April Biggs lives in Milwaukee. She worries about her parents, who are both in their mid-70s, living in Jacksonville, Florida. Both have serious health issues and Biggs hopes to encourage them to get additional help when she can’t be there, so they can remain in their home.
“We’re at a point where they cannot really care well for themselves or each other,” she says.
Sound familiar? Biggs, 48, is one of the estimated 56 million unpaid family caregivers—and among the 11% who are long distance caregivers, defined as living an hour or more away from their loved one, according to AARP.
Her own serious health challenges make travel difficult, but Biggs recently had to make a trip south to help out her mom, who was discharged from a skilled nursing facility after extensive complications from hip surgery. Biggs said the health crisis also called attention to her dad’s difficulties with tasks like managing household finances and doing certain chores. Being there makes Biggs feel like she can be an advocate for her parents.
The most basic challenge is not knowing exactly what's happening with your loved one, according to AARP’s family and caregiving expert Amy Goyer. “It’s hard keeping a handle on their health, how they're doing, physically, mentally, psychologically and emotionally, when you’re not there,” she says.
“Isolation is a big thing and they can tell you, oh, I'm doing fine and everything on the phone, but is that really what's happening,” Goyer says.
Experts say several strategies can help ensure the safety of a loved one from afar.
Build a care team
Having people who are your eyes and ears on the ground, who can call you if they notice something amiss, is crucial, Goyer says. She suggests building a team of other family members, friends, neighbors, members of their faith or civic community. Include “gatekeepers,” too, like the postal carrier, regular delivery drivers, doctors and nurses, and ensure they have your contact information. There are even websites and apps to help you coordinate schedules and tasks.
You may also be able to tap into other free and paid caregiving services or programs. However, they’re not always easy to find or access. Some require out of pocket payments, but others may be covered by health insurance or a long term care policy.
Goyer suggests first calling your local Area Agency on Aging. They will know about local programs that can be a big piece of your caregiving puzzle. A local AAA can also help determine if your loved one qualifies for initiatives like PACE (program of all-inclusive care for the elderly), state, or county programs which may provide free or low-cost assistance. Eldercare locator can direct you to your nearest AAA and other community services.
Hire an aging life care manager
Also known as a geriatric care manager, a social worker or nurse will manage your loved ones’ care and act as a surrogate when you can’t be there. They can coordinate medical care, including accompanying your parent to medical appointments, manage medications, conduct regular check-in visits, and can be involved as much or as little as need—and budget—allow. Even if you decide not to use their services full time, it may be a good idea to hire this specialist for a one-time assessment, get an outside perspective on your loved one’s health status, limitations, cognition, home environment and needs, Goyer suggests. Most will even provide a basic care plan which you can use as a template for future paid or volunteer care.
Use employer or insurer sponsored help
Companies like Papa help those on Medicare Advantage, Medicaid, and some employer health plans connect members and their families to companion care, which reduces isolation, assists with everyday tasks, transportation, and other non-medical services.
“Our Pals can act as an additional source of care for family caregivers who are struggling to find the bandwidth to drive someone to an appointment, make sure they are active enough, taking their prescriptions, etc,” says Ellen Rudy, Ph.D., head of research and social impact for Papa.
The negative effects of loneliness, especially on older adults, are well-documented. Among people 60 and older who struggle with chronic loneliness, 45% risk dying sooner than their socially-connected peers. The health risks tied to loneliness are greater than obesity, physical inactivity, excessive alcohol consumption, or even smoking up to 15 cigarettes per day, according to Rudy.
Consider a home care aide or personal care assistant
Some Medicare Advantage or long term care insurance will pay for an aide or assistant for a specific number of hours. PCAs can help prepare meals, do chores like laundry or light housekeeping; home health aides assist with bathing and dressing, and other daily living activities.
Medicare will not pay for a home health aide unless skilled nursing care is also necessary (such as post-hospital care) and the recipient is homebound. While home care can quickly get expensive—monthly median costs for a homemaker or home health aide hover around $5,000 for 44 hours per week—Goyer points out that many older people don’t need full time help.
Try an adult day center
These facilities deliver integrated therapeutic, social and health-related services to help elders and those with disabilities remain in their community, according to the National Adult Day Services Association. The organization has an online center finder and helpful tips on choosing the right center for current and future needs.
Most centers charge a fee, depending upon the level of services required. Payment may be available on a sliding scale, depending on household income. These costs may be covered under a long term care policy or state waiver program. Adult day centers differ from traditional senior centers—in addition to social and physical activities, they provide on-site nursing care, daily health monitoring, medication administration, memory care, mobility assistance, and transportation. Staff are trained in emergency care.
Tap volunteers
Religious or fraternal organizations, high school or college service clubs, or community non-profits may have volunteers available to regularly call or visit. These interactions can help alleviate social isolation, check to make sure there’s food in the fridge, run quick errands, or do simple chores.
Go high tech
Tech can help you monitor a loved one’s movements, from whether the fridge has been opened lately to how many times mom got out of bed last night. Sensors and smart gadgets can whisk information right to your laptop, allowing you to spot potential issues before they become bigger problems.
It’s a constant balancing act between her parents’ needs and her own life in Milwaukee, Biggs admits. She is considering moving closer to her parents in the next few years, but meanwhile, hopes to convince them to hire a part-time home health aide. “They have been ferociously independent all their lives. So I think it is going to be hard for them to say okay.”
That’s a pretty common struggle, especially among long distance caregivers, says AARP’s Goyer. She suggests starting with small steps, like having someone come help with house or yard work. When they get comfortable with that, you can explore adding additional in-home supports.
Goyer also stresses that regardless of distance, caregivers need to take care of themselves, process their emotions and get support from other caregivers or counseling. And, don’t be afraid to ask for help.
