It is the growing dilemma of our age. In an increasingly mobile society, grown children seldom live down the road from Mom and Dad, and often they’re more than a time zone away. Of the estimated 25 million Americans who serve as caregivers to an elder, more than a quarter are doing it long distance. And that number is expected to grow as more baby boomers take on the heart-wrenching task of mothering and fathering their parents. Today the array of services available to seniors is dazzling, from home health aides to community-living facilities. The choices may seem overwhelming, but as offerings increase, so do the resources for sorting them out.
Instead of nursing homes, seniors are increasingly choosing either assisted-living facilities or continuing-care retirement communities (CCRCs). The former, which charge anywhere from several hundred to several thousand dollars a month, offer residents meals and housekeeping and help with basic tasks, such as dressing and bathing. CCRCs offer a wider range of living choices, enabling tenants to move from apartments to nursing facili- ties within the same complex. They’re pricier, too: for a one-bedroom apartment, entry fees alone run as high as $87,000, with monthly rents of $1,000 and up.
Despite these options, many seniors–even those confined to wheelchairs–prefer to stay in their own homes. As a result, home-health-care services are booming. The number of certified home-care agencies has nearly doubled since 1989; but many others lack any certification, and state regulations governing them vary widely. Even with the best intentions and regular phone calls, it’s difficult to monitor the quality of care. A recent federal audit, for example, concluded that 40 percent of home visits paid for by Medicare were unjustified. ““There’s a wide margin for fraud and abuse,’’ says Donna Wagner, author of the National Council on the Aging’s recent study ““Caring Across the Miles.''
When Matthew Jampol’s 76-year-old mother was released from a California hospital two years ago, Jampol, who lives in Florida, took the hospital’s recommendation for a home-care worker. But when Jampol visited her several months later, he found ““the place was dirty, the food was rotting and she didn’t look good at all.’’ So he turned to a so-called geriatric-care manager (GCM), an on-site family proxy who can arrange and oversee services. Jampol’s choice, Senior Care Management of Beverly Hills, Calif., selected a competent home caretaker and even persuaded Mrs. Jampol to attend a senior-day-care program. ““She’s happy and enjoying life,’’ says Jampol.
GCMs don’t come cheap. Their fees range from $50 to $150 an hour. ““Geriatric-care managers are a bridge to information,’’ says Wagner–““but they’re a toll bridge.’’ Still, they are a godsend for many families who feel guilty that they’re too far away to offer their parents much more than emotional support. Mary Barringer, a GCM in Springfield, Ill., recently helped a 90-year-old woman make a flight from Chicago to Atlanta for her granddaughter’s wedding. ““We’ll shovel the walk; we’ll get the house painted,’’ she says. ““Whatever needs to be done, we’ll do it.''
Unfortunately, GCMs are not licensed, and their backgrounds are divergent. ““There are shysters out there, hanging out shingles,’’ says Elizabeth Bodie Gross, president of the National Association of Professional Geriatric Care Managers. To avoid getting duped, check with the association first. All members are human-services professionals and abide by a code of standards. You don’t have to hire a private manager to get good help. Every state has an Area Agency on Aging (AAA), offering references on everything from housing to lawyers. A national service, Eldercare Locator (800-677-1116), provides local AAA referrals. All it needs is a ZIP code. There are also a growing number of support groups for families caring for an elder.
The key to long-distance care is mapping out plans early. Experts warn against putting off painful discussions. ““The worst time to do the planning is when there’s a crisis,’’ says Donna Wagner, ““but that’s what typically happens.’’ Start talking to parents while they’re still alert and mobile. Ask how they feel about retirement communities, since many have waiting lists. Untangle their finances. Meet their friends. Seek out services in their neighborhoods.
Once you and your parent have agreed on a plan of action, it is possible to monitor even the most routine activities from far away. Linda Ziskind of Bakersfield, Calif., used to feel guilty about living so far from her mother, Ellen Kagan, in Boston. But with the help of local services, Ziskind arranged for a home-health-care aide, an adult-day-care program and a meal-delivery system. At home in California, Ziskind has the telephone number of every key person in her mother’s life. She keeps a calendar filled with her mother’s appointments, so she knows when she’s at the doctor or the hairdresser. Her mother’s bills are sent directly to Ziskind to ensure they get paid. When Kagan needs new clothes, Ziskind gets duplicate catalogs and the two shop together by phone. It’s a lot of work, but Ziskind prefers it to the constant worry. ““I feel so good now,’’ she says. ““I really did it.''
Even the best care won’t work if the person who needs it resists. Include parents in the decisions that will affect them. Some other tips
Get referrals: Call your parent’s state agency on aging or a national group like the American Association of Retired Persons.
Do backgroup checks: Ask home-care agencies if they’re licensed; request inspeciton reprots from nursing homes
Tap the grapevine: Before buying into any service, talk to other clients with needs similar to your parent’s.
Plan a visit: don’t act on secondhand information. Meet the home-health-care worker, or tour the assisted-living site.
