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Long Distance Caregiving - Aging Wisely

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.

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