I was recently reading an article in the Journal of Financial Planning where Pamela Yip financial columnist from the Dallas Morning News described the issues that most concern her readers. She described that her constituency wants to talk about life planning issues, beyond just the numbers. The top 2 concerns of her readers were: 1. retirement issues (will I be able to retire?) including the fear of outliving resources and 2. taking care of aging parents. This struck a cord with me, because these are the two core issues of my business.

As good professional advisors, having resources to help clients deal with these critical life planning issues is the key to being successful, in my humble opinion. We are fortunate to work with advisors who do just that…and I believe that is why they continue to thrive. Personally, having my financial advisor ask about our life plans, family, goals, worries…and then being able to connect us to good resources for estate planning, long term care, and caregiving for aging parents…is what makes me feel my advisor is worth it–and makes me loyal (as well as confident in referring others). Don’t you want to be the “go to” resource for your clients–even if it is outside your purview? Those clients are sure to stick by you, when they know they can pick up the phone and you can help. There’s an inherent trust there that goes “beyond the numbers”.

Every day my phone rings and it is one of those clients (or even the professional advisor themselves) calling about their concerns (typically caring for an aging parent or aging and trying to coordinate a plan that works with the resources they have). Often, after we help, we get letters of thanks from the families and very often, they give great thanks and praise to that professional advisor who had the solution for them when they most needed it.

Any of us in an advisory role to clients need to equip oursleves with an understanding of their concerns, motivations and goals. Then, we need to make sure we have the tools and partners to address them. As humans, our financial, legal, medical, social, spiritual (etc.) lives are intricately connected and each can have a huge impact on the other.

One parting thought, from the same publication, this stat: 55% of Americans say being a burden on their family is their #1 concern when it comes to long term care needs. The best advisors will help clients address their top concerns, such as this, and will “do well by doing good”.

We were inspired to write this after reading an article by Angil Tarach-Ritchey on the Alzheimer’s Reading Room. It was a very helpful list for families trying to care for loved ones from a distance. The author works in home health care and serves as a long distance caregiver, and a trip home to help her Mom through surgery sparked this article.

As with Angil’s article, we come at this out of professional and personal experience. Many of our team members have aging parents living out of state and know the associated worries and helpless feelings of not being there to help. We have met hundreds of families over the years who come to visit their parent(s) in Florida and are shocked by what they find. Many times parents are able to conceal what is going on over the phone and sometimes they “rally” during your visit as well, leaving you without an accurate picture of their needs. It is unfortunate because there are great resources that could enhance safety and independence, but often fear and other emotions get in the way.

What can you do when you’re a long-distance adult child trying to make sure your parents get what they need?

Fortunately, today you have the option of bringing in a geriatric care manager to be your local eyes and ears. Consider talking to a care manager in their area prior to visiting, to discuss how they might help or set up an appointment for when you are in town. Bringing a professional partner on board can save you a tremendous amount of time and energy and help you avoid future crises.

When planning a visit, consider setting up a decent amount of time so you can personally assess what is going on and have time for necessary tasks and appointments (and some family time besides!). Below we expand upon Angil’s 11 tips for getting the most out of a week visit.

