two of the six activities of daily living: bathing, continence, dressing, eating, toileting, transferring.” How early should a person look for coverage? “Most people come to us when it is too late. The lowest premiums are when one is youngest. You can start early with a progressive sequence of plans with upgrades along the way, many times without medical exams required. Most people look at life insurance when they start a family, and that is also a good time to look at the long term picture.” Sounds like it is for caregivers… What is the right level of plan a caregiver may need? “Traditional LTC insurance has been based on a person being in a nursing home. You anticipated how long you would anticipate be in a facility and how much that might cost. Today, 80% of people want to stay at home when they cannot do two of the ADLs. They want to stay in community. So, there are now plans that cover the cost to do that by paying caregivers, or adult day care centers, or drivers…and you stay out of a facility.” Can my older parents get covered? “Once you are over 70, it is tremendously expensive. …and then there are pre-existing conditions. When you are young and healthy is when to start. Care receivers cannot get new insurance…but it is the right time for the kids who are the caregivers to get their plan.” Anything else caregivers should know? “The biggest misconception of people who come to us is that Medicare will cover long term care. It is not designed to cover sustained care over 90 days. Medicare is diagnosis-based and is built on a plan of care for a person to get better. Long Term Care Insurance should be seen as a way to assure the ability to live a long and happy life without being a burden to the children. …and to preserve your choices.” 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.
Although Alzheimer’s disease is the most common type of dementia, there are over 100 different causes of reduced brain function and cognition…dementia. Although we are all hopeful for a cure...or should I say cures. So, it is huge when we begin to learn what factors predispose someone to reduced cognition and how we can modify behavior or the environment to reduce the risk and that cognitive outcome. Let’s take them one at a time:
1.Dementia has been statistically tied to high mid-life blood pressure
Longitudinal research recently reported in the British journal Lancet Neurology statistically linked higher and rising blood pressure in early to middle age with a higher incidence of dementia in later life. In this research “middle age” was defined as 36 to 53 years of age, and “later life” was defined as 69 and older.1.Dementia is linked to decreased brain size This is where it is all linked. The higher blood pressure or rising blood pressure in early life is also linked to a smaller brain volume. In the British study they followed people from birth to older age with 20 measurement points along the way. The link between brain size adjusted for early life cognition is not necessarily a direct one. We talk about “adjusted for early life cognition,” because people who have cognitive issues early in life tend to have more as they get older. But those with smaller cranial size have an even great incidence of cognitive impairment. The researchers speculate that it is the clear link between reduced brain mass and the development of white matter brain lesions that gives rise to the dementia, not just a matter of brain size.
2.White matter brain lesions are linked to the later onset of dementia
Here is where the link becomes really concrete. The researchers showed that a given increase in blood pressure yielded quantifiably more white matter lesions. Back to brain size, the same sort of trade off was demonstrated with brain size…more pressure yields smaller brain mass. The bigger the increases in blood pressure the greater the incidence of white matter and the smaller the brains.
3. 30% of dementia cases are modifiable
Yet, blood pressure alone was not directly associated with cognitive function at any given point in time. It was the early rise and sustained high blood pressure that created the brain size and white matter problems later. These were tied to diminished cognitive abilities. And this now gets back to modifying risk factors for dementia, and it is pretty clear. Everyone gets their blood pressure check early and regularly…and gets it under control if it is elevated!
4. All of the above
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.
For so many medical conditions, the package inserts - that thin white paper with the fine print - for doctor-prescribed medications say that "diet and exercise" are first line. This applies to medications used to treat high blood pressure, weight loss or even type 2 diabetes. Would it surprise you to hear that diet and attitude are first line defenses against dementia or other cognitive decline? More and more research is pointing to the importance of the foods we eat as well as our outlooks on life as preventive measures to forestall the onset of dementia. Start with cynicism. Researchers in one study started with a group of more than 600 people whose average age was 71.3 years at the beginning of the study. Initially, the researchers collected data on the patients overall health, their levels of cynicism (yes, you can measure cynicism) and their cognitive statuses using validated scales. Over the course of 8.4 years, the researchers continued to assess all patients' levels on all these metrics. At the end of this time frame, 46 of the original number of patients had, in fact, developed dementia. The scientists adjusted for age, gender and depression, but still found that individuals who started out this study interval with higher measureable cynicism were statistically more likely to develop dementia. Moreover, about two years later more than half of the study participants had died, and those who had been classified as statistically more cynical were more likely to be among the number who died. Switch gears now, and another study based out of Rush Presbyterian Medical Center in Chicago found a positive link between people with quantifiable "purpose" in their lives and their ability to live dementia-free. This study followed about 1,000 people age 80 for about seven years. It measured physical, psychological and cognitive aspects of these patients over the duration of the study. These subjects also agreed to donate their brains for further analysis upon their deaths. At the end of the seven years, the researchers found that those with the highest scores on "purpose" were 2.4 times more likely to remain free of any signs and symptoms of Alzheimer's Disease. These subjects also were less likely to develop mild cognitive impairment, one of the early signs of impending Alzheimer's. Those with high purpose also had had a lower mortality rate than the others and had fewer disabilities as they aged. When the patients did die, the doctors performed autopsies of their brains. Even among those who had manifested no signs of Alzheimer's on cognitive tests and had maintained measurably higher levels of "purpose" some still had the plaque of AD on their brains. The conclusion was that the patients with purpose could more readily work through the deficits and maintain higher functioning cognition. The moral? We often hear people talking about the importance of attitude. And a good attitude certainly enhances the quality of life of those around the people with good attitudes. Evidently, it is also very good for the health, mental functioning and longevity of those with the positive attitudes too. 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@cr eativecaremanagement.com.

