Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • senior livingChicago'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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Nursing Home or Village?
A recent report from the Congressional Budget Office created a bit of a stir among geriatric care managers, because...
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July 8, 2013
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Geriatric Care Management Services for Renting
I have talked in the past about making home safer for seniors as well as geriatric care management services...
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May 28, 2013
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In the Caregiver's Words

Recent Client Praise

There seems to be a cliché for everything, so we’ll start with this go-to for COVID: “We’re not out of the woods yet.” In fact, our scientists/pathfinders cannot tell us how far we may have to go to truly be “out of the woods.” If the “woods” is the COVID Pandemic, the patch of woods many are now in is the “long COVID woods.” Public health professionals are telling us that approximately one in five individuals who do become infected with COVID will also have the added journey of long COVID…and it’s more common in our older loved ones that younger people who become infected. If you have an older loved one who has been infected with COVID – and hopefully been vaccinated – be on the lookout for lingering symptoms. It gets a bit complicated, because many of the long COVID symptoms are similar to those that older adults with heart disease, lung disease or cognitive impairment may be manifesting already. These include difficulty with memory or conversation, tiredness, muscle and bone pain, shortness of breath or heart racing and more. If you don’t seek out attention from their medical providers, you may not recognize the underlying causes of such symptoms in order to treat them effectively. And here’s is the real catch, there is no real test for “long COVID,” and there really is not much consensus for clinical treatment either. First, seek the advice of their medical provider, but be prepared to ask for a referral to a specialist or in some areas, a referral to a long COVID clinic. There are about 66 health systems across the U.S. that have put together interdisciplinary teams to tackle the complexities of long COVID. Go on-line if you have to get access to those clinicians who can really help. Second, be prepared to ask a lot of questions as you call on clinics or providers. It can help to go to the web site of a “long COVID clinic,” so check out what these clinics say about the condition on-line. The University of Southern California may not be in your backyard, but read what they do so you can be conversant in what to expect and what to ask. Third, get a plan for what can be done at a clinic as well as at home. After a clinician determines that it likely is long COVID, they can help you form a plan around restoring your older loved one to full “pre-COVID health.” Also, Google “activities of daily living” for the list of deficits that may need some work to get fully back from COVID. But go slow. Older adults lose endurance rather quickly with the “deconditioning” that comes from COVID, so it may take some time to get back to “normal.” Start low, go slow. Don’t start with long walks; start with very short walks. Don’t start with pressing weights or even push-ups; start with resistance bands to build back lost muscle mass and tone. A physical therapist may be a great help in developing a training program. Fourth, be a cheerleader, not a coach. Encourage your older loved one to be persistent but also have the patience for the time it will take to fully recover. Cheer their successes. Older adults will simply take longer than they may have a couple decades younger to recover the muscle tone and strength that has been lost. Help them pace themselves and reward themselves for small steps toward goal. Otherwise, you may have a setback on top of long COVID. Remember that social isolation and depression are some of the challenges all older adults face, so help them to find a positive path to physical and mental health. And be patient also…long COVID is called “long” because it can stay around for a lot longer than anyone will want. 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.
For a what, you may ask? I have either talked about or invited elder law attorneys to talk about advanced directives like Do Not Resuscitate (DNR) orders, living wills, powers of attorney and other documents that will help to assure that an older adult's end of life wishes are honored. And that is where POLST comes in. It is a standardized (by state) document that walks through a patient's wishes for end of life care that falls short of a DNR. POLST is Physician Orders for Life-Sustaining Treatment. The majority of states have enacted such legislation following the lead of Oregon in 1991. It is standardized for the state and is typically a brightly colored single sheet so that it will stand out in a patient's file. (Illinois' form is two pages.) Not only doctors, but first responders and other clinicians will understand the instructions of the POLST. It is not for everyone, but if your older loved one is frail or suffers from a life-limiting illness, you should consider having a talk with your loved one's physician along with your loved one. If your older loved one's physician can honestly say they would not be surprised if that person died in the following year you would be well-advised to start the conversation in order to have the POLST on file. What would that look like in a standardized form? In Illinois, the form asks for all the usual patient-identifying details, contact information for your older loved one's preferred contact, physician contact information and the physician's signature. The rest is pretty much a check list. Check yes or no if your loved one agrees to having CPR in the event their heart stops. If your loved is still breathing and there is a pulse, check yes or no for comfort measures only, for limited added interventions or for intubation for ventilation. To these the physician can add other measures. Finally, check yes or no for what kind of nutritional supplements are desired if your loved one cannot be fed by mouth. The rest is referred to as documentation that this discussion occurred between competent adults. To see the Illinois form, please go to this link (http://www.idph.state.il.us/public/books/dnrform.pdf) As you can imagine, life or end of life decisions are not so cut and dried. There are some potential ethical issues to be addressed here. Clear and sensitive discussion needs to occur among you as the caregiver, your older loved one and the rest of the family. And then there is the real question of whether your older loved one can really understand all the medical speak. It may prove helpful to bring in a professional counselor to talk this through with the family unit so that all voices are heard and all questions or objections are raised. Most important, however, is that your older loved one feels that it is they who are in charge. This ultimately is not about the doctors or the family; it is about the care receiver.
We all hear the phrase used as an excuse for a bit of memory lapse … that it’s just a “senior moment.” It doesn’t seem to be ageist, because in older adult communities the phrase gets tossed around about as frequently as “hello” or “goodbye.” But it’s wrong. This time of COVID places us all at risk for the “Memory Moments,” because they’re not caused by age. Yes, short term recall issues are something to which we all are susceptible, but they are not caused by age. Memory issues like dementia are not caused by age; they have organic causes. There are steps we all can take to stay more mentally sharp no matter our age and despite COVID. During this time of sustained pandemic quarantine – for those of you following the state and local mandates, that is – memory lapses can seem to become more common. Even these “COVID moments” are not inevitable, however, if you keep your mind engaged and active. Here are six tips to help fend off the cognitive impact of COVID 19:
1. Do Something New – We all have heard about “lifelong learning” as it may describe someone who seems always to be pursuing new knowledge, a new language or a new craft. Your brain still has a lot of room to expand what you know, so keep at it.
2. Don’t Cram – Just like the tests when you were back in school, the best learning cannot happen the night before the exam. Spread your learning of a new language or a new musical instrument over a number of sittings and days, and it will more effectively take root.
3. One More Time – The learning takes place over time, and you need to go over the same ground over and over. Repetition is important so that the new language you’re studying becomes like a new habit.
4. More Senses Make More Sense – When you are working a new recipe in the kitchen, you learn by reading, tasting, smelling, touching, etc. With learning a language, you learn by seeing, hearing, writing, saying, and so on. Use as many senses as you can to maximize your cognitive process.
5. Don’t Sweat the Small Stuff – It’s okay to let your devices or your habits free up your brain to work on the new things you want to learn. Make a written list of your “to do’s.” It will free up the brain space to actually determine how to do what you want to get done.
6. Yes You Can – Don’t ever call it your “senior moment,” because that means you have lost confidence in you. While you are practicing what you wish to learn, practice having confidence in your learning. If you don’t believe in a “senior moment,” you are far less likely to have one.
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.
Last month, we talked about conversations with older loved ones about residential living choices. While might find this is a suitable option, others may be able to retrofit their houses for senior living in Chicago, to keep daily living familiar to their local location and make it more comfortable for their aging loved ones. It is only a matter of making certain adjustments in your home, though this task might not be as easy for some as it is for other. Below are some pointers on how you might be able to make your home a positive environment for your loved ones.

