If Your Parents Need Help

When you live far away, surrogate care for a loved one is the next best thing to being there.

By Jane Bennett Clark, Senior Associate Editor

From Kiplinger's Personal Finance magazine, February 2004

Ersilia Garritano, 81, is proud of her husband's garden. "You don't see one weed in it!" she says of the large plot where Dominic Garritano, 91, grows garlic, eggplant, escarole and tomatoes. In the 30 years that the Garritanos have lived in their neat ranch house in Boardman, Ohio, they have tended this garden and watched the geese make the seasonal journey over their expansive backyard.

It's a life they'd like to continue. But lately Ersilia has suffered from arthritis, making driving difficult, and Dominic hasn't been behind the wheel in years. The Garritanos' only child, Sandra Greaves, lives in New York City, where she has her hands full with a job in the fashion industry. Greaves wishes she lived close enough to help her parents navigate the world beyond their neighborhood. Instead, she orchestrates assistance from afar and regularly visits Ohio for long weekends and holidays. "There's never enough time to do everything," says Greaves.

Greaves, 48, is a member of the rubber-band generation--some seven million family members who stretch caregiving across the miles and travel several hours each way so that elderly or ailing relatives can remain in their own setting. Each month, according to the National Council on the Aging, people in situations like Greaves's devote an average of 35 hours to such informal caregiving. And they spend $171 of their own money, the National Alliance for Caregiving reports. Nevertheless, many express guilt that they aren't doing more. "I feel terrible about it," says Greaves of the 435-mile distance that separates her from her parents.

Hook up with help

A little over a year ago, Ersilia Garritano's arthritis worsened from minor discomfort to debilitating pain, and Greaves worried that driving might at times be both difficult and dangerous. Although Ersilia still drives around town, Greaves decided she should have someone take her mother on longer trips or when the weather is bad.

She contacted Home Instead Senior Care, a franchise business that provides nonmedical care services and has offices in 45 states. So-called chore agencies have multiplied in recent years as an aging population increasingly requires their services, which cost between $12 and $20 per hour. Greaves now pays $13.50 an hour for Pam Traino, a soft-spoken caregiver, to spend about ten hours a week doing such chores as driving her mother to the doctor's office, picking up prescriptions and stopping off at the grocery store. "It's a godsend," says Greaves. "Pam is very caring, and they get along well." Ersilia wholeheartedly agrees. "Pam's wonderful. Anytime I call her, she comes. I could never find a better person."

As Greaves and her mother can attest, long-distance caregiving is an oxymoron. "There's no way to do it without some person representing you or substituting for you on-site," says Bonnie Lawrence, of the Family Caregiver Alliance. Just sorting through the elder-care resources in a distant community can be a challenge. "You need help navigating this very fragmented system," says Lawrence.

Many families start with the federally sponsored Eldercare Locator (800-677-1116), which puts people in touch with local services that provide transportation or hot meals, or volunteers who check in periodically with elderly clients in person or by telephone. "Sometimes it's the real simple things that are the most important to people," says Deanna Clifford, of the Area Agency on Aging near Boardman, one of the offices to which Eldercare refers.

Your employer may help you do the spadework. About half of the large employers surveyed last year by Hewitt Associates, a benefits-consulting firm, offered elder-care programs. When Janie Helms of Dallas needed help for her ailing mother in Quincy, Ill., her employer, Texas Instruments, sent her to LifeWorks, a referral service. LifeWorks located the Meals on Wheels program in Quincy, found a chore service and gave Helms the names of local lawyers who specialize in elder issues.

In complicated cases, you may need to hire a geriatric-care manager -- often a nurse or social worker -- who makes in-home assessments, coordinates services and keeps out-of-town relatives up to speed. "They know the area and can efficiently come up with a solution, whereas family members spend a lot of time spinning their wheels," says Suzanne Modigliani, a care manager in Boston. According to a recent survey by the AARP, you'll pay about $175 for an initial assessment, $170 for a care plan and $75 an hour for ongoing supervision.

If the plan calls for visits by a nurse or home health aide, figure on an average cost of about $100 per visit for a visiting nurse or $15 an hour or more for a home health aide, according to the Visiting Nurse Associations of America. If your family member is homebound and needs skilled care, medicare may pick up the cost (for details, go to www.medicare.gov). Private insurance typically mimics medicare requirements, so check your policy.

For volunteer help, you'll find good Samaritans through faith-based groups, such as the Faith in Action network (877-324-8411). Faith in Action enlists everyone from retirees to Cub Scouts to help with chores ranging from chauffeuring to raking leaves. "The goal is to help people remain as independent as possible in their own homes," says Maureen Drummond, of the Volunteer Services Agency, an FIA affiliate in the Boardman area.

