WEST PALM BEACH, Fla. - Kristy Bryner worries her 80-year-old mom might slip and fall when she picks up the newspaper, or that she'll get in an accident when she drives to the grocery store. What if she has a medical emergency and no one's there to help? What if, like her father, her mother slips into a fog of dementia?

Those questions would be hard enough if Bryner's aging parent lived across town in Portland, Ore., but she is in Kent, Ohio. The stress of caregiving seems magnified by each of the more than 2,000 miles that separate them.

"I feel like I'm being split in half between coasts," said Bryner, 54. "I wish I knew what to do, but I don't."

As lifespans lengthen and the number of seniors rapidly grows, more Americans find themselves in Bryner's perilous position, struggling to care for an ailing loved one from hundreds or thousands of miles away.

The National Institute on Aging estimates around 7 million Americans are long-distance caregivers. Aside from economic factors that often drive people far from their hometowns, shifting demographics in the country could exacerbate the issue: Over the next four decades, the share of people 65 and older is expected to rapidly expand while the number of people under 20 will roughly hold steady. That means there will be a far smaller share of people between 20 and 64, the age group that most often is faced with caregiving.

"You just want to be in two places at once," said Kay Branch, who lives in Anchorage, Alaska, but helps coordinate care for her parents in Lakeland, Fla., about 3,800 miles away.

There are no easy answers.

Bryner first became a long-distance caregiver when, more than a decade ago, her father began suffering from dementia, which consumed him until he died in 2010. She used to be able to count on help from her brother, who lived close to their parents, but he died of cancer a few years back. Her mother doesn't want to leave the house she's lived in for so long.

So Bryner talks daily with her mother via Skype, a video telephone service. She's lucky to have a job that's flexible enough that she's able to visit for a couple of weeks every few months. But she fears what may happen when her mother is not as healthy as she is now.

"Someone needs to check on her, someone needs to look out for her," she said. "And the only someone is me, and I don't live there."

Many long-distance caregivers say they insist on daily phone calls or video chats to hear or see how their loved one is doing. Oftentimes, they find another relative or a paid caregiver they can trust who is closer and able to help with some tasks.

Yet there always is the unexpected: Medical emergencies, problems with insurance coverage, urgent financial issues. Problems become far tougher to resolve when you need to hop on a plane or make a daylong drive.

"There are lots of things that you have to do that become these real exercises in futility," said Ed Rose, 49, who lives in Boston but, like his sister, travels frequently to Chicago to help care for his 106-year-old grandmother, Blanche Seelmann.

Rose has rushed to his grandmother's side for hospitalizations, and made unexpected trips to solve bureaucratic issues like retrieving a document from a safe-deposit box in order to open a bank account.

But he said he has also managed to get most of the logistics down to a routine.

He uses Skype to speak with his grandmother every day and tries to be there whenever she has a doctor's appointment. Aides handle many daily tasks and have access to a credit card for household expenses. They send him receipts so he can monitor spending. He has an apartment near his grandmother to make sure he's comfortable on his frequent visits.

Even for those who live near those they care for, travel for work can frequently make it a long-distance affair. Evelyn Castillo-Bach lives in Pembroke Pines, Fla., the same town as her 84-year-old mother, who has Alzheimer's disease. But she is on the road roughly half the year, sometimes for months at a time, both for work with her own Web company and accompanying her husband, a consultant for the United Nations.

Once, she was en route from Kosovo to Denmark when she received a call alerting her that her mother was having kidney failure and appeared as if she would die. She needed to communicate her mother's wishes from afar as her panicked sister tried to search their mother's home for her living will. Castillo-Bach didn't think she could make it in time to see her mother alive once more.

"I won't get to touch my mother again," she thought.

She was wrong. Her mother pulled through. But she says it illustrates what long-distance caregivers so frequently go through.

"This is one of the things that happens when you're thousands of miles away," Castillo-Bach said.

Lynn Feinberg, a caregiving expert at AARP, said the number of long-distance caregivers is likely to grow, particularly as a sagging economy has people taking whatever job they can get, wherever it is. Though caregiving is a major stress on anyone, distance can often magnify it, Feinberg said, and presents particular difficulty when it must be balanced with an inflexible job.