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There are a lot of misconceptions about Alzheimer's Disease or dementia in general, and these misconceptions can make simple conversation frustrating for both the person with the condition and the well-intended caregiver. If you are in a position during these holidays to converse with someone with dementia, it is important to follow some basic guidelines so that the conversation can be more positive for you and for the person with dementia.

We may get the notion that dementia means that a person is "losing touch" - yes and no. Dementia can be as varied as people themselves are different from one another, and it does not progress in a straight line decline over time. Most of us have conversations that have a fairly clear beginning, middle and end...or with best friends, it is just a conversation that never ends. Here are some very basic tips that can help you and your loved one with dementia to move beyond what has the potential to be awkward or frustrating for both of you.

1.    Avoid loud or unfamiliar environments when you are selecting a place to have a chat; both of these are very unsettling to a dementia patient and aggravate inherent difficulties in concentrating and conversing.

2.    Be patient and sensitive to your loved one with dementia; they may feel afraid, because they are "lost" and your validation is important.

3.    Be empathic by trying to appreciate what it may be like to be in the shoes of the person sitting across from you who lapses into moments of "talking with a stranger" in a strange place and they cannot remember the way home.

4.    Do not get caught up in whether the person is "making sense;" it is not about winning an argument about what decade it is as much as passing some pleasant time with a loved one.

5.    Keep the conversation light and follow their lead; they may wish to talk about family and happier times, even if they cannot remember family names - let them revel a bit in what is a safer place for them.

6.    Monitor your body language; even though you are carefully screening what you say or don't say, your posture or facial expression may be screaming at your loved one - take calming breaths and relax.

7.    When all else fails, simply ask them how they are; they will always know how they are, and it will give them comfort that they know the answer to that question.

      There is a lot we don't yet know about dementia, but these tips can help you have a conversation that all parties can enjoy. Go to the Alzheimer's Association web site for more information, and be prepared for lucid surprises along the way as well as the occasional recitation of Shakespeare, the Pledge of Allegiance or a prayer from someone who can't remember what they had for lunch. And did I mention, be patient - with yourself. As I have said many times: You don't have to be a perfect. You just have to be “good enough.”

      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.