Tuesday, January 26, 2016

Caring for Mom when you are far away



My mother in law fell recently. A fall can be a devastating event for an older adult. One out of five falls causes a serious injury such as broken bones or a head injury. Each year, 2.5 million older people are treated in emergency departments for fall injuries.
A widow, my mother in law (who I will refer to as “gramma”), lives thousands of miles away from my wife, her only child. While we talk on the phone daily, the distance is a big barrier to our ability to provide her with the broad range of supports she needs as she ages.   
The fall happened on a Saturday at a restaurant where she was dining with friends. No one saw the fall but it was clear that she had hit her head and injured her knee and foot. Two of her friends took gramma to the emergency room where it was determined that she was badly bruised but there were no broken bones.
Things could have been much worse. There was no broken hip, which can be a real killer. According to a Kaiser Permanente study women ages 65–69 who break a hip are five times more likely to die within a year than other women of the same age. For women ages 70–79, a hip fracture doubles the risk of dying within a year. Each year at least 250,000 older people are hospitalized for hip fractures and more than 95% of hip fractures are caused by falling.
But, while gramma was lucky, she was also confused and in pain and in need of a lot immediate care support. And my wife and I were thousands of miles away. How could we get her the immediate help that she needed?
Fortunately, the help was available. My wife and I had previously hired a professional care manager, Bonnie, in the town where gramma lives. As soon as we got the call from the emergency room we contacted Bonnie and filled her in. She swung into action at once. She visited gramma and evaluated her condition. She implemented a system of caregivers to stay with gramma. She set up a Monday morning appointment with gramma’s physician, attended it with her, and reported back to the family.
Bonnie served as the family’s eyes and ears and local expert and was able to ensure that gramma got the care and support she needed when she needed it.  
Our care manager could “hit the ground running” because she was already in place when the crisis arose. She already knew gramma and understood her situation, and gramma already knew and trusted Bonnie. Our care manager was a godsend to our family in this emergency situation. Thank you, Bonnie.
Hiring a local care manager is one of the steps my wife and I have taken to help us care for gramma from a distance. Our idea has been to have a support structure already in place before some Saturday when we suddenly find we need it. That planning paid off when gramma fell.
I thought it might be helpful to readers of this blog if I listed some of the other advance planning steps we have implemented with gramma’s consent.
Create a Contact List. We put together a contact list of gramma’s medical providers, insurance and financial advisors, accountant, friends, neighbors, and church people who we could reach in the event of an emergency. One trusted neighbor has a key to gramma’s residence.
Collect Medical Information. In addition to our list of gramma’s medical providers we established online access to them and to her medical records. We separately collected and documented information on her medical conditions and treatments, including a listing of her medications and dosages.
Set up regular home delivery of prescriptions. This will allow for continuation in the event that gramma is unable to go to the drug store to fill a prescription. It is also cheaper.   
Collect Financial Information. We made copies of gramma’s most recent financial statements, including bank and credit card statements, retirement account statements, and recurring bills. We established online access to her banking and credit card accounts which allows us to monitor her payments and watch for any unusual or fraudulent activities. We collected the names, phone numbers and account numbers for her utilities, phone, and cable/internet suppliers. We put together a listing of gramma’s assets, income and expenses.
Set up Auto Payments. We set up automatic payments for gramma's recurring bills where possible. Such payments can usually be set up to be made from a care recipient's checking account or credit card.
Document Power of Attorney Authority at Financial Institutions. We established power of attorney with gramma’s financial institutions. Although we have a separate power of attorney document, we tried to use the “in house” forms created by the financial institutions to avoid later delays or issues. We ordered a separate book of checks that we can use to pay bills from gramma’s checking account if she becomes unable to do so.  
Collect Tax Information. We made copies of the most recent year’s federal, state, local and real estate tax returns. We gathered the information required to make future estimated and other tax payments if that becomes necessary.
Establish HIPAA privacy disclosure authority for health information. Gramma has authorized her medical providers and medical insurance to disclose her protected health information to designated family members. This can be accomplished on forms available from the providers.
Collect Insurance Information. We documented gramma’s insurance coverages and made copies of policy numbers and company contact information.
Set up a journal to track issues and events. I set up a journal where I document what is happening in gramma’s life. For example, I document medical information including health concerns and results of doctor’s appointments. I also include information about interactions with financial, legal, accounting and other professionals, vendors, and even friends where that information may become important later. I summarize calls and copy emails with gramma’s care manager.    
Arrange for a family member or caregiver to accompany gramma to her medical appointments. This needs to be someone who knows gramma and can help her relay information to gramma’s medical professionals. This caregiver can also serve as a second set of ears at doctor’s appointments and someone who can raise questions that need to be asked.  
Retain a local elder law attorney. Even though I am an elder law attorney I don’t practice law in the state where gramma resides. So I retained the services of a local elder law attorney to provide the legal planning services gramma needs. Now that this relationship is established we can call on this local lawyer to deal with any legal issues that arise in the future.  
I’ll admit that this all took time to set up. It wasn’t simple and it wasn’t easy. But, we didn’t try to do everything all at once. We were able to accomplish most of these tasks while we were visiting gramma.
I’m sure that the listing above misses some additional things that we should have addressed. Please feel free to comment with your experiences and suggestions. I’d love to hear them.
I do know that having this long-distance care support structure in place is reassuring to both gramma and my wife and I. It is becoming increasing useful as time goes by and gramma grows older and her abilities decline.  And, when gramma fell, having the local care manager in place made all of the effort worthwhile. That one step alone was invaluable.