Elder Care: long distance careGIVING

Caring for a relative who is living in a different town or state than you can be a challenging and sometimes overwhelming experience. There are many resources available to assist you with decision-making as you embark upon the journey of long distance caregiving. Expect to have several conversations over a period of time, as needs evolve.

The University of Michigan provides employees with a comprehensive set of support programs through the Turner Geriatric Center, Turner Senior Resource Center, Housing Bureau for Seniors, FASAP (Faculty and Staff Assistance Program) and EAP (Employee Assistance Program for U-M Health System employees). Even if your relative lives far away, these local resources provide an excellent source of education and support to help you know what to look for and what questions to ask. Long distance caregiving information and resources are provided below:

  • Help your relative accept care
  • Identify caregiver support
  • Consider a care manager
  • Check in regularly
  • Gather information
  • Locate housing options
  • Connect with local resources
  • Additional resources

Help your relative accept care

  • Explain that you want the best for their health and comfort. Acknowledge and address any of their concerns.
  • Treat them with respect and realize that they are ultimately in charge of their own care, unless they are unable to make decisions. Having a financial and medical power of attorney set up in advance makes it much easier to make decisions if your relative’s condition worsens.

Identify caregiver support

  • Establish a relationship with your relative’s church, neighbors, and/or personal circle of friends.  Collect phone numbers and/or email addresses for contacting them with your questions/concerns.  Be sure they all have your contact information as well.
  • Solicit help from other family members either through a regularly scheduled phone conference call or arrange for an in-person meeting which may involve travel for some. It may be helpful to have a professional lead the family meeting if one is available.
  • If your relative has been admitted to the hospital, there may be social workers there who can assist you with planning. 

Consider a care manager

If a close neighbor, family member or friend cannot be identified, and you need someone to help provide informal support and formal services to your relative, you may want to consider hiring a professional care manager. A care manager (also called a case manager) specializes in assessing and monitoring the needs of older adults. Names of care managers are available from the National Association of Professional Geriatric Care Managers at www.caremanager.org. When contacting a care manager, consider asking the following questions:

  • What services are offered?
  • What are the care managers’ professional credentials and licensing?
  • How much experience does the care manager have in providing caregiving services? What type of services have they provided in the past?
  • What are the fees associated with this service?
  • Can a list of references with contact information be provided?
  • Is the care manager available for emergencies? 

Check in regularly

  • This can be tailored to the person’s needs by considering how often visits may be required, taking turns with other friends/relatives when planning visits, or having someone who lives near your relative make regular visits.
  • When visiting, assess their ability to provide self-care including preparing meals, access to healthcare appointments and medications, transportation, errands and chores, money management, social activities, and psychological health. Be aware that some medications can bring about unexpected changes in physical and mental health.
  • Use phone calls as a way to check in regularly. If your relative has a hearing problem, arrange a specific time so your call is expected. If you don’t have time for long daily conversations, ask them to leave a short phone or email message daily to “let you know all is well.” Or, send them a quick message and await their reply.
  • Listen for any changes in their interactions with you on the phone. Ask about how they are doing in order to assess whether any additional support will be needed.
  • Schedule doctor appointments to coincide with your visits so you may become familiar with the doctor and his or her staff. Have your relative complete a HIPAA form (Health Insurance Portability and Accountability Act) with each of their physicians to authorize you to have access to their medical information.

Gather information

  • Keep track of personal information, insurance and medical information, medical providers’ names and contact information, legal and financial information, and more. The Work/Life Resource Center has a list of recommended information to gather at http://hr.umich.edu/worklife/eldercare/contactinfosheet.html or visit www.myphr.com.
  • Keep photocopies of important documents such as Social Security cards, health insurance cards, other insurance documents, a will/trust, advance directives or living wills for end-of-life wishes, and Durable Power of Attorney documents for health care and finances.

