Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • Hospitals & DoctorsChicago's Geriatric Care Manager Center of Excellence

Older Adults Surviving the ICU
Our vice president for geriatric care management services, Steve Steiber, Ph.D., brought some startling information to my attention recently,...
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September 11, 2013
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Geriatric Care Management Services for Functional Status
As a geriatric care manager, I have to admit that we are very skilled at not only providing senior...
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June 24, 2013
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Caregiver Preparation for Emergencies
As a caregiver for an older adult you cannot prevent a medical emergency, but you can prepare for one. ...
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June 6, 2013
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Managing Geriatric Care Hospital Sticker Shock
Do you know how much a pacemaker costs…fully installed? Well, if you or a loved one have no heart...
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May 30, 2013
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In the Caregiver's Words

Recent Client Praise

Do you know how much a pacemaker costs...fully installed? Well, if you or a loved one have no heart condition that would require a pacemaker, it may not mean much to you, but how about the cost of a hospitalization to treat your loved one's pneumonia? That is definitely on the radar of geriatric care consultants and most caregivers with an elder parent or loved one under their care. And by the way, the answer to both questions is the same: what you spend for care depends on where you go for the hospital stay. The fact is, however, that now you can actually begin to compare the prices for 100 of the most common medical procedures performed in about 3,300 hospitals across the country who accept Medicare reimbursement. The published prices are now available to the public under one of the many reform provisions of the Affordable Care Act (ACA), referred to by some as ObamaCare. The reason that these prices are now going to be made public is because "sunshine" is now being shed on the many factors that have made the "health care marketplace" far from an actual market in which consumers can make decisions based upon having all the information that should be available in a free market. The sticker prices are now available. For instance, go to Vista Medical Center East in Waukegan for that pacemaker and the sticker price will be $165,000. Travel 30 miles to Centegra Hospital in McHenry, and you will see a bargain price of only $36,000. Go to Loyola Gottleib Memorial in Melrose Park with pneumonia, and your bill will be about $32,000. Yet, go to Stroger Hospital, and a simple case of pneumonia will be treated for $7,674. There is one hospital in Dallas that will charge over $38,000 for the same pneumonia case, and another not far away in Texas will change only $14,610. You may not pay the same prices, because your insurer (e.g., Medicare) will have negotiated a lower rate, so you will want to do your homework on that. For those who are concerned about differences in quality of care that area associated with the price differences, data on quality of outcomes also will be available for these hospitals. One of those "quality measures" will include the number of people who are readmitted to the hospital for the same condition within 30 days of their discharge. In fact, the ACA will begin penalizing hospitals if their rates of readmissions are above the national average beginning in October of this year. Check out these web sites in Illinois: hospitalcompare.hhs.gov and healthcarereportcard.illinois.gov. Charlotte Bishop is a geriatric care consultants 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.
Elisabeth Kubler-Ross introduced her five steps of grieving for a loved one who has died four decades ago in her book On Death and Dying. A couple of new authors, Barbara Okun and Joseph Nowinski, have revised these five steps in light of our present day experience of dying which tends to be a more protracted process. As a geriatric care manager, I find myself spending more time helping caregivers prepare for the death of a loved one than helping them after death has occurred.

The very practical fact is that people simply do not die in the same way they did nearly half a century ago. We do not hear of folks just “dropping dead” as much as ultimately succumbing to a terminal disease from which they have been suffering for some time. Modern medicine has given us more warnings of life-threatening conditions and more tools to forestall the assault of terminal conditions like cancer or heart and lung disease. With that change in how we die has come a need to address the anticipatory trajectory of caregivers as they attend to an individual and as they prepare to say good bye.

Okun and Nokuski offer a psychological road map for caregivers anticipating the demise of a loved one in their book, Saying Goodbye: How Families Can Find Renewal Through Loss. The authors help readers to develop the communication skills to address the old family issues that will surface during the protracted caregiving a terminally ill individual will require. It is a self-journey handbook for the caregiver to address the inevitable emotional challenges they will face, and I recommend it.

An important counterpoint to the emotional navigation aid Okun and Nokusi offer is the guidance that Dr. Kevin Pho offers. In his blog posting, KevinMD, Dr. Pho offers advice on how to navigate what he calls the “medical maze,” how to interpret medical speak, ask the right questions, be proactive. For any of you facing these end of life passages, I strongly encourage you to check out both of these resources. We all need to be willing to “stop and ask directions.”

