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

What “Senior Real Estate Specialists” Do
I have posted a number of times on how to make home safer as well as how to evaluate...
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September 4, 2013
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Caregivers Need to Prepare for Medicare Too
I recently spoke with one of the financial advisors we list on our Geriatric Care Management Support Tools page,...
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August 28, 2013
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It Is Never “Just” Diabetes
I have again asked our vice president for geriatric care manager services, Steve Steiber, Ph.D. to share his insights,...
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August 21, 2013
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Dangerous Drugs and Medical Devices Caregivers Should Be Aware Of
I have had the good fortune to connect with Jennifer Mesko, Managing Editor of a great website and resource,...
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August 14, 2013
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The Other Reason Caregivers Should Panic About Tylenol
I have asked our vice president for geriatric care management and senior services, Dr. Steve Steiber, to share a...
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August 7, 2013
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Emotionally Healthy Older Adults
I had the good fortune recently to meet Jennifer Muskat, the Director of Client Services for San Diego Home...
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June 10, 2013
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In the Caregiver's Words

Recent Client Praise

It ended with almost uncontrollable laughing. That’s how one of our team describes his conversation with his mother about making her funeral plans one day not long ago. Yes, you heard that right…they talked about her memorial service and had a great laugh together. My take on that is that once the incredible stress around a topic that no one wants to talk about is addressed, the relief is almost giddy. We laughed too when he relayed the part about Googling funeral hymns and singing along with his mom the ones she particularly liked. Trust me; this is not a unique story, and it is only one of the “difficult conversations” families can have. According to AARP, 70 percent of Americans say they feel that it is important to have an end of life conversation with their family members, but only 30 percent have had that conversation. The younger generation in the family may not hear the conversations that older adults have among themselves about death and dying, and parents may not want to “burden” their adult children with talk of end of life. But that will not change the fact that death is a universal event for all of us. If you are that adult child who would like to help your parent with the conversation, there are some ways to “break the ice” in order to have a productive conversation. First, you don’t have to start with end of life questions; you can start with some of the more mundane issues about health or medical issues. Every professional painter will tell you that there is a whole lot of prep work before they even put the brush to the paint. Start with mentioning perhaps a friend whose parent had a medical episode, and the adult children were not even aware that their parent had a problem with their (fill in the blank…heart, lungs, etc.). So those same children could not even supply their parent’s physician’s name or the medications they were taking or any of the other details that the paramedics or emergency room personnel had asked. Or you may even point out that your significant other has all the details on your medical health “just in case.” Would your parent also wish to have you in the know about their health…just in case? And there may be certain circumstances…
- Mom, if your medical professional makes any kind of new diagnosis, do you want to know every detail, treatment options, prognosis, or just the big picture stuff?
- Dad, if the doctors have treatment options for a condition, do you want to know all the details, or just what your doctor recommends?
And there are some issues that can be clearly laid out in documents for the medical record. Called POLST in Illinois (Practitioner Orders for Life Sustaining Treatment), it is considered a legal document that becomes part of a patient’s permanent record which states what kind of measures they wish to have applied in emergency situations. It is more than a Do Not Resuscitate (DNR) order; it covers the extent to which medical professionals should work to sustain them in an emergency. The Illinois site for this legal document also has suggestions for how to have the conversation. Obviously, the conversation can get into details like the one I started this post with, but it may not be the first conversation. We as Geriatric Care Managers also get the call to help families cover these kinds of issues, and we have made this into a form called the Life Span Care Plan(SM). 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.
“Charlotte was incredibly helpful to me yesterday and more so today. I'm delighted to have such a competent, caring partner. Also, Charlotte was instrumental in finding a new primary care physician for Margaret.”
Harriet Brandt, Faith in Action Evanston
Alzheimer’s Disease affects nearly 6 million Americans and despite having some clinical therapies that modestly impact the disease onset or progression, there is not yet a cure. Yet, there is accumulating evidence that the best “cure” for Alzheimer’s may be a lot like the cure for other chronic, degenerative diseases. That is, the best cure is in prevention, according to research reported in JAMA, Psychiatry. What I have to share today is not truly new, but the findings reported by some researchers in China suggest that certain “intellectual activities” can protect aging adults from the onset of Alzheimer’s. Other studies have shown that engaging in games and social contact is associated with lower rates of Alzheimer’s. This study, however, is noteworthy because it follows a very large number of subjects – more than 15,000 – and the researchers followed them for nearly seven years. The scientists further controlled for other factors that have muddied the research waters in the past, factors such as physical activities, other psychiatric