The signs are subtle at first. Your mom’s fridge is less stocked than usual. Dust appears on surfaces that once gleamed. You spot a ding on the car. As you’re leaving for the airport after a visit, her next-door neighbor makes a point of asking how she’s doing and urges you to come back soon.
Later, you get a call about a fall, an illness or another minor car accident, and suddenly you’re one of the seven million or so people playing the role of long-distance caregiver, defined as someone who helps a parent or relative living an hour or more away. The job can involve anything from visiting more often to orchestrating services and taking on financial and legal responsibilities on behalf of a parent.
Start the conversation. Persuading your parent that he or she needs help requires tact and patience, says Christina Irving, of the Family Caregiver Alliance. “Bring up what you’re noticing and let them know you’re concerned and would like to help as much as you can.” If the problem involves finances, such as racking up overdraft fees, appeal to your parent’s practical side, says Cal Brown, a financial adviser at Savant Capital Management, in McLean, Va. “Point out the errors and say, ‘Look, you can’t do this anymore. It’s costing you too much money.’ ” Consider including a trusted adviser in the conversation, such as the family doctor or lawyer, for support.
Set up the team. Usually, one family member becomes the point person in long-distance caregiving, says Irving. If that’s you, discuss with your siblings and other interested parties what roles they can play. “Focus on the strengths of different family members. The person who is good with money can manage the finances. The person who lives closest can work on getting in-home help. If one person has a medical background, that person can take on the medical piece.”
Or, if the roles don’t break down neatly, divvy them up according to who has time to make arrangements and who has the money to help pay for services. Also ask family friends, neighbors and perhaps church members to help -- say, by providing an occasional ride. Tools such as CaringBridge can help you organize tasks and keep everyone informed.
Whatever your plan, remember that you don’t have to go it alone, says Jody Gastfriend, vice-president of senior care services for Care.com, which helps families find caregivers. “In most cases, one person, usually the daughter, bears the brunt of work. It’s a mistake for that person to shoulder it all.”
Gather information. Put together a file or notebook that includes the names and contact information of your parent’s doctors, lawyers, financial advisers and other key players, including the friends and neighbors who have agreed to help out. Make a list of all medications, and find out where the prescriptions are filled. (Some pharmacies, including CVS, let patients manage their prescriptions online, making it easier to keep track. And some pharmacies still deliver.) On the financial side, gather information about your parent’s income and assets. Identify bank, investment and credit card accounts and passwords, and know where insurance policies, legal documents and tax returns are kept.
Get authority. One of you will also need your parent’s durable power of attorney, which lets you make legal and financial transactions on your parent’s behalf. With this document, anything the person giving authority can do, the agent should be able to do, “no matter what the situation,” says Howard Krooks, president of the National Academy of Eldercare Attorneys. That agent (presumably, you or a sibling) can set up automatic payments for recurring fixed expenses, such as the mortgage, and pay other bills online.
One of you will also need a durable power of attorney for health care, which allows that person to make health care decisions on your parent’s behalf if your parent cannot. Also have your parent complete a release form that gives doctors permission to share medical information. (For more on elder-care documents, see Get the Documents in Order.)
The family member who is coordinating medical care should be the one to communicate with the doctors, says Gastfriend. “There’s nothing more frustrating for doctors and nurses than to talk to five different siblings who have five different opinions.”
Line up home services. If your parent is recovering from an illness or injury or is having trouble with basic activities such as dressing or bathing, he or she may need home health care. Home health aides, who are often nurses, can supervise medications and provide physical or occupational therapy, as well as skilled nursing. The average cost runs $21 an hour. Medicare covers home health care under specific, limited circumstances; private insurers generally follow the same criteria Medicare does. See more information on the rules and find a Medicare-certified home health agency here.
For nonmedical assistance, look to home-care franchises, such as Home Instead Senior Care and Comfort Keepers Home Care. Aides from agencies such as these will help with meals, light housekeeping, personal care and transportation, typically for about $20 an hour. Keep in mind that you’re introducing a stranger into the household, says Irving. “It can take work to find the right person, with the personality fit and the skills, who you trust and feel comfortable with.”
Enlist volunteers. The National Volunteer Caregiving Network (some chapters continue to use the name Faith in Action) lists about 500 programs in communities across the country whose volunteers provide free services, including transportation, yardwork, light housekeeping, respite care and friendly visits. Not every program provides every service, but most at least offer transportation, says Rhonda Anderson, executive director of the network, “because that’s the biggest need.” Programs usually run a background check and vet the driving records of volunteers, she says. To find services near you, use this interactive map.
Hire a geriatric care manager. If your parent’s medical situation becomes more complicated than you can handle, or you simply need guidance, hire a certified geriatric care manager. Such professionals will assess your parent’s needs, help identify services and, if necessary, provide ongoing care management.
The cost: $100 to $200 an hour, depending on the location, says Jullie Gray, president of the National Association of Professional Geriatric Care Managers. That’s pricey, but it may take only one or two meetings to come up with a plan you can execute yourself, says Gray. “It’s an affordable way to get on track.” Care management can also be cost-effective if you live across the country or abroad and would otherwise face out-of-sight travel expenses. And sometimes, having boots on the ground is worth any price. “If Mom or Dad ends up in the hospital, we talk to doctors, coordinate care and make sure everyone knows what’s happening,” says Gray.
For a one-stop shop to find services in your community, call or visit the Eldercare Locator (800-677-1116). The locator can connect you with local agencies and volunteer programs that belong to the National Aging Network. For help paying the bills, visit www.benefitscheckup.org, which identifies programs that help pay for prescription drugs, health care and other basics. Also see the Consumer Financial Protection Bureau’s Managing Someone Else’s Money.