Long-distance caregiving. Any advice?

The Cleaning Lady is going to be worth her weight in gold.

The NOK, POA or yourselves (the appropriate person/s of contact) can hopefully set up good, open communication with her.

So the Cleaning Lady can feel ok to call. To blow the whistle when required.

If/when that call comes.. "I'm a little concerned..." then Project *It's time for a chat* can roll out.

This may include a long visit with her local Doc, a good physical check up, sneak in a cognitive screening test & take it from there.

Hopefully the goal to obtain more supportive living can be achieved when required. Until then, the seeds have been sown, the key planners are being identified & some rough plans can be made.

This balance: freedom of choice vs adequate care is a tough one to walk.

You can also ask the local police station in her town to do “ wellness checks” once a week. Sadly, that is how many seniors who insist on living alone without help are discovered dead.

It seems to me that when an elder gets cranky & causes chaos, the relatives (and or the AL) shouldn't just throw their hands up & wave the white flag of surrender, drive the cranky elder back home to isolation, unpack their things and say Adios, leaving them to rot alone b/c they 'prefer it that way.' But that's just me. The woman can wind up falling, lying on the floor alone for 2 weeks until the cleaning lady arrives back there one day to find her corpse on the floor. But then again, this woman will have lived life on her terms 100%. Not the way I'd allow my parents to live, but again, that's me and how I do things, apparently not how your relations do things with their elderly loved one, I don't know.

This relative is obviously suffering from some level of dementia, too, based on your description of her having no short term memory (asking about the cat and unpacking her things, etc). This is extra dangerous b/c short term memory is what enables us to function on a day to day basis. It's what enables us to go thru the steps required to take a shower or cook a meal. W/o short term memory in place, that's the elder who forgets she turned the stove on and causes a fire. Or who walks out the front door and doesn't know why she's outside in the freezing cold weather with no shoes or coat on after she's locked herself out. Or turns the bath water on, forgets it was done, and floods the bathroom. Dementia is the #1 reason why an elder needs help inside her home or to be placed in a facility where she can be looked after properly and be SAFE.

You can get her a Life Alert button but I guarantee you she won't wear it or forget how it's used. Same with any other 'gadgets' designed to help. Dementia causes them to lose their ability to work said gadgets.

You can arrange for wellness checks to be done on her regularly, but she won't like that either, and may not even answer the door. But that would be my #1 choice in this situation.

Arrangements were already made for an in home caregiving company to come into her home and they 'left their card', meaning the ball is in HER court now, and nothing further will be done. You or the other relatives can hire this company to come in and provide services to the elder BUT the elder will have to let them in.

All YOU can do is call the woman on a regular basis and hope she answers the phone. Living 900 miles away, what more CAN you do?

Likely, she'll fall or suffer some other crisis and call 911 for help. Then the hospital or rehab SNF won't allow her to return back home to live independently afterward. THAT is when her choices vanish. THAT is when she moves into a Memory Care ALF or a SNF, depending on what condition she's in after the crisis resolves itself. This is quite often the scenario for stubborn elders who refuse to see to it that they get the help they require BEFORE disaster strikes.

If dementia is at play, which it sure sounds like it is, whoever is POA can get guardianship for her after a medical diagnosis is made (of dementia) stating she is incompetent. THEN she can be placed in a Memory Care ALF against her will, for safety purposes and to insure she eats, bathes, and is cared for properly on a daily basis. Otherwise, you have no idea WHAT will transpire if she's left alone at home.

Wishing you the best of luck with a difficult situation.

Medical alert button

How does she feel about her isolation?

If the CCC doesn't provide some kind of resource, you could find a check-in service near LO's location. There may be a (small?) fee so try the County first since many have a volunteer resource for check ins.

Thank you, Geaton777, for replying. You raised so many points that I hadn't even considered.

It is the POA relative/couple 600 miles from her (God bless them!) who arranged everything along with her to move to the AL an hour from them. When that became chaotic, they drove her back home. (I was pretty upset when I heard it because from what little I know, the *staff* should have stepped in and handled the situation, but they didn't.) At this point, they have backed off; maybe they just need a cooling off period.

She's fairly capable in all ADLs (during our recent two-day visit) but I'm concerned the about forgetfulness. For example, her short-term memory is pretty bad. Repeating herself, repeating "where's the cat" (whom we just found under the bed 2 minutes ago), couldn't remember she'd not eaten breakfast the day we were unpacking the moving van, couldn't remember packing all the things we were unpacking (which she had just done 4 weeks prior).

She only visits her doctor once a year, due in September. She's never had a cognitive test, which I believe is essential at this juncture in her/our journey. Right? I'm thinking it would be best if one of us makes the trip to accompany her to the neurologist for that testing?

She has one neighbor whom she has managed not to offend who said they'd try to keep an eye on her. And the cleaning lady who lives on her street (Hallelujah!) offered to check on her when she can. Just lean on them for now? We have their phone numbers.

She and her now-deceased husband moved far away from what little family they had (two children) to retire in comfort/peace. He passed away just 6 years after, so living alone for 25 years now.

Her funds are in good shape. She even has LTCI that covers 1/2 of in-home care. I don't believe she is a flight risk, as she doesn't even like leaving her house.

Sorry there's so much in the post, we're obviously new to the aging care world.

If no one is her PoA then someone can contact social services for her county and report her as a vulnerable adult WHEN she begins to have problems with her ADLs (activities for daily living). But being so far away -- how will anyone know? Does she have any neighbors who could check on her daily? Groceries can be ordered for her online and delivered; house upkeep can be hired out. Hopefully she has the funds to pay for it all.

If she does have a PoA and the criteria for activating the authority is met, then I think this person needs to go there in person to try again to get her to transition into IL or AL. The house should be sold right away so that she doesn't have a place to return to. If she has dementia and is a flight risk then the facility would move her into MC. She should go to a facility located conveniently near the PoA.

Often there are no good solutions, only least bad options.