Last week, my 82-year-old, widowed mother called from her home more than 3,000 miles away saying she did not feel well. She was coughing so hard that I could hardly understand a word she was saying. She is typically not a complainer and rarely gets sick. "Have you seen a doctor?" I asked. "Yes, I went to the clinic up the street, I wasn't feeling well enough to go to my doctor who is half an hour away. He put me on antibiotics and cortisone." With my nursing background, I thought he should have taken a chest x-ray, but like so many kids in my situation, managing a senior's health care across the country has its challenges, especially if you are an only child like myself. I think we have to trust and believe that things are okay until things seem tenuous, and if they do, we need to reach out for others to help or to hop on a plane cross-country. The entire scenario is even more challenging if you have an independent mother like mine, who often tells me that something was wrong only after-the-fact.
Like many in similar situations, I have battled with the idea of moving her closer to me so that I can manage her care, but the idea of taking her out of her normal routine has been the largest deterrent. Her routine includes daily visits to see her horse, which she stopped riding a few years ago afte a horse accident landed her in the ICU with a concussion. After her horse accident, we had the talk most adult children should have with their parents, presenting the "what if," scenario. She did tell me that if she was unable to look after herself, she would prefer a caretaker in her own home over being placed in a nursing facility. I promised to honor her request. I realize that there are and will continue to be many more decisions which pop up before then, such as: Is she getting checkups? Does she have any underlying diseases going unnoticed? Is she a safe driver? Is she eating well? Who will find her if she falls or collapses? Who do I call in an emergency?
I have read that millions of middle-aged children like myself manage their parents from afar. In fact, the National Institute on Aging estimates that about 7 million Americans consider themselves long-distance caregivers. The challenges accompanying this factoid are huge, but studies show that in most cases, it is best to keep the senior in their own familiar surrounding for as long as possible.
Although my daughter and son-in-law live within an hour of my mother, they work full-time and have their own lives. In an emergency they would surely make the trip out to see her, but I cannot expect consistent care and would not want to. For now, I call her daily to make sure she is all right, eating well and not isolating herself. I set her up to go to a local fitness center to train with a trainer once a week. As a nurse who was once director of nursing in a chronic care hospital, I know that it is the isolation and lack of activity that presents the most risks for seniors living alone. Hopefully, my mother can live out her days in her familiar environment, although if she develops Alzheimer's Disease or something which renders her less cognizant, I might decide to move her closer to me. At that time it won't matter if she doesn't have any ties in my community.
It has been said that long-distance caregivers often suffer from guilt and regret when a parent passes away. We might have missed out on sharing the golden years and end up holding on to the guilt and regret of not having the memories of sharing their golden years, but the only thing we can do is what seems best to do at the time.
In summary, here are some things I learned on my reading on the subject:
1) Remain in close daily contact to keep the emotional bond.
2) Keep up to date with health issues. Remain in touch with their physician.
3) Ensure that they have assistance around the house.
4) Suggest activities to minimize isolation.
5) Hire someone to run errands and to drive to appointments.
6) Offer financial assistance as needed.
7) Arrange other family members and friends to visit.
8) Have an emergency network system in place.
9) Ensure they have a cell phone.
10) Set them up with a computer so Skype is a possibility.
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