long-distance caregiving

7/27/2019 Long-Distance Caregiving

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By Jim Distasio

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Try these worry-free caregiving strategies if your family members live far away.
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On a trip rom suburban Detroitto visit her 90-year-old mother, Ernestine Stew-

art sensed something wasnt right. Her widowed mother, Louise Purham, had always

maintained a strict regimen o mopping and scrubbing to keep her home in the

small town o Covington, enn., spotless. But this time the home was unkempt.

Stewarts concern turned to real worry when a young man came to the door at 3

a.m. that morning asking or money. Stewart spoke with the man and began to

realize he may have been there beore to extort money rom her mother. She grew

concerned that Purham could no longer live on her own, so ar rom amily.

Purham said she would preer to stay in her home i possible. So

Stewart enlisted the help o 10 siblings to draw up a long-term, long-distance caregiving plan that was as complex as it was compassionate.

My mother said, Surely 11 children can gure out what to do with one mother,

Stewart remembers.

Since all o the adult children lived at least 50 miles awayand some much ar-

therthey divided the caregiving tasks based on skill set and when they would be

able to visit. Troughout the ve years prior to their mothers passing, the siblings

booked airplane tickets to visit, made long-distance phone calls to coordinate her

care, cooked her meals and drove her to doctors appointments. Te daughters

took turns living in Purhams home or weeks or months at a time, as their work

situations permitted. Te sons promised to handle their mothers nances and

assisted with home improvements, including making the house more accessible as

Purham became wheelchair-bound.
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StreSS can run

high. Buthelp iS

availaBle. the key iS to

match therightassistance

to your unique

caregiving Situation.

We did it cheerully, Stewart says. My mother used to say, I just want to coop-

erate with whomever comes because I appreciate it so much.

LonG-distanCe CareGivinG in the United statesStewarts situation is not uncommon. Tere may be as many as 7 million adults

taking care o aging parents over long distances in the United States today, accord-

ing to the National Institute on Aging. While the vast majority o amily caregivers

live within 20 minutes o the care recipient (according to a 2009 survey rom the

National Alliance or Caregiving and AARP), increasing numbers o adult children

and amily members care or a senior in a dierent city and state.

Tese are oten uncharted waters or many adult caregivers who juggle their

own amilies, careers and personal obligations. Stress can run highbut help

is available. Te key is to match the right assistance to your unique caregiving

situation. Use the ollowing strategies to create a long-distance caregiving plan

tailored to your amilys needs.

Know when and how to step inTe rst step is always to talk to your parent about her living situation and see how

she is eeling. But when you live ar away, phone calls and emails dont always paint

an accurate picture o an aging parents living situation, says Miriam Scholl, a licensed

master social worker and eldercare manager with Westchester Elder Care Consultants

LLC, in Westchester, N.Y.



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In-person visits tell a truer tale, so plan regular trips and thoroughly assess the situation,

making note o how well your parent handles his daily routine. ime your visit or

when you can accompany your parent to the doctor i he is comortable having you in

the room to listen in. Make sure hes interacting with the physician so that importantinormation is conveyed directly to him.

Understand yoUr UniqUe sitUationYour amily caregiver experience greatly depends on the mental and physical health

o the person who needs care, as well as her personal nances and living situation.

Among the key AreAs to Assess Are:

Finances and how they will be managed, including how much money a parent

has set aside or available through long-term care insurance or Medicare

Health care needs and who will make decisions i the loved one

becomes unable to do so

Housing options, which can range rom occasional assistance to ull-time in-home

care to senior living communities (more on this on page 6)

Tere has to be a leader, Sheik says. I you get too many voices involved, itmakes the process more complicated.

Every situation is dierent, but there are a ew common levels o needed care, says

Sherwin Sheik, ounder and CEO o CareLinx, an online resource that matches am-
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ilies with proessional in-home caregivers. Some loved ones may only need assistance

getting to and rom appointments or the grocery store, while others will need help

with daily tasks such as grooming, meal preparation and remembering to take medi-

cation. Your amily member may only require a caregiver who drops in or an hour or

two every day. Ten there are those who require more intensive care due to chronic

conditions, disabilities or disease, which can necessitate 24-hour, live-in care either in

the home or in an assisted living acility.

Many o the most important decisions a amily makes regarding long-distance carewill be driven by what is economically easible. A 2007 study rom Evercare and the

National Alliance or Caregiving showed long-distance caregivers had the highest over-

all annual expenses, about $8,728, compared to the expenses o those who lived near-

by, approximately $4,570. For amilies that choose in-home care, Sheik estimates at

least $40,000 per year in care expenses through a traditional ull-service agency, with

the costs rising depending on a loved ones mental and physical condition. Families

that choose to hire a caregiver privately can save money, but must educate themselves

on the caregivers background and ability to comply with caregiver laws, Sheik says.

piCK a LeaderFamilies with multiple adult children sometimes nd ways to share tasks so no one

person carries the entire burden. But even among adults, sharing isnt easy.

