Editor’s note: The Caregiving Chronicles blog has partnered with Century Health Systems to bring additional expert information and advice to the MetroWest caregivers we strive to serve at CaregivingMetroWest.org. Century Health Systems, the parent corporation of Distinguished Care Options and the Natick Visiting Nurse Association, has allowed Caregiving Chronicles to get some valuable insight from its staff for our ongoing series of Q&A sessions with caregiving experts.

In this entry, we discuss long-distance caregiving. While we would like to be on hand to help the loved ones we’re caring for in person, that isn’t always possible. But there is still plenty you can do, even from afar. We’ll cover some of the ways you can help, some of the challenges you may face and what you should do to best care for a loved one from a distance. Providing insight is Judith Boyko, MBA, MS, RN, who has served as the CEO of Century Health Systems since it was established in 2001.

Boyko holds a Bachelor of Science degree in Nursing from the University of Pittsburgh, a Master of Science in Public Health from the University of Massachusetts, Amherst and a Master of Business Administration from Clark University. She has been recognized by the Home & Health Care Association of Massachusetts as Manager of the Year in 1997 and received the Deborah Blumer Community Health Leader Award from the MetroWest Community Health Care Foundation in 2007. She can be reached at info@natickvna.org or 508-651-1786.

Caregiving MetroWest: What are some of the things you can do to help care for a loved one even if you live far away from them?
Boyko: Here are some of the ways you can help as a long-distance caregiver:
•    Communicate regularly with your loved one – by telephone or Skype or FaceTime, if you and your loved one have that capability via computer.  Maintaining connection is important for your loved one’s well-being, as well as your own peace of mind.
•    Arrange with someone geographically close to your loved who can physically check in on your loved one and act as an emergency contact, should that be needed.
•    Assess your loved one’s living conditions and arrange for in-home supportive care as needed:  services such as home care aides, homemakers, companions, chore workers, and/or volunteers from local religious organizations, service groups, etc. who could assist with things such as housecleaning, food shopping, meal preparation, errands, mail and bill-paying, outdoor home chores, e.g. snow-shoveling, leaf-raking, etc.
•    Make sure your loved one’s health needs are being taken care of:
– Make sure your loved one has designated Health Care Proxy and Advanced Health Care Planning documents in place.  These need to be in writing, signed by the appropriate parties, and shared with your loved one’s health care providers.
– Check with your loved one’s physicians’ offices to see when routine and/or acute appointments have been made; follow-up as needed
– Make sure transportation is available for any medical/dental appointments
– Consider referral for home health nursing, if there are specific on-going health problems that need to be addressed, e.g. medication management, vital sign monitoring, etc.

CGMW: How can long-distance caregivers coordinate with and help others who are caring more directly for their loved ones?
Boyko: Here are some some things to consider for that:
•    Make sure that any volunteers, neighbor-helpers, emergency contacts, and other care and/or service providers have your contact information; maintain regular contact with them.
•    If possible, designate one person who will be the “health care contact,” who will stay connected to all of your loved one’s health care providers.  This individual’s contact information should be shared with all health care providers and any necessary written permission to share Personal Health Information (PHI) needs to be documented, to meet requirements of HIPAA.  This individual can share information with other designated family members as needed.

CGMW: Are there any new technologies or devices that can help the long-distance caregiver?
Boyko: There are quite a few technological advancements that can help long-distance caregivers, including:
•    Using Skype and/or FaceTime to communicate directly with your loved one, and/or other care providers, emergency contacts, physicians, etc. who have this capability
•    Use of tele-monitors, via home health care organizations or physician practices, which can transmit daily vital signs, weight, certain blood tests, etc. to the designated health care provider.  This technology can help keep your loved one’s chronic health condition under control:  maintaining medication management, detecting changes in vital signs quickly, so that timely intervention can take place – often avoiding trips to the MD office and/or emergency room at the hospital.
•    Smart phone/notebook/tablet apps that can assist caregivers and their loved ones to share health related information

