Your Eldercare Compass
Helpful tips for family caregivers

Working with doctors long-distance

It can be challenging to stay on top of a relative’s medical needs when he or she lives far away. Success depends on three factors: information, cooperation, and communication.

Information is essential. Learn the basics about each disease affecting your family member. This way you can understand the doctor and ask good questions. Know the symptoms and how they affect daily living. Is there any way to prevent or minimize problems? Find out about treatment options and the likely course of the illness. See our past article about researching health treatments online.

Cooperation from your relative is key. The doctor can’t give you information without your family member’s consent. Assuming your relative welcomes your participation, have him or her sign a HIPAA release and any other papers the providers require for you to access medical records. Keep copies of this paperwork for yourself.

Communication with the doctor may take many forms.

• Office staff can be very helpful. They may be able to answer your questions. Know the members of the team by name. Say “thank you!” for their assistance.
• Ask if you can correspond with the doctor via email. Many healthcare systems offer secure messaging or Patient Portals.
• Review online medical records. If they are available to patients, ask your loved one if you can have his or her login information.
• Attend appointments as often as you can. In person, if you are in town. Or virtually, via cell phone. (Your relative can call from the exam room and put you on speakerphone.) You might want to arrange a separate follow-up call with the doctor, which you may need to pay for yourself (not covered by Medicare). Or consider hiring a care manager as an advocate. He or she can accompany your loved one and keep you current on recent decisions.

Keep a health “diary” with up-to-date notes on your relative’s health events, doctors’ recommendations, and medications.

Complications of diabetes

Diabetes is common, affecting one of every four older adults. The condition occurs when the body doesn’t process sugars correctly, leaving too much in the blood. This is a setup for complications, many of them quite serious.

To reduce the impact of the most typical complications:

Check the feet. Many diabetics experience nerve problems in their feet and legs: numbness, tingling, burning, or pain. It’s important that your loved one visually check his or her feet every day. Look for cuts, redness, bruises, sores, ulcers, or infections. A hand mirror on the floor can help with seeing all around the foot. Your diabetic relative could have an infection and not even feel it! Such infections can lead to toe or foot amputation.

Get an annual eye exam. Diabetes injures the blood vessels, which in turn can cause problems with the eyes. Spots or dark strings (floaters) are signs of diabetic retinopathy, as are blurry vision or dark or empty spots. Have your relative’s eyes examined once a year.

Prevent falls. Numb feet and poor vision create balance problems. As a result, diabetics are at great risk of falling. Be sure your loved one has good glasses and sturdy shoes. Fix any tripping hazards around the home. Watch for bladder issues, another common complication, that could cause rushing to the bathroom (and then a fall). Also have the doctor review medications. Ask about alternatives for any drugs that list dizziness as a side effect.

Fortunately, most complications develop gradually. To avoid them, help your loved one keep his or her blood sugar stable. Daily exercise, healthy eating, taking medications as directed, and stopping smoking all will contribute to a lower risk of developing any serious problems. Ask your doctor what is available in terms of special programs to help diabetics manage their condition effectively.

Funeral logistics

Funerals are like weddings: gatherings of family and friends to mark a life passage. They are typically very emotional and can be very sweet. And they can also get very expensive!

Plan ahead
It’s optimal to talk with your loved one about his or her funeral wishes well before there is a need. Allow him or her to decide what is personally meaningful. If possible, talk as a family. Then everyone will understand your relative’s wishes.

Consider the options
Several logistics should be coordinated. Cost and lead time for making arrangements are often big factors.

• Cremation or burial. People frequently have very strong preferences based on religious beliefs or family tradition. As a practical rule, cremation is usually less expensive. It does not require preplanning. Burial requires a cemetery plot.
• Casket. Cremation does not require a casket. If burial is desired, ask about alternative containers. They cost less.
• Embalming. If the body is buried or cremated within two days of death, there is no legal requirement for embalming. If you will need more time, then embalming will likely be required. You must then work with a funeral home. Ask if refrigeration is an option. (It tends to be less expensive.)
• Viewing and location. Do you want a ceremony that involves viewing the body? If so, do you want the service at home? At home, the ceremony must take place within 48 hours of death. The funeral home must then pick up the body for immediate cremation or quick burial. If you need more time or wish to have a more public viewing, consider other sites. Services can be arranged at funeral homes, religious institutions, or directly at the graveside. If you would like to arrange for a viewing and then cremation, you will need to arrange for renting a casket.
• Memorial service. A memorial service does not include viewing of the body. A memorial service can happen at any time and at any location.

You can get more information from the Funeral Consumers Alliance.