The Long-Distance Caregiver Visit Checklist

1. Attend a doctor’s appointmentwith your parent. Have him or her sign a release of information so the doctor is able to share medical information with you when you return home. Get a current list of their diagnoses, medications, allergies and health history (we can share some great tips for storing the information so you have easy access and can keep it updated, and our geriatric care managers can serve as your liaison at appointments to assist your parent). Give the doctor’s office your emergency contact information, and ask them to contact you with any significant changes. If your parent doesn’t have advance directives in place, including a durable power of attorney and healthcare proxy, make that a priority.
2. Check with the pharmacyto make sure your parent is getting all his or her prescriptions filled and on a timely basis. If your parent is seeing more than one doctor, check to make sure these doctors are communicating. Multiple pharmacies and physicians are a recipe for disaster without careful organization. Check your parents’ medications for expired or discontinued medications, and discard any non current meds. Check out our patient advocacy services to learn more about help in this area.
3. Assess your parents’ ability to purchase groceries, and prepare meals. Weight loss is a great indication of poor diet, though not the only one. Make sure to report weight loss to the doctor as it can also be a sign of something more serious. Check the refrigerator for outdated food and leftovers. If your parent has outdated food or appears to be only eating convenience foods, he/she may be unable to manage shopping and preparing meals anymore.
4. Assess driving ability, if your parent’s still driving. Make sure to let your parent drive while visiting so you can get a preview of how he/she is doing. If your parent refuses or makes excuses, this might also be an indication of a problem. If you spot concerns, the next step will be how to address it and setting up alternatives (you don’t want your parent to become isolated post-driving). Understand that giving up this part of independence is extremely difficult for many seniors, but safety needs to come first. You can get a copy of our “Taking Away the Car Keys: Tips on Senior Driving Safety” for more specifics on how to handle this concern. We can set up a professional assessment, as well as help in the conversation and options.
5. Meet your parents’ neighborsand close friends. Get their phone numbers, and provide your emergency contact information and ask them to check on your parent if appropriate. Developing rapport can be helpful to encourage them to contact you if they notice something wrong and neighbors can be a great support system for elders. We warn against overreliance on neighbors, though. Look at the larger support network and how they can help, such as your parent’s church community (do they have a parish nurse?) and professional advisors. Isolation is a problem for many seniors, so their support system is vital not only to their safety but their mental well-being. However, it may be helpful to engage a caregiver to help with tasks like household needs and transportation so as not to overburden neighbors (your loved one may feel they are doing so even if the neighbors are happy to help) and to allow social relationships to continue in a more natural way.
6. Discuss your parents’ wishes for health care and finances if they are unable to make those decisions in the future. Make sure your parents’ have chosen a power of attorney for health care and finances, and the documentation is complete and available. Aging Wisely’s “Essential Eldercare Checklist” offers more tips on the documents you need and steps to take at various stages of your aging parents’ care.
7. Gather a list of trustworthy, reputable eldercare and related resources in the community, should you need help in the future. This could include skilled home health agencies, private home care agencies, rehabilitation facilities, nursing homes, care managers and government agencies. You might wish to start getting information on assisted living facilities as well. Many times families contact us in shock about what they have found when in a crisis. They didn’t know what Medicare covered (and didn’t) or how much certain options cost, so they’re caught unaware and unprepared. If your parent has an unexpected illness or injury, the last thing you will want to do is have to gather all that information at the last minute, while you are trying to plan the trip to be with your parent. Pre-planning will significantly reduce the stress in an unexpected crisis. If you hire a care manager initially, they will significantly help the process of any care needs in the future. Care managers also help when family members disagree about choices and decisions, as well.
8. Get copies of your parent’s insurance card(s), physicians’ names and phone numbers, key contacts and past medical history. The easiest thing is to store this electronically…save a picture on your phone or keep it “in the cloud” so you can access it from anywhere. You can use general storage, like Googe Drive or your mail program, to do this (be careful about security) or a specific healthcare or caregiver management program.
9. Do a safety evaluation of the home. Check out general home safety: Is all plumbing and electrical in good working order? Are smoke detectors installed with new batteries? Are any areas of the home in disrepair? Do an “aging in place” review too: Are there precautions in place such as grab bars in the bathroom? Is the home free of clutter, throw rugs and other fall hazards? Is your parent using steps that are difficult to maneuver or have poor lighting? Consider aging-in-place resources: Is there medical equipment your parent may need to stay safe, such as a cane or walker? Would a raised toilet seat or a lift chair help them transfer more safely? Does your parent have vision deficits, and are those being addressed (glasses updated, appropriate assistive devices)? Might your parent benefit from home health therapy to increase strength? Could an in-home exercise program help? Further decline will mean increased need for care. It can help to approach it this way with your parent, so they understand you do not wish to take away their independence but actually support it.Consider a professional safety and falls prevention evaluation of the home.
10. Consider a personal emergency response system(PERS). These types of systems are useful for virtually any situation with elders (or persons with disability or major illness) living at home. There are many different systems and the latest technology offers special features like monitoring, fall detection and medication reminders. For a small cost, a PERS provides great peace of mind.
11. How is your parent’s personal care? Do a comparative grooming check (i.e. compared to what is usual for that person): Is Mom clean and well groomed? Is there an odor in the home? Are there signs Dad isn’t caring for his feet and nails? Are there problems with incontinence (and can he/she handle them)? Poor hygiene can be a sign of physical difficulties or depression or dementia.