CGMW: What should you do or look for when you are able to visit with the loved one you’re helping to care for from a distance?
Boyko: Here’s a rundown of some of the most important things to consider when you visit your loved one:
•    Check out the living situation/home environment for:
– General safety (use of grab bars in bathrooms; removal of items that could cause falls, e.g. scatter rugs, clutter, power cords, furniture placement; interior and exterior lighting; etc).
– Interior temperature (adequate heat/cooling)
– General repair or maintenance issues (plumbing, heating/cooling system, electrical system; etc.)
– Exterior condition of an owned home:  roof; gutters; landscaping; insulation/window conditions; etc.
– Status of food and water supply, to ensure proper nutrition and adequate hydration; arrange for home-delivered meals, if needed
– Loved one’s ability to handle finances:  bill-paying; banking; etc.; arrange for this to be accomplished by someone responsible, if your loved one cannot do it.
•    Check out your loved one’s general health and ability to handle activities of daily living:
– Personal hygiene:  bathing, grooming, dental care, etc.
– Laundry
– Grocery shopping and meal prep, including use of stove and other appliances
– Getting around the home and/or outside safely with/without use of assistive devices
– Medication management; arrange for home health assistance if needed
– Accompany your loved one on Medical and Dental appointments; arrange for same if needed, including any transportation
– Hearing and Vision:  arrange for evaluations, follow-up for needed hearing aids and/or eyeglasses
•    Evaluate your loved one’s social support system:  neighbors, friends, church/synagogue, community resources and volunteers, etc.; assist with connecting social supports for your loved one
•    Investigate the availability of geriatric care management services, which can assist you in coordination of all health/social services for your loved one
•    Assess your loved one’s ability to drive, if they still have a license and a vehicle for their use; if their driving ability is questionable, arrange for other transportation

CGMW: What other ways are there to keep in contact and stay aware of what is going on with your loved one?
Boyko: Here are some other ways to stay on top of how your loved one is doing even when you cannot be there:
•    Maintain contact information (address, telephone, email, etc.) for your loved one’s neighbors, friends, religious organizations, community volunteers and keep in touch with them regularly
•    Share your communication information with your loved one’s health and social contacts
•    Connect regularly with your loved one and his/her health and social contacts, using appropriate means of communication, e.g. “snail mail,” telephone, email, Skype, etc.
•    If your loved one is living in a Continuing Care Retirement Community (CCRC,) Assisted Living Facility (ALF,) long-term care facility, or other non-single residence, connect with staff at those facilities on a regular basis

CGMW: What can or should you do if your loved one requires more support than you can offer from a distance?
Boyko: Here are some ideas for getting the additional help your loved one may need:
•    Speak with your loved one’s physician, to arrange for home health care if needed; check on any insurance, Medicare/Medicaid coverage for this care
•    Arrange for other services as needed:  homemakers, home care aides, companions, chore service, social services (to assist with securing food stamps, home-delivered meals, transportation, counseling, etc.)
•    Explore other living arrangements, if/when it is no longer safe or healthy for your loved one to remain independent at home, e.g. CCRC, ALF, long-term care facility, etc.

CGMW: Is there anything else a long-distance caregiver should know?
Boyko: As every caregiver knows, there is always more to do or learn. Here are a few things to keep in mind:
•    Remember to take care of yourself:  don’t hesitate to utilize other helpers and your loved one’s health and social support system
•    If you have other family members that can assist you, make sure you are all involved in making plans for your loved one and in providing “fair-share” care and support of your loved one.
•    Make sure that there is one person assigned to handle all health-related issues; have that individual maintain contact with all other family members
•    If needed, arrange for Power of Attorney status for appropriate individual(s) for both health and financial issues

•    Enjoy each visit; if possible, arrange to do something special or meaningful for your loved one.  As a long-distance caregiver, you need to consider “quality vs quantity” when it comes to visiting.

For further information about long-distance caregiving, please check out the section of our InfoCenter dedicated to that subject.