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

Forgetfulness-A Caregiver’s Warning Signs
There are an estimated 30+ million cases of dementia worldwide according to the latest statistics. That amounts to a...
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April 11, 2013
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Accommodating Dementia at Thanksgiving
I’ve talked about being on the lookout for signs of early onset dementia as we all begin our holiday...
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November 15, 2012
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In the Caregiver's Words

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Count slowly from one to sixty-seven…one thousand one, one thousand two, one thousand three… By the time you reach 67, one more person in the United States will have been diagnosed with Alzheimer’s Disease. In fact, one in three Americans will die with Alzheimer’s Disease. I have talked in the past about new diagnostic breakthroughs and some pharmacological and nutritional and other ways to modestly stave off the progression of this disease, but the fact is that there is no cure for Alzheimer’s. Alzheimer’s remains the only disease in the top ten causes of death in the United States that cannot be prevented, cured or slowed. But from the perspective of geriatric care management, it is not just the patient with the disease that requires help; it is their families and other caregivers in their orbits. To that end, I would like to share a brief overview of some of the resources available to support all the individuals who need help when this disease strikes:
1. Alzheimer’s Disease Alzheimer’s and Dementia Caregiver Center (http://www.alz.org/care/alzheimers-dementia-support-help.asp ) is an arm of the Association that has done the most to help patients with the disease as well. The Center provides training and other resources to caregivers as well las a 24-hour telephone hotline.
2. Family Caregiver Alliance(https://www.caregiver.org/national-center-caregiving) offers families resources at the local, state and national level. Not all locales may be covered, but their information and other resources at the national level can be a real asset to families.
3. Rosalynn Carter Institute for Caregiving (http://www.rosalynncarter.org) offers training and education going beyond basic pamphlets. They do peer-reviewed literature searches across a host of related topics as well as sponsorship of researcher into interventions that work.
4. Eldercare Locator (http://www.eldercare.gov/eldercare.NET/Public/index.aspx ) is funded by the U.S. government and provides a unique matrix resource approach to resources nation-wide. From their web site one can search a range of service types by zip code to find specific services in your own locale.
And, of course, the Aging Life Care Association (https://www.aginglifecare.org) helps visitors to their web site with a Care Finder down to the specific zip code level. If you reflect back on other public health challenges where cures ultimately have been found, they all started with building from the grass roots a support system that not only supported the patients and their families, but also the march to a cure. It takes a village. Charlotte Bishop is an Aging Life Care Professional and a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.
This is the first in a series of posts on dementia in advance of the release of my new book, "How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia." It will be released in July through Family Solutions Press of Los Angeles and available from Amazon. We will keep you up to date on details. Count slowly from one to sixty-seven…one thousand one, one thousand two, one thousand three…by the time you reach one thousand sixty-seven, one more person in the United States will have been diagnosed with Alzheimer’s disease. In fact, one in three Americans ultimately will die with Alzheimer’s disease. And when we interviewed nearly three dozen Professional Care Managers in 2016 and 2017 dementia was the most common issue they dealt with among their clients– more than 66% of their cases. There have been new diagnostic breakthroughs and some pharmacological, nutritional and other ways that have proposed to help slow the progression of this disease, but the fact is that they have no substantial or durable effect. Alzheimer’s remains the only disease in the top ten causes of death in the United States that cannot be prevented, cured or slowed. Dementia is a category that includes about 100 specific cognitive conditions. Generally speaking, most dementias are diagnoses of exclusion. That is medical talk for the fact that one narrows down what a person is manifesting by successive steps of eliminating other possible explanations for a behavior. For instance, a medical work-up when dementia is suspected will include a review of all the medications a patient may be taking. Some medications have a pronounced effect on a person’s memory, noteworthy among them most of the sleep aids such as diphenhydramine, or Benadryl. Yet, this typically results in memory lapses that will recede if the medication is stopped. Doctors now also talk about “risk factors” for dementia that they place into three major categories. The first they tie to “body composition.” Simply put, what physicians have noted is that people with more fatty tissue, or a higher Body Mass Index (BMI), is associated with more amyloid deposits on the brain, a precursor of Alzheimer’s. The second set of risk factors center on “inflammatory processes.” Increased blood levels of sugar and cholesterol are associated with higher risk of dementia as well as heart disease…something of a double hit. Finally physicians also look at how well a person scores on “cognitive tests.” Dementia often is thought of as forgetfulness, but it really is the inability to process information and make a retrievable memory. They have cognitive tests that can measure that, one of which they call the Mini-Mental Test. A person’s cognitive health also is enhanced by creative pass times like playing a musical instrument, taking adult education or actively engaging in stress reduction. In my book, we cover what we know about dementia, what can be done to stave off the effects of dementia and most importantly what caregivers can do for their loved ones with dementia and for themselves. 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.
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You have heard from me before about how there is a new Alzheimer’s Disease diagnosis in America every 67 seconds…about one a minute every day and every night! According to medical professionals it is becoming even more prevalent worldwide. By the year 2050, this rate is expected to double to one new case every 33 seconds. It is ranked as number one in prevalence of all neurodegenerative conditions affecting 5-6 million Americans and as many as 47 million people across the globe. Translated, that means about one in eight individuals over age 65 will be affected by Alzheimer’s and that climbs to almost half of those 85 years and older. It has been studied for more than 100 years with little headway on what causes Alzheimer’s Disease, let alone how to treat it. I am going to talk more about treatment, and there are some avenues that show promise, in a second installment to this two part series on Alzheimer’s. In this part, let’s go over how Alzheimer’s is diagnosed accurately today than ever before. Not that long ago, Alzheimer’s could only be diagnosed after a patient had died when they could actually investigate how much beta amyloid plaque had accumulated in their brain. That is so yesterday. There are now three ways to arrive at an Alzheimer’s diagnosis in a patient. The first starts with a genetic marker that predisposes an individual to developing Alzheimer’s. It’s called the APOE4 gene, and about one in seven to one in ten people carry this gene. Those who have one copy of this gene are about two to three times as likely to develop the dementia as those who do not have the gene. And if a person has two copies of this gene the likelihood shoots up to 12 times that of a person with no copies of the gene. Should everyone get the genetic test? Well, talk to your doctor, but as medical professionals have consistently shown early diagnosis can be the first step toward more effective treatment of any condition. A second step toward diagnosis will be what is termed a neuropsychological test which assesses a person’s cognitive function. It should be conducted by a neurologist, not just a primary care physician. Combined with the genetic test, it can help to pinpoint Alzheimer’s Disease, but not without the third test. Brain-imaging can not only help to look for the signature of Alzheimer’s activity the brain, but also rule out other issues like hemorrhage or tumors that may be causing mental difficulties. It will also more concretely assess the extent of any Alzheimer’s spread in the brain. This latter testing can be done by a number of technologies like CT or PET scanning, but the most common test is MRI. Look for Part 2 next week when I review the existing as well as new, promising treatments for this condition. You all may recall that I have a book that I have co-written on what a caregiver should know about Alzheimer’s…it is noted in the closing paragraph here. If you want to save 20 percent off the Amazon price, please just send me an email and we will send you a copy for $19.97 which includes shipping and handling. 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.
About 50% to 70% of Americans will die without a will. So, you can imagine that the percentage without a “living will” or other type of “advance directive” is even larger. I attended a program last month in which a local lawyer specializing in elder law, Eric Parker, shared a lot of useful information about the types of advance directives and answered some common questions people have about them.