You may have amily members who dont get along with each other, amily mem-

bers with dierent objectives and motivations, Sheik says.

Either way, its important to pick one person to assume a leadership role andcoordinate care. Tere has to be a leader, Sheik says. I you get too many voices

involved, it makes the process more complicated.

Tat leader may be the oldest sibling, the one who lives closest to the elderly par-

ent, or the one in whom the parent condes the most.

t b l. if u g m c l, mk c m cmlc.

Sherwin Sheik



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Whomever is chosen to take the lead, that person should discuss with amily

members what each person is willing and able to contribute, and how each eels

about the situation.

enList heLpI your parent is looking or other liestyle options or needs more help than you

can oer, consider assistance through:

Continuing CAre retirement Communities: Tese senior living com-

munities oer multiple levels o care all in one place, including independent

living, assisted living, skilled nursing care and memory care. Tis setup is ideal

or seniors who do not want to have to move as their needs change as well as or

situations where one spouse needs more care than the other.

Assisted Living: Assisted living communities are or those who are not able to

saely live alone. I you need help with preparing meals, certain hygiene tasks (such

as bathing or dressing) or taking medication, this may be an ideal choice.

skiLLed nursing FACiLities: Skilled nursing acilities (or nursing homes) oer

a high level o medical and personal care or those with higher-acuity needs.Residents receive constant care and typically have access to a range o medical

proessionals, including physicians, nurses and physical therapists. I a parent has

a chronic illness and/or requires regular attention, this may be the best solution.



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home CAre: Home care is as it soundscare provided by proessionals in

the seniors home. Home care does not involve the services o doctors and

nurses but may incorporate transportation services, meal services, cleaning

services and so on.

home heALth CAre: Home health care is proessional medical care provided to

seniors in their own homes. For seniors with medical conditions, this option can

allow them to nd treatment without relocating.

No matter what type o assistance you settle on, this is likely an emotional time

or your parent, who may eel a loss o independence and control. alk about both

o your concerns in person, and suggest a gradual transition.

So much o this is a process, and there might be some resistance rom your

parent, Scholl says. Your parent possibly isnt going to let you change her liestyle

and move as ast as you want to.

Get Copies oF paperworKI you have been given power o attorney and are tasked with managing the

aairs and care o your aging parent rom a distance, your eorts will be most

eective i you have all o your parents personal inormation at your nger-

tips, Scholl says.

During your visit, ask your loved one to help you collect certain items. Te

ollowing inormation may come in handy when trying to access insurance or
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government benets programs, secure nancial assistance to deray care expenses

or settle an estates obligations:

Birth certicate

Social Security and Medicare account numbers

Will and benefciary inormation including powers o attorney

Income statements

Investment and asset documentation

Bank and credit card account inormation

A listing o creditors and payments due

Designation o a medical power o attorney (also known as a health

care proxy)

Contact inormation or your loved ones riends and neighbors in case you

need to call them in an emergency

Contact inormation or accountants and lawyers

Keep copies o this inormation both with you and with your parent where he can

nd it easily.

echnology can be a huge help or long-distance caregiving. You can help monitor

your parents credit card and bank accounts online and assist with online bill pay.

Scholl also suggests setting up alerts so that i a payment isnt made, you are notied.

Tis is particularly important or insurance payments, including long-term care

insurance, Scholl says. Missing those can be catastrophic, he says, noting it could

give insurance companies reason to reject or delay claims or even drop coverage.

stay in the heaLth Care Loop

Whether your loved one is relatively healthy or experiencing difculties, its

benecial to remain in contact with his health care providers. Many doctors will
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update out-o-town amily members via phone or email i your

parent has given the doctor approval. Staying up to date is

especially important i you have medical power o attorney. Te

medical power o attorney names a health care proxy to make

medical decisions on behal o someone i they are unable todo so on their own. Rules or medical powers o attorney can

vary by state, so its a good idea to rst nd out what your state

requires so that your documents will be considered legitimate

when you need them. As an example, check out Caliornias

requirements online.

I your aging parent makes her own medical decisions, but agrees

to give you some oversight o her health, she simply needs to

complete a release orm that authorizes the doctor to speak toyou about care, prescriptions and treatments, medical bills and

insurance-related issues. Once the document is signed and shared

with the physician, make sure to place the document in your

loved ones medical records and keep a copy or yoursel.

It is also useul to have your parent drat a living will, even i she

is currently healthy. Te living will clearly species what medical

actions should be taken in the event o incapacitation. Tis

can be a difcult subject to bring up with your parent. But it is

important that, in the event o incapacitation or death, her wishes

are clear and understood by all potential decision-makers.

I theyre happy and theyre comortable, [everyone is] going to

have a better experience, Sheik says. n
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