We're a mobile society. Long-distance calls and visits on holidays and special occasions are often enough to nurture family ties as long as everyone is in good health. But as parents age, these simple contacts are not enough, especially when children take on the responsibilities of long-distance caregiving. This is an increasingly common situation. According to the National Council on Aging, seven million Americans care for parents or loved ones who live more than an hour away.

The responsibilities of long-distance caregiving can seem overwhelming. By dividing your parents' needs into individual problems that you can solve, your situation will seem more manageable. Do they need help with transportation? Many communities offer low-cost van service. Do they need assistance after the death of a spouse? Counseling is often available from specialists who deal with grief. Do they need modifications to their home? Your job may be to find a reliable contractor.

You can find a great deal of information by consulting your parents' local phone book or by finding their community's homepage on the Internet. You might also consider hiring a geriatric care manager to serve as your local eyes and ears and to help you assess and manage your parents' care.

If you’re caught in the middle between your responsibilities to your spouse and children and caring for your aging parents, you’re a genuine member of the sandwich generation. You know the stress of never having quite enough time or energy to give all members of your family the attention you feel they deserve.

Should you attend your daughter’s soccer game or take your father to his doctor’s appointment? Should you go to a movie with your spouse or visit your mom? These decisions are never easy to make.

There’s obviously no perfect answer to dilemmas like these—but there are steps you can take to make it easier for you to balance your family responsibilities:

• Involve your spouse and your children. Share your feelings with them about how important it is for you to care for your parents. Work with them to develop a weekly schedule and do your best to adhere to it. Ask for their advice and support when making decisions that could affect them.

• Understand your parents’ true needs. Learn all you can about your parents’ condition and how you can best help them. Aim to provide the most appropriate care while respecting their independence.

• Nurture your marriage and your important relationships. Make time to enjoy the company of friends and to preserve the romance in your marriage. That’s because these vital connections will remain important even after you complete your responsibilities as a caregiver.

• Give yourself a break. Eat well, stay rested, and exercise regularly. Give yourself credit for doing the best possible job you can do rather than focus on things you haven’t accomplished. Know your limits and give yourself a break when you reach them.

We live in a highly mobile society where family members commonly live hundreds and even thousands of miles apart. When everyone is healthy, regular telephone calls and visits can bridge the distance. When a parent falls ill, the distance itself becomes the dilemma. Across the miles, even such a simple task as ensuring that your parents have transportation to their doctor’s office can become a daunting, time-consuming challenge.

That’s why it pays to put a system in place that can help you provide steady support for your parents and provide a first response in case of emergency.

Here are some steps you can take now:

• Collect all the necessary medical, financial, and legal information. Know the phone numbers of your parents’ physicians and file privacy forms with them so that you can discuss medical matters. Make a note of your parents’ date of birth, social security number, Medicare or Medicaid number, health insurance information, and the dosages of all medications they are taking.

• Investigate engaging a geriatric care manager. These trained professionals can serve as the key to a care network that links you and your parents to the most appropriate, highly regarded community resources. They can also act as your eyes on the scene, keeping you up-to-date on your parents’ situation.

• Get the lay of the land. On your next visit, introduce yourself to neighbors and friends. Have your parents tell you where they keep essential documents and keys. Bring back a copy of their local telephone book.

If you take these few steps, you will go a long way toward ensuring your parents’ safety and your peace of mind.

Find a Geriatric Care Manager
The National Association of Geriatric Care Managers, a nonprofit, professional organization, can help you find care managers in your parents’ community. Visit their Web site, www.caremanager.org or call 520-881-8008. This service is free and without obligation.

For most families, "don’t ask, don’t tell" seems to be the accepted approach to financial matters. But as parents get older, such silence can be costly. When financial reserves grow thin, all it takes is a sudden change in circumstance to upset an otherwise comfortable lifestyle, plunging seniors into debt and adding to the financial burden of adult children with their own families to support.

With a little tact and understanding, however, such conversations are not only possible, but they can bring a family closer together. Here are some simple things you can do to make your conversation more productive:

• Choose your agenda carefully. It might make everyone uncomfortable to discuss assets during an initial conversation. Instead, begin by reviewing the locations of the personal and legal documents that may be needed in case of an emergency.

• Be prepared. Think the conversation through ahead of time, research the facts needed for you and your family to make informed decisions, and bring your knowledge to the conversation.

• Pick a quiet time to talk. Thanksgiving and other traditional family gatherings may be convenient, but they hardly allow undivided attention on such potentially emotional and complex issues.

• Share information. Your goal is to build a picture of your family’s overall finances, so that you can work together as a team.

• Be sure to follow up. Everyone should leave the discussion with a to-do list—and a commitment to meet again at a specific time in the future. Most of all, listen carefully and suspend your judgment. After all, the success of these discussions depends less on individual financial decisions made in the past than on what you decide as a family about your future.

When your parents are ill and can’t attend to their affairs, you may have to step in and represent them. Here’s what you can to ahead of time to be prepared:

• Fill out all HIPAA forms required by insurance companies and health care providers.

• Become a joint owner of bank accounts and safe deposit boxes.

• Have your parents make out a durable power of attorney giving you the right to make financial decisions if they become ill or incapacitated.

• Ask your parents to complete state-specific advance directives, such as a living will or a health care durable power of attorney.

For many years, memory loss and senility were considered part of the normal aging process. Forgetting names and once-familiar faces, confusing dates and addresses were just part of "growing old."

Today, scientific findings show that "growing old" is far too simple a description for these events.

In many cases, confusion and forgetfulness in elderly people stem from a physical cause that can be treated and sometimes slowed. If drug interactions are the cause, a doctor can modify or change prescriptions.

