Caring for Mom or Dad from a distance

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Sharon Brothers MSW

Long Distance Caregiving: Advice for the 'Sandwich Generation'

Caregivers of America

Today’s struggling economy and the population’s increasing life expectancy have placed huge demands on caregivers of the elderly. The primary demographic for senior caregiving is the so-called “sandwich generation” – the adult children of seniors who are, in many cases, retirees themselves. The sandwich generation has been tasked not only with caring for their nuclear families but also with taking responsibility for their aging parents. Most feel stretched thin at best and often left wondering how they can alleviate the growing burden of caring for their parents.

Today’s children, too, are often unable to provide the kind of round-the-clock attention they would like to give their aging parents. Families have become increasingly dispersed. Gone are the days when children live in the city or town or even the state which they were born.

Sometimes, children are forced into the heartbreaking position of having to send their parents to a nursing home or a similar community-based health care facility when they require skilled medical care on a daily basis. And some seniors who are still capable of living moderately independent lives are sometimes thrust into uncomfortable and undignified position of having all of their freedoms stripped away simply because no one is available to assist them with simple chores and personal care, or to monitor their daily intake of medications. In these cases, this course of action may be unnecessary by taking some early preventive actions.

So, if you live far away from your loved ones who need some assistance but don’t require skilled medical care, how do you handle caregiving in a long-distance relationship? The following plan will allow you to create a working guide to making assessments, developing care plans and formalizing them into an agreement that will help ease the complication factors of long-distance caregiving.

STEP 1: ASSESSMENT
The first step to conduct is your own assessment in a quiet unobtrusive manner. This can be done via telephone. But it is important to involve those who are physically present with your loved one, such as a friend, church member or someone who regularly sees your loved one and can help you understand his or her needs.
Open the lines of communication.
Ask without being patronizing.
Pay attention and listen.
Poll others.

When you have a concern, it may be tempting to rush to intercede. But it’s better to avoid taking over. Try to come up with a plan together. That way, your loved one will feel as though he or she is making decisions with your help.

STEP 2: DEVELOP A CARE PLAN
The end goal of a care plan is to permit your loved one to age successfully in the home – meaning, there needs to be a plan to address the individual needs of the aging family member. Try to assure that the solutions are really needed, not a struggle for agreement or acquiescence. List the needs for support and additional care that you believe are needed and that others have observed. These will generally fall into the following areas:
Housekeeping – Note what seems to be slipping around the house and move this to the top of the list.
Social and safety needs – transportation, companionship and daily telephone checks. Ask what makes your loved one happy socially.
Nutrition – meal planning, cooking, and meal delivery. Have your loved one make a list of favorite meals. Involvement in the process will go a long way toward making your loved one more receptive.
Health care – nursing, social work, physical and rehabilitative therapy, and medication monitoring. If there are pre-existing conditions, arrange for help to come in or make it as simple as taking a daily stroll.
Personal care – assistance with personal hygiene, medical equipment, dressing, bathing and exercise.

Once you have identified the specific care needs, decide who can devote necessary time and attention to provide support – whether paid help or a family member or members. One of the most important decisions associated with developing a long-distance care plan is considering who will be able to handle the responsibility. Get specific commitments, which need to include, as appropriate, a statement of who, what, when, where, and how.

To relieve some stress, try to spread out the responsibilities. This is especially important when coordinating long-distance caregiving. Then make a list of specific help needed for each task. Try to plan a schedule so tasks are fairly evenly distributed over the week.

In some cases, you may want to consider seeking other forms of support, such as nutrition or preventive health services, and caregiver support services. Keep in mind that many outside services are funded in part through the Older Americans Act and administered by the U.S. Administration on Aging.

STEP 3: CREATE A CAREGIVER AGREEMENT
Setting up a formal caregiver agreement is vital for the protection of all parties involved and is even more important in long-distance caregiving arrangements. Agreements need to be extensively documented and must stand up as arm’s length contracts. Family members involved in the process need to be sensitive to how arrangement might affect relationships among family members. Here are some tips on setting up these necessary agreements:
· Carefully define care needs. At this point in the process, an assessment has already taken place. Take this assessment and clearly outline the specific duties and responsibilities the caregiver will be required to provide. It immediately defines the caregiver role and helps families avoid communication problems later. Keep in mind that agreements need to anticipate future changes, depending on health and environment of your loved one.
· Put the plan in writing. The care plan is the set of instructions for the caregiver to follow when assisting your loved one with the activities of daily living. It includes instructions on personal care, exercise, meal preparation and household activities that you created in Step 2. Putting the instructions in writing should alleviate any questions and help you manage the process from a distance.
· Make a financial plan. Conduct a financial assessment based on current and future resources. Properly developed caregiving agreements enable compensation payments that do not adversely affect Medicaid eligibility. The payments can also reduce the assets subject to estate taxation of the person receiving the care.
· Put the contract in writing. Whether it involves family members, a friend or hired helper, the contract must be in writing. Include a medical report with specific medical services needed from a doctor. To protect everyone involved, the family should use an attorney to help with the agreement.

Remember: The care plan is an ever-changing document. You will need to evaluate and modify the plan, based on feedback from your loved one, your own assessment or a professional caregiver’s observations. It is especially important in a long-distance caregiving situation to check in frequently with all parties involved and adjust the agreement, based on changing needs.

While the aging loved one in your life is likely to prefer the idea of staying in his or her own home, as a long-distance caregiver, there are many considerations and worries that go along with this decision. Use the tips provided to get started and know that long-distance caregiving can be a successful option for many with the right planning, communication and cooperation