issues and some social and demographic traits. The intellectual activities that had the effect of reducing the number of people who succumbed to Alzheimer’s disease were as simple as reading or playing card or board games….even betting on horse races. Active participation in intellectual activities, such as reading and playing board games or card games, may delay or prevent dementia in older adults, even if these activities take place in late life, this new research suggests. All subjects in the study were at least 65 years old, and the researchers found that by year three they could identify individuals who had some measurable cognitive decline. This decline continued with those who measured lower on the equivalent of the mini-mental health scale. Those who declined were involved in about half as many of the intellectual activities. They also tended to more often be women than men, they were less educated and they had poorer diets and physical activity than those who scored higher on cognition. An interesting side note is that there were comparable rates of smoking and other psychological diagnoses across the dementia and non-dementia groups. As with most research into dementia’s onset, there are still questions. For instance, how much did a better diet affect the outcomes. Or did people who engaged in more intellectually healthy activities also more often engage in other healthy activities. Clearly, there is more to come. I would conclude that engagement in more intellectual activities is good for your brain, but I would add that you may not wish to bet too much on the horses! 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.
You remember the Tom Hanks movie where he is stranded on a Pacific Island and how he learns to adapt. Unfortunately, Hollywood does not offer a role model for us, because we are not suggesting you resort to a diet of raw fish or having heartfelt conversations with your volleyball. But there is some good advice available to us all to help us lean into this situation and get through it. It comes from our own government’s Substance Abuse and Mental Health Services Administration. Let me give you the short version:
- Minimize News Exposure – I find this one particularly hard to follow, but think of it as sunshine. It can be illuminating, but over-exposure can cause burning. And since we don’t have “news screen” as we have sun screen, limit your exposure to 30 minutes or so.
- Stay Informed – This may seem to contradict the first suggestion, but getting the facts is important for understanding how this pandemic is affecting everyone, how it can be contained and the progress we are making toward containing it. It’s a fire presently out of control unless we contain it. This means to not get glued to opinion media – see number one. Opinion “newscasters” are to the pandemic what gasoline is to a fire.
- Sitting is the New Smoking – Take regular breaks from whatever it is that is occupying your time. If you are working from home, take periodic walks around the block, make a call to a friend, anything to put what occupies you on pause. Try to fill your pause with something good for you: walking, meditating, praying, whatever renews you.
- Reach Out – I mentioned in an earlier post how my family gets together each Sunday on ZOOM. Helping them know how you’re feeling is good for them, and it is equally gratifying for you to know they are holding up as well. I participate in a phone tree to check up on people we would normally see, but are unable to see now. With ZOOM dinners we actually are making better friends of existing acquaintances and new acquaintances on top of that. We are a social species, so don’t cut yourself off.
- Become Stronger – How many times have commitments or work gotten in the way of doing what we should to sustain ourselves? Getting enough sleep has no excuses anymore. There are no excuses to not take time for long walks or working out. For this latter, you may have to get creative, but pushup-ups and sit-ups need no equipment…or leg lifts, etc.
- Ask for Help – If all of the above still leave you feeling depressed, mentally fatigued or just out of sorts for a reason you cannot quite put your finger on, reach out. The SAMHSA that I referenced in my introduction has a help line, so don’t be afraid to ask: 1-800-985-5990.
We at CCM want you all to remain safe and follow the rules so that you all will get through this health crisis. It has been only 37 days so far. Be safe and be healthy. 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.
Associate Care Manager Gregory is 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. Gregory has been a part of CCM, Inc. for over a decade. – Charlotte Lots of people play simple games on their phones while waiting. On this blog, we’ve often mentioned that any game play encouraging cognitive and spatial orchestration is great for the player’s cognitive future. But what if there were a fun game whose results also helped doctors learn more about dementia? That would be especially helpful, keeping our own brains sharp while we contribute to research. That sounds like double duty! Well, set sail at full mast, because that game exists. At first glance, “Sea Hero Quest” [iOS/Andriod link] is a fun mobile game like any other. It is special, however, because it exists to provide researchers with more data on 3D spatial cognition, often a first casualty to a dementia diagnosis. In the game, the child of a parent suffering from dementia sets out on an odyssey to recover their parent’s lost memories. On the path to discovery, there are navigation, orientation, and chasing adventures. The ways that the players advance levels is precisely the kind of valuable information hoped for; and the more people that play the game, the more information to help. Alzheimer’s Research UK is a major player in supporting the data obtained from gameplay, and it is hoped that the information gathered will make inroads towards early detection and consequent treatment. In addition to the regular mobile version, there is also a Virtual Reality (VR) release which combines the game with scene immersion. It tracks head movement and provides even more data to researches about how players obtain information about their environment. So, if you’re a mobile game player of any sort, consider the introductory video below, download, and start gaming! You just might have a great time helping your future self.
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

