LONG DISTANCE CARING
by Emily Carton, LSW
In today's society, it is not uncommon for families to be separated by great distances. But what happens when one or both parents reach a stage in their lives where they appear to be frail and vulnerable? What can you do to keep from living with an enormous amount of guilt and worry, or feeling obligated to sacrifice your own life? Will you become the family caregiver?
This article will offer a few suggestions as starting points for gaining control of the situation. For practical purposes, I will consider that we are talking about one parent and will assume that it is a man.
Begin by having a thorough assessment of your parent's situation. You need to make sure that what you hear long distance from your parent and about your parent matches the reality of the situation. Everyone has different perceptions about how one should live and when one's safety is as risk. Naturally we all apply our own values to what we see and do not live in a time when there is a consensus about the care of our elders. A dirty or cluttered house may not necessarily mean that a parent can not longer live by himself, only that he needs help in caring for his home. It may mean that he is willing to live with lower standards in order to remain at home. If you are uncertain about the situation and potential risks consider an assessment by an outside professional who can offer a more objective evaluation.
A careful evaluation means taking a close look at the physical, emotional, and social well being of the older person to determine what his needs are. For example: is your father able to prepare his own meals? Does he still have friends and a social life? Are his medical needs being taken care? Is he managing his own medication. How safe is his living situation? Is he still able to manage his finances. What is the state of his health? What long term plans need to be made?
Once you understand what the issues are then a care plan can be put in place. Are there people or agencies available to him that can provide him with home delivered meals? Are there senior centers where he can go? Does he have an informal network of people, such as neighbors, relatives, friends, members of a church or synagogue that can look in on him or telephone him? Does he have funds to pay for services that he might need? Is there a friend or a professional that could be an emergency contact? Is relocating to a different environment the best option for him?
There are many issues you need to think about. Clearly, an aging family member causes a great deal of emotional turmoil, guilt, and concern. It is important to remember that if your parent is still able to articulate what he wants, is still found by a physician to have the capacity to make his own decisions, then it is his decision as to where and how to live. Just as a parent needs to let go of an adult child to live his or her life and to take life's risks to achieve what he or she wants, a child needs to give his parent space as well. Unless the parent wishes to move or to receive more assistance he has every right to refuse even if family and friends do not think this is the best decision. All that you can do is make sure he is making an informed decision and to share with him your concern.
If you feel that your parent is not capable of making an informed decision: meaning, that you question whether he can understand fully the consequences of his decisions, then you need to contact his physician for an assessment of his cognitive abilities. This poses different questions about safety and the ability to care for oneself. Yet, in even cases of dementia, there still might be resources available to help keep your parent at home. To do this, unless you are willing and want to be the primary caregiver, you can find a geriatric social worker to assist you in making up a care plan and obtaining the necessary resources. If this is not possible due to a parent's extreme incapacity or limited resources, a social worker can also help you to either relocate him to a safer environment or assist in relocation to a facility closer to you.
The Role of Professionals
Without fully assessing the older person's situation no one can offer you specific options. May I suggest if you are unclear as to how to proceed you find a professional who can fully evaluation the situation and provide a series of options from which to choose. Prior to your next visit to your parent you may wish to locate a physician if your parent does not already have an ongoing relationship with one. You can also contact a social service agency or a private care manager to meet with you and your parent. If there are legal matters you may need an attorney. By trying to locate services prior to your next visit you will save yourself days of searching and waiting for appointments.
There are no simple answers or solutions. Each person's situation is different. Each child has a different relation with his or her parent which may also be a determining factor as to what the level of involvement will be. You need to think not only about your parent's needs but about your needs as well. You can not force services upon a parent who is capable of making decisions and willing to live with some level of risk in order to remain at home. However, if your parent is no longer capable, then you need to act. Even if you notice only a small decline, it is not too early to know what resources are available and who might be able to help. You don't need to do it all yourself. Elicit the help of family members and friends, and if appropriate find a professional who knows the resources and can help you through the maze of decision making. You do not have to face this alone.
Children of Aging Parents 800-227-7294
Emily Carton MA, LISW, is a licensed social worker who works with Elder Options, a private care social service firm in the DC Metropolitan Area. She is also an is an intern in Bibliotherapy at St. Elizabeth's Hospital in Washington D.C.
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