Caring for a Parent From Out of State

The National Institute on Aging (NIA) describes a long-distance caregiver as anyone living an hour or more from the person who needs care. That covers a daughter in Phoenix with a father in Torrance, and also a son two counties away who cannot drop by after work.

NIA lists the jobs a long-distance caregiver can often take on from a distance. These are:

• Helping with money management, insurance claims and paying bills.
• Arranging care management or in-home help.
• Ordering medical equipment, medicines and supplies.
• Acting as the family's information coordinator: researching conditions, keeping track of changing needs and benefits.
• Helping with advance care planning, such as choosing a health care agent and preparing a living will.
• Finding, organizing and updating important papers.
• Researching long-term care options, such as assisted living or a nursing home.

Distance makes one problem much bigger: people on the phone may not be allowed to tell you anything. Sort this out early, while your parent can make their own choices.

Medical information. The U.S. Department of Health and Human Services (HHS) explains that the HIPAA Privacy Rule does not require a doctor or health plan to share information with family, unless the family member is the patient's personal representative. A provider may share it with family who are involved in the person's care or in paying for it, if the patient says it can or does not object. In practice, your parent can tell each doctor's office, in writing, that it may speak with you. Ask the office whether it has a form for this.

A personal representative is someone with legal authority under state law to make health care decisions for the person. HHS says a personal representative stands in the patient's shoes for most HIPAA purposes, including access to records relevant to that role.

Health care decisions. California's court self-help site describes an advance health care directive, which lets a person name someone to make health care decisions if they cannot, and record the treatment they would want. It must be signed by the person and either notarized or signed by two witnesses.

Money and legal matters. The same site explains that a power of attorney lets one person name another to make financial or other decisions. A durable power of attorney continues for as long as the document exists. A springing one takes effect when something happens, such as a finding of incapacity.

These are legal documents, and the right choices depend on your parent's wishes and situation. An elder law attorney can draft them and explain the options. If your parent can no longer sign them, the court site describes other routes, including conservatorship, and says a court will want to see that less restrictive options would not work.

NIA suggests asking, with your parent's permission, the people who see them regularly to call you with any concerns: neighbors, friends, doctors or local relatives. Often one person ends up doing most of the hands-on care, usually a spouse or the relative who lives closest, and NIA notes that this person needs support from the rest of the family too.

Paid and public help can fill the gaps. NIA names geriatric care managers as especially useful when family members live far apart. The federal Eldercare Locator, run by the Administration for Community Living, connects families to local services for older adults by phone at 1-800-677-1116, by text, chat or email.

When a move to assisted living is on the table, a local placement specialist is another set of eyes. A good one knows the homes in the area, tours with the family and keeps you informed when you cannot be there. Before you rely on anyone's list, you can check each home's state license and inspection history yourself: see how to check an RCFE license.

NIA suggests a few habits that make distance easier:

1. 1

   Keep one shared contact list

   Doctors, pharmacy, neighbors, the building manager and anyone else involved, in an online document every relative can open and update.

2. 2

   Use a shared calendar

   Appointments, refill dates and who is visiting when, so nothing depends on one person's memory.

3. 3

   Join appointments remotely

   With your parent's permission, sit in on telehealth visits. If your parent moves, NIA suggests joining care meetings with the assisted living or nursing home team by phone or video.

4. 4

   Help your parent with the phone

   Show them how to text and make video calls, so the two of you can see each other between visits.

NIA's advice for short visits is to talk to your parent beforehand about what they want to do, and to ask the main local caregiver what they need. Then decide on your top priorities and leave the rest for another trip.

If a move is likely, plan the trip around the things that need you in person: tours of two or three homes, a meeting with the doctor, and a sit-down with your parent about what matters to them. NIA also reminds families to leave time to simply be together, such as a meal, a drive or a movie, not only errands.

If your parent may come to live near you instead, the questions are different. See moving a parent to California assisted living for the reverse case.

Hamssa Benrekia is a placement specialist in Torrance who helps families find licensed assisted living communities and board and care homes in the South Bay and Harbor area of Los Angeles County. Families can work with her from out of state: she can talk with you by phone, text, WhatsApp or email and with relatives who are local. Ask her how tours can work when you cannot be there in person. To start, contact Hamssa, or read more in the California Assisted Living Placement Guide.