What are the challenges of caregiving if I live out of town?

Has this happened to you? You plan a trip to visit a parent and when you arrive, it is clearly evident that they need help and that it's necessary for you to step in immediately. It is the rare occasion when a family member eases into the caregiving role; it is generally a role that a person is thrust into unexpectedly. Not everyone should be a caregiver and to choose to be one out of obligation or guilt is not a good idea. There is no shame in participating in the caregiving in a different way - perhaps financially, perhaps by handling the paperwork or by researching options for your loved one's care.

You do not mention whether or not you have primary responsibility for caregiving. If you share the responsibility for caregiving with another family member who is local to your loved one, open communication is extremely important to prevent misunderstandings, resentment, or conflict among those involved. 

Although the local caregiver is closer to the situation, you may be able to provide objectivity (that may or may not be welcomed.) It may be best for everyone if roles are defined early on in the process.  If you are particularly good at something, like making phone calls, or emailing updates, offer that.  For example, your sister will provide the hands on care and you will make the phone calls and keep other family members up to date.  It may also be helpful to acknowledge to the primary caregiver that you appreciate her efforts and want to help and then ask what tasks you might help with. 

However, if you are the primary caregiver and live out of town communication will again be very critical.  It may be helpful to set up a list of people who need to know that you are the 'point person.' This list may include:

• primary physician
• companion/caregiving agency (if one is involved)
• neighbors
• pharmacist
• religious/spiritual resource

If there is no power of attorney document that indicates you as the responsible caregiver, you should have a letter signed by the patient indicating that it's OK for those folks to speak with you on the patient's behalf. That way, when you call for information or to ask a question, you won't be stopped by the HIPAA law.  Trust me, there's nothing more frustrating than trying to get information about your elderly parent and being told, "We don't have proper authorization to speak with you."

Depending on the circumstances, of course, you may be very easily able to handle the caregiving responsibilities from afar if you have set up a good team.  Ask for regular updates from the clinical caregiving team, either by email or phone, and hold them to it.  It doesn't have to be a long and involved update, but just enough to know that all is well. 

If circumstances change, and the patient is requiring more attention, it may be helpful to hire a geriatric care manager or a patient advocate to oversee the care.  By hiring someone to be your "eyes and ears," it provides you with some peace of mind as well as a specially-trained resource to captain the team.