Avoid financial panic

Greaves pays Home Instead out of her own pocket and handles her parents' finances from New York, transferring her father's pension electronically to an account set up for that purpose and paying most of their bills online. She has her parents' durable power of attorney, an instrument that gives her legal authority to handle their financial transactions.

Some banks and brokerage houses have their own forms for powers of attorney -- check with each company your family member does business with. Eileen Freiburger, a financial planner in El Segundo, Cal., recommends visiting your family member's bank to put the power of attorney on record, so all you need to do is show a driver's license and a signature. What you're trying to avoid, says Freiburger, is a situation in which "Mom and Dad are incapacitated, you're in a panic, you're flying in from out of town, and you can't find the power of attorney, or the bank doesn't honor it because of some legalese. I've seen families in tears."

Establishing a joint checking account for bill-paying or to cover emergency expenses may be convenient, but it's often a bad idea, says William Browning, president of the National Academy of Elder Law Attorneys. Not only does it give the co-owner carte blanche over the account, but it can also legally remove those funds from the inheritance pot. "In most states, that child gets all the money, and the other children get squat," says Browning.

Still, being the child designated to swoop down in a crisis can be costly. "When one person suddenly has to fly out, or help with groceries and medications, it can get to be pretty expensive," says Freiburger. If your relationship with your parent is rock-solid, he or she could add your name to a credit card or give you ad hoc permission to use the card. To cover big-ticket items, such as in-home care, Freiburger recommends that parents establish a home-equity line of credit that they -- or you, if the power of attorney authorizes it -- can tap when necessary.

Setting up a living trust can be cumbersome, but this is one situation in which such a trust, coupled with the power of attorney, may be helpful. It avoids last-minute scrambling because it can direct a seamless transfer of authority over the trust assets from your parent to a successor trustee -- possibly you -- in a crisis. As with a power of attorney, it also allows people to spell out how they want their affairs to be handled and holds the agent legally accountable for carrying out those wishes.

Whatever the plan, set it up now, lest you discover that your window of opportunity has shrunk. "Children walk into their parents' home and realize the food in the refrigerator is moldy, and they're not cleaning their clothes or keeping up the household," says Kathleen O'Brien, of the Alzheimer's Association. When O'Brien's own father developed Alzheimer's, "we had no idea he had not paid his health insurance. We had to pay the medical bills with our own money."

In the absence of a durable power of attorney or living trust, you could end up ceding control of finances to a court-appointed conservator (called guardian in some states). "If I meet with clients and it's obvious they don't comprehend what we're talking about, I have no legal recourse but to pursue guardianship," says Browning. You could be named guardian, but that would involve court proceedings. And if you live out-of-state, you may have to share the role with an in-state guardian.

Even if you do have legal authority through a power of attorney, you may not have the time or inclination to manage two sets of books. David Katzman, a certified public accountant in Boca Raton, Fla., says his firm handles everything from mundane chores for elderly clients to monitoring their investment portfolios. "We take in their mail, pay all their bills and reconcile bank accounts," says Katzman. Equally important, "we're the eyes and ears for the children. They feel secure that someone is watching over things."

A CPA firm might charge $35 to $75 an hour for bookkeeping by a staff member and $85 to $130 for tax preparation by a CPA. CPAs are subject to professional oversight -- a backstop that can be especially important when dealing with elderly clients.

An extra pair of ears

Like many on-site caregivers, Pam Traino has developed a relationship with Ersilia Garritano that goes beyond running errands and chauffeuring. Traino accompanies Garritano on her visits to the doctor, interprets her Italian accent and relays the details to Greaves. "It's good to have someone you trust go in with her and hear what the doctor has to say," says Greaves. Federal privacy laws permit that kind of participation as long as the patient agrees. Doctors may share information with adult children if they conclude that doing so is in a patient's best interest.

Regardless of such discussions, you'll still need a durable power of attorney for health care (sometimes known as a health-care proxy or directive) to make medical decisions on behalf of your relative if he or she becomes incapacitated. To avoid scavenging the family homestead, make sure you know where to find the medical and legal paperwork you'll need. Life Ledger, a subscription service offered for $50 a year by ElderIssues, lets you scan in your loved one's care proxy and other documents, and update medications, physician numbers and insurance information on a Web site accessible to both authorized health-care professionals and family members.

A delicate balance

A few years ago, Greaves suggested that her parents move to suburban Connecticut, a two-hour drive from her Manhattan apartment. "I'd visit every weekend, bring them here for holidays, get them a little more initiated into the community," she recalls. "But they didn't want to do it." For now, she's willing to let Traino, who calls the Garritanos almost every night, be her surrogate. "They want to be independent, and I'm glad they think of her as another daughter."

Like any caregiving situation, however, the arrangement could change if the Garritanos suffer a crisis. Loath as she is to uproot her parents to a city setting where a garden amounts to a few window boxes, Greaves isn't ruling it out. "We're taking it one day at a time."

--Reporter: Amy Esbenshade

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