Connecting With Nursing Homes: Making the Most of Visits
Caring for an aging relative from a distance, whether across the state or across the country, is a challenge
faced by increasing numbers of adults the world over. In the United States, we often assume that families
are separated when children go off to college and relocate to the area of their schooling, or when adult
children pursue careers in other towns or states. While this is true to some extent, more and more
frequently, it is the older relative who moves, to enjoy retirement in another climate, to relieve themselves
of the responsibility of homeownership, or be closer to an adult child.
If your family is separated, for whatever reason, and you provide even a small amount of care (e.g.,
advice, concern, or emergency help) for an older relative from a distance, you may be experiencing
anxiety, stress, and/or guilt about your role. It is likely that, in addition to your caregiving responsibilities,
you must also meet the needs of your spouse, children, and career. And when did you last take time for
Although long distance caregiving can be stressful, it need not overwhelm you. There are some basic
steps you can follow to assess your aging family member's needs, put systems in place to help him/her
remain as independent as possible, make good use of visits with your elder, and create and fine tune a
care plan that works for everyone involved.
Assessing Needs From A Distance
As a caregiver, you probably understand that people experience changes and limitations as they grow older. Many of these changes may be a source of concern for you, but quite often the person experiencing the changes adjusts to them beautifully. It may mean that your older loved one may be willing to put up with minor inconveniences in order to maintain independence. So, if things don't seem perfect, be sure they require your attention before you intervene.
Initially, you will probably assess your elder's situation over the telephone. Regular phone calls can be
brief yet informative if you plan the conversation ahead of time and stay focused. A gentle yet persistent
approach, using a pleasant conversational tone of voice, can get to the heart of concerns you may have
about an elder's physical, mental, or emotional well-being. You can then put the informaion you uncover in
such "telephone assessments" in context with what you know about your aging family member's condition
from his/her physician, your most recent visit, the medications s/he is taking, recent life events, and other
You can even make a simple chore like a trip to the grocery store into an adventure. For instance, you
might talk about where the products on the shelves are primarily eaten. Explain that tortillas are common
in Mexico, spaghetti is a favorite in Italy, and Gouda cheese comes from Amsterdam. When you get home,
you might locate these countries on a map together. In this way, an ordinary trip to the supermarket can
be made appealing and even educational.
You may find that many people are willing to help, but don't know how. Consider asking your elder's
helpers to do one or more of the following:
Be sure to provide your elder's helpers with your home and business contact information, and encourage
them to call you collect whenever necessary. Remember, too, that other family members and friends can
help, even if they aren't nearby. You might ask more distant relatives to assist with such things as sorting
and processing financial or insurance paperwork, or calling to arrange services for the elder.
Of course, even if you could manage to care for your aging family member entirely from a distance, you may
still want to visit. As a long distance caregiver, however, such visits necessarily will be more than social,
and may, in fact, come about suddenly and/or unexpectedly. Although not easy, there are ways to manage
both emergency and non-emergency visits with minimal stress, disruption, and expense.
Should You Stay Or Should You Go?
If, however, you are not dealing with such a clear crisis, there are a number of things to consider in
determining whether or not an in-person visit is necessary. While it is true you will need to rely on your
older relative's perception of the situation to some extent, you can balance his/her input with that of
others, as well as what you know about your elder in general. Think about the following:
On the practical side, determining if or when to visit in a non-emergency situation might include
consideration of the following:
As a long distance caregiver, it is normal to experience a certain amount of stress and anxiety. Try not to
compare yourself with others, or burden yourself with a lot of "shoulds" and "if onlys." Only you can
balance the needs of your older relative, your family, your career, and yourself.
Planning To Care
Although you have been making regular assessments of your older relative's situation and needs via the telephone and informal support network, it is important that you confirm the major concerns you have identified are really the most important ones. During your visit, you will have the opportunity to observe a great deal about your elder's situation, such as:
In addition to observing, you will want the input of other concerned family members into the development
of a care plan for your elder. A family meeting, including the older person, can be a very effective way not
only to brainstorm possible ways to provide care, but also to ensure the cooperation and support of others.
All major concerns should be addressed at the family meeting, with as many relevant people present as
possible. Your elder's participation is very important, and provides an excellent opportunity for everyone
else to find out what s/he wants. Conversation about sensative topics may be difficult, but is crucial to
creating a good care plan. After addressing such issues as housework, transportation, meal preparation
and companionship, the group can begin to determine how the older relative's most important needs can
best be met. Each family member can take on specific tasks; any unmet needs can be addressed by the
informal support network, or by retaining professional services. Remember to set up a system whereby you
can monitor the care plan, often at first, and then less frequently once you are comfortable that the plan is
Of course, the best laid plans do go away, and there are many reasons why even a good care plan
may need adjustment. Perhaps helpers you rely on to provide services to your older relative prove less
than reliable, or maybe your elder will not accept the help you have arranged. Most importantly, the needs
of the older person will change over time. Emphasize with your support network that you want to be kept
informed of any changes in you aging family member's situation so that you can adjust his/her care plan
Caring For You
Resources For Further Information
Lustbader, Wendy, and Nancy R. Hooyman.
Material in this InfoSheet was excerpted with permission from Long Distance Caregiving. We
gratefully acknowledge the author and publisher for their generosity in making this valuable information
For more information or a list of other Heritage Planning educational materials on helping your parents, contact:
Richard Smith or Roger Erickson