For years, one of Edna´s* favorite pastimes was to feed the residents of her small hometown´s Jewish Old Age Home. She felt good about volunteering and took great pleasure in keeping in touch with the residents – many of whom were friends and neighbors who could no longer live on their own. When a serious fall prevented Edna from living independently, she was transferred from the nearby hospital into the same Home where she had volunteered for more than a decade.
Edna was so familiar with the facility and its residents that she felt right at home. She also had sisters-in-law and several cousins in town. Months into her stay, however, both of her daughters, who lived 120 miles away in New York, decided it was only right that their mother move in with one of them. After all, they thought, how could they in good consciousness shirk their responsibility as daughters?
With little say in the matter, Edna left her hometown of 80-plus years to move to her daughter´s house in Brooklyn. Although she was now able to see her several grandchildren often, she missed the friends and relatives she left behind. She was absolutely miserable, and died a lonely woman.
Edna´s daughters´ dilemma is not uncommon. With people living into their mid-80s, on average, and sometimes well into their 90s, they need more care. Yet their children often live far away, necessitating long-dis-
tance caregiving. Indeed, the challenges and stress of these circumstances affect the lives of seven million Americans, many of whom are entering their senior years themselves.
The Goldbergs* are a middle-aged couple residing in Baltimore with seven children, aged 11 to 30. Until a month ago, they had been sharing the care of Mr. Goldberg´s elderly parents, who lived in Florida, with his siblings in Baltimore and New York,.
“Before my in-laws moved to an assisted living facility in Baltimore, they were in their home,” notes Mrs. Goldberg. “They had aides round the clock, who did all the cooking, shopping, and medication management. As my in-laws were becoming more and more dependent, I would say that one of the most challenging and worrisome issues had been managing their medication. We were checking up on their meds when we visited, but that was only every couple of weeks; a visiting nurse came in once a week to check on the medication. There were medical crises that could have been averted or at least mitigated had we been there on a daily basis.
“Another difficulty of long-distance caregiving is managing the financial situation,” continues Mrs. Goldberg. “We had hoped my in-laws were managing everything but we were really not sure. Luckily, my husband´s siblings were also active participants in trying to manage all this.”
What advice does Mrs. Goldberg have for those who find themselves in
her former long-distance caregiving situation? “Try to convince your parents to move closer to at least one child while they are still healthy and well. We did try for years, but my inlaws did not want to move. We feel more sure that they are safe, now that they are near us.”
Shloimie Kreindler, president of Adir Healthcare in Baltimore, says his agency offers peace of mind to distance caregivers by providing quality home health care for their homebound loved ones. His staff comprises certified nursing assistants (CNAs) and geriatric nursing assistants (GNAs), licensed by the state of Maryland.
“A large percentage of my clients have children and other loved ones who live in the New York-New Jersey area, and even out of the country, in Eretz Yisrael and Canada,” notes Mr. Kreindler. “Some of their distance caregivers have young children, so they cannot conveniently get here. They wish they could do the shopping; they wish they could sleep close by their parents; they wish they could bathe them and take them to the doctor. However, because of familial and or work obligations, they are unable to be here as often as they wish. Our entire staff is quite familiar with kashrus, Shabbos, and Yom Tov, providing additional peace of mind for their distance caregivers.”
Mr. Kreindler offers this preliminary advice to family members who need to entrust their loved ones to the care of paid home health care assistants: “Before you allow someone into your home or your loved one´s home, do a background check. The best thing is to hire someone who comes personally referred – by a family friend, for example. Or go with an agency that has done the investigation and criminal background check. Just because you see an ad in the newspaper or a flier in a store, it does not mean this person is okay to use. Your loved ones´ lives are at stake.”
Rabbi Dr. Tsvi Schur, a Jewish chaplain at Johns Hopkins Hospital and former coordinator of the nowdefunct Jewish Hospice program, shared his own family´s challenging personal experience, in addition to his professional advice. His 91-yearold father-in-law lives in an assisted living facility in Chicago with a fulltime caregiver. “While my son and sister-in-law live there, it´s hard on my wife here in Baltimore. She calls her father every day and visits when pos-
sible. In general, while being in another city is very difficult, depending on the mental capacity of your loved one, it is very important to let them know that you are very involved. For someone ‘totally with it,´ sending ‘thinking of you´ cards can brighten up their day or, at times, make them miss you more; but if it lets a loved one know that you are thinking of him, all in all, it´s important for you to do.”
Susan Weikers Balaban has been a long-distance caregiver to her mother for several years. She lives in Philadelphia and makes daily phone calls and periodic visits. But she relies on her sister and brother in Baltimore to look in on their nonagenarian mother, who resides in Levindale Hebrew Geriatric Center and Hospital.