Long Distance Caregiving: Planning For the Future

It would be great if our parents all stayed healthy and well. Even if the signs you see right now reveal that your parents are doing okay, the likelihood is that they will need more help over time. If they have health problems or minor difficulties today, now is the ideal time to be proactive to avoid future crises. This is especially important as a long-distance caregiver.

Now is the time to do some research, get a geriatric care management consultation and better understand the resources available to help. Here are some primary areas where aging parents often need help and some of the solutions available.

1. Medication Management– Medication errors are a common problem for seniors who take multiple medications and can cause an array of problems.  Some possible solutions are special packaging by dose (offered by some local pharmacies or mail order companies), someone setting up a pill box weekly or monthly, electronic medication reminder systems, and medication management by a home care company (here is a link for EasyLiving, Clearwater home health agency for medication management in Pinellas County). The option(s) that will work best for your loved one depends on a number of factors, from the state of his/her memory to the complexity of the medication regime. There may also be ways to simplify the regime or eliminate/reduce medications.
2. Meal Preparation– Meals on Wheels or another meal delivery service can deliver nutritious meals. Though Meals on Wheels may have a waiting list, there may be other fee-for-service options in your community or you can hire a home caregiver to assist. Private duty home caregivers can grocery shop, prepare meals (even according to special diets and personal preferences), provide companionship during meals and monitor nutrition.
3. Transportation– If your parent doesn’t drive and has difficulty getting to appointments, or running errands, there are a few options and the best choice may be a combination. Friends and loved ones can help, but your parent may hold back from asking. Most communities have senior transportation available for a small fee. The public transportation system in your city often has some type of senior transportation or senior discounts, so check that as well. Many private duty home care agencies will provide transportation. They also can assist with shopping, putting away groceries, preparing meals, hygiene assistance, light housekeeping and more. Many services can also come out to the home and you might be able to find a visiting physician.  Many seniors find some combination of these options works best to maximize flexibility and can be done for a reasonable cost (especially when compared to maintaining/operating a car).
4. Declining mobility or health– If you have seen a major change, contact your loved one’s doctor about ordering home health care.  Medicare will pay for a nurse, and/or therapist to visit the home temporarily if there has been a significant change in health status. At the same time, a general assessment can help identify what is going on and any possible solutions to offset changes or support your parent safely.
5. Memory problems– If you notice a marked deficiency in your parents’ memory, it’s imperative to get a thorough evaluation, preferably from a memory clinic or specialist. With a good diagnosis, you can make better decisions as a family. Unless memory issues are being caused by a reversible issue, dementias like Alzheimer’s disease are progressive so future planning is essential.
6. Multiple problems– If you find problems are increasing or activities of daily living are proving difficult, your parent will need some type of care. Involve your parent and other family members in the decision-making process. Don’t wait until the situation gets worse. Get things in place that will help your parent have the best quality of life possible, and help prevent further complications. If you are noticing multiple problems, schedule a geriatric care management assessment today.
7. Household Deficiencies– If your parent is unable to keep up the home or it is in need of repairs, you can hire those services, either to a company that specializes in those tasks, or a company that can do it all. A care manager can also arrange and oversee various services on your behalf and help protect your loved one from scams. Some communities have resources available to assist in home repairs to those with low income.

When you are caring for elderly parents long distance, you want to know that everything is okay. We can help! From assessments to consulting on specific concerns to being your “eyes and ears” and serving as a local advocate for your aging parents, Aging Wisely can provide peace of mind! Give us a call at 727-447-5845 or contact us online for a free eldercare consultation and needs analysis.

