With the aging population expanding, an increasing number of individuals are taking on the role of caregivers for their family or friends. Whether it involves arranging transportation for medical appointments, assisting with financial matters or household chores, or coordinating hands-on assistance for personal care tasks such as showering, dressing, and meal preparation, caregivers address diverse and challenging needs in the lives of their loved ones. The complexity intensifies for those providing care to someone living far away, presenting additional hurdles like extended travel time, increased expenses, the inability to attend medical appointments, and uncertainties about seeking assistance.
What do caregivers do when they live far away from their ageing loved one? Long-distance caregiving, defined as living more than an hour from the care recipient, can present its own set of challenges. Long-distance caregiving manifests in diverse ways, ranging from handling a loved one’s financial matters and bill payments to extending emotional support. Coping with long-distance caregiving is undeniably stressful and frustrating. Drawing on our experience as social gerontologists adept at navigating such scenarios, here are some valuable tips.

  • Roshan J Mundapallil, Sowmya Lakshmi

In today’s world, families are often scattered geographically, making it challenging to offer the hands-on care we might desire. Navigating caregiving from a distance poses complications, and the role of a long-distance caregiver is undeniably stressful and frustrating. Some children live couple hours away, others live very far away. Sometimes the separation from parents can be transient in nature due to some business engagement or a temporary assignment. In most cases, it is ‘permanent’ in nature, as the children settle in different cities or countries leaving behind the aged parents to fend for themselves. Across the world, more and more people are taking on the role of long distance caregiver to an ageing parent or relative.

In the normal scenario, caregiving can entail a wide variety of tasks—starting with instrumental activities of daily living (IADLs) like providing transportation, grocery shopping, paying bills, or housekeeping, and/or helping with activities of daily living (ADLs) like bathing, assisting with toileting, managing medications etc,. It’s a lot to take on, even on a part-time basis, especially for caregivers who may also have a career and their own children. (Refer Another Article about sandwich generation). Have you ever thought about the plight of long distance caregiving. What do caregivers do when they live far away from their ageing loved one? Social Gerontologists like us define, ‘Long-distance caregiving’, as living more than an hour from the care recipient, which can present its own set of challenges.

We recommend one of the adult child to take the lead and pay a visit with the sole purpose of a definitive action to settle things with the parents. Many times a visit can be emotionally charged and consist only of spending the limited, quality time together. Few others club these visit with other non-essential things. Recently one such ‘child’ coming to visit elderly parents, (mother demented) clubbing the visit as a vacation time to visit Goa with her fiancé. When asked by us, the answer is ‘I’m taking a break’. It is essential, for a long-distance caregiver to be more focused, practical and take care of the caregiving “business” while visiting, to establish robust support systems for after they’re gone. In this article, we teach you to make the most of visits, see the warning signs, and rely on “substitute” eyes and ears while away from an ageing loved one. It is nothing but establishing ‘Foster Care Arrangements’.

We come across many long distance caregivers who fumble and mismanage things for want of a clear idea of how to take it forward. Here also we suggest early preparation which preempt undesirable outcomes. Though our seniors dodge the necessity of planning with regard to health and finances in old age, the adult children must be planning on behalf of them. First and foremost is the “need assessment”.

While visiting the parents, adult children should arrive prepared to take care of bills, (taxes, water & electricity, garbage ) and other standard tasks. Meeting with physicians and specialists is high on the priority list. Again, lawyers and financial professionals are also good resources for family members. Caregivers should not forget to have talks with the neighbors, local friends and other family members who are in touch with your loved one on a regular basis. All such interactions are critical to establishing a safety net around you aged parents and many a times, noticing any changes in a person’s behaviour. These reliable people are on the front line and the best resources for a long-distance caregiver.

You cannot entirely rely on your personal contacts because they themselves are busy and sometimes erratic. So better to study the scenes thoroughly and personally. Seeing changes firsthand will confirm and validate for the long distance caregiver if your parent is in need of more assistance. There are many warning signs a long distance caregiver should be looking for. This why we told, a flying visit is not enough. For a thorough verification and validation of the changed scenario, you need more quality time spend with parents. Some changes are more noticeable than others, and ageing parents are very good at “hiding” changes, in order to protect their independence and avoid burdening their family members.

Let’s go into detail. There are many behaviours to watch you pay attention to. Following is a probable list.

