How do I decide how to help my father from hundreds of miles away?

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Through a series of tragedies over the last 30 years - including both my mother's and my younger sister's death - I've ended up as the only surviving family member of my 75 year old father, aside from his 77 year old sister. I live hundreds of miles away from him; I don't have a family, but I've have a career and a life here for the past twenty years, though I visit my dad several times a year.


Dad has had many health issues over the last 10 years, including a major stroke and quadruple bypass surgery. Now, he's ended up with colon issues that have left him with surgery and a colostomy bag. He's getting less and less mobile, his health issues keep compounding, and to complicate matters, he has very little money - just SSI and some disability, no savings, no retirement, nothing. He's currently in a rehab facility, but he will only be able to afford it for a couple of weeks while insurance covers it, after which he may or may not be able to take care of himself.


I can't bring him back here to take care of him - I live in a small place with my partner, and my own mental health issues leave me wholly unsuited to full time caretaking. His sister has been helping, but she's getting older, and has her own issues to deal with. She wants him to go to an assisted living facility, but even putting aside whether or not he'd agree to it, I don't think he can afford to do so right now, not from the research I've done. I'm very much at a loss to figure out how to help from so far away. I can go down there for short periods at a time, but I can't afford to take long-term time off from my job to help in person. I don't know what we're going to do with him when his weeks at rehab are up, because my aunt can no longer do as much for him as he needs, and I don't know what kind of help either my dad or I can afford to get him.


If anyone here has any advice - either practical or emotional, ways to deal with the crippling guilt I'm feeling right now - I would greatly appreciate it.

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You need to speak with the social worker/discharge planner at the rehab and tell them what you’ve told us. They will help you and your aunt find a place for Dad to go after he’s discharged.
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Reply to Ahmijoy
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This ain’t easy. I did it with both parents from 600 miles away for over 5 years. My mom died about 2 weeks ago. I finally got them in assisted living back in December. Dad is in memory care now.

Some things to consider......

If Dad is competent and cooperative get him to grant you power of attorney. You can then take care of his affairs.

If he’s broke, apply for Medicaid. Don’t use your funds for his care.

Get him in a facility there or move him near you. In my case it was easier to leave my folks in their hometown. The logistics of moving them would have been impossible.
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Reply to Windyridge
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Contact the social worker at the rehab. Make certain they understand there is no one who can take care of your dad when he is discharged. Also, contact your aunt make sure she doesn’t give the impression that she can provide care. It is VERY important that neither of you yield on this. The rehab can’t release him if there’s no proper care in place. He will stay where he is. Medicaid application will be made. You will have to ‘spend down’ his funds and it will be worth seeking help of an elder law attorney to do that correctly. DO NOT let the folks at the rehab settle on any arrangement that has dad going home alone with a plan for some home health. The way to prevent that is stating simply and forcefully that neither you nor your aunt can provide care.
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Reply to IsntEasy
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Ask the social worker to help your dad apply for community based Medicaid. I'm impressed with the services they are providing to keep my loved one at home. (The services offered are probably different in each state, but I'm very happy so far!)
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Reply to Marcia7321
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Please consider hiring an Aging Life Care Professional (also known as a Geriatric Care Manager) who is located near your father. They can serve as a responsible, professional contact for you and they can address day-to-day needs. A care manager is like the social worker or case manager at the rehab, except she or he works for you and your father, and services aren't connected with the rehab center. Services continue anywhere Dad is - not just in a care facility! Plus, she (or he) can help with non-medical needs, too, such as help with mail management, daily money management, home modifications (if needed), etc.

Find one by searching on www.aginglifecare.org.

If there isn't one nearby, search for an eldercare advocate or a private social worker. If you still can't find one, ask the Area Agency on Aging in your father's area, the social worker at rehab, or a local elder law attorney.

Finally, some things you can do from afar are:
- manage finances
- arrange for meals to be delivered (not just Meals on Wheels - see "Mom's Meals" or "Magic Kitchen")
- keep records (medications, appointments, doctors lists, important documents)
- learn more about long distance caregiving (Google search)

We had a care manager for my dad when he was on his own after my mother passed away. It was so very helpful for our family.

