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

Three Tips for Relieving Elder Stress
I have really lost track of how many conversations and/or blog postings I have had about Caregiver Stress. As...
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August 1, 2013
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A Good Enough Family Caregiver?
So my professional label is a certified geriatric care manager, but it could as easily be caregiver support team...
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July 17, 2013
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Geriatric Care Advice for Quantifying Caregiver Burden
There is no doubt that being a caregiver to an older loved one can be a positive and rewarding...
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July 3, 2013
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In the Caregiver's Words

Recent Client Praise

The most common question I hear after "What is a geriatric care manager?" is, "When do I know that we need a GCM?" It may actually be more accurate to frame the question as 'When would my family benefit from a care manager working with us?" And that is when I usually respond with a question of my own, "What is it that encouraged you to reach out to me now?" Usually there is an event or a culmination of events which encourage a person to look for a solution to a problem, an answer to a question or just plain help. Here are five of the common circumstances people with whom I speak talk about:
1. There has been a sudden event in your older loved one's health, and you are wrestling with what to do. This can be a stroke, a heart attack, a fall or just the most recent trip to the hospital with a condition that has been worsening. It represents one of those forks in the road where it seems that keeping on with the way things were will not be adequate, and the caregivers need to know their alternatives. GCMs have answers.
2. The caregiver in your family seems to be approaching "burn out." Caregiving usually falls to one of the adult children in a family, typically the daughter or the one who lives closest to mom or dad. This lead caregiver wants to do all they can, but there may not be enough hours in the day, and the guilt about not delivering may keep them from asking for help until you see the signs: fatigue, forgetful ness, irritability, depression or other signs they are overwhelmed. GCMs help the older loved one, to be sure, but they also are there for the caregiver.
3. It may be clear that something needs to be done on behalf of your older loved one, but the family does not know or cannot agree on what to do. A GCM has answers, because this is what they do. Think of a GCM as a "wedding planner" for getting older. A GCM does not bake cakes or cater meals, etc., but they can lead you to the best professionals who do. A GCM also can be a helpful mediator to help get everyone back on the same page for mom or dad.
4. If your older loved one does not seem to be getting the benefit from their care providers or they seem anxious around the care attendants, follow your instincts. A GCM can spot elder abuse and respond with the advocacy necessary to assure your older loved one's safety and well-being.
5. Your older loved one may just be confused, but it may also be signs of a more serious deterioration of their faculties. A GCM will help by finding a diagnostician to assess your older loved one's capabilities. A GCM also will help to assess if your loved one would benefit from social activity, better nutrition, exercise, etc.
These are just a handful of the kinds of first conversations I often have with those who reach out to us. You will find much more on the web site for the national association who accredits us as geriatric care managers. If you are a caregiver to an older loved one and you have questions, visit: CareManager.org 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.
When we speak of dementia, it almost invariably is about Alzheimer’s Disease, but there are multiple types of cognitive decline that fall under the heading of dementia. In fact, the second most common dementia – accounting for 15-20 percent of all dementia cases - behind Alzheimer’s Disease actually has an important attribute that its more common and better known sibling does not have. Vascular dementia actually can be prevented in much the same way that cardiovascular disease can be prevented…through diet. Over the past decades, we have radically improved lifestyle and health style understanding of what causes heart disease. By extension we also have improved our understanding of vascular health which means we are better able to prevent heart attacks/myocardial infarctions as well as strokes. Most people, if asked, can tell you what their good cholesterol (HDL) and bad cholesterol (LDL) numbers are or at least if they are “good” or “bad.” Surgeons have become quite talented at eliminating blockages around the heart and also in addressing some of the potential vascular threats that could become strokes. They have not become quite as good at preventing or removing the threats of mini- or major strokes. But the vascular element that is shared across the types of strokes could be lumped into two categories of diet that we could refer to as “heart healthy” and “head healthy.” But just as there are people who don’t pay much attention to their diet and exercise as ways to live healthier by being thoughtful of their heart health, there may also be a shortage of people who will work to maintain “head health.” Scientists in France examined a large sample of over 1,600 people whose mean age was 72.3 years and 63% of whom were women. They looked for diet differences that could predict “cardiovascular disease burden” (CVD) which, in turn, could predict vascular dementia. People who were under 75 years of age who also consumed two to three portions of fish weekly helped reduce their CVD risk for vascular dementia as much as having hypertension increased the risk of vascular dementia. For people over 75 years of age the effects were not as strong. So, what does this tell us? First, one has to start early in a healthy diet to have a significant effect on brain health. But it likely is never too late to change diet for the better. You just get more return on your dietary investment before age 75. Something for both you and your older loved ones to “chew on.” 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.
Our vice president for geriatric care management services, Steve Steiber, Ph.D., brought some startling information to my attention recently, and it concerns the risk we don't often think of when we hear that an older loved one has been hospitalized. He has nearly two decades experience in pharmaceutical medical device consulting prior to joining CCM.