  1. Are you able to notice a drastic weight loss? Weight loss is one of the most prominent signs of distress, both emotional and physical, in an older adult. This may be due to a serious illness such as heart failure, dementia or depression. Also, it shows a lack of energy to cook, even difficulty reading directions or washing dishes after a meal.
  2. Is there food in the refrigerator? Is it spoiled? Is the person eating regular meals? If the answers are in the negative, we must suspect something wrong.
  3. What is the condition of the inside and outside of the home? Has it changed? Lack of interest in keeping the place tidy, shows boredom, depression or lack of energy.
  4. Are the bills paid? Are there piles of unopened mail? Again it points the above mentioned aspects or may be forgetfulness.
  5. Do friends and relatives visit regularly? Even if they visit, is it just ‘courtesy’ visits or with an intention to monitor things. The visits which end in the living rooms has no meanings. It is in no way going to help.
  6. What is the person’s appearance like? Is the person bathing and grooming? This aspect is important. As many elders become very lethargic and try to avoid grooming. Personal hygiene is Important and if compromise on this, the elderly can invite lot of infections.
  7. Is the person still able to drive safely? At a particular age, when the faculties are diminishing, it is inviting trouble. So better ask the parents to avoid driving if you have doubts of your parents ability to manoeuvre. Increased car accidents indicates slowed reflexes, poor vision, physical weakness, or general inability to handle a vehicle.
  8. Is your parent able to differentiate and take medications on their own? Many of the elderly who again having diminished faculties or forgetfulness, may not be able to manage medications. Sometimes they take, skip, repeat or overdose. Elders have poly pharmacy and most of the elders at an advanced age could not differentiate the medicines.
  9. Have you noticed his or her steps? Is it wobbling or very slow? How they walk, bend, and simply move around can say a lot. Maybe they are experiencing pain, limping or wincing with movement. If unsteady on their feet, this behaviour can be a real risk for falls, which leads to more severe complications.
  10. Do you think that the physical structures need some renovation or restructuring? Many houses are not elder friendly. Need modifications to suit the need of the seniors. Stairs become dangerous, as do yards, icy walkways, tile or laminate floors and even wet bathrooms.
  11. Have you noticed any old or fresh injury marks or burns? It again suggests, forgetfulness, weakness or even alcoholism.
  12. While talking, is your parent constant suspicion about persons or events? Extreme suspicion points to an impending thought disorder. It is very common among the elderly that their neighbours, friends, family, doctor, and lawyer are all conspiring against them. It can be even the start of depression.

Inference of all these observations will lead to a conclusion. The million dollar question is he / she able to age in place, and if so, how far. As the age advance, managing a house and staying independently becomes a risky affair. And you being far away, there is this possibility of constant worry, and anytime you can expect an emergency call. If you happen to be one of those long-distance caregiver, you know how difficult it can be to get an accurate handle from afar on how your loved one is faring. Skype and FaceTime may help the children, but it’s still no substitute for assessing and managing a situation in person. Of course, a simple solution would be to either move closer to the ageing loved one or have them move closer to you, but that often isn’t a viable choice. We are against uprooting the parents, or you sacrificing the career. So, if long-distance caregiving is the only or most practical option, institutional care is the best.

If you live inside the country itself but far away by few hours rather focusing on all things, concentrate on the many things you can do remotely. To make work ‘ageing in place’ for the healthy seniors, following tips we suggest.

For example: • Research and find a reputable social gerontology practitioner, and ask to schedule weekly or fortnight visits to your parents home. • Call your parents physician/specialist to get an unbiased assessment of any health issues. Plan periodic health checkup with social gerontologists. • Set up online banking for your parents accounts so that you can manage their bill payments remotely. Better they no longer operate the accounts. • Arrange a food or meal delivery service if it is available in your city or town. In today’s hectic world, there are more and more options available for healthy food or meals to be brought to your doorstep in cosmopolitan cities. It possible to arrack a cook but the logistics can a trouble. • If a sibling or other family member lives closer and is acting as a primary caregiver, ask them to accommodate the parents for a few days as the change of location and routine can be rejuvenating. (This we call as respite care.)

The Indian state of Kerala, where the authors originate, spearheads the demographic transition. It is distinctive for witnessing emigration, primarily of adult males, to Gulf countries, leaving their parents, spouses, and children behind. Situated in the southern part of India, Kerala stands at the forefront of the country’s demographic shift, with over 12% of its population aged 60 and above, surpassing the national average of 8.6%.