This excerpted article, by Angil Tarach-Ritchey on the Alzheimer’s Reading Room, is very helpful for all those families trying to care for loved ones from a distance. She both works in home health care and serves as a long distance caregiver—and a recent trip home to help her Mom through surgery sparked this article. See for full article. I have also added some additional comments (in bold) I think might be helpful from my experience working with a lot of long-distance families.

I am writing this article out of professional and personal experience. My mother lives out of state, so I know the worries associated with the helpless feeling you can get when you can’t be there to help. I have met dozens of families that have come home to visit their parent(s), only to be shocked by the condition they find them in. Many times parents are able to conceal their real needs in a phone call, that leaves you feeling like everything is going well, only to find out that all is not well. So what do you do when you are unable to be near your parents, and a move isn’t in the near future?

Consider visiting them for at least a week, so you are able to assess the entire situation. Or, use a geriatric care manager to provide an assessment (or meet with one while in town to use them as an extension of yourself and share these duties so you can have some visiting time and benefit from their expertise). Below are 11 tips for getting the most out of a week visit. It may be an exhaustive week, but could save you from endless phone calls and trips to attend to your aging parents’ needs.

1. Attend a doctor’s appointment with your parent. Have him or her sign a release of information so the doctor is able to share medical information with you when you return home. Get a current list of their diagnosis, medications, allergies and health history. Give the doctor’s office your emergency contact information, and ask them to contact you with any significant changes. If your parent doesn’t have advance directives in place, or a medical power of attorney, this is a great time to get those very important documents taken care of.

2. Check with the pharmacy to make sure your parent is getting all his or her prescriptions filled and on a timely basis. If your parent is seeing more than one doctor, check to make sure these doctors are communicating. If your parent is using more than one pharmacy, this is a problem. Multiple pharmacies and physicians are a recipe for disaster. One pharmacy can quickly identify drug interactions, or over-medicating. Check your parents’ medications for expired or discontinued medications, and discard any non current meds.

3. Assess your parents’ ability to purchase groceries, and prepare meals. Weight loss is a great indication of poorly managed meals. It can also be an indication of something more serious, so report weight loss to the physician. Check the refrigerator for outdated food and leftovers. Make sure your parent(s) is able to obtain groceries and prepare healthy meals.

4. Assess their driving ability, if they are still driving. Many adult children will drive their parents while they’re visiting, never checking if their parent is able to safely continue to drive. You may want to do this prior to the doctor appointment. If you find your parent is not driving safely, but you know it will be a battle to get him or her to stop, you can call the doctor in advance of the appointment and have the doctor assess, and discuss this very delicate issue. Understand, giving up this part of independence is extremely difficult for a senior, but safety needs to be first and foremost. If your parent will continue to drive, check for current auto insurance. Get our paper “Taking Away the Care Keys: Senior Driving Safety” for more specifics on how to handle this concern.

5. Meet your parents’ neighbors and close friends. Get their phone numbers, and provide your emergency contact information. Ask them to check on your parent, particularly if you have one parent living alone, and contact you if there are any needs or problems. If your parent does not know his or her neighbors, or has no friends, this is a cause for concern. When our elderly lack socialization, it contributes to declining health, and depression. Lack of socialization may be caused by depression, which is often undiagnosed in the elderly. If there is someone that can regularly visit, get them involved. Take a proactive approach with this, understanding neighbors may hesitate to reach out to you or may be limited in what they can assess/see. Make similar contacts with various people involved in your parent’s life: church community (is there a parish nurse?), professionals (doctor was mentioned, but also their attorney, financial advisor, etc. as your parent will allow), caregivers, etc.

6. Discuss your parents’ wishes for health care and finances if they are unable to make those decisions in the future. Make sure your parents’ have chosen a power of attorney for health care and finances, and the documentation is complete and available.

7. Check with your parents’ preferred hospital social work department (or local Area Agency on Aging – www.eldercare.gov) for a list of trustworthy, reputable agencies and facilities, should you need help in the future. This would include home health agencies, private duty agencies, rehabilitation facilities, nursing homes, and care managers. Depending on your parents’ situation, you may want to also have a list of assisted living facilities. If your parent has an unexpected illness or injury, the last thing you will want to do is have to gather all that information at the last minute, while you are trying to plan the trip to be with your parent. Preplanning will significantly reduce the stress in an unexpected crisis. If you hire a care manager initially, they will significantly help the process of any care needs in the future. Care managers also help when family members disagree about choices and decisions, as well.

