The sandwich generation, those who are responsible for the care of their children and aging parents, often work hard to make sure their senior relatives stay safe at home. But striking a good work-life balance with caregiving duties can be challenging for this generation, especially for those with aging parents in their 80s or older. Caregivers who live far away from their parents face the additional challenge of choosing senior care options based on phone calls and pictures rather than in-person visits.
The National Institute on Aging reports that roughly 7 million Americans are long-distance caregivers. Their level of involvement varies depending on the needs of their older relatives. Some seniors may only need occasional assistance, while others may remain relatively independent but rely on their long-distance caregivers to help sustain them. Still others should not be left home alone.
Healthcare professionals are in an excellent position to recommend senior care options for those whose family caregivers live far away. In addition to knowing the needs of your patients, try to understand what the caregivers are experiencing by putting yourself in their shoes. Caregivers can be hard on themselves, but there are solutions to many of the care challenges they face.
The best step long-distance caregivers can take is to proactively develop a care plan. Encourage them to make an assessment of their loved ones’ care needs and take appropriate action based on the information collected. With that, you can assure them that they are doing all they can for their loved ones.
Planning a Visit
Your patient’s caregiver may have no idea where to begin, and out-of-town family members are sometimes unaware of problems until their senior loved one ends up in a hospital. To avoid this, advise the caregiver to make a carefully planned home visit. Suggest that she:
- Make a list of concerns and questions
- Obtain contact information for medical providers
- Identify her loved one’s medical conditions and medications, along with their side effects and interactions
- Ask her loved one to release his medical records
It is imperative that the caregiver’s senior relative understand why she is involved: to safeguard his independence, not take it away. He might be reticent to talk about personal matters over the phone or not even welcome intervention, so she’ll need to listen more and talk less. A team approach between senior and caregiver is essential for developing effective senior care solutions.
If there are any legal issues, the caregiver and senior may want to seek out the services of an elder law attorney. These lawyers specialize in issues related to older adults and can provide counsel as well as assist with living wills, healthcare powers of attorney, and guardianship.
Making a Holistic Assessment
Remind caregivers that assessing their loved ones’ health means looking for changes. For example, if the caregiver’s loved one has always been unkempt, that may not be the best indicator of health. However, if the caregiver is used to seeing her dress a certain way and notices that she is no longer doing so, that could indicate an issue. That said, some habits might be getting in the way of the senior’s health. Habits can take decades to develop, but with the caregiver’s support, breaking them isn’t impossible.
To fully understand what care the senior needs to remain at home safely and independently, several areas should be assessed: his physical and mental health, his personal safety and care needs, and his support and social networks. From there, the caregiver can rally the resources necessary to address any issues.
The caregiver can learn a great deal about his loved one’s physical health simply by being observant during the visit. Among other things, he can monitor food and fluid intake and make sure he has all access to all necessary medical equipment. Accompanying the senior to medical appointments is also important, as is watching how he manages medications.
Mental status is equally essential. Advise the caregiver to watch for signs of depression or dementia. Is she exhibiting symptoms of any of these conditions? Do they interfere with her ability to live independently?
Beyond any physical or mental health threats, the caregiver should assess his relative’s safety risks, such as the risk for falling. Important safety features to check include fire extinguishers, working smoke alarms, and secure stair rails. Personal care should be evaluated as well, including hygiene, ability to dress herself, and any trouble with meal preparation or housework.
Changes in socialization and support should be evaluated as well. Is the senior an active member of a church or a civic or service organization? Does she meet regularly with friends, or does she appear socially isolated? The caregiver should check what kinds of community services his loved one is receiving (if any) and whether she is in need of a reliable means of transportation — particularly if she used to drive normally but now has difficulty behind the wheel. With the senior’s permission, the caregiver may also want to look into his loved one’s financial situation, such as debts, income, assets, and any issues with medical bills or insurance companies.
Identifying Resources for Senior Care
After identifying her loved one’s needs, the caregiver can make an informed decision about whether remaining home is realistic for him, depending on what he needs to maintain his independence. Your patient and his caregiver may not know where to go to find help for a variety of senior care needs, so you may want to discuss the following with them:
- Ensure that primary medical care is in place. In addition to regular medical screenings, the senior should have dental and vision care lined up, and the caregiver should be informed of any specialists involved in the care plan, such as mental health services. Explain the importance of senior immunizations, including influenza, pneumonia, and shingles, which are available at the doctor’s office or from pharmacies. If medications are difficult to manage, suggest medication dispensing technologies. The senior may also benefit from a home health service for monitoring or treating medical issues.
