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Rural Caregiver

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Helping From Far Away
By Kate Shuman

Because Americans have become such a transient culture, adult children are now finding themselves having to deal with an ever-growing crisis: taking on the new-found role as long-distance caregiver. A recent study on long-distance caregiving showed that the out-of-pocket expense of caring for an elderly or physically challenged loved one who lives more than an hour away has doubled since 1997. It is estimated that long-distance caregivers spend about $392 a month on phone calls, travel expenses, medicine, medical supplies, meals, and home maintenance, as well as other necessities, compared with monthly expenditures of about $196 seven years ago. Presently, long-distance caregiver’s yearly expenses are more than $4,700, which is roughly the same amount of money needed for a year of community college education. Along with the financial costs, there’s also the cost of time. About 80% of all long-distance caregivers are employed, and of this, at least 44% of them have had to rearrange their work schedules, with the other 36% of them having to miss an average of 20 hours of work each month in order to conduct caregiving duties. These costs may even be higher among those long-distance caregivers who worry about people in rural areas, where it is not so easy to have a community agency check-up on them. How do you not only juggle the caregiving duties of a long-distance nature, but how can you be sure that relatives in rural areas are getting the care that they need? In this case, you’re not only dealing with distance, but you’re also dealing with isolation.

When caring from a distance for a person who lives in a rural area, you must first realize that certain services in these communities will not be as abundant as those in metropolitan areas, due to a much smaller population. However, living in a rural setting can actually have an advantage -  the closeness which exists among the people in these communities is genuine and strong - this can be a very valuable resource. When you visit your loved one in their rural setting, it’s important for you to get to know their neighbors and friends. By engaging with this community, you’ll also be able to make sure that your loved one won’t be isolated when you are unable to be there. Attend as many community events with your loved one as you can, such as fairs or church functions. Check with local churches, community centers, and local service clubs in order to learn about volunteer and support services which may benefit your situation.

Getting a case manager can also help decrease the pressure that’s on you, since they can work with services available in your loved one’s area, like personal support, nursing services that can come to their home, delivery of meals, in-home foot care (important for those with diabetes), as well as help with personal hygiene. When you return to your own home, be sure and stay in touch with the friends and neighbors you’ve met.  Talking to them will make you feel less guilty about not being there, and also less afraid for your loved one’s well-being.

Suggestions regarding other things you can do to be proactive in the care of your loved one, even from a distance include:

Investigate the options for a personal emergency response system for your loved one’s home.  This will allow 24 hour assistance for your loved one in the event of an emergency; it may be a good idea to leave a key to your loved one’s home with a friend or neighbor so that they have quick and easy access to your loved one in case of an emergency; when you’re back on a visit, plan to meet with the care providers involved, and have them bring you up-to-date with your loved one’s progress; create a “communication book” where care providers can make note of concerns or questions for you, then you’ll have the ability to follow-up on a weekly basis; prioritize the tasks that you want to accomplish with each visit; in order to stay focused and less confused on visits, keep a list of people you’ll need to speak with; and make sure that care providers know where and how to reach you, where ever you may be.

Here are some other helpful tips:

Research travel alternatives - be prepared to “care commute” at all times. Investigate travel options in advance. If you’ll be utilizing your car most of the time for these visits, keep your car in good repair, and check on the route and weather before traveling. If you have to rent a car, look for the best rates. Remember, you don’t have to pay for rental insurance if you already carry full coverage, or if your credit card company offers coverage. You may get a discount when buying bus or train tickets if you disclose that it’s an emergency. Know to purchase airline tickets seven days in advance and stay over a Saturday night.

Discuss legal and financial issues - these topics may be difficult to talk about, but they help ensure that the older person maintains decision-making authority even when incapacitated. Preplanning will also lessen family disagreements and protect family resources. Such issues include information concerning a will, a power of attorney, a trust, if there’s going to be joint ownership, is a representative payee needed (a caregiver who receives government checks for an older person unable to manage money), and information concerning Medigap insurance. 

Take care of necessary paperwork - know where to find all legal, financial, and insurance documents, including birth certificates, social security cards, marriage or divorce decrees, wills, and power of attorney before and emergency happens. Also, know where to find bank accounts, titles, sources of income and obligations, and auto, life, homeowner’s, and medical insurance papers. Review these documents for accuracy and update them if necessary. Store documents in a secure place such as a safe-deposit box or a fireproof box. It’s always a good idea to make duplicate copies of everything.

Contact the aging network - contact the local department on aging in your relative’s community. This agency can help you identify helpful services, including obtaining a case worker. Use the National Eldercare Locator Service at (800) 677-1116 to find local aging agencies.

Create a plan of care - if at all possible, try to gather the family together for a meeting with the person who is in need of caregiving. Find out directly from that loved one what their immediate needs and concerns are, and work on getting them the assistance they need. Summarize your agreement in writing among all the family members who are involved. Keep in mind that family difficulties are typical. You may need to bring in a family therapist or social worker to help.

Once you’ve had enough time to really assess what the true needs of a loved one are, you’ll probably be able to create a really solid plan of action and care for them, even though there may be thousands of miles between you. Planning for the future, continually gathering information, and taking care of what’s needed right now are the three main areas of focus for a long-distance caregiver, and while it may be stressful, it’s not impossible, especially if you remember that you don’t have to take this walk alone.


Needs Assessment

  • Help with chores, laundry, yard work and household maintenance.
  • Help with grocery shopping.
  • Need for meals delivered to the home or fixed and served there, with clean-up included?
  • Is help needed with personal care, such as getting dressed or bathing?
  • Do they need transportation to places important to your relative, such as church or social gatherings, the pharmacy and doctors’ appointments?
  • Is assistance needed with medical appointments, and/or consultation with doctors and other health professionals?
  • Do they need assistance with paying the bills, banking, budgeting or other money matters like looking into financial assistance to make ends meet?
  • Is it time to get a referral to an attorney experienced in elderlaw issues?
  • Help with dispensing of medications and ensuring they are taken on time?
  • Have a safety inspection of the house (test smoke alarms, look for uneven flooring, loose rugs, lighting) in order to decrease in-home dangers.
  • Install grab bars or ramps to make the home safer and easier to navigate.
  • Arrange for trips out of the house, perhaps to an adult day care or senior center.
  • Utilize the network of friends and neighbors in the rural community who can make sure on a weekly or even  on a daily basis that your loved one is well.
  • Arrange for additional social visits from friends, family and other care provider volunteers.



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