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

Building a Survivor Safety Net for the Caregiver
I have written a lot about caregiving, who the caregivers are, how to cope with caregiving and how to...
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October 1, 2013
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In the Caregiver's Words

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One of the most challenging conversations I help facilitate as a geriatric care manager is to address the prospect of nursing home care among elders and the family members who care for them. Much of the discussion comes down to point of view and what a caregiver may find important versus what the prospective resident will find important. In future postings I will also talk about timing and when to consider nursing home care as an alternative to independent living and the options in between. Let’s first look just at everybody’s points of view for a moment.

An article that recently appeared in Seniors Housing and Care Journal compared the opinions of residents and families as well as state agencies on the quality of nursing home care across 89 nursing homes. We all appreciate that nursing homes are regulated, and that the state surveyors that monitor the nursing home quality of care in most states use a fairly standard report card. This report card is called the Online Survey, Certification and Reporting (OSCAR), and you access the report cards for any nursing home you may be considering in your own family discussions. Each facility whom you interview should make a copy of the most recent state audit available for your review.

The authors of an article I came across (“Where Allies Part Ways and Strangers Converge: Nursing Home Performance in the Eyes of Residents, Families and State Surveyors”) found some interesting differences and similarities in evaluations of nursing homes as each of these groups looked at quality. First, whether families or residents would recommend a nursing home was highly correlated with the ratings state surveyors gave to the residences. Residents and families also agreed in their relatively high ratings of “staff show respect” and “ensured resident safety.” At the other end of the rating continuum, both families and residents rated “numbers of nursing staff” lower.

The differences came when residents and families were rating what could be termed quality of life versus quality of care. Residents rated quality of life components higher than families did. Families rated quality of care higher than the residents did. I see two lessons here. First, how State Surveyors rate the facilities you or your loved ones may be considering as a future home will be a pretty good indicator of how home will feel to the resident. Second, when having the family discussion about a potential move, caregivers need to be aware that what is most important to them (quality of care) will not have the same importance for the loved one (quality of life). If you as a caregiver want your loved one to “own” the decision, it is important to keep a focus on quality of life in your discussions with them. I will be talking more about this decision process in future postings.