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.,geriatric care manager Chicago, geriatric care Chicago

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This is not going to be a course in economics, but quite often caregivers of family members get more focused on how much respite care casts instead of on how much everyone benefits. Talking about costs first, there are three kinds of costs for respite care: dollars you pay, dollars someone else pays and what you can get for free. Starting with the dollars you pay, give careful consideration to the level of care you need for the older adult for whom you may be the caregiver. If the adult in your charge needs help with a whole range of activities of daily living such as eating or toileting, then there will be a higher hourly rate in order to get qualified respite care. If, you are closer to the other end of the continuum and mom or dad can get around quite well, but need to be watched so that they do not wander, then you may be able to save significant dollars by simply engaging the services of an aid or similarly-trained individual. Getting respite care for free? First, don't forget to consider other members of your own family. Even a brother or sister who has a day job can offer respite care in off hours or on weekends. Get to know other caregivers in your own circle of friends so that you can get some respite when one of them is willing to watch your mom or dad along with their own and vice versa. It is good for everyone when your respite becomes their chance to socialize. Check out resources for Chicago senior services, local community colleges or even high schools for students who either need to generate hours for community service or need hours toward course requirements in social work or other helping profession. And consider the following resources that may subsidize respite care:
Most important, don't forget the benefits of respite care. The most important of which is you will do a better job caring for someone else when you care for yourself.
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. Learn more about What We Do and how we can help you support your loved one.
Some have called it an epidemic. And it’s particularly virulent within the senior population. The epidemic leads to even more serious conditions. But the cure is simple, and it distills down to three words: “Never Cry Alone!” I’ve written many times about the isolation that so many older adults in America face as they age. And then comes the COVID pandemic and all the rest of us who are not yet of an age got the chance to experience isolation first hand, and social media assaults, and out political climate, and out climate climate…the list goes on. It’s a feeling of loss that sets in and in many cases becomes full blown depression so much so that mental health tops the list of the health care issues threatening our society. It’s Simon Sinek that offered the simple message based on years as an inspirational author and speaker: Never Cry Alone! Ironically, Sinek doesn’t talk about loneliness or depression as something to deny or from which to create as much distance as possible. It’s part of being normal, he says. Resilience is the goal, not just happiness. Surround yourself with friends … or at least a friend … whom you can call when you just need to say, “This is not just a bad day; can we talk?” What does that good friend do, because remember friendship is a two way street? A truly good friend is not there to “fix things” for you, and a truly good friend is not there to “cheer you up.” A truly good friend is there to listen. That may sound simple enough, but extremely few of us are “good listeners” without some training. In fact, a psychologist named Kenneth Haugk, Ph.D., started an entire movement called Stephen Ministry in 1975, based on this simple premise of “active listening” to others with a problem, a tough situation or just in need of a sensitive ear. So, it’s just listening? Well, it’s all about active listening. I have a go-to phrase with my family when they come to me with problems: “Do you want me to problem solve or just listen?” With listening in motion, the active piece comes into play with additional questions that may sound like:
- I’m sorry to hear that; how are you feeling now?
- How is that working for you?
- You mentioned ____; talk to me about that.
- You’ve given this some thought; what do you think?
And maybe based on Mr. Sinek’s advice, you learn to allow your friend to cry and simply provide the tissue. And keep listening. Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of, 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.
How many times have we all seen the commercial with the plaintive actor on the floor crying, "Help, I've _____ and I can't get up." No one would ignore a plea for help from an older person who has fallen and cannot get up. But a lot of caregivers may be ignoring a similar plea with all of the health threat that a fall can represent. It is just that this fall is in slow motion. And it goes like this: "Help, I am so fatigued that I don't feel like getting up." Tired often does not get enough attention in medical circles, but it is a common symptom reported by people age 65 and older. We tend to discount fatigue, because we cannot accept that a person who has retired and now enjoys six Saturdays and a Sunday every week could not be well-rested. And if you are a caregiver to an older loved one, you may find it a bit challenging to muster the sympathy for your older loved one when you already are stretched across your responsibilities for your children, your partner, your job and... Yet, we should all pay attention to the subjective complaints of fatigue in our older loved ones, because tired can be a symptom of more serious medical conditions and because tired can lead to serious physical decompensation. Let's start with the other medical conditions for which fatigue can be a warning sign. Perhaps the most common clinical condition that presents with fatigue is depression, itself one of the most common comorbidities of aging. Depression often can arise from the hallmark aspects of getting older - loss, diminished physical capacity and social isolation to name a few. Chronic fatigue also can be a symptom of sleep apnea, restless leg syndrome, fibromyalgia, chronic obstructive pulmonary disease and any number of heart conditions. Poor quality sleep may also be indicative of musculoskeletal conditions or pain. If your older loved one is consistently tired, it may be time to accompany them on a visit to their physician for an assessment and a conversation. Sleepiness can also be just one more step along the slippery slope to frailty. Fatigue can be a strong disincentive for your older loved one to be as active physically as they once may have been. Fatigue also puts a damper on appetite which in turn reduces the quality of the fuel the body consumes to run the body's engine which leads to increased tiredness and low motivation for physical activity. And all of this translates into decreased mobility and frailty. Medical professionals refer to frailty as a "pre-disability." So, if the tiredness has gone on for an extended time, begin to look for signs of genuine frailty. No surprise, the signs include exhaustion ("hyper fatigue?"). Frailty also is predicted by weakness in grip and slower walking pace. And by weakness, we mean a quantum reduction in ability to grasp, and by slower we are talking a fraction of former strides. All of these point to diminished physical activity. Think of frailty as one step away from a permanent reliance upon a walker or wheelchair. The next time you are speaking with an older individual who reports being consistently tired, it may be time to wake up and take stock of their overall health. 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.