Today’s posting is from one of our long-time business associates and health care industry expert. Mr. John Marchica is founder and president of Darwin Health, a research resource and think tank in the industry. He is a published author and national speaker on the U.S. health care system. The Centers for Medicare and Medicaid services announced results from the second performance year of its Independence At Home demonstration. Evaluators found that participants saved over $10 million—on average, about $1,010 per beneficiary. CMS said all 17 participating practices improved quality in at least two of six quality measures and four practices improved quality on all six. Seven providers received a total of $5.7 million in performance incentives. “The Independence at Home Demonstration is a patient-centered model that supports providers in caring for chronically ill patients in their own homes,” said Dr. Patrick Conway, CMS acting deputy administrator and chief medical officer. “These results continue to support what most patients already want–the ability to have high quality care in the home setting.” In this demonstration, providers must meet the performance measures for at least three of the six following areas:

Follow up contact within 48 hours of a hospital admissions, hospital discharge, and emergency department visit

Medication Reconciliation in the home within 48 hours of a hospital discharge and emergency department visit

Annual documentation of patient preferences

All-cause hospital readmissions within 30 days

Hospital admissions for Ambulatory Care Sensitive Conditions

Emergency department visits for Ambulatory Care Sensitive Conditions The Independence At Home initiative serves about 10,000 Medicare beneficiaries. In order to be accepted into the program, participating practices are required to demonstrate experience in providing care in the home to high- cost, chronically ill beneficiaries. Selected providers include primary care and other multidisciplinary teams led by physicians or nurse practitioners, are organized for the purpose of providing physicians services, and serve at least 200