Best of luck!
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Reply to LaurenBond
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Another option you might consider is in home care a few days a week until you can get some sort of assisted living arranged.
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Reply to Litlebit67
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My mother in law was able to get SSI to pay for her assisted living place. Call them and find out how you can get that.
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Reply to whaleyf
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Wow, you sure do have a heavy load and you are bearing it so well! You have had heavy loss over the years (your mom and sister) that I'm sure is resurfacing in light of the situation with your dad, my heart and any strength I can offer is with you. While I am far from alone in it I too am hundreds of miles away from my mom who has had some of the same medical events as you dad by the sounds of it so I can somewhat relate. I am fortunate to have a brother who still lives in the area and since it's the area we grew up in many attachments and familiarity, I'm going home.
It doesn't sound like your dad has cognitive decline or issues (dementia of any sort) unless the stroke left him with aphasia? That may make it easier or it may make it harder depending on his cooperation level. How ingrained in the area is he still? Does he have a network of friends he sees regularly, a network of doctors it would be hard to leave or is he open to the idea/necessity of moving closer to you? Is he resigned to the idea of moving to some sort of group care facility or is he still determined to live in his own home? All of these questions/answers come back to needing skilled assistance of some sort of course, it's just a matter of how much is needed and what he can get where so Ahmijoy's point that you need to sit down with the coordinator/social worker at the rehab facility he's currently in is spot on. They are often very helpful and full of good info when you show interest and the willingness to put some effort into finding the right situation. You might need to do a little pushing to show that you are involved and care to get their best service and you might get it either way but they are often a wealth of knowledge and connections, help.
You might consider making a trip now to meet with the care team at rehab which will include the social worker/care coordinator and work with that person to set up whatever you decide. This is one of those pivotal decision times that is probably easier and best when you can be there in person to do everything but can be done from far away if it's your only choice. Being there gives you the opportunity to keep Dad more involved, discuss things with him better or at least feeling more involved too. Sooner the better because in my experience things suddenly move very quickly when it's time to move on according to Medicare, starting ahead of time gives you the opportunity to be better prepared and make better, more considered long term decisions. You might want to consult with his personal doctors for instance if they know him well and he knows and trusts them. You may find this is the right time to make a big move or you may decide he's still able and would be happiest going back home with a better set up for that to be successful for a while. Either way being there gives you the time to set either of those up well and start laying the groundwork for when it is time for the big move and have a better idea at least about whether that will include moving closer to you or staying in his current area.
If you do end up moving him back home first I am very happy to share some of the things we have set up that are helping to make my mom living in her home work for now. Some of them would probably help you having him in a facility in his home area too actually. One last thing, if you aren't able to work out a trip to do those things, meet with his care team now consider having a Family Meeting (that's what they called it in mom's rehab anyway) and or meetings with your dad and the social worker via Face Time or some equivalent. Being there with your face in the room really can make a difference I have found.
We did this for doctors appointments and each time a provider came into the hospital room when she had her stroke, my brother would have me there on Face Time (before I got there in person) and we even set up her Ipad so she could call me on the phone and then I could call back via FT on the Ipad when he wasn't there. It worked when the hospital staff knew to do it and didn't mind (most doctors even surprisingly were really supportive of this probably because she was having such a hard time communicating so having someone there able to give answers was helpful but she had a hard time answering FT and following it all with her hearing issues and her aphasia, setting up the earphones was too much without one of us to do it. so it wasn't ideal but it worked and would for pre-set sessions for you. We have since found the Amazon Echo Show which allows us to "drop in" without anyone having to do anything and the connection/presence is much better but that wont work without some prep. We did use it during her last 10 day stay in the hospital and it was so helpful but that's a different conversation.
I know this is all feeling very overwhelming right now and for sure it is a lot for one person to take on but you are already doing so much better than you realize. Just reaching out here, recognizing you have big stuff coming and need some help and then going out to find it, you are special and very capable of doing this and doing it well. Your dad is very lucky. I hope you will recognise that you aren't alone or at least don't have to be unless you choose to be. You also don't have to move him in with you or feel guilty about not doing that, you don't need to feel guilty about anything here. Keep up the good work, stay ahead of it as best you can by not putting stuff off and keep reaching out. Use as many resources as you can find that sound reasonable to you, not everything that works for me will work for you but collect it all and then decide for yourself and your dad. Hang in there and stay in touch. Feel free to reach out publicly or privately, there are lots of people here and elsewhere happy to share and help. It takes a village and one has been created here.
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Reply to Lymie61
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Is your father a veteran? There are some benefits he might be eligible to receive or he night be able to move into a veteran's facility. Just an idea.
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Reply to Rosyday
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The top vote getters(Ahmijoy and Windyridge) in answering your question seem to have the right approach. I would add to this to contact the local Office for Aging where your dad lives to see if they can help you. They deal with these things every day and should know how to advise and direct you. They are extremely helpful in my area. They will probably confirm what the top vote getters are recommending
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Reply to EdinElmiraNY
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