Jane Kaplan, a retired art therapist, lives in West Orange, NJ, with her husband. Her 98-year-old father, Nathan Glasser, lives in Florida. Despite the 1,100 miles separating them, Kaplan is one of her father's main caregivers. This wasn't the plan when Glasser and his wife moved to Florida from Bergenfield, NJ, in 1997, after Glasser retired from his editorial job at Hearst Newspapers. When his wife died unexpectedly less than five months after the move, Glasser chose to stay in his adopted state and visit his three children and their families in New Jersey throughout the year.

Glasser's children supported their father's decision to remain in Florida, where he had an active life, working part-time, making friends, and pursuing new hobbies. But about three years ago, Glasser's health began to falter. He developed kidney cancer, he was diagnosed with essential tremor, and his memory started to slide. Initially, his children hired an aide to help bathe and dress him. When he was diagnosed with dementia about two years ago, his family moved him to a nearby assisted living facility. Despite his essential tremor, he can still feed himself and hold a cup of coffee, but he can't write anymore and uses a cup to drink soup and an electric razor to shave.

"As an editor, he used to pride himself on his memory and remembering all the facts and details, but he forgets words regularly now," Kaplan says. "When I call to talk to him, he says things that I later find out from the nurse didn't even happen, so communicating with him is getting harder."

Kaplan and her brothers discussed moving their father back to New Jersey, but none of their homes could accommodate his needs. And Glasser still enjoys living in Florida and getting outside for fresh air using his walker. "It's not easy for me to be so far away from him, but we made the decision for him to stay in his environment," Kaplan explains. "He can't travel to see us anymore, so our family takes turns visiting him at least once a month."

Managing the Miles

Kaplan is among the rising number of long-distance caregivers, people who live more than an hour away from relatives who need their help. Of the estimated 66 million caregivers in the United States, about 15 percent are considered long-distance, according to a joint report by the National Alliance for Caregiving and the AARP. Many of them look after aging parents while also juggling the demands of full-time employment and children of their own. They may not provide direct, everyday care due to distance and their own responsibilities, but they often arrange the necessary services, says Gary Barg, founder and editor of caregiver.com and the author of The Fearless Caregiver (Caregiver Media Group, 2001). "The physical and emotional demands of long-distance caregivers can be taxing."

Kaplan and her brothers divide up responsibilities. Kaplan's older brother David, an attorney, handles Glasser's legal and financial matters. The oldest brother, Sam, doesn't have a specific responsibility, but he is involved in all decisions, visits regularly, and makes sure his kids see their grandfather.

Kaplan is in charge of her father's medical needs and is in close contact with Judy Uzzi, the geriatric care manager the family hired eight years ago to oversee Glasser's care. Uzzi has permission to speak to Glasser's doctors and takes him to all his medical appointments. A licensed social worker by training, Uzzi works with many families who are out of state and have older parents living in Florida. "I communicate with family members over the phone and through email on a daily basis to keep them updated," she says. "After a doctor's visit, I always provide a report to the family." Uzzi is employed and paid by Glasser's family. "Judy is worth every penny," says Kaplan. "If you can't be there to do it on your own, then you need someone like Judy to represent you."

In the absence of a care manager like Uzzi, caregivers can arrange to call their relative's doctor before or after medical appointments to get an update and ask questions. "I have used video calls during visits to connect with family members across the miles," says Maisha Robinson, MD, a neurologist at the Mayo Clinic in Jacksonville, FL. "People can get creative in how they participate in their loved one's care from afar, particularly with the level of technology these days."

To Move or Not to Move

It's natural to want relatives nearby when caring for them, says Barg. It makes it easier to keep an eye on them and see if they are eating well, taking their medications as prescribed, keeping doctors' appointments, and staying safe in their home, he says. But it's not always practical.

Moving family members away from homes and communities where they've built a lifetime of memories and personal connections can be traumatic. Finding a new medical team can be difficult and disruptive, and seniors may become frightened or confused when adjusting to new surroundings. Barg recommends researching local help first, including cleaning services, home health care, food, and transportation, before contemplating moving a relative.

However, if a family member becomes very ill and is unable to live alone and resources are limited, it might be worth moving him or her closer to home. The money that would be spent hiring health aides, housekeepers, and other support services could be put toward a nearby assisted-living facility, Barg suggests.

