How to Deal with Long-Distance Issues

You get the call at work from your husband. Your mother-in-law has fallen at home, broken her hip, and is on her way to surgery. You just returned from visiting her last weekendóan eight-hour ride. You weren't planning to go back for a few months. You are trying to figure out what to do about work demands and your children's schedules. Your husband is feeling frustrated and guilty. He tried to convince his mother to move to an assisted living facility a few months ago, but she wouldn't agree. Now he is overwhelmed thinking about how to arrange for help once his mother is out of the hospital.

In today's world it's common for family members to live in different cities and states. Sometimes the parents move away from the place where they raised their family, perhaps to retire to a warmer or more appealing environment. Often it is the children who scatter geographically. So, many adult children must help from a distance when their older parents and other relatives need assistance. The task can be difficult, stressful, and time consuming.

This article is designed to help. It suggests issues for family members to consider when thinking about how to get needed support.

Caring Across the Miles

Families whose members live at a distance from one another face difficult questions and issues. For example, most long-distance caregivers cannot visit frequently and cannot provide care in the home. It can be impossible financially and practically. Other important responsibilities, such as jobs, family, and children, come into play. Yet, despite the best intentions, adult children usually end up feeling guilty that they cannot spend more time with their parents. They also may feel overwhelmed by the challenges of arranging services long distance. This is especially true if they have no experience in dealing with community services.

How to know when you're needed and when you should make the trip to see your parents rank among the most difficult aspects of long-distance care. The phone is often of little help. Your mother may not admit there is a problem. Dad may be very dramatic. In addition, your perceptions and preconceived ideas may cloud the issue. While changes related to aging may worry you, your parent may adjust to them very well. What you see as a major safety concern your parents may consider a minor risk that they are willing to take to remain independent.

Some long-distance caregivers think that the situation will be easier to handle if a parent moves closer, possibly into the adult child's home. Yet many older people don't want to move at all, or they don't want to live with their adult children and their families. Those who do move face losing old friends and trying to make new ones. Problems can also occur when families aren't realistic about their relationships. For example, a parent and child may care about each other but have a history of conflicts that would make living together a special challenge.

Another common dilemma that adult children face is how to interact with their siblings, especially those who live nearer to their parents. Will the closer sibling take the lead in caregiving? How will the adult child who lives further away help out? What family issues will this new situation raise?

Finally, long-distance caregivers express frustration about not being familiar with resources and services in another part of the country. Frustration often follows a sense of helplessness to obtain needed services from afar.

What You Can Do
 

• Determine with your parents, and perhaps other family members, what assistance they need.
  Options to consider: Opportunities to socialize. Help with chores or housekeeping. Personal care, such as help with bathing or dressing. Fixing meals. Legal assistance regarding money or health care matters. Help paying bills. Checkups with the doctor. Help after the death of a spouse or someone close to your parents. Transportation. Changes to the home. Living somewhere else.
• Gather information on community services that can meet your parents' needs. Take notes on the services offered, the application process, waiting lists, and fees. Keep your notes together. You can get a lot of information over the phone and the Internet; even family members who live in the same community as their parents usually start with these tools. If an organization requires an in-person interview with your parent, find out what documents you need to take to the meeting. If you cannot go with your parent consider sending someone in your place and be sure you clarify their responsibility for expressing your goals.

Use the Eldercare Locator (800-677-1116) to determine which local agencies provide service where your parents live. It will refer you to the area agency on aging in your parent's community.

• Identify people your parent can call on. This includes friends, neighbors, clergy, and others in regular contact with your parent. You may want to introduce yourself to close friends or neighbors and keep a list of their phone numbers and addresses. If you can't reach your parent or you have a particular concern, calling these folks can ease your mind. In addition, they may be able to help out with shopping, transportation, or visits.
• Work with parents to collect necessary information before crises occur.
  What to include:
  Medical: Your parents' medical conditions, the medications they take, and names and phone numbers of doctors.

Financial: A list of what your parents own and their debts with dollar values, their yearly or monthly income and expenses, a statement of net worth, and information on their bank accounts, other financial holdings, and credit cards.

Legal: Other relevant legal documents they have or want to create (wills, advance directives, trusts, powers of attorney); where they keep important documents (birth certificates, deed to home, insurance policies); their Social Security numbers; and information on health insurance and driver's licenses.

• Make the most of your visits.
  What to include: Talk to your parent and decide together what you need to do and who can help. While you are visiting, be observant. Do you notice anything unusual? Are your parents eating nutritious meals regularly? Are their finances in good order? Are there any obvious health or safety problems? Allow yourself enough time to visit social service agencies or housing that your parents are considering. Be sure to include time to socialize and enjoy each other's company though. A visit that is all business won't be good for anyone.
• Work with your parents to help them accept help. Be sensitive to their views of the situation. At first they may not want strangers in their home, or they may have trouble facing change. Even though dealing with these issues can cause frustration, it's important to maintain a positive focus.

Tips: Explain that the services are designed to help your parents remain independent. Explain how the services will work. If possible, offer to contribute to the cost of care without appearing to offer charity. You can also have someone your parents respect recommend the service, such as the doctor.

Be careful not to make your parents angry or stir up old family disputes. Use a relaxed approach that doesn't threaten your parents' independence. Don't change how you normally communicate as it may seem insincere. Plan what you want to say and say what you want to plan. Anticipate your parents' possible reactions and how you might respond. Suggest, perhaps, that your parents will be doing you a favor by accepting some help. Asking them to do it for you, not for themselves, might be a way for them to accept assistance.

• Don't forget your needs.
  Tips: Recognize the strain that long-distance caregiving causes, and take steps to reduce it. Learn and use coping skills, get support and/or counseling, and take time for yourself. Accept that it's impossible for you to provide all the help your parent needs. Give yourself credit for your efforts to determine needs, coordinate services, and offer support by phone and occasional visits. Ask for help when you need it. If you don't feel that other family members are doing their share, consider a family meeting to help resolve any issues. Eat right, exercise, and get enough sleep.

 2003, 2004, 2007 AARP. Reprinting by permission only.