Last year, when Dr. Conway announced first-year results from the demonstration at an ACO conference we attended, the crowd roared. The comparatively modest program saved $25 million, or about $3,000 per beneficiary per year. Everyone was impressed. This year’s results appear to be more modest until you look deeper into the numbers. In 2014, the average target expenditure per beneficiary per year (PBPY) was $4,646. In 2015, the average PBPY target expenditure was $3,873—a 20 percent decline. Actual PBPY expenditures dropped 17 percent, from $4,290 in 2014 to $3,672 in 2015. Looked at another way, CMS’ target was more than $400 less in 2015 than providers actually received in the first performance year. They set the bar higher and providers still managed to save money. Unfortunately, isn’t possible to compare savings from both performance years because CMS changed the regression methodology used to calculate the control groups that allow it to determine savings. But the takeaway is clear: this program has been wildly successful at controlling costs for the most expensive, chronically ill patients in the Medicare program. We wouldn’t be surprised if CMS pulls the plug on the demonstration and rolls out the program nationwide. We are happy to share this guest posting on Charlotte’s Blog. For subscriptions to Darwin’s regular weekly information, just click here. 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.
I’ve talked about this often in past posts: older adults have a greater fear of Alzheimer’s than of any other medical condition. In a recent survey, 39% of adults over age 55 feared Alzheimer’s while cancer trailed with 30% of these respondents reporting that as their fear. What we don’t hear as much about is the fear that the future caregivers of Alzheimer’s patient have…and with what they will have to cope. They don’t seem to have done any surveys, about future caregiving to an Alzheimer’s patient, but it’s likely the fear is mutual. When first confronted with a loved one’s diagnosis, caregivers naturally ask what they may now expect from their loved one…but the answer is a moving target. The symptoms of Alzheimer's disease devolve over time which dictates their capabilities and the appropriate interactions from the caregiver. Stage 1: It’s called mild or preclinical, because before the diagnosis is even made a patient’s brain is losing some of its original capabilities. During this first stage, loved ones may begin to see some changes in word-finding ability, name recall or what we can often write off as just “forgetfulness.” My husband’s mother had vascular dementia, but her early experiences were very parallel to Alzheimer’s. One of her go to questions came to be, “How do I know you,” which we used as a title for my book on dementia. Planning became more difficult, so she found it increasingly easier to simply let others organize her days and her life. Loving caregivers responded by simply picking up the slack in order to preserve her quality of life and her dignity. Stage 2: In some ways the progression to this stage is an amplification of the early stage symptoms, but diminished nerve cells take an understandable toll. As a caregiver, one learns to not simply remind the Alzheimer’s love one, but perhaps to also pick up the slack. The forgetfulness also extends to more fundamental activities of daily living. A caregiver will not merely help with finding the right word, but also the appropriate clothing for the season and other choices that earlier were almost done without a thought. Caregivers should also look for psychological withdrawl or moodiness and offer comfort. The patient will still continue with normal activities of daily living, but require more assistance. Stage 3: The final stage is marked by a graduation from anything that could be called mild impairment to more obvious shortcomings. A client once described life with his Alzheimer’s mother as having graduated from getting only four hours of uninterrupted sleep a night to now having only four hours of interrupted sleep each night. In this stage it becomes increasingly important for a caregiver to seek added help for what has become constant demands from their loved one. The patient’s overall health also is affected. It also takes a special kind of love as personality changes also begin to surface to the point that the loved one no longer is herself, but soothing music or loving touches can help. Alzheimer’s ultimately does “take a village” with professional support as well as the loving help of friends and extended family. It also is a significant help to have had a family health care provider engaged from the early stages forward so that they also have monitored as the caregiver sees the changes that need to be addressed. And everyone sees the patient who was and is. Let me also add that it is very important to seek out caregivers and care managers who are certified and accredited in supporting the family as well as the patient. 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.
Most of us have grown up with the faith that when we have a medical issue, there is likely to be a drug to take to alleviate the problem. Yet, we as geriatric care managers have found that more than 700,000 hospitalizations each year result from adverse events or side effects of drugs or because patients are over-medicated. Most of these patients are older adults, despite the fact that those over age 65 years of age represent only about 13.5 percent of the population. If you are a caregiver to an older adult or other person with special needs, you should pay particular attention to the following to keep your loved one out of the hospital:

It is not just prescription drugs that should concern you. Most of the medicines that we all purchase over the counter (OTC) were once prescription medicines. They can represent potentially harmful side effects like Tylenol with its potential for liver toxicity. And don't forget that even aspirin is an acid; but it was on the drug store shelf before there was an FDA to protect us from its stomach slide effects.

Keep track of all the medicines your elder may be taking (and include the OTC meds). Most doctors' offices are getting very good about asking what medicines are being taken with each visit, but be prepared with your loved one's lists at each visit. And ask if any can be dropped; you may be surprised at how many prescriptions handle the side effect of another medication.

