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

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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It is the "crime of the century" and you have heard of it, but you may be having a rough time remembering it right now. That is, in part, because it has gone largely under-reported, and the bad guys may not have been prosecuted. If you are thinking this is the story about the financial institutions who were responsible for the crisis that fueled the "Great Recession," you are wrong, but it is a financial crisis. Those who are 65 years of age or older in this country represent only 13% of the population, but they get a disproportionately large share of the attention from scammers. And it is not just the affluent and older population; it is the relatively poor as well as the rich among those who are of an age. The National Council on Aging warns of some of the more common scams that occur. 1. Medicare/Insurance Fraud: A federal grand jury just this month indicted a Florida physician for up-charging Medicare for over $2.1 million; since Medicare is funded by you and me, all of us pay for that one. 2. Fake Drugs: Even with the provisions of the Affordable Care Act, medications can cost a lot. The internet and phone callers have been targeting older adults by selling "cheaper medicine," but the drugs are counterfeit. 3. Funeral Crashers: A scammer can follow the obit column and show up at the funeral to present the grieving family with a false debt allegedly owed by the deceased. 4. Looking Marvelous: In search of the eternal youth elixir, consumers at any age who want to look younger than their years can find a whole host of scammers with fake goods that make big promises and cost big dollars. 5. Phone Fakes: It is not bad enough that an older person can be duped by a fake telemarketer, but it often happens that an accomplice of the first scammer will call later to secure even more dollars offering to help reclaim the first loss. 6. Going Phishing: Older web surfers may not recognize the difference between a legitimate request for updated personal information and one that is stealing their identity and their dollars. 7. Too Good: Yes, if the investment is too good to be true, please appreciate that it is just that. Does the name Bernie Madoff ring a bell? And he built his pyramid scheme with money from friends. 8. Candy Grams: Beware of any callers who request that the money - ostensibly for a family member in trouble or a worthy charitable cause - be sent via Western Union or MoneyGram. These don't require ID at the receiving end. If this does not scare you on behalf of your older loved one, what should scare you is that all these scammers are incredibly creative. Today's scam always has the potential to transform into a new version that will surprise someone tomorrow. Beware of the Nigerian prince who offers to share his inheritance... 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.
We all know of someone who has received that call out of the blue that a mother or father has fallen and fractured a hip or has had some other unexpected medical emergency that demands a caregiver response. We don't always hear about a adult child of an older parent who actually has been really prepared for the emergency. I would like to offer some advice here about how everyone with an older parent - whether there has been a crisis or not - can benefit from having some sort of plan in place to make being a caregiver a less frantic and more thoughtful transition.

1.     Have the Conversation. Think of this the same way you would in a business setting. If you have an older parent, call a meeting of the siblings and your parent(s). This could be when everyone already is going to be together for the holidays, and make it like any other meeting. This meeting may be easier to have without the older parents present as a first step so that all the kids in the family can openly and honestly express their concerns and questions. Have an agenda, and circulate it ahead of time. You should ask if there is a will, are there advance directives, a power of attorney? Find out who is best able to provide what kinds of caregiver support in advance of an emergency.

2.     Know Your Family. You all grew up together, and most or all of you now have families of your own. Yet, you still are brothers and sisters and some of the family dynamics that may have been vexing when you were very young will still be challenging. Having some of this conversation early will give everyone a chance to see who can be counted on and for what. It also will give you all a chance to sort out some of the challenges without the added stress of a medical emergency at some later date.

3.     Interview Your Parent(s). Set a time when you can talk with or without a recorder going about their memories of home and the family as you all were growing up. They may like speaking "for the record" about their memories of their own parents as they grew up and older. You can also use this as an opportunity to talk about how their see their futures. You may have had your own experience like this as your kids have gone off to college and they want to know what you will do when they leave home. And if your parents want to move to a new, more manageable place, this is a chance to explore that as well as the options.

4.     Know Your Resources. Become familiar with the hospital where your parent(s) may be admitted in the event of an emergency. Get to know the social workers at the hospital, because they will know what you also should know about how they manage emergencies and discharges subsequent to hospitalizations. Have your parent(s) sign a disclosure document so that you will be able to speak with a health care provider. Make sure you also have phone numbers and names of neighbors who may be called upon should there be a medical emergency.
          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.
Illinois long term care has been ranked at about number 24 out of the 50 United States on a number of dimensions by AARP, The Commonwealth Fund and The Scan Foundation. So, does that mean that Illinois’ long term care glass is half full or half empty? Let me share my perspective as a geriatric care manager on some of the details of this national study so that you can be the judge not just about the national study, but also about facilities you may be investigating for an elder or other special needs individual in your orbit.

