Family Caregiving From a Distance: How to Make It Work

When his elderly mother went into the hospital with a gallbladder condition, Tim Ingram^* stayed with his father for a week to help around the house. Because he lives more than 100 miles away, Tim’s previous visits home had always been for a few hours at a time because he had to get back home to his job as a schoolteacher.

It wasn’t until the week when his mom was hospitalized that Tim realized how challenging life had become for her and his dad. Their mobility issues had been making it difficult for them to leave the house and do chores like grocery shopping. Plus, his dad no longer wanted to drive because his legs bothered him, and Tim discovered he had been canceling doctor appointments because of it. “I had no idea basic tasks had become overwhelming for them,” says Tim. “I was extremely concerned. I knew I had to do something fast. But I also realized that my parents needed to feel in control, and I understood that. We had to find a solution that would get them the care and support they required and make them feel comfortable.”

Signs That Your Loved One Needs Help

Like Tim, 11 percent of caregivers live one or more hours away from their older loved one, according to a 2020 report from AARP and the National Alliance for Caregiving. This can create logistical and emotional challenges, especially if the distance is far enough to require a plane ride instead of a drive. Being far apart can make it difficult to know if and when your parents need help—and how to get them that support when you can’t be there.

First, you have to figure out if care is needed. “Children often don’t hear about it when their parents are having difficulties,” says Amy Seigel, RN, BSN, a Certified Care Manager and the CEO and General Manager of Advocare, a professional care management company that is part of TheKey. “The parents know they’re struggling, and they don’t necessarily want to talk about it because they are afraid of burdening their children or being asked to move out of their home and into an assisted-living or nursing-home community.”

If your parents are like most older adults, you’ll need to do some investigating. There are a number of clues to look for—whether you’re visiting your parents or connecting with them over the phone, says Seigel. This is what to be on alert for:

Red Flags That Signal Your Parents Might Need Help

Look for these signs when you visit them:

Unusual behavior: Compare what your parents are doing now to what they did in the past. For example, maybe your mom has always prided herself on looking her best, but now she’s not styling her hair or putting on makeup, or perhaps your dad always made a point of going through the mail daily, but now it’s piled up on the counters.

Difficulty with medications: You know your mom needs to take her pills every morning, but you see that they’re still sitting in her pill organizer, or perhaps she seems confused about her prescriptions in general or can’t keep track of when to take them.

Poor hygiene: Dad doesn’t seem to be showering or brushing his teeth very often. He may look unkempt, need a haircut, or even smell bad.

Financial disorganization: Bills are sitting unpaid on the kitchen table, or you find an overdraft notice from the bank. When you try to help your parents get caught up, you discover their accounts are in disarray, or you notice checks made out to questionable charities on their bank statements.

Memory issues: Your parents forget about pots cooking on the stove, or maybe they keep asking the same questions or repeating the same stories. It’s one thing to lose track of car keys—but when your parents keep forgetting where they parked the car, there may be a real problem.

Kitchen cupboards are bare: There’s not much food in the refrigerator—or what’s there is old, moldy, or rotten. Give anything questionable the sniff test and check for best-used-before dates, then toss what’s no longer safe to eat or past its prime. And do a quick review of expiration dates on cans and packages in the pantry, too.

Lack of interest in meals: They might skip eating and say they’re “not hungry right now,” or that they ate earlier. Ask what they’ve eaten that day. It may be that food no longer smells or tastes good to them (also, loss of the sense of smell can be a warning sign of dementia). And if they can’t remember what or if they ate earlier, that’s a warning sign, too.

Trouble sitting, standing, or getting out of chairs: You see them struggling to get to their feet or they hesitate, seeming weak, fearful, or insecure when trying to sit down.

Unsteadiness when walking: They have an unstable gait or trouble keeping their balance, or you notice bruises indicating that they might have fallen.

Missed doctor appointments: When you ask about their last appointment, they’re vague and try to brush it off, or they say the doctor canceled and needs to reschedule.

A messy house: It always used to be neat, but now it’s untidy.

Car dents, scratches, and dings: The damage could be caused by a vision problem, which can be corrected with an eye exam and updated prescription. But if frequent dents, scratches, and dings are occuring while driving, it can also indicate a decline in their spatial perception—often a sign of cognitive impairment or dementia.