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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There is a lot of news about the "older market" or other stories featuring someone who has reached the landmark age of 100 years and more. In my geriatric management experience, while working with elder adults and their families, all of what I see in the news is just snapshots of people at a certain age. What I have found is that who a person is at 80 or 90 is really a product of experiences that preceded the present. A long term study of aging by the Harvard Study of Adult Development followed a cohort of Harvard sophomores along with a group of young men in Greater Boston since the 1930s. My title stretches their findings a bit, because of course no one lives forever, but the study did offer some great insights into living long and living well:
1. Get rid of the cigarettes. The Harvard Study showed that men who did not smoke clearly out-lived those who were smokers. Other research continues to show that giving up smoking is a positive influence on health and longevity at almost any age.
2. Practice competent coping. It is not about the hand that life dealt these study subjects; it is about how they played the hand they were dealt. People who adapted to the events of life overall have lived longer than those who did not.
3. Waistline leads the lifeline. The researchers found that those subjects who maintained a "healthy waistline" and weight fared better than their obese counterparts. It is not about being stick thin, but it is about avoiding the other extreme.
4. Regular exercise contributes. Any kind of regular exercise improved both the physical and mental health of the men the study followed. Exercise also likely contributed to that healthy waistline and positive attitude.
5. Be mentally engaged. It starts with pursuing an educational degree, but those who lived longer also always seemed to have something they were excited to explore whether it was keeping a journal or studying a new subject. Intellectual activity seemed as important as physical activity.
6. Make and keep friends. That also includes the person one marries. The researchers found that those who were the most socially engaged also tended to live longer.
I have not talked about how old one's parents lived or one's cholesterol. These factors did contribute to longevity, but the researchers noted that they contributed less than expected. Even stress in a study subject's life was not a negative predictor of longevity as much as how the subjects coped with the stress. Charlotte Bishop is certified in geriatric management and founder of Creative Case Management, led by professionals who are advocates, resources, counselors and friends to elder adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
I have really lost track of how many conversations and/or blog postings I have had about Caregiver Stress. As a certified geriatric care manager, we work with families, and a substantial part of my focus is upon the stress of a caregiver trying to both deal with a loved one's eroding health, but also the demands on them from the others who depend on them. I would like to devote a bit of space here to addressing the stress of the aging loved one and how a caregiver can help them to cope with what life throws their way. Retirement is a break from the stressors of a workaday world, to be sure. But as one lives to do what one wishes as a reward from a long career, there comes a time when new stressors emerge. There can be increasing physical challenges from a medical condition that is not going to get better. Many of these conditions like arthritis, cardiovascular or pulmonary issues just get worse with time. As a person becomes less and less able to do the things they used to do to take care of themselves, the stress mounts. Other very common stressors are those that come with needing an elder caregiver, a spouse or partner to help with every day tasks; it takes an increasing toll. With general changes in health status can come a profoundly diminished sense of well-being and just plain depression. So much for the Golden Years. As a caregiver, look for these warning signs of excessive stress in one or both of your older loved ones:
- signs of anxiety, undue worry or outright panic attacks
- irritability or angry outbursts
- sadness, melancholy or lethargy
- indecisiveness or difficulty focusing
- difficulty getting to sleep or staying asleep
- an array of aches, pains or other issues of nonspecific origin
- rashes, breathing problems or other "new" allergies
- drinking or eating too much or too little; or
- an increasing number of prescription or OTC medications on hand.
As a caregiver, you can help by helping your loved one to find a remedy for the stress. There is no absolute way to rid ourselves of all stress at any age, but the key is finding help to cope more effectively with the stress in our lives. For your older loved one, consider:
1. Gently and persistently encouraging your loved one to be more socially engaged with friends, clubs or outings in order to get a break from the stress cycle;
2. Help your loved one to find seek out talk therapy; it is not about getting another prescription nearly as much as "unloading" to a trained therapist;
3. Seeking a physical aid in the form of gentle massage therapy, exercise classes like yoga, relaxation therapy or just getting out for longer walks.
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@creativecasemanagement.com.
Once in a while “yesterday’s news” is also tomorrow’s news. Earlier this year you probably heard or read that Medicare is now authorized to negotiate prices directly with drug manufacturers. It’s not a blanket permission to negotiate; it’s focused on single source, patented drugs that may be prescribed for older adults. When drugs go generic, there is competition which generally brings prices down for the consumer, but “single source” is simply code for the company that won the race to be patented gets to pretty much set the price of the “new” drug. I put the “new” in quotes, because it’s not always a truly novel medicine; it may be a combination of two or more existing drugs that can work well together to manage a medical condition like hypertension or HIV or others. This is a welcome relief to older Americans, many of whom are on fixed incomes. A study released just this past week by AARP looked at the top brand name 25 medicines with the highest spending among Part D drugs. They’ve more than tripled since their entries into the market, and they did not start out cheap. We all hear monthly reports on the consumer price index (CPI) and howl a bit when gasoline goes up 32 cents (8 percent) a gallon. Many of these new drugs didn’t start at four dollars per unit as gas may have. Their market entry price has often been in the hundreds of thousands of dollars a year. But all of this restraint by way of CMS’s negotiations will be resulting in howls of “unfair” from drug manufacturers, some calling this move “extortion” to their industry. And we’ll probably be hearing the howls for a while as the negotiations are slated to occur this year into 2024. The negotiated prices will not take effect until 2026, but we are off to the races. If you have an older adult in your family or you, yourself, qualify for Medicare, you have a home work assignment. Look to your loved one’s or your own medication list to see what the list price is for any of your branded meds. Be prepared to perhaps even drop a letter or a call to your federal representative to see where they stand on the new authorization. If they backed it when it moved through congress to become law, thank them. If they hedge on the issue or just admit they did not support the bill, ask them why. Being an active citizen just might turn out to be really good for your health! 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.
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Home Health
Home Health involves licensed medical professionals (often nurses or physicians) trained in providing aid to those who need health monitoring and assistance. This service is ideal for those who have recently been hospitalized, are in need of rehabilitation or medication assessment, or have suffered a decline in physical mobility.

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Home care provides services for those who need help with ADL (Activities of Daily Living) tasks. For instance: transportation to doctor’s appointments, grocery shopping, house cleaning, and other every day needs. This service is ideal for a family caregiver who needs someone they can trust to take care of their mom or dad while they are away. It is also helpful to those who need short-term assistance after a hospital stay or during physical rehabilitation.