For older adults, who are admitted to a hospital intensive care unit, it would seem that discharge from the hospital means they are out of the proverbial woods. Not so, according to researchers affiliated with Vanderbilt University Hospital. They studied older adults who were discharged from the hospital after a stay in the ICU. What were they were looking for? Complications from what they termed Potentially Inappropriate Medications (PIMs) and Actually Inappropriate Medications (AIMs). Very simply, AIMS are medications whose side effects or likelihood of adverse events outweighed the potential benefits the medications were supposed to confer. PIMs were seen as medications where the jury might still be out. In short, they were looking to see what negative outcomes were associated with the patients' prescriptions separate from their medical conditions. This is a big deal if you are a caregiver to an older adult, very simply because drug-related admissions for 65 to 84 year olds have increased by 96 percent between 1997 and 2008. And approximately half of all drug-related hospital admissions are among adults 80 years of age and older. As we all know the over 65 age group is growing more rapidly than the population at large, so we can only expect this risk to grow. Getting back to PIMs and AIMs, about half of all older adults are discharged with at least one PIM, and four out of five of these older adults are discharged with an AIM. This is all the more exaggerated among patients who have been in the ICU, since 85% are discharged with at least one PIM and more than half are prescribed at least one AIM. The lessons the researchers learned is that some of the AIMs that patients were discharged with were appropriate and useful in the ICU, but should have been discontinued upon discharge. As a caregiver, be aware of the new medications that your older loved one was started on in the hospital ICU, and ask your attending physician if they should be continued at home. The most common AIMs that patients carried home with them on discharge were:
- anticholinergics (37%) - These drugs are used to treat asthma, COPD, incontinence, stomach cramps, and muscular spasms. They can be used to help patients sleep when they are hospitalized.
- nonbenzodiazapene hypnotics (14%) - These are almost always used as a strong sleep aid, but if a patient takes them home beware of their effect with alcohol.
- opioids (12%) - These are indicated for significant pain, most often associated with trauma or in post-surgical recovery. There is significant addictive potential, and these should not be maintained long term.
So, if your older loved one carries home any of these prescriptions, ask the provider why they are appropriate for use at home. If they are appropriate, also then inquire for how long the patient will be taking them safely or for what kind of side effects you should be looking. Please let Steve know if you have any questions about drugs or their side effects or the unique medical challenges faced by older adults or others with special needs. Please email to: ssteiber@creativecaremanagement.com.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends who deliver geriatric care management services to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.
As geriatric care managers, we provide advice, counsel, advocacy and support for older care receivers or other people with special needs of any age. Care managers, however, also provide support to the front line caregivers to these care receivers by adding our CMs eyes and ears when the caregiver cannot be present, our advice based on the experience we have that first time caregivers just cannot have and support for the caregivers themselves. This last is important, because the person most often neglected by the caregiver is they, themselves. They do not sufficiently care for themselves while they are involved in caregiving. That said, there are different kinds of caregivers, and the care they need will be different. We can make a lot of distinctions about kinds of caregivers, but one important dimension that I see a lot very simply is defined by the relationship to the care receiver. By that I mean, the difference between intra-generational caregiving and intergenerational caregiving. Let me explain. Intra-generational Caregiving. According to all the surveys I have seen, one of the most common caregiver relationships is that of one spouse caring for the other. But it also can be siblings who care for one another as one falls ill, or it can be friends, cousins, neighbors and more. These intra-generational caregivers could benefit from the greater knowledge of community resources that GCMs have, the correct questions GCMs can ask at a medical appointment, the help GCMs can bring to the caregiving to avoid harm to the caregivers. This last is especially true when both the caregiver and the care receiver are older and frail. I have seen cases in which the caregiver is injured in a fall while trying to attend to their fallen care receiver. Yet, such accidents can be avoided if a care manager is brought in to "leverage" the good intentions of a caregiver. But a caregiver may feel guilty about asking for help when they perceive they should be taking care of everything. The family needs to talk about helping the caregiver. Intergenerational Caregiving. The other common caregiving relationship is the son or daughter (most often the daughter) who is trying to be the caregiver for mom or dad. This same daughter or son, however, are also responsible for a spouse, or their own children or a job. These are the truly stressed caregivers who would benefit from a trained care manager to attend the medical appointments and to ask the right questions that will get the best care for mom or dad. They also would benefit from a very subtle form of counsel on just how to establish the new ground rules for caregiving. I hear some caregivers say something to the effect that the roles have been reversed, and now mom (or dad) is the child and they are the parent. Wrong! The roles have changed, but they have not reversed. When a child to an older parent steps up to the caregiving role, there need to be some difficult conversations about everyone's expectations and about the older loved one's dignity. A third party like a GCM can be an invaluable arbitrator, not to mention a great resource about all the options in the community that can make caregiving much less stressful and much more rewarding. As I have said in other postings, just as it may take a village to raise a child, it also takes that same village to care for all our older loved ones! 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.