Be careful about how a medication is to be taken. Make sure your older loved one and you both understand the time of day a drug is to be taken, with or without food or how it might interact with another medication or even certain foods.

Read the fine print. Every prescription has something pharmacists call the package insert or PI. Read the indications and usage section of this long page and call your provider with any questions. Also read the adverse events to make note of anything that has a greater than 5% incidence - and what steps to take should that event happen.

Make sure you watch for anything out of the ordinary and ask your loved one how they feel. It may be just a dry mouth, or it may be hard stools or other side effects they may not volunteer. Everything is important to monitor. And if your loved one suddenly has any difficulty breathing or feels anxious, call your provider.

Underlying all of these caveats, appreciate that your older loved one has less fluid per pound than a younger adult. Their metabolisms also function more slowly. And most drug trials are conducted only with younger and healthier adults, so side effects may be minimal and less consequential. Birthdays and drugs may have bigger side effects than the pharmaceutical companies may have found in their trials. 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.
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 key member of the CCM team for over a decade. – Charlotte This is the second 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.” In the last post, I discussed the structure of Medicare, and its division into two main parts (A & B) and a supplemental part (D). In review, the major portions of the program look like this:

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 Primary Care Provider visits, or referrals)

Part D – added under the Medicare Modernization Act of 2003, covers select prescription drugs.

Let me start with some of Medicare’s surprising omissions of coverage. Again, the way the public thinks that the service works and how the service functions in practice are not the same. For example, Part A is designed for stays in medical facilities, but not all stays, and not all facilities are covered. The same can be said for Part B, which does not cover all physician office visits. How does this work? While most traditional, scheduled physician visits are covered, you shouldn’t expect to be covered by Medicare Part B for:

Most dental care

Eye exams related to prescribing glasses

Dentures

Cosmetic surgery

Acupuncture

Hearing aids and exams for fitting them

Routine foot care

Which facility stays are not covered under Medicare Part A?:

Long-term care

“Custodial” care

It may come as a shock to many, but Medicare does not pay any part of the cost for permanent residence in a Skilled Nursing Facility (commonly called a Nursing Home). Without long-term care insurance, many aging adults find themselves unsure how to manage to pay for extended, custodial care. Next week, we’ll talk about options to close the “gaps” in coverage and how folks covered by Medicare are planning for themselves with the help of Medicare Counselors. 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.
Raise your hand if you haven’t heard enough bad news in 2020. I thought so. We know we are not yet out of this pandemic, but I am not going to talk about any of that today. Instead, let me share the top five good news stories coming out of this past year…news that has been reported, but may not have reached all of you given a plentitude of COVID and related news. This is not my usual focus on elders and the families who support them, but I think good news may be in order. Please let me know which of these you may want to learn more about.

Eliminating Cancer: Scientists from Australia reported lab results that perhaps promise a vaccine for a number of blood cancers as well as some malignancies such as breast, ovarian, pancreatic, lung, renal and glioblastoma.

Food Insecurity: The Nobel Peace Prize for 2020 went to the World Food Programme for supporting almost 100 million people who have been victims of hunger and malnutrition in nearly 90 countries

Artificial Eyesight: A team of scientists from around the world collaborating in the Hong Kong University of Science and Technology have created a spherical eye with 3D vision capabilities. It is being refined for use in humans as well as possibly in humanoid robots.

Cleanup on Plastic: This is a list all countries should be on, but so far, it is Ghana, Vietnam and Indonesia who have committed to cut their plastic waste by 100%, 75% AND 70%, respectively by 2025. They are partners in the Global Plastic Partnership.

Water on the Moon: Okay, many of you are familiar with the 1968 Movie based on the book, 2001: A Space Odyssey. There is more water on the moon than has been thought, and that means that a sustainable base for humans on the moon may be within reach. By the by, there are plans to launch a woman and a man to the moon in 2024.

Let’s put 2020 in our rearview mirror and look forward to more good news in 2021. Remember your masks, remember your social distance, remember to wash your hands and look to a better future. 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.

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