Locate housing options

  • Most people want to stay in their homes as long as possible. There are many ways to make modifications to make the home safer. One source to contact is the National Association of Area Agencies on Aging at http://www.n4a.org/ Their primary mission is to build the capacity of its members to help older persons and persons with disabilities live with dignity and choices in their homes and communities for as long as possible. The n4a administers the Eldercare Locator, a public service of the U.S. Administration on Aging at http://www.n4a.org/programs/eldercare-locator/ or 1-800-677-1116.
  • Other options include adult foster care, independent living in a senior community, assisted living, memory care, and long term care in a nursing home or hospice. There are many national search databases that identify facilities by zip code such as the Eldercare Locator. This can provide a good place to start, however asking for referrals from others in the community is also a valuable way to find quality facilities.
  • The U-M Work/Life Resource Center has additional information regarding national elder care resources at http://hr.umich.edu/worklife/eldercare/eldercareresources.html

Connect with local resources

  • Identify local friends, relatives, religious groups, or neighbors who can be trusted with a home key and help check in on your relative. Knowing someone who can be called upon in an emergency can help ease your concerns. Be careful not to over burden neighbors and friends, caregiving can be a very daunting task. Be sure to have a key made for yourself as well.
  • Establish a list of local names and phone numbers for your relative’s physicians, dentist, landlord, utility companies, and others who may provide services. You may want to call periodically to see if there are any problems/concerns regarding payment. 
  • Consider setting up automatic deposits of Social Security and other income and automatic payments for monthly bills.  You may want to consider setting up a joint pass through account to just pay bills. This is helpful if the older person is in the hospital or in rehabilitation for an extended period of time or if they have some cognitive limitations and are at risk of late payments or unpaid bills.  Also share copies of a financial or medical power of attorney to enable a caregiver to discuss financial matters and the older person’s status with their health care providers. 
  • Connect with other groups such as organizations, clubs, and religious communities in which your relative participates. Ask if they have a network of volunteers that can assist you. Check to see if they have a local Meals on Wheels program.
  • Consider hiring a non-medical home care agency to assist with meal preparation, companionship, and other basic needs such as bathing. Be sure to do your due diligence in screening the agency’s hiring  (e.g. drug screening and criminal background checks) and supervising practices for their caregivers and be aware of their business practices (e.g. rates, minimum service hours etc.). You may also want to arrange for a house cleaning service once or twice a month.
  • Consider setting up an emergency medical alert system that provides a way to request immediate help in the case of an emergency. One way to find options is to do a web search for medical alert systems. Be sure to ask about fees and 24/7 response time if requests for assistance are made.
  • Check if local pharmacies or grocery stores will deliver. This is very important if your loved one should become homebound for an extended period of time.
  • If they are in assisted living or a nursing home, be sure to establish a good working relationship with the staff. Check in with the staff on a regular basis to ask for their observations or input. You may want to have someone pay an unscheduled visit to check out how things are going. You need to be an advocate. Review the care plan and be sure your relative gets what they need. Participate in their care conferences in person or over a speaker phone. Make sure the staff knows your wishes.  Do you want to be called before your relative goes to the emergency room or soon after? Do you want medication changes to be discussed with you prior to a change being made or afterwards?

Additional resources:

  • The AARP has a multitude of resources about caregiving, as well as information on support networks. You can visit their Caregiving Resource Center web site at http://www.aarp.org/home-family/caregiving/ or call their support phone line at 1-877-333-5885.
  • The Association of Area Agencies on Aging (n4a) is another great resource for finding referrals: http://www.n4a.org/                                 
  • Using a Care Manager: information on both government-funded and private care management can be found at http://www.agingcarefl.org/stage-one-section-4-using-a-care-manager/ and the National Association of Professional Geriatric Care Managers can be reached at www.caremanager.org
  • Care.com is a national database that directs you to local resources who provide senior care, pet care, child care, tutoring, yard work, and housekeeping. By entering a zip code, individuals providing services in a specific area are listed. Care.com is also a source for articles on topics of interest. There is a monthly fee to use this web-based resource.
  • For additional information, contact the Work/Life Resource Center at worklife@umich.edu or visit http://hr.umich.edu/worklife/eldercare/index.html