Every Sunday, Dennis telephoned his Aunt Catherine from his home in Washington, D.C., to check up on her. At age 87, she lived alone in her longtime Lower Manhattan apartment, and, except for an attack of angina a couple years ago, was in relatively good health.
He asked, as he usually did, about her weekend and was heartened to hear she had gotten out with friends. "My neighbor's daughter took us to the Metropolitan Museum," she said, sounding uplifted.
His relief turned to alarm a few weeks later when he asked again about her weekend, and she answered virtually the same thing -- verbatim. Yes, she had gotten out, she said, on a trip to the museum with her friend and the friend's daughter. In his role as Catherine's closest living relative -- she was widowed, with no children -- Dennis realized that those half-hour weekly phone calls were no longer enough of a check-in.
That next Sunday, he made the four-hour drive to New York and found his aunt in declining health. While she recognized him instantly and joyfully, she looked terribly thin and wasn't sure what day of the week it was. The refrigerator held little more than butter and cheese, and bread on the counter had molded.
Knowing how important it was for her to stay in her beloved apartment, he decided to get help in providing her care, and he knew he would have to increase his participation as her caregiver, even if it was from more than 200 miles away. He contacted our home health agency, Partners in Care, to assess his aunt's situation and, if warranted, provide nurse and home health aide services.
Some 65.7 million American adults currently provide care to someone who is ill, disabled or aged, according to a study by the National Alliance for Caregiving and AARP. Most caregivers live near the loved one for whom they are caring. Indeed, proximity is often a major factor in deciding which sibling, for example, serves as the primary caregiver for an aging or infirm parent.
But Dennis is far from alone. The National Institute on Aging estimates that there are as many as 7 million Americans caring for a loved one from a distance of more than one hour away. As long-distance caregivers well know, the miles can add another layer of challenge to an already challenging responsibility.
Trying to Overcome Distance
Often, a long-distance caregiver relies on the telephone as the first and most frequent mode of communication. Vladimir Kotelnik, a nurse and geriatric case manager who works with elderly clients and family caregivers (both nearby and long-distance), suggests that long-distance caregivers listen hard for clues when talking to elderly relatives by phone. "Spend more time with them on the phone," he suggests. "Listen for if they contradict themselves, or repeat something they said earlier. If you can use Skype, look for any changes in appearance or hygiene. Is their hair combed? Are they wearing the same clothes as last time you spoke?"
Ask specific questions. What did you have for breakfast this morning? Or, How did you sleep last night, and the night before that? Beyond What are you doing?, find out, Who have you seen in the last couple days? Or, What show was at the Museum?
If you can, Vladimir suggests, enlist a friend or neighbor who lives nearby to pay a visit and report back to you, until you can make the visit yourself.
You will learn more, of course, in a visit. Look and listen for changes in mood, appetite, memory, hygiene, sleep habits and sociability. Check the refrigerator and cabinets to make sure food is adequate, fresh, easy to prepare. Ask for a list of medications, and check the bottles. See when they were filled, how often they are to be taken, and how full the bottles are. This should give you a clue as to whether they are taking their medications properly. You will also want to assess the physical environment: Are there stairs, and how does your loved one handle them? Keep an eye out for tripping hazards, such as rugs or clutter. If possible, schedule doctor's visits while you are in town, to make sure you have a full understanding of your loved one's health.
Home Health Aides: Your Eyes and Ears
If your loved one needs help with activities of daily life -- which you cannot manage from several states away -- home health aides can provide a vital first line of defense in the home. In addition to providing companionship and helping with shopping, cooking, dressing, bathing and toileting, home health aides are trained to notice subtle changes that could signal or cause deeper medical problems. These might include change in appetite, change in mood, sleeping more or sleeping less, change in sociability, or change in gait, including limping.
Aides then contact a supervisor so the home care and medical team can investigate the cause of the change. A change in appetite, for example, which is a common barometer of health and well-being, could have many causes, including:
- discomfort caused by an underlying illness
- side effects of medication (reducing appetite or causing nausea)
- hot weather
- boredom with the eating regimen, indicating that creative solutions are in order
- the progression of an illness, particularly if the elder has dementia
Because a home health aide's chief task is to know the client's routines, understand his or her usual behaviors and monitor for subtle changes, this well-trained set of eyes and a caring set of hands makes all the difference for caregivers who cannot be there on a regular basis.
The home care team will check in with family members -- local or long-distance -- to report any concerns or changes in well-being. Sometimes, notes Vladimir, the team will call the doctor first, or even 911, if the situation is medically urgent.
When you work with a home care agency, make sure you understand its procedure on reporting changes in the patient's health. Changes could indicate a new and serious condition that might require immediate attention from a doctor. The sooner you are notified about changes in your loved one's well-being, the sooner you can be provided with options for new medical or therapeutic treatments to combat the problem. This provides all-important peace of mind for a caregiver -- whether you are next door or hundreds of miles away.
Additional Resources for long-distance caregivers
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