How to Tell Over the Phone If Your Parents Need Care

It’s difficult when you can’t be there in person, but there are clues you can listen for when you speak to your parents by phone, such as:

Forgetfulness or memory issues: They ask the same questions or tell you the same stories more than once in the same call, or they forget basic facts like their friends’ or grandchildren’s names.

Evasiveness: When you ask about certain things, like whether they’ve filed their taxes or if they’ve been to the dentist lately, they seem to be uncomfortable and change the subject.

They never mention outings: You rarely hear about them going to church, out to lunch with friends, or meeting with their book group. When you ask, they may have an elaborate story about why they’re home more. But the facts don’t quite add up.

They have difficulty hearing or comprehending you: Your parents keep asking what you just said. This could be a simple hearing problem, but it could also be difficulty following the conversation, which may indicate a cognition problem. A visit to an audiologist or a neurologist might be in order to diagnose the problem.

They’re very quiet or they just don’t sound right: Go with your gut. If you have the sense that something is wrong, it very well may be. A visit to their primary care physician for an exam can help them get the care they need. Isolation among older adults is a common problem that can lead to loneliness and feeling down, especially when someone lives alone.

6 Steps to Getting Your Parents the Right Level of Help From Afar

“If you see signs that indicate your parents need help, it’s imperative to take action and get them assistance right away before problems escalate,” Seigel strongly advises. Here’s how to set the process in motion.

Step #1: Talk to Your Parents

Sit down with your mother and father and tell them what you’ve noticed. Ask them about their needs and wishes, and discuss the different options together. Do they want to stay in their home with help to assist them, for instance? Would they prefer to move closer to you? It’s extremely important to involve them in finding the right solution. If they are resistant to help, explain that having a plan in place can help them remain independent. [RELATED: How to Get a Parent On Board with Home Care When They Don’t Want Help]

Step #2: Make a Plan

If you have siblings, meet with them via conference call or Zoom and, with your parents’ input, work out a plan of action. For example, perhaps the person who lives closest to your parents can start visiting them once or twice a month or whatever is realistic for their schedule. The rest of you can take over other responsibilities to help share the load. One person can take on bills and finances, another can handle medical care like doctor visits and lab tests, and a third can find and hire services for home maintenance, lawn care, and snow removal. If you don’t have siblings, consider involving other family members like aunts, uncles, cousins, or even your adult children.

Step #3: Consider Going High-Tech

Decide if a remote monitoring system with a camera like the Nest Cam or Lorex Elderly Monitoring Solutions could be of help so that you can check in on your parents regularly to make sure they are safe, even if you only put one camera in the kitchen and another in the living room to start. You’ll need to have a discussion with them about it, of course, and get them on board.

Step #4: Safety-Proof the House

Do a thorough safety assessment. Walk through every room of the house, including the garage and entrances and exits where there are steps. If you can’t do this in person, hire a local professional to do it. Look for potential fall risks, insufficient lighting or light bulbs that are out, and focus on places in the home where transitions happen—getting up and out of bed, getting into the tub or shower, going up or down steps or stairs. Then install safety equipment like handrails in hallways, grab bars in bathrooms, and motion-detecting lights for when they get up at night.

Step #5: Get Some Backup

Speak to neighbors you trust and ask if they can stop by your parents’ house once a week or so. Give them your number and have them call you if they notice anything worrisome. For example, maybe they haven’t spotted your parents in two days, or the house is unusually dark early in the evening. (In return, you can get them a gift basket, or send them a holiday gift as a thank you.) If you don’t know the neighbors, think about your parents’ wider circle. Do they have friends who would be willing to check in on them weekly? If they belong to a church or synagogue, talk to their pastor, rabbi, or priest about possible home visits.

Step #6: Consider Home Care

This is personalized, nonmedical support and companionship provided by a skilled professional caregiver who is trained to assist people in their home. Home care can range from a few hours a week for errands and housekeeping tasks to everyday assistance with personal hygiene (bathing, dressing, incontinence support); cooking; grocery shopping; medication reminders; cognitive engagement; and transportation to medical appointments, among many other things.

^*Name has been changed for privacy.