I would like to share a bit of insight into what our more mature male friends should be aware of regarding prostate cancer, and it is not about the cancer itself. If you ask most men of an age what health issues they fear, chances are that prostate cancer will be high on the list. One in seven men will be diagnosed with prostate cancer in their lifetimes, but only one in 39 actually will die of this disease. Even so about 80% of men who reach age 80 will have cancer cells within their prostate. For men who may have a family history of prostate cancer or who are getting on in years, it is important to be vigilant. A patient may have signs of possible prostate cancer from other screenings such as MRIs, and this usually results in a referral to a urologist. If you or an older loved one comes to this fork in the road, listen carefully to what test is proposed to see if there is cause to truly be addressing the potential for cancer…or is it just a suspicion or a possibility. If the urologist talks of a random transrectal biopsy, that means they are planning to take a number of samples from the prostate. The random means that they don’t have a specific locale to investigate, so they will check around to see if there is anything to cause concern. They may take a dozen or so samples and test for cancerous cells. The tansrectal part is pretty clear as their point of access to the prostate, but this also is where other more immediate problems can arise. In about one in twenty of these procedures, an infection results. Since this infection will now be inside the patient, there are no signs before the fever spikes, and since it is inside, it can quickly turn into a full-blown sepsis. As many as one in three patients will die from a “severe sepsis,” so this is not a sequence of steps to be taken lightly. And there are alternatives. Ask your physician about the utility of a color Dopplar ultrasound or an MRI to check for signs of prostate cancer. These procedures can be repeated over time to be on top of things. There also are alternative biopsy procedures such as a transperineal approach which has an infection rate of only 0.5 percent. There are also MRI-guided biopsy systems which can be directed specifically at any suspicious tissue first identified by non-invasive imaging. And by the way, random biopsies do not have a stellar diagnostic track record either; they miss up to 30% of actual tumors. So, it is important to be watchful in all cases, but it also is important to listen carefully to what is recommended by your physician or the specialist to whom you have been referred. And never hesitate to ask for a second opinion. 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.
Today’s posting is from one of our long-time business associates and health care industry expert. Mr. John Marchica is founder and president of Darwin Health, a research resource and think tank in the industry. He is a published author and national speaker on the U.S. health care system. The Centers for Medicare and Medicaid services announced results from the second performance year of its Independence At Home demonstration. Evaluators found that participants saved over $10 million—on average, about $1,010 per beneficiary. CMS said all 17 participating practices improved quality in at least two of six quality measures and four practices improved quality on all six. Seven providers received a total of $5.7 million in performance incentives. “The Independence at Home Demonstration is a patient-centered model that supports providers in caring for chronically ill patients in their own homes,” said Dr. Patrick Conway, CMS acting deputy administrator and chief medical officer. “These results continue to support what most patients already want–the ability to have high quality care in the home setting.” In this demonstration, providers must meet the performance measures for at least three of the six following areas:
- Follow up contact within 48 hours of a hospital admissions, hospital discharge, and emergency department visit
- Medication Reconciliation in the home within 48 hours of a hospital discharge and emergency department visit
- Annual documentation of patient preferences
- All-cause hospital readmissions within 30 days
- Hospital admissions for Ambulatory Care Sensitive Conditions
- Emergency department visits for Ambulatory Care Sensitive Conditions The Independence At Home initiative serves about 10,000 Medicare beneficiaries. In order to be accepted into the program, participating practices are required to demonstrate experience in providing care in the home to high- cost, chronically ill beneficiaries. Selected providers include primary care and other multidisciplinary teams led by physicians or nurse practitioners, are organized for the purpose of providing physicians services, and serve at least 200
Last year, when Dr. Conway announced first-year results from the demonstration at an ACO conference we attended, the crowd roared. The comparatively modest program saved $25 million, or about $3,000 per beneficiary per year. Everyone was impressed. This year’s results appear to be more modest until you look deeper into the numbers. In 2014, the average target expenditure per beneficiary per year (PBPY) was $4,646. In 2015, the average PBPY target expenditure was $3,873—a 20 percent decline. Actual PBPY expenditures dropped 17 percent, from $4,290 in 2014 to $3,672 in 2015. Looked at another way, CMS’ target was more than $400 less in 2015 than providers actually received in the first performance year. They set the bar higher and providers still managed to save money. Unfortunately, isn’t possible to compare savings from both performance years because CMS changed the regression methodology used to calculate the control groups that allow it to determine savings. But the takeaway is clear: this program has been wildly successful at controlling costs for the most expensive, chronically ill patients in the Medicare program. We wouldn’t be surprised if CMS pulls the plug on the demonstration and rolls out the program nationwide. We are happy to share this guest posting on Charlotte’s Blog. For subscriptions to Darwin’s regular weekly information, just click here. 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.

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Posts tagged with ‘stress’

Three Tips for Relieving Elder Stress

A Good Enough Family Caregiver?

Geriatric Care Advice for Quantifying Caregiver Burden

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