“Although we are only 100 miles apart, there is the sadness of not being present for all of my mother´s
activities and not being able to share all of the joys of celebrating life on a daily basis,” says Susan. “Although I share the responsibility of being with her with my sister, brother, and other family members and dear friends, I am totally responsible for her financially, which I consider a privilege, given what she has meant to me and to all of us. My Mom is 99 years young and has clearly outlived her finances.
“I am fortunate to be able to own an apartment in Baltimore, the city of my birth, so I have adjusted my life to spend time with my Mom several times a month, and it also is an opportunity for me to be with dear friends,” continues Susan. “My best advice to caregivers who live far away is to plan time to not only feel responsible but to share the fun and joy of having a parent in your life. That is my gift, and I am grateful.”â—† © Margie Pensak 2013
*pseudonym
TIPS FOR LONG-DISTANCE CAREGIVERS
By: Margie Pensak
Keep a List of Important Resources
Create a list of the address and phone number of friends, neighbors, doctors, rabbanim, and others who can be reached in an emergency. Give a copy to your parent one and keep one yourself.
At least one person on this list should be someone who can easily check on your loved one. Consider giving this person a key to the home, if your loved one approves. Talk to neighbors who might be able to help your parent with shopping, transportation or visits and add them to the list.
Organize information before a crisis. Have the following records handy:
â—† Medical record and notes on their condition
â—† All medications taken
â—† Names and phone numbers of all doctors
â—† Name and phone number of their pharmacy
â—† Insurance policies: carriers and account numbers
â—† Phone numbers for utilities, including electric, phone, cable, and internet
â—† Financial information, including all assets and debts, yearly or monthly income and expenses, and a statement of net worth
â—† Account numbers of bank accounts, other financial holdings, and credit cards
â—†Legal documents (i.e., wills, advance directives, trusts, powers of attorney)
â—† Location of important documents (i.e., birth certificates, deed to home)
â—† Social Security number
When Visiting
Enjoy your time with your parents or loved ones. Happy, positive experiences are important to their health and well being. At the same time, take advantage of the visit to assess their needs and schedule appointments. Take note of anything out of the ordi-
nary. See what they are eating. Is there enough food in the house? Go out to buy food and household items, if necessary. Go through mail and old papers. Inspect for safety hazards, like loose rugs, missing handrails, or poor lighting.
Check if your parent´s daily needs being adequately met. Are they:
â—† Socializing with friends and relatives? Attending religious services or other regular events?
â—† Keeping up with chores and housekeeping?
â—† Maintaining personal appearance and hygiene?
â—† Eating well with a variety of foods in the house?
â—† Responding to correspondence insurers, banks, and others?
â—† Paying bills and balancing the checkbook?
â—† Scheduling and getting to doctor appointments?
â—† Getting out to the store or recreational activities?
â—† Taking medication as directed?
Community Services
If your loved one is faltering in any of these areas, he or she may need more help on a regular basis. Here are some services of Baltimore´s Jewish community:
â—†CHAI senior home repair program: 410-500-5316
â—† CHAI´s Northwest Neighbors Connecting matches seniors with volunteers: call Risyl Edelman, 410-662-6620.
â—† Jewish Community Services senior resources program: www.seniorresources.jfs.org, 664-6914.
â—† Bikur Cholim has various services, including rides to medical appointments: 410-999-3700.
â—† Senior Kollel at Machzikei Torah: call Rabbi Nachman Klein: 410-358-5365.
If more care is necessary, private geriatric care managers will assess your loved one´s needs and set up a plan for care. Some employers pay for these services, or they may be covered under a long-term care insurance policy. For a list of local professionals, visit the National Association of Professional Geriatric Care Managers or the National Association of Social Workers.
You can find government-funded programs by using the Eldercare Locator feature on AARP.org. Check out their services, application process, waiting lists, and fees.
Use the AARP.org´s Benefits QuickLINK to find helpful state, federal, and private benefits programs for which your parents might be eligible that can help them save money and cover costs of everyday expenses.
Some communities have a Carrier Alert Program, in which mail carriers or utility workers are trained to spot and report concerns, such as accumulated mail or trash. Contact the local post office to see if this program exists in your parent´s area.
Communicate
It is a mitzva to relate to parents with kavod (respect). If they do not want strangers in their home or are having trouble facing change, be patient and positive. Explain how the services will work and how they will help them remain independent. If possible, offer to contribute to the cost of care without appearing to offer charity. If your parent does not accept your suggestions, he or she may agree if they are recommended by a third party, like a doctor.
You
To reduce the stress of long-distance caregiving, accept that it is impossible to provide everything your parent needs. Ask for help, if necessary. If other family members are not doing their share, consider a family meeting to resolve issues. Give yourself credit for your efforts to determine needs, coordinate services and offer support by phone and occasional visits. Take care of your own needs. Eat right, exercise, and get enough sleep.â—†