As men migrate, gendered dynamics place a caregiving burden on women, particularly spouses and daughters-in-law, with responsibilities extending to elder care. Employing the social exchange perspective and based on in-depth interviews with caregivers left behind in households with emigrant men, we delve into reciprocal motives, expectations, and perceptions of this caregiving burden. The findings underscore gendered norms and social expectations, reinforcing the role of women as primary caregivers. Daughters-in-law often make sacrifices, including pausing their careers and enduring separation from their husbands, to transition into these caregiving roles. This phenomenon is a prevalent social issue in the northern part of Kerala, where households lacking male members are common.

In the central Travancore region of Kerala, another migration pattern represents a social challenge. Numerous youngsters from the Christian community are relocating to Europe, the Americas, Australia, and various other global destinations. Notably, many of these individuals do not have plans to return.

Celebrating a long and fulfilling life should be a joyous occasion. However, for Annie Titus, a once vibrant and fiercely independent Customs officer, this is not the case. Following retirement, Mrs. Annie resided in her ancestral bungalow in Tiruvalla, initially supported by a few servants. Unfortunately, they gradually left her side over the years. With her two sons residing in New York and infrequent visits, this now frail lady, who struggles to walk, is being cared for by home nurses.

In contrast to Annie, 87-year-old Urmila Unni has four children – two sons and two daughters – who are leading successful lives. Despite her children’s prosperity, she resides in an old-age home in Kochi. Although her daughters live in the U.S., her sons are in the same state. The attendants at the old-age home vouch for her sons and says that both sons visit regularly, at least once a fortnight. Urmila Unni, who has developed arthritis and occasional forgetfulness admits, “My children are kind to me, but I chose to stay here because I don’t want to be a burden to them.” 20 years ago, her husband passed away. Being hard of hearing, she’s not interested to watch TV and her main pastime involves flipping through carefully kept photographs from her younger days, kept by her bedside. Urmila Unni receives attentive care at the facility, evident in her well-fed and well-groomed appearance. In contrast, Mrs. Annie appears frail and unkempt, suggesting potential nutritional issues and a lack of close monitoring in her case. Moreover, she exhibits signs of depression due to a lack of socialising, a common challenge associated with aging in place. There is no dearth of such stories of trauma and loneliness in the our state, which is undergoing a rapid transformation—both socially and demographically. Children who leave behind their parents must make arrangements for their upkeep and must closely monitor them on a regular basis.

We, from our social gerontology practice, never suggest ‘ageing in place’ as it is a risky business if the primary caregiver is far away. You cannot entirely rely on relatives, neighbours and friends to substitute your role. You think it will work if you appoint a caretaker! How far we can depend on such people. Here in India, unlike other developed nations, no qualification or accreditation mandatory to become caretaker. Ultimately you entrust your loved one to an unprofessional who has no knowledge in the caregiving aspects. Lacking knowledge and expertise coupled with indifference, a deadly concoction will do more harm. Agencies who provide such caretakers are also ‘fly by night’ operators with no knowledge in social gerontology. The agencies take a good amount as monthly charge, and pay the caregivers a paltry sum and many are in the habit of not even paying them. This is where you need to look into the qualification and expertise of the people who runs such organisations as well as the track record of these organisations.

I’m Even when you choose an assisted living facility or ‘old age home’, better be cautious. Here also you need to quiz the management to find out the protocols and care standards. Probe deep into their management and staffs qualifications, experience, clinical abilities, hygiene policy, infection control, medication management, prevention of bedsore and falls, and clinical reviews.

If your city or town has a geriatric care manager, (social gerontology partitioner), it is another option to consider too. He or she can act as a “professional relative” for those who need care, though their services can be pricey (from 2500/- an hour). They can help you with everything from doing in-person visits with your parents to hiring and coordinating in-home care or co-ordinate with the care facilities and also help with clinical aspects.

Once you’ve had enough time to really assess what the true needs of a loved one are, you’ll probably be able to create a really solid plan of action and care for them, even though there may be thousands of miles between you. Planning for the future, continually gathering information, and taking care of what’s needed right now are the three main areas of focus for a long-distance caregiver, and while it may be stressful, it’s not impossible, especially if you remember that you don’t have to take this walk alone.

As we mentioned in the beginning of this article, about the importance of a thorough need assessment \of all sorts, you’ll probably be able to chart a solid plan of action and navigate this difficult times, even though you live thousands of miles away. Planning for the future well in advance, continually gathering information and assimilation, and taking care of what’s needed right now are the three main areas of focus for a long-distance caregiver. While it may be stressful, it’s not impossible. Being a long distance caregiver, we understand it is tightrope walking, and you remember that you don’t have to take this walk alone provided you have “foster care” arrangement.