"It's a huge stress," she said. "It can have enormous implications not only for someone's quality of life, but also for someone's job."

It can also carry a huge financial burden. A November 2007 report by the National Alliance for Caregiving and Evercare, a division of United Health Group, found annual expenses incurred by long-distance caregivers averaged about $8,728, far more than caregivers who lived close to their loved one. Some also had to cut back on work hours, take on debt of their own and slash their personal spending.

Even with that in mind, though, many long-distance caregivers say they don't regret their decision. Rita Morrow, who works in accounting and lives in Louisville, Ky., about a six-hour drive from her 90-year-old mother in Memphis, Tenn., does all the juggling too.

She has to remind her mother to take her medicine, make sure rides are lined up for doctor's appointments, rush to her aid if there's a problem. She knows her mom wants to stay in her home, to keep going to the church she's gone to the past 60 years, to be near her friends.

"We do what we have to do for our parents," she said. "My mother did all kinds of things for me."
http://news.ca.msn.com/top-stories/millions-now-manage-aging-parents-care-from-afar

One of my first weekend's on at the hospital I had to search for a daughter on Princess Cruise in Australia because her mother was touch and go in the ICU.  The 23 yo grandson was the POC in this case at the time and truthfully I didn't think it was fair to him, but it just had to be.  

I've had my mother since 1997 and she is way, way harder on me than I ever was so I don't believe the payback thing, but it is what it is.    I don't have her living will and I should.  She's always been full code and truthfully until she is actually ill I will keep that status.   People should transfer assets from the parents to their heirs while they are living. I think it's $13K a year to first degree relations.   In NJ, if a patient has to go to a nursing home you get 30 days with medicare.  If you have less than $50K liquid assets medicaid will pay for you in the nursing home.  Your family usually spends that month enrolling you in medicaid.   I have a little old lady now with a "failure to thrive" diagnosis, they inserted a feeding tube, and her son coming in from Ohio to fill out the paperwork for medicaid.  She either went today or will go to the nursing home tomorrow.  

My dad took care of my mother during the years prior to her death when she had congestive heart failure.  Upon her death my dad had instructions written up that if he was unable to care for himself he wanted to be moved to the VA home in our hometown and live his life out there.  He had one stroke that kept him pretty much at home but he still had a good quality of life.  When he had his second stroke it totally paralized his right side and it was his choice to be moved to the VA home but my sister and brother were able to see him every day since they lived in the same town and since hubby and I lived in Texas at the time, I flew in every other weekend.    Should something happen to hubby or to me, I don't think he or I would either one move into our sons house nor expect him to move into our home and take care of us even though I do think our son would want to.  I don't want to be a burden on any relative.

I went through this with my mother (not the log distance part though) when she developed Alzheimers.  She had to give up her apartment and move into mine.  It was not an ideal situation because she eventually needed more supervision then I could give her seeing as how I had to work.  My sister helped out when she could but she had a husband and three kids to take care of and she was also caregiver to her husband's parents.  I wish I had known then who to contact and what services were available to her - it would have made things a lot easier.

Anyway, we eventually had to put her in a nursing home.  It was becoming a safety issue because she was declining fast and needed round-the-clock supervision.  We had a really good social worker who helped us get mom into the nursing home she had worked in before she retired.  Best part of that - there were nurses and aides still working there who she had trained and worked with and we knew she would get the best of care.  And, my sister and I both visited every week to check up on her.

No matter how you look at it, if you are stricken or disabled when you are elderly, you will need someone to be an advocate. Hopefully that will be someone who loves you. Otherwise, you'll be stuck in a facility and promptly neglected. That happens more than you realize.

This!  I can tell you from my own experience living in a nursing home, if you are the resident and don't have all your mental  faculties, you need to have a friend or family member who is authorized to act in your best interests and is willing to visit often and regularly to make sure you are taken care of properly.  I got along fine because I could advocate for myself but I saw too many of the elderly residents who had no one to speak for them, no one to make sure that the staff was taking proper care of them.