8. Get copies of your parent’s insurance card(s). Physicians names and phone numbers, and past medical history. Be sure to take a copy with you when you leave. Consider organizing electronically—from simply scanning to a flash drive to using some of the online and mobile programs out there, so you have quick and easy access to this information.

9. Do a safety evaluation of the home. Is all plumbing and electrical in good working order? Are smoke detectors installed with new batteries? Are there precautions in place such as grab bars in the bathroom, and a home free of clutter and throw rugs? Is your parent using steps that are difficult to maneuver? Is there medical equipment your parent may need to stay safe, such as a cane or walker? Would a riser on the toilet or a lift chair help them transfer easier? Does your parent have vision deficits, and are those being addressed, and glasses or assistive devices available and appropriate? If you have found your parent to be weaker, or less steady, speak with the physician about ordering in home therapy, to increase strength, and improve balance and gait. Further decline will mean increased need of care. Also, consider a professional safety and falls prevention evaluation of the home.

10. Does your parent have a personal emergency response system (PERS)? If you have two parents living together, you may think a PERS isn’t necessary, but if one parent is caring for the other or one frequently leaves to run errands, etc, the primary care-giving spouse, or the parent left alone needs the ability to access emergency services. I frequently meet with one spouse caring for another with dementia. If the person who is well has a fall or needs emergency services, the spouse with dementia will not be able to call for help. This is why a PERS can be life saving, even in a two-parent home. There are advancing technologies coming out regularly, including buttons that can sense a fall if someone cannot push it, GPS systems, monitoring systems, medication reminders and more.

11. How is your parents’ personal care? Are they clean and well groomed? Is there an odor in the home? Are they able to care for their feet and nails? Are there incontinent episodes, and are they able to care for that? Is their skin in good condition, particularly their feet and buttocks? How is the oral care? If they have dentures, are they in good repair and fit appropriately? Poor hygiene can be a sign of depression or early dementia.

12. Plan for your parents’ future needs and care. It would be great if our parents all stayed healthy and well. The fact is, too may won’t, and if you are among the millions of families that face a crisis with an aging parent this investment in time and planning will save you from the tremendous stress that families have when they don’t plan.

Depending on what you find on your visit, there are several actions you can take. I’ve listed seven typical areas an aging parent may need assistance with and helpful strategies to those needs.

1. Medication management – There are simple solutions to assist your parents in filling their medications, taking the correct dosage at the correct time, and coordinating the orders of more than one physician. Some possible solutions are Accupax (pre-packaged, dosed meds), and similar services offered by local pharmacies; someone setting up a pill box weekly or monthly, electronic medication reminder systems, and medication management by a home care company (this may especially be needed if your loved one cannot carry out administration of medication using any of the other solutions).

2. Meal Preparation – Meals on Wheels or another meal delivery service can deliver nutritious meals. Contact the local Department of Aging for specific information. Private duty homecare agencies can grocery shop, prepare meals, and monitor intake.

3. Transportation – If your parent doesn’t drive and have difficulty getting to appointments, or running errands, there are a few options. Finding a friend who lives close to assist would be best, but that isn’t always an answer. Most communities have senior transportation available for a small fee. Private duty home care agencies in many communities provide transportation. They also can assist with shopping, putting away groceries, preparing meals, hygiene assistance, and light housekeeping. Changing to a visiting physician is also a great choice for senior unable to get to doctor appointments.

4. Declining mobility or health – Call the primary physician and ask him/her to order home health care, if the physician is aware of the decline. Medicare will pay for a nurse, and/or therapist to visit the home temporarily if there has been a significant change in health status.

5. Memory problems – If you notice a marked deficiency in your parents’ memory, it’s imperative to get a thorough evaluation, preferably from a geriatric specialist or memory clinic, so a diagnosis can be made. It is also imperative to make sure your parent is still able to make appropriate decisions to remain safe or there needs to be immediate supervision.