Glenda Noriega, a waitress in Dallas whose parents live in Guatemala, would love to have them move in with her, but her mother's health problems—gout, epilepsy, headaches, vision loss from a stroke, uncontrolled high blood pressure—prohibit that.

Instead, Noriega visits her parents at least twice a year for two weeks so she can see firsthand how her mother is doing. During the first week she follows up with her mother's doctors, buys her medications, and pays for her tests and visits. When she's not visiting, Noriega talks to her mother several times a week. "I feel better when I hear her voice," she says.

Noriega's two siblings live in Guatemala near their parents, but they both have large families. So most of the caregiving responsibilities fall to Noriega, who has one child. "My mom has always relied on me more because we've always been close," says Noriega, who doesn't complain and is grateful for an understanding employer. "My waitressing job is flexible, so I can take time off when I need to visit my mom."

Guilt Trip

Day-to-day caregiving is certainly demanding, but caring from a distance comes with its own set of emotions and complexities, says Barg, who was a long-distance caregiver for his grandmother after she was diagnosed with Alzheimer's disease.

"It's very, very difficult, and no matter how involved you are there is still a lot of guilt when you're not there by their side," says Kaplan. That's especially true in emergency situations, says Barg. And the constant juggling often leads to feelings of inadequacy. "What I hear so often from long-distance caregivers is that they feel guilty taking time for themselves because they should be worrying about their loved one," says Gail Hunt, president and chief executive officer of the National Alliance for Caregiving, a nonprofit group based in Bethesda, MD. As a result, they often ignore their own health, which can be detrimental to their physical and emotional well-being.

"It's essential to exercise, take mental breaks, and ask for help," says eldercare expert Donna Wagner, PhD, professor and dean at New Mexico State University in Las Cruces, NM. She recommends support groups such as the Alzheimer's Association's Caregivers Forum and inspire.com, online groups that address the challenges of long-distance caregiving.

It's also important to recognize what you can and cannot do. "Be realistic about what help you can provide from far away. And figure out how to fill in gaps through a local network of people or services," says Barg. "This can help ease feelings of guilt."

Work-Care Balance

In addition to the guilt and worry, many long-distance caregivers struggle with logistics—for instance, when or how to ask for time off from work to visit the person who needs care or to help out with caregiving responsibilities.

"It's been a challenging few years juggling the needs of my mom with the demands of my job and taking care of my 4-year-old son," says Noriega. "There's always a lot of follow-up with the doctors or making sure my mom gets the right medicine and the right care."

Kaplan doesn't work full time and has more flexibility with her schedule than her brothers, who both still have active careers, so a lot of the responsibility and day-to-day communication with their father and the geriatric care manager falls to her. To keep from feeling overwhelmed, Kaplan exercises regularly, pursues her hobbies, and leans on friends.

To accommodate caregiving responsibilities, people often make adjustments to work schedules, such as coming in late, leaving early, telecommuting, or calling in sick. In the MetLife Study of Long-Distance Caregiving, conducted with the National Alliance for Caregiving, half of all respondents reported making major adjustments at work, with 44 percent saying they changed their schedules. A small percentage of caregivers switched from full-time to part-time work to accommodate caregiving, and 12 percent said they took a leave of absence.

There are lots of different ways to take time off from work, says Amy Goyer, AARP's family and caregiving expert. A former long-distance caregiver to her parents, Goyer encourages caregivers to use a combination of vacation, sick time, and unpaid personal leave. For people trying to determine how much time to take off, she offers this rule of thumb: "Account for things like regular visits and doctor appointments, but always prepare for the unexpected emergency health problems."

Under the Family and Medical Leave Act (FMLA), eligible employees can take unpaid, job-protected leave and maintain their health insurance coverage. Taking care of a parent is considered a qualified reason. The 12 weeks of unpaid leave do not have to be consecutive, but they need to be taken within a 12-month period. Goyer adds that companies with fewer than 50 employees are not required to provide unpaid leave, and employees have to work a certain number of hours to qualify.

Support Strategies

When it comes to caregiving, you can't go it alone, and you shouldn't, says Barg. He recommends making a list of people you trust (friends, neighbors, co-workers, pastors) and assigning appropriate responsibilities to each. "Once you put the list together, you'll have easily manageable and specific tasks that will support you and make your friends and family members feel good about helping," he says.

Relatives can also provide "vacations" for the main caregivers by taking over responsibilities for a few days, giving the caregiver a break and time to recharge, Barg says.