- If the senior has trouble meeting his nutritional needs financially, he may want to apply for food stamps at the local social services department. If ability to cook is an issue, receiving deliveries from Meals on Wheels is an option, as is traveling to a local senior center for a hot lunch or dinner.
- Home modifications help make the senior’s living environment safer. The caregiver can reduce her loved one’s risk of falling by removing throw rugs, cords, or other tripping hazards, ensuring that there’s adequate lighting, and installing grab bars and handrails. Investing in a personal emergency response device, such as Philips HomeSafe or GoSafe systems, can give both the senior and his caregiver peace of mind, as well.
- Will personal care assistance benefit the senior? If he’s homebound and signs up for a skilled home health service such as physical therapy or nursing, Medicare may cover the expense. Alternatively, Medicaid or the local Area Agency on Aging may cover care, depending on the senior’s circumstances. Another option is to hire a privately paid aide.
- To avoid social isolation, the caregiver can help her loved one seek out veteran’s organizations, civic or other clubs, senior centers, or a variety of other groups. Adult day care is an option, as well. Seniors can attend for up to five days a week, and transportation is sometimes provided. The senior’s local United Way should have more information about this and other senior care options.
- Seniors in need of help with financial management have several options. Bills could be mailed to the caregiver, and she could become his representative payee for Social Security, giving her the ability to receive and manage payments. Alternatively, the senior could grant his caregiver durable power of attorney, allowing her to manage all of his financial affairs. You or another of your patient’s healthcare providers may know of medical or medication assistance programs. Your patient and his caregiver may also benefit from a consumer credit counselor for financial advice, such as budgeting.
- Most communities provide seniors with transportation for such activities as grocery shopping and medical appointments. Transportation assistance can be found through the local United Way or Area Agency on Aging.
Identifying available senior care options can be a challenge, but these and numerous other resources for seniors are available if you point the senior and his caregiver in the right direction.
Deciding on Care Management Options
Distant caregivers must sometimes rely on the help of others to manage their senior’s care on a day-to-day basis. For instance, hospitalized seniors often have the services of a social worker for discharge planning. These healthcare professionals are familiar with local resources, so they can help the senior and caregiver formulate a care plan and rally services. If the senior is unable to return home right away, the social worker can admit her to a rehabilitation hospital or a skilled nursing or assisted living facility, which provide discharge-planning services, as well. Once the senior is ready to go home, the social worker arranges medical equipment and home health services. He can also make referrals to a variety of community services and help the patient with disability applications. A county caseworker may be able to provide similar, though limited, services outside the hospital.
Another option for care management is to hire the services of a geriatric care manager, the privately paid equivalent of a discharge planner or county case manager. These professionals serve as the caregiver’s surrogate and provide comprehensive care, from assessment to monitoring. Geriatric care managers are often expensive, however, regardless of whether they charge by the hour or per service.
If the caregiver believes that his loved one is neglecting self-care and refusing any help, he should call the department of social services in his senior’s county. They may determine her level of competency for making decisions and for understanding the consequences of her actions. Following that, community services or placement assistance may be given — with the senior’s consent. If the senior is declared incompetent by a court, the caregiver may be able to serve as her legal guardian and choose comprehensive interventions.
Sometimes, the best choice may be to relocate the senior to a long-term care facility capable of meeting his needs. There are three levels of care:
- Independent living, which is similar to an apartment complex. Such services as transportation and recreation may be offered, but the senior otherwise remains on his own.
- Assisted living, which varies from apartment-like settings to rest homes that don’t much differ from skilled nursing facilities. All senior care needs can be provided for at this level, including cooking, cleaning, medication management, and medical treatments and therapies.
- Skilled nursing facilities, which have registered nurses on site at all hours of the day. Many patients at these facilities have transferred there from a hospital to continue treatments or therapies. Others may be there because skilled nursing or physical therapy is not practical or safe at home.
Some facilities provide multiple levels of care on the same campus, and residents can transfer within, depending on their needs.
Long-distance caregivers sandwiched between their children and their parents often need assistance. By viewing senior care from the caregiver’s perspective and offering the above tips and resources, you’ll help them obtain the peace of mind that comes from knowing that their loved ones are receiving high-quality care.