With the holidays coming and everyone getting together, I get a lot of questions as a geriatric care manager about how to help an older adult or someone else with special needs. The holidays may be a good time to have some discussions about what an older loved one really wants. In very plain terms, this conversation – while potentially awkward – will help assure that others do not make the critical health care decisions for an older adult. And, of course, these are discussions we do not have to be “old” to begin to have.

I start out by saying that I am a geriatric care manager, not a lawyer, and this is not legal advice. But let me give you a brief overview of the legal documents you should consider having in place so that health decisions are in accordance with what your loved ones actually want. If you want more information, I also will give you some Web resources to answer your questions.

First, a “living will” allows the writer to tell their doctor whether they want death delaying procedures used if they have a terminal illness or if they are unable to act. This only works with incurable or irreversible illnesses, so it is limited.

Second is the Gold Standard of advance directive, the “durable power of attorney for health care.” It allows the individual to name a person who will make health care decisions on their behalf. This can include refusing “life-saving treatment,” but it really is meant to take the place of the patient’s own decisions, so it covers a lot more than a living will.

Third, is the “do not resuscitate order” or DNR. It is limited to dictating that the patient does not want CPR if the heart or lungs stop.

Finally, the last one is not truly an advance directive, but it allows a family member to make certain health care decisions on behalf of the patient if there is no other advance directive. It is called a “health care surrogate act.”

Now comes the hard part – determining what is best for your loved one. And that is where good legal counsel is essential, but do your homework first. Check out some of the following elder resources:

Eric Parker has a ElderLaw Blog with lots of helpful information

AARP about advance planning

Caring Connections has state-specific advance directive requirements

Rainbow Hospice and Palliative Care talks about advance directives

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.
That’s not covered.
The estimate is that about 28 million older Americans have opted out of traditional Medicare and for what are called Medicare Advantage plans. They are not just Medigap which came about soon after Medicare was enacted to help pay for what Medicare did not cover, like prescription drugs and more. They are touted as plans that can offer better services, more services or better value, but these “advantages” have been brought into question lately. There may be value in these plans, but they also go on record with tens of millions of denials for tests or services each year. A report from Medicare administrators (part of the Centers for Medicare and Medicaid Services, or CMS) found that three-quarters of denials for medical services to covered patients were reversed on appeal. An investigation further found that 18 percent of payments for care that had been denied would actually have been covered by Medicare. Insurers use a step in the medical process that requires that approval be sought from an insurer before a procedure can be covered; they’re called prior authorizations. These “prior auths” appear to have been expanding well beyond what they originally were intended to do. The step was initially set up to stave off expensive or unproved procedures and medications. A new medication perhaps has been found to work against a different diagnosis than was originally approved by FDA, but it might not be approved for coverage until it has become a “standard of care.” But it has been used far more commonly to deny a host of services, tests or prescriptions, and patients may not know that they can appeal…or at least give the feedback to the provider who ordered the services, tests or prescriptions. If you are a caregiver to an older loved one who has one of these Medicare Advantage plans, be watchful of services or prescriptions that are denied. Become an advocate for your loved one with their provider and ultimately with the insurer. The real litmus test for the services that may be questioned is whether they would be allowed by Medicare. If Medicare would allow a service, Medicare Advantage plans must also provide for that service. Medicare Advantage plans may have their own criteria for processing services and reimbursement, but they cannot be more restrictive that Medicare. Federal investigators admit that even some of Medicare’s own rules may need to be updated. 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.