As a family and caregiving expert for AARP, Amy Goyer has made a life's work out of studying how to best take care of aging loved ones, including those that live at a distance; what she's learned she's put into practice. "I've been a caregiver my whole adult life, both long-distance and live-in," says Goyer, author of Juggling Life, Work, and Caregiving.
What she and other experts have found is that the issue of providing long-distance care for older loved ones doesn't discriminate based on gender, age, socio-economic status, or ethnic group: 13 percent of the 34.2 million caregivers providing unpaid care to someone age 50 and older live 20 to 60 minutes away, and 12 percent live more than an hour's drive away, according to the National Alliance for Caregiving. "Long-distance caregiving is becoming more prevalent," says Joe Caldwell, National Council on Aging director of long-term services and supports policy. "It is still most often the case that a single family member will assume the bulk of caregiving tasks, but increasingly we see multiple family members sharing tasks, particularly when they are apart from their loved ones."
Whatever the parameters of your situation or however much help you have or don't have, there are steps to help ensure the best care and quality of life for your long-distance loved one. Here's what experts say to do.
Your visits to a loved one may happen weekly or twice or year or somewhere in between, but no matter how often you see them it's vital to look for three things, says Goyer: safety, healthcare, and quality of life. The way to do that is to observe changes in how your loved one was and how they are now. "Are they not cooking anymore, or eating a lot of fast food? Is mail piling up, and are they not able to manage their affairs? Is the house unclean? Has their personal care deteriorated? Is the yard messy, or are there burned-out lightbulbs on a stairwell because they can't reach them?" Goyer says. Drive with your relatives, too, and look for dents on the car or missed traffic cues.
Independence and quality of life are often dependent on each other, and no person wants either taken away, says Goyer. That's why it's important to approach any caregiving conversations with sensitivity, compassion, and understanding. "Start with examples—'I see you can't keep up with the yard, so how can we address it?"—or anecdotes—"I have a friend whose parent had an issue, and if this would happen, what would you want?'" says Goyer.
It doesn't have to be you that initiates the conversation; it might be a trusted doctor or friend, or another relative. But do some homework ahead of time—transportation options, for example, if a loved one is no longer able to drive. "Remind them you aren't telling them what to do, and talk about what will happen when, long before it ever happens," says Goyer. "Remind them that everything you are doing is motivated by love, and that you want them to be safe and happy, and as independent as possible as long as possible."
The biggest challenge, says Goyer, is knowing what's going on when you're not there; to address that, build a team of on-the-ground eyes and ears. "This might include neighbors, friends, people in their faith community, or gatekeepers like postal carrier, or even paid help geriatric care managers or aging life care specialists," says Goyer; that gives you the role of coordinating, assessing, and monitoring. Technology can be a huge help, with video monitors, apps, and smart devices that allow check-ins on basic routines. You can set up motion sensor alerts to monitor if a loved one got out of bed, for example, or whether he or she took medication. Many doctors are also amenable to a FaceTime or Skype connections during appointments, says Goyer. "I've done it," she says. "We're such a mobile society, doctors tend to be happy when there's a caregiver involved."
Paperwork is a huge component of long-distance caregiving, says Goyer; you'll need to know the whereabouts of everything from neighbors' phone numbers and names to a will and advanced directives for healthcare and powers of attorney for both healthcare and finances. "Create a document with the information," says Goyer. "There are things you probably haven't thought about, like all sources of income and public benefits so that you know their financial support and budget and what they can afford if you're trying to help arrange care." Don't forget about certificates—military, birth, marriage—as well as doctors' names, medication lists, insurance and prescription cards, and medical history.
What are your responsibilities, your flexibility, and your financial commitments? These are all part of the caregiving equation, says Goyer. "You'll have to constantly reassess and know that in most situations, there's a gradual increase in support that's needed over time," she says. "Get a realistic idea of what you can handle and how you can fill the gaps with other people or services."
And don't forget the emotional tug: Long-distance caregivers tend to report more financial and emotional stress. They feel guilt and fear for not being there, which is why those early conversations and advance planning pays off in better care for loved ones—and yourself. "It's not selfish to take care of ourselves, it's practical," says Goyer. "A car can't run on empty; neither can we. Fill your tank so you have the energy to provide care. You will make sacrifices, but balance that with taking care of yourself."