Noriega often asks her siblings to pitch in. They will take their mom to doctors' visits when Noriega can't or stop by to check on how she is doing. "While my siblings have busy lives," she says, "they will drop what they're doing and help me out, and that's a huge relief for me."

Same goes for Kaplan, who says she relies on her two brothers when making decisions about their father's care. She appreciates that they all—children, grandchildren, great grandchildren, and in-laws—take turns visiting him. "It's not only the time it takes to go back and forth to Florida. It's also the financial commitment," she says. "It makes it easier when you have help from your family."

Any support is appreciated, whether it's financial, moral, or personal, says Hunt. "The trick is to be supportive without being intrusive," she says. "Don't second-guess the main caregivers' decisions or question what they're doing. Find ways to be positive and empathetic."

Burnout Bypasses

All caregivers need a break, whether they live close by or many miles away, experts say. Caregivers who are overtaxed and overwhelmed can't help themselves or anyone else, says Barg. When they're at that stage, they need to reach out to family, friends, neighbors, and anyone else who provides comfort and support, says Hunt.

Formal groups are not for Kaplan, but she frequently speaks to friends who are in similar situations. "We talk and listen to each other. It's definitely comforting to know they're going through the same thing. It can be very lonely sometimes, but we support one another and get through the tough times together."

She admits that she and her brothers are constantly re-evaluating their decision to keep their father in Florida. "It's stressful questioning our decision and second-guessing whether we made the right one. But we know he's happy where he is, and that's very important."

Bridge the Gaps

These eight expert-approved strategies will help you get organized, which is key to long-distance caregiving.

1. Collect information. Create and keep in a safe, handy place a list of your care recipient's medical, legal, and financial details, including phone numbers and email addresses for doctors, lawyers, accountants, insurers, and bankers. And gather it all before an emergency arises. The National Alliance for Caregiving website provides a useful one-page document that summarizes the information you need, such as wills, power of attorney documents, and insurance policies, among other important paperwork.
2. Create a network. Reach out to local friends, neighbors, and members of religious and community groups who can serve as your eyes and ears. They can be helpful in emergency situations or just to provide informal updates on whether and how much your mother is eating, for example, or the state of your parents' house—all of which can ease your stress and worry and allow you to intervene as soon as possible, if necessary. Be sure to have their phone numbers and email addresses on hand.
3. Identify local resources. Check with the State Units on Aging or the National Association of Area Agencies on Aging, which help older Americans and their caregivers address all aspects of aging, including answering questions about Medicare, legal and financial matters, and nursing homes. To find one nearest to the person you're caring for, visit the US Administration on Aging.
4. Develop a care plan. Hold a family meeting in person or over the phone to discuss future plans. Depending on your relative's mental state, you may decide to include him or her in the meeting as well. If so, allow your relative to voice his or her wishes and concerns. Determine who can provide assistance and be a primary or secondary caregiver, and learn about community resources. If you're worried that not everyone in the family has the same idea about what's best for the care recipient, invite a trusted family friend or social worker to mediate and help resolve differences.
5. Consider paid care providers. If few family members live nearby, it may be worthwhile to identify local providers for help. Social service agencies, for example, can recommend in-home aides. Visiting nurses and geriatric care managers are also trained to manage health needs. Geriatric care managers are often licensed social workers, and they may be able to help with financial and legal matters. Maintain regular communication with the care team to get updates following doctor visits. Learn more by contacting groups like the Visiting Nurse Associations of America and the Aging Life Care Association.
6. Stay in touch and involved. Getting help and surrounding yourself with a care team is important, but don't relinquish your involvement to others. Set a time each day or week to speak with your relative. Remain involved in his or her personal life, as well as all health, legal, and financial decisions. Don't delegate all the responsibilities to a care manager or health aide.
7. Do your own research. If the person you're caring for gets sicker or develops a new health problem, educate yourself about the new development. Understand what he or she is going through, what the illness means, how it can be treated, and how to manage any side effects from treatment. This knowledge will make it easier to talk to health aides, care managers, and doctors.
8. Prepare for emergency travel. Before a crisis occurs, learn about different travel options. If you're within driving distance, keep your car in good shape and check on the route and weather before hitting the road. When buying bus, train, or airline tickets, disclose the nature of the emergency; you may get a discount, depending on the company. If you rent a car, look for the best rates, and don't pay for insurance if you already carry full coverage or your credit card company offers coverage.