Long Distance Care Giving

From a distance: constructing a safety net for parents of adult only children.

We have received many letters from adult only children who live far from their parents. While there are a number of concerns, those that emerge as primary include handling financial issues, (everything from helping parents deal with Medicare and supplemental insurance, to showing a parent who is suddenly alone how to balance a checkbook), addressing medical problems, and when circumstances dictate, finding the right attorney to handle a legal matter. Sometimes elderly parents have medical emergencies that adult only children fly in to handle. But once the crisis is over, there are jobs and families waiting back home. Of course, it’s better to have a safety net in place before such emergencies arise. But how is that possible if you don’t live nearby?

Leaving ill or vulnerable parents can be devastating to any child, but particularly an only one. Adults with siblings can ask (sometimes beg), brothers and sisters for help, but only children have to devise other strategies to handle aging parents. There are some simple, rather uncomplicated things the long distance caregiver can do to make himself and his parents more comfortable, many of which are outlined in the book, Parentcare Survival Guide by Enid Pritikin, m.s.w., l.c.s. and Trudy Reece, m.s.o.t.

Pritikin and Reece offer invaluable advice to anyone who must deal with parents from a distance, but this advice is particularly important for adult only children. The authors suggest that if no relatives live near your parents, then with your parents’ knowledge, you should try to establish relationships with their friends. Friends are often more compassionate and giving than relatives, and may very well offer their help. If they do, accept the offer. It will make them feel needed and give you some comfort. Let them know your parents’ needs, then work out a plan for them to check on your parents, perhaps help them get to the doctor from time to time, or run errands. If these special people are your parents’ close friends, they will also stay informed about your parents’ medical condition and will communicate their observations to you.

When you visit parents, advise Pritikin and Reece, get to know their banker, doctors, attorneys, and clergyman, or anyone else with whom they may have frequent contact. Parentcare explains, “Many of these people will know how your parents are functioning better than you will, and they may be able to catch problems before the difficulties get out of hand. If your mother’s banker notices that she keeps coming into the bank with questions and that she never seems to get things right, he can let you know. You may decide to hire a bookkeeper to help her with financial affairs, and this decision could prevent her from making an embarrassing and possibly expensive mistake. Give these people your phone number and tell them to call you collect if they notice anything unusual about your parents’ behavior or medical condition. You should also make sure that you have their phone number so that you can stay in touch on a fairly regular basis.” You may find that some of these people turn out to be the angels you always hoped were out there but had never encountered.

Pritikin and Reece advise that when you are with your parents be as open with them as possible. Don’t be combative. Don’t fall back into old patterns. Remember, you are now a grown-up. Discuss issues about their well being that concern you and listen carefully to their concerns. Respect their wishes and judgment, but help them understand that you need to be sure they are doing well.

When you live far away keeping lines of communication open is essential. If you phone your parents once a week, be sure to ask them about things that are on your mind. If one of your parents has recently been ill, ask questions that directly pertain to recovery. You need to be specific. Don’t just ask if dad has been eating well or following the diet he is supposed to be on. Get the details. Ask what he ate for breakfast and what he is planning to eat for dinner. Has he been exercising, and is he still socializing with friends? Dig as deeply as you can without being offensive. If it looks like your parents are going to have to alter their lifestyle, you may, counsel Pritikin and Reece, want to contact some experts in their community. They suggest starting with a call to your parents’ local Area Agency on Aging.

You may have parents who require consistent help with their daily lives, in which case, the Parentcare Survival Guide recommends hiring a private geriatric care manager, “He or she may be able to save you a great deal of worry as well as time and money by maintaining regular and direct contact with your parents, by keeping you posted on what’s happening with them, by helping them solve any problems that come up, and by taking care of hiring the help that they need. Also, many care managers have counseling skills, so they might be effective in convincing your parents to hire help when they aren’t so sure that they need it.” But what if you don’t have the money to buy this kind of peace of mind? Once again, check with your parents’ local Area Agency on Aging; they may have some excellent solutions that aren’t expensive.

All of this is well and good until the day when you and your parents feel that they should live closer to you to ensure their physical and mental well-being. At first this may seem the perfect solution. You will be able to oversee their medical and financial affairs, and you won’t be so jumpy when the phone rings late at night. It’s much easier to drive a few minutes or even an hour to deal with a crisis than to get on a plane and travel five hours. But is it? Any major move involving older parents requires careful planning and serious thought. After all, if your parents have a network of friends, a fulfilling social life, and a home in which they are comfortable, then you must consider how they will reorient themselves when they move near you. You will be their only friends and life support system, and it will be your job to introduce them to the community. Pritikin and Reece explain that, “It may be more convenient for you to have them near you, and there may come a time when such a move is necessary. But you should know that they could end up almost totally dependent on you. It’s not easy for older people to make new friends, so they may look to you as a replacement for all of the people who used to give their world a sense of comfort.”

There are no easy answers, but at least the “safety net”, offers a solution, however temporary. The adult only child who is a long-distance caregiver will never be totally free from worry, but worry can be eased. Here is a mother /daughter scenario related in Parentcare. Pearl’s daughter, Helen, came to care for her mother after she had been discharged for the hospital. The hospital arranged for a home health care nurse to stop by Pearl’s home and make sure that she was taking her medicine properly and to check her blood levels. “Helen spent the next few days with her mother until she was satisfied that she would be all right. Before she left, however, Helen wanted to make sure that Pearl would be watched after better than she had before. So she arranged to call the home health agency nurse a few times a week to check on how things were going. She also met with a few of her mother’s friends and neighbors and asked them to call her collect if they noticed anything unusual about Pearl.” By the time Helen left, she felt confident that she had a secure safety net in place…at least for awhile.