Sometimes, however, the cause for the confusion and forgetfulness may point to Alzheimer's. Alzheimer's is a progressive, irreversible brain disorder that affects an estimated 4 million Americans, most of whom are over 65 years of age (persons with Down Syndrome may develop Alzheimer's disease much earlier).

The Alzheimer's Association estimates that 10% of people over 65 years of age and nearly half of those over 85, have Alzheimer's or some form of dementia. Age is the biggest risk factor for Alzheimer's: 3% of seniors ages 65 to 74 have the disease; 19% of those ages 75 to 84; and 47% of those ages 85 and older. As the population ages, the number of people with Alzheimer's is expected to climb from 4 million today to 14 million by 2050.

Alzheimer's Warning Signs

There are many warning signs for Alzheimer's. For example, memory loss begins to affect daily activities like managing household finances. The individual may become confused, get lost easily, exercise poor judgment, and generally lack a zest for life.

Often a person's memory-troubles progressively increase, and their attention span shortens. The individual may have trouble recognizing friends and family, organizing thoughts and speaking logically. Other characteristics may be that the individual becomes suspicious, may hide possessions, and can be terribly restless, especially in the late afternoons and evenings - referred to as Sundowners Syndrome.

Eventually people with Alzheimer's cannot recognize family members or even their own reflection in a mirror. Even with good nutrition, weight loss will occur along with loss of verbal communication and bowel or bladder control. Ultimately, Alzheimer's is a fatal disease.

Caring for Someone with Alzheimer's

Providing care to persons with Alzheimer's can be particularly difficult; the disease can manifest a wide range of challenging or disruptive behaviors, including aggression, agitation, eating problems, delusions, excessive worry, wandering, and withdrawal.

Dealing with the behavior problems on a day-to-day basis can be very challenging. The caregiver must have patience, often handling the individual in the same manner as that of a child. Instructions need to be extremely clear and detailed, and often need repeating many times. When the person becomes upset or hostile, there is no point in trying to reason with him or her; rather the caregiver can refocus the situation on something else.

At the same time, the person with Alzheimer's is an adult and should be encouraged to be independent to the extent possible. Often, caregivers become overwhelmed with the physical and emotional toll and the need to provide constant supervision. There may come a point when there is a need for more personal care and supervision than the family can provide. When this occurs, it may be time to consider a nursing facility, assisted living facility, or other supportive program.

Housing and Care Options

If you feel a long-term care setting may be needed, try to begin planning well in advance. Discuss the matter with your physician and other professionals; find out the type of services likely to be needed and the various care and housing options available.

Once you've narrowed the field to two or three facilities, make an appointment to tour the facility. If possible, visit each facility at several different times of day. Try to involve the prospective resident in the planning process to the extent possible.

Anticipate that you will have many questions about the admissions process and your feelings and concerns about the future. Discuss this with the appropriate staff at the facility, such as the administrator, director of nursing, director of health or wellness, social worker or admissions director.

The long-term care professional team should be eager and able to help make this transition as calm and positive as possible.

Professional caregivers, trained in understanding persons with Alzheimer's, are knowledgeable in ways of preserving dignity and helping them to live a quality life.

The housing, care and services options available tend to fall into five categories: nursing facilities, assisted living facilities, adult day care, respite care and hospice.

Nursing Facility

Some nursing facilities specialize in caring for Alzheimer's patients; many others have special care units designed to meet the unique needs of these residents. In general, nursing facilities are equipped to take care of people in the later stages of Alzheimer's, and increasingly, facilities are providing a specialty in this type of care and supervision. Look for facilities with staff who are experienced in caring for Alzheimer's patients.

Assisted Living Facility

Likewise, some assisted living facilities care solely for Alzheimer's residents and many others have designated units or wings for these residents. Options and accommodations may vary greatly from one assisted living facility to the next (e.g. private rooms, private baths, kitchenettes, etc.). Personal needs and preferences are important criteria for selecting a facility. Look for facilities with personnel who are experienced in caring for Alzheimer's residents.

Most assisted living facilities allow individuals to stay as long as their physical and mental impairments can be supervised and maintained by the direct-care staff or through contracted services. Many states allow for skilled nursing services to be temporarily provided in the assisted living setting. However, most assisted living facilities do not deliver the level of ongoing health and nursing care found in nursing facilities.

Hospice

These programs provide care and comfort, without using heroic lifesaving measures, to persons dying of Alzheimer's. This service is available through local hospice organizations and many home care agencies, hospitals, nursing facilities and assisted living facilities.

Other Help

Many nursing facilities and assisted living facilities often schedule group meetings to encourage Alzheimer's families to support each other. The Alzheimer's Association has chapters throughout the country that also organize support groups.

Help Is Available

Any form of dementia is a challenge to deal with. However, help is available. You may find comfort and support from people who can help. Here are some information resources:

Alzheimer's Association
919 North Michigan Avenue, Suite 1100
Chicago, Illinois 60611-1676
(800) 272-3900
(312) 335-8700
http://www.alz.org

Medicaid, Medicare and Medigap
(The Centers for Medicare and Medicaid Services)
7500 Security Boulevard Baltimore, MD 21244-1850
Phone: 410-786-3000
http://cms.gov

National Hospice and Palliative Care Organization
1700 Diagonal Rd, Suite 625
Alexandria, VA 22314
Phone: 703-837-1500
http://www.nhpco.org

Social Security & Supplemental Security Income
Social Security Administration,
Office of Public Inquiries
Windsor Park Building
6401 Security Blvd.
Baltimore, MD 21235
Phone: 800-772-1213
http://www.ssa.gov