Caregiving


The Long-Distance Caregiver

EDITOR'S NOTE: This article was originally published in the May 2009 issue of Kiplinger's Retirement Report. To subscribe, click here.

Visiting her mother a little more than a year ago, Ann Hofkin confronted a harsh reality: The 84-year-old was slipping. Checks weren't cashed, the cat's litter box was dirty, and there wasn't much food in the refrigerator. The usually tidy home was in disarray.

Hofkin's mother also seemed depressed. She had little interest in eating. "I was concerned that she was taking very poor care of herself," Hofkin, 65, says.

The situation was complicated by the fact that Hofkin lives in Long Lake, Minn., while her mother resides in a continuing-care retirement community outside Boston. Hofkin is one of seven million long-distance caregivers. These are adult children who care for aging parents who live an average of 450 miles away, according to the National Alliance for Caregiving and the MetLife Mature Market Institute.

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Adult children often first realize that Mom or Dad needs help when there's a sudden hospitalization or a frantic call from an overwhelmed parent. In many instances, a child will discover evidence of a parent's deterioration during a visit.

Having to move quickly, family members who live far away are unable to easily navigate the labyrinth of medical, social and financial resources that aging parents may need to live safely in their own home. "It is very difficult for a layperson to manage the different aspects of the fragmented delivery system," says Penny Hollander Feldman, director of the Center for Home Care Policy and Research at the Visiting Nurse Service of New York, located in New York City.

If you're too far away to monitor a parent, you have a couple of options. You can hire a professional to oversee your parent. Or you can coordinate the care yourself by assembling a network of neighbors, medical specialists, drivers, housekeepers and other helpers.

In either case, you first should get a geriatric assessment, in which a professional identifies problems and suggests a care plan. An assessment ranges from $100 to $500, says Feldman. Such an assessment would cover a range of issues: Is your parent showing signs of depression or dementia? Does a parent need help preparing meals? Are bills getting paid?

Ask your parent's doctor or a hospital discharge planner for the name of someone who performs geriatric assessments. You can also get a recommendation from the local Visiting Nurse Associations of America (www.vnaa.org; 202-384-1420) or the local Area Agency on Aging (use the Eldercare Locator at www.eldercare.gov to find the nearest agency or call 800-677-1116). Or contact the National Association of Professional Geriatric Care Managers (www.caremanager.org; 520-881-8008).

Once you get the assessment, you'll need to decide how to proceed. Hofkin, a photographer, decided to hire a geriatric care manager. A physician friend referred her to Suzanne Modigliani, a Brookline, Mass., clinical social worker.

Geriatric care managers assess and address the complex needs of the elderly. They'll arrange for transportation to doctor's offices and make sure a parent's house is fall-proof. If a parent's health deteriorates, a care manager can decide if assisted living or a nursing home is the best option and then find a suitable facility.

After conducting an evaluation, Modigliani presented Hofkin and her siblings with a plan to help Mom remain at home. She found a personal organizer, who set up a system for bill-paying, closed some bank accounts and sorted through clothing.

Modigliani also found a psychiatrist for Hofkin's mother, who suffers from depression, anxiety and mild dementia. She hired a driver and a home-care aide, and monitors these service providers.

When Hofkin's mother needed to be hospitalized last summer, Modigliani arranged for a private aide to stay in the hospital room. She helped the elderly woman address some issues, such as the amount of attention she was getting from the doctor. During her regular visits, Modigliani checks if her client is taking her medicine, exercising and eating enough. "It eases everything for us and my mother," Hofkin says.

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