6. Multiple problems – If you find problems are increasing or all activities of daily living are more difficult, your parent will need some type of care. Whether the family chooses private duty homecare or an appropriate facility is typically based on preferences and finances. Don’t wait until the situation worsens. Get things in place that will help your parent have the best quality of life possible, and help prevent further complications. This is one area you’d probably find high value in hiring a care manager: they can evaluate and lay out the choices and related costs/pros and cons. This typically saves you tremendous time, and gives you confidence in your choices.

7. Household Deficiencies – If your parent is unable to keep up the home; if it is unsafe from clutter; or is in need of repairs, you can hire those services, either to a company that specializes in those tasks, or a company that can do it all. A care manager can also arrange for getting housekeeping, and repair services. Some communities have resources available to assist in home repairs to those with low income. Care managers will usually know of a trustworthy and reputable company that works with seniors.

You may also want to grab a copy of EasyLiving Home Healthcare’s Checklist for Long-Distance Caregivers When Visiting an Elder.

Contact us at 727-447-5845 for help today with any of your elder care management concerns!

Does your loved one live in Florida and get a lot of support from neighbors and friends? Do the neighbors check in and provide a sense of safety and security? What happens when the snowbirds leave to head north for the summer? Or, when a very involved friend or neighbor takes an extended vacation or suffers from his/her own health issues?

While I am continually impressed by the community spirit that exists and the way neighbors, church communities, friends and volunteers reach out to support elders in the community, families need to think about the “what ifs”. Each year, the Dept. of Children and Families receives increased calls in late spring/early summer which can be partly attributed to the phenomena of snowbird support systems heading north. Perhaps we all need to think more comprehensively about what a person might need and how we can accomplish that together. A neighbor can offer support and for example, help pick up some groceries or check in, bring someone their mail, cook meals when ill, etc. But when providing more support, it might be time for a conversation about what other options and services are available.

Some ideas to consider:

1. If you are a neighbor or friend helping an elderly person, help them make some calls for information. Contact your local Area Agency on Aging and related elder services, or a geriatric care manager. Find out what might be available for this person, now and in the future. There may be services and programs that can help where you cannot, or this can free you up to help in other ways. (You may have to think of different ways to approach this as the person may not want to reach out for help. You may need to be firm, elicit help from others the person trusts, and explain that this is important as a way to help make sure the person can stay safe and independent.)

2. As a family member, realize realistic limitations of neighbors. Many families at a distance expect neighbors to be their eyes and ears, and I’ve heard a # of stories where things fell through the cracks this way (why? perhaps the neighbor didn’t know what to look for, the neighbors had their own health issues, or felt strange “tattling” on their friend).

3. Consider introducing some services, even if friends and family can handle everything currently. This gives everyone a comfort level if something changes or an emergency occurs. One way to do this may be for “respite” when for example, you are going on vacation or having surgery. Try using a home health agency or transportation service for specific needs or a limited time, for example (when everyone is pleasantly surprised how well this works out, it can always be extended).

4. Don’t forget about the big emergencies. What would happen if your elderly grandmother fell at home (the neighbors come by daily, but how long would she lie there without help and who would pick her up)? What happens in the event of a visit to the ER (who will be there with her, what if it is the middle of the night, who will keep you informed, who knows her history)? What’s the plan when hurricane season hits (the plan from 5 years ago may not be relevant)? Do not await that dreaded phone call to realize you should have contingency plans in place.

5. If you are that helpful neighbor, give yourself a pat on the back for all you do. Informal caregivers (non-paid–i.e. family, friends, neighbors) provide the bulk of care to the elderly in the U.S. and the value is billions of dollars, plus a huge difference to the person/persons you help. If neighbors and friends help your loved one, say thanks and check in with them on ways you can support them.

As summer approaches, don’t put on your blinders on these issues. Seek out information and help. Get an evaluation or seek a consultation with a professional care manager. Do your loved one, neighbor or friend the biggest favor you can–be prepared and plan ahead.