Bob DeMarco Alzheimer's Reading Room

Monday, June 7, 2010

12 Tips for Long Distance Care Giving


I had a long conversation with a family member of a client we are providing homecare to that lives out of state. These recent experiences prompted me to post my tips for long distance caregiving.

By Angil Tarach-Ritchey
+Alzheimer's Reading Room

When I was young families lived nearby, neighbors helped and looked out for each other, and if an elderly person needed something, there were people available to help.

Things are very different today.

Families are spread out all over the nation, and adult children are finding their parents who live in a different state are in need of care.

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. 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 gorceries 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.

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.  If not, private duty homecare can provide companionship and safety checks, giving you regular updates.

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. Power of attorney is only utilized if or when your parent is unable to make his or her own decisions. Advance Directives are a necessary part of your parents wishes.

7. Check with your parents’ preferred hospital social work department 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 significanlty 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.

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.

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. Many companies offer PERS. Most have monthly fees, while some do not. They also differ in their response and range. Most have call centers, very few go directly to 911. Shop around for a system that would best suit your needs, or contact me for more information.

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. I work with and refer to Accupax .  This is not the only medication management company.  Some small independent local pharmacies will assist with medication management.  This is an answer for all the problems of medication management except administering. If your parent doesn’t take their medications, and needs them administered, I suggest hiring a private duty agency to come into the home or moving your parent’ to an environment that administers medications, such as assisted living.

2. Meal Preparation - Meals on Wheels or another meal delivery service can deliver nutritious meals. Contact the local Department of Aging for specific information. There are private companies like  Seattle Suttons that deliver nutritious meals.  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. You could get that information from their local senior resource center or hospital social work department. Private duty 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. This is paid by Medicare, they generally visit once a month, or more frequently if needed. Again you can find homecare physicians through a local senior resource center or social work department.

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 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, 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. A private duty agency can supervise on a temporary or long term basis. If the diagnosis is progressive dementia or Alzheimer’s, it is time to get homecare in place,, move your parent to live with you or another famile member, or plan the move to a memory care facility even if the needs don’t appear that great at the onset.

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.

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. They are also called Case Managers. For more information about their services or to find one in your parents location go to Case Management Society of America.

Even though most of us wish we still lived in simpliar times when families were close and neighbors all knew each other and were social, we are very far from that.  It takes time and effort to provide long distance care, but the more prepared you are before a crisis, the more you will be able to make confident and appropriate decisions.

*Angil Tarach-Ritchey has cared and advocated for seniors since her passion was sparked by a box of love letters she found in the nursing home she worked at as a 17 year old girl in 1977. She is a Registered Nurse, Geriatric Care Manager, National Eldercare Expert, Best-Selling and Award Winning Author of Behind the Old Face: Aging in America and the Coming Elder Boom, Speaker, Consultant, and Educator.

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Original content +Bob DeMarco , the Alzheimer's Reading Room