The report is enlightening in how it rates and ranks what it refers to as long-term services and supports (LTSS) on four important dimensions. And this is the first of its kind multi-dimensional scorecard on state-level performance. When I mentioned that Illinois ranks number 24, that is an average across all four dimensions. In reality, the state ranks:
1. Number 12 in affordability and access which they calculate based on a numberof indicators such as the private pay cost of nursing home or home health care, other measures of insurance coverage and just how easy it is for those who need LTSS to receive them ;
2. Number 33 in choice of setting and provider which is based upon the diversity and number of provider options available for both public and private pay individuals with needs;
3. Number 24 in quality of life and quality of care which recognizes that it is not just the quality of care, but also how individuals who need LTSS can still preserve their safety, freedom from abuse and human dignity; and
4. Number 27 in support for family caregivers which recognizes that there has been a decline in recent decades in non-family care and services such as respite care that help preserve quality of life for the caregiver as well as the elder or special needs individual.
With our own state ranking about the middle of the pack, the scorecard tells us that there is tremendous variability in the quality of care available to elders and others with special needs in Illinois. It is also important to appreciate that when the need arises for long term care, it usually is following an accident or sudden event like a stroke, a fall with hip fracture, etc. So, when you are looking for a facility or home service for someone in your orbit, remember the key dimensions in this report as guidelines. Check out the full report to get a better sense of the details of how they measure these attributes at Raising Expectations. If you are looking to evaluate nursing homes in Illinois, you also will find a great web resource that will help you facility by facility in Illinois.

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.
There will come a time for everyone with an aging parent that the question will arise, “Is it still safe for mom (or dad) to live alone?” And then there will be the checklist to be certain the solution to your older parent’s solitary risk is feasible:
- Is the caregiver I hire trustworthy?
- Is the caregiver I hire affordable?
- Is the caregiver I hire someone whom mom or dad will like?
- Is the caregiver I hire vaxed and healthy?
- Is the caregiver I hire willing to work overnight or weekend shifts?
Your own list may grow even longer as you sort through your prospects owing to your parent’s medical status, challenging personality or isolated geography. But technology may be central to your solution on virtually all counts. We’ve all seen the ads for the portable device that accepts that call of “Help, I’ve fallen and I can’t get up.” But for the majority of incidental needs for the older loved one living alone, being able to summon a first responder may not be the only solution they need. But Alexa may be…or technology with attributes like those ever-present audio monitors a lot of folks use to play their favorite music or to turn down the room temperature or draw the curtains and more. A company called SmartCompanion is taking responsive monitoring to the next level. Set-up in your loved one’s home is actually quite inexpensive - $250 – and includes battery backup and a video screen. Small two-way speakers can be placed strategically throughout the home, and some companies also offer robotic dogs, cats and even birds to stand in for just a piece of tech. The devices can be programmed to offer a veritable menu of outbound calls including which family members as well as first responders. The tech companies that provide these techno-companions are riveted on making them more responsive to a host of unique needs for the hearing-impaired, those with poor eyesight and more. Besides their affordable responsiveness, these technologies are also addressing the larger demographic shift which forecasts a substantial labor shortage of caregivers as the percentage of 65+ year-olds begins to dwarf the available labor force. And your mom or dad’s “Tech Friday” can be programmed to not just respond to urgent or mundane requests, they can be programmed with daily or weekly or longer calendar reminders for pill regimens, medical appointments or family events. From what I’ve seen, these new technological companions may outgrow their intended target market of older and isolated individuals and eventually insinuate themselves into everyone’s households like the George Jetson’s family tech support. “Jane, stop this crazy thing!” 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.
In my last posting I shared geriatric care management services for caregivers communicating with a loved one who may be suffering from dementia. If you have a loved one who has Alzheimer's or one of the other types of dementia, you know all too well that they are not the same person they once were. But have you actually spent some time trying to understand who they are? Have you tried to understand what it is like inside dementia? Try this hypothetical situation. As you awaken tomorrow morning, you make note of the time, and you know that the dogs need to be walked because they have been in their crates all night. You have just enough time to walk them and then have breakfast and get to work. As you go downstairs to the kitchen, the crates are not there, the dogs are not there. In a minor panic, you turn to your wife who is there and ask where on earth the dogs and their crates are? If your wife of many years tells you the dogs have been dead for six years and that you have dementia which is making you confused, how do you feel? ...probably confused, anxious, frightened, and then sad - very sad. That used to be what professionals recommended to caregivers of individuals with dementia - a bit of reality-grounding, but today, the more accepted approach is one of empathy or what therapists call redirection and validation. So, this kinder approach to the situation might be to apologize for not letting your loved one know that the dogs are being groomed and that if they wish you can prepare a breakfast for them. A patient with dementia may suffer from delusions or hallucinations, and these can be intense and stressful events. So, affirming their feelings and then helping them to shift to something more soothing can be very helpful. This older adult who just happens to suffer from dementia still is the person with feelings who is just behaving in what they perceive to be a rationale manner. By validating their feelings and then redirecting their behavior, you are helping them to cope with the world as they see it. Some therapists even suggest that this helps to restore a sense of self-worth that will be helpful in avoiding some future episodes or anxiety:
1. First, ask questions that will help you understand what has triggered the response. I had a client who saw little people around the perimeter of the room painting the baseboards. Once we understood that these people did not speak or harm him, we could incorporate them into his world while still interacting with him.
2. Don't think that it all has to be logical. It is more about how your loved one feels than it is about if it makes sense. Just go with it.
3. Especially if your loved one is upset, try to gently find out what makes for the upset. Then, validate by agreeing that you would be troubled also if its happened to you. You will find that the anxiety for both of you will subside.
4. The bottom line for all of this is to gently give your loved one an out and a chance to save their self-esteem.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends who provide geriatric care management services to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.

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