Fall-proof

Leg strength wanes as people get older. Because of this, even the most innocuous fixture or furniture, or the most routine activity in the home can cause a fall. Start fall-proofing your home by making sure that all the walkways inside your house are well-lighted, and the spaces in your rooms are cleared of clutter, to provide ample space to move around. Reroute wires, should you find them crossing walk paths, and remove unsecured decorative rugs. It’s important to fix worn carpeting on which one might trip.

Fall-proofing your home works both ways. Talk openly with the elders on ways they can avoid fall accidents. Ensure that they get their vision and hearing regularly checked, and help them keep their senses sharp so they cannot miss fall hazards. Encourage them to use canes and other aids if you feel that these will help them.

Sleeping Arrangements

It is most ideal to situate their room in the first floor of your house. This gives them easy access to the main parts the house such as the living and dining rooms, and the common bathroom. Not only will that save them from straining their legs walking up and down the stairs, but will also keep them safe from fall risks.

Emergency Kit

Aside from keeping your emergency kit stocked with bandages and medicine, make sure that you keep phone numbers handy in case of medical emergencies. Include your mobile number, the number of the local hospital and your loved ones’ physician, and the contact information of your neighbors. Leave these close to the telephone, on the refrigerator door, or other visible spots.

Hire Help

Hiring a caregiver in Chicago can help lighten the load. As a care manager, I’ll be able to help assess the home and provide a plan in order to make the environment safer. Enlisting help can ease your worries about getting professional care for your parents and loved ones while you’re away.

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.
Autoimmune diseases have gotten a lot of press in the past decade or so, because scientists have developed biologic agents that have been able to slow or halt the progression of many of these diseases. The list includes the usual suspects you have seen on television commercials like rheumatoid arthritis, plaque psoriasis or Crohn’s disease. But the category also includes conditions like type 1 diabetes, lupus, multiple sclerosis and nearly twenty other medical conditions. Well, these conditions may be poised to get some more attention. Researchers in the United Kingdom have found a link between patients who early in their lives have been diagnosed with an autoimmune condition and those same patients later developing dementia. This includes both Alzheimer’s disease and vascular dementia. It all comes down to big numbers. The researchers accumulated data on roughly 1.8 million patients who had been diagnosed and treated for autoimmune conditions between 1998 and 2012. They also had a control group of about 7 million patients – those who had not been diagnosed with an autoimmune condition. Of the 25 autoimmune conditions, 18 of them proved to be statistical predictors of later development of dementia. The disease with the most dementia diagnoses later was hypothyroidism. Over all the autoimmune conditions, the risk of developing dementia later was about twenty percent higher than for the control cohort. That said, we are talking very small risks for either group. Of the dementias, Alzheimer’s disease was a slightly lower risk outcome than vascular dementia. The researchers speculate that as patients with a disease like RA likely will be taking NSAIDS like naproxen or ibuprofen which may also have a neuroprotective effect against Alzheimer’s disease. Overall, the risk for developing any dementia was slightly higher for men over women, but there was substantial variability across specific autoimmune diseases. The research seems in general to be encouraging further study of anti-inflammatory drugs as preventive care against dementia…perhaps to see if the same anti-inflammatory drugs that address autoimmune conditions can have an effect on neuroinflammation. The Alzheimer’s Association is taking this seriously. Last year they announced a $7million investment in clinical trials looking at drugs addressing brain inflammation. The researchers suggest that the data are preliminary, but admit that the inflammatory route is worth more analysis. 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.
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.