Planning for the "in case" - how do you manage when 200 miles away ?

[BookWorm45]

Hoping some kind MNer will have some experience or wisdom to share on this...

Visiting elderly FIL at xmas - he is mid 80s and has a bunch of health problems, including difficulty with walking (quite unsteady at times). He has one of those emergency call pendant / necklace things but doesn't wear it very much (only occasionally when at the far end of the garden, not when in the house). He is in a 1930s bungalow, which has some large doorsills / steps / floor height changes in it due to a previous owner's renovations. FIL lives ~ 200 miles away. DP is the only direct relative in this country (DP's sister lives in California so in practical terms no good for any immediate emergencies).

DP is trying to think ahead so that if there is a sudden emergency, we have some awareness of what might be possible. The most likely concern we have been thinking about is a trip / fall / breaking hip etc.

DP's job means it isn't possible to take holiday during certain times of the year (though there is emergency leave, this is normally expected to be only for a couple of days or so).

How have people managed in similar situations if they've had to respond to concerns (imagine elderly parent breaks their hip, post-surgery they need someone around for a few weeks).

Do people typically take unpaid leave for a few weeks so as to have time off (even though a hit to monthly income which is another factor) ?

Or do people liaise with care agencies so as to provide care during the working week, and then visit at weekends ?

Are there any options for nursing homes which will take people on a shorter term basis such as 3 /4 weeks ?

(We are separately having a conversation about what are the best long term options, the query above is really about how people cope in emergency / urgent situations).

Thank you for any thoughts you have !

First of all, FiL needs to wear the emergency button at all times. DM has fallen in the bathroom, the kitchen and the bedroom - not the garden.
If there is an emergency, clearly one or both of you will have to go to visit him and sort things out. You probably don’t realise what giving care might mean so I would say that you would have to arrange 7 day a week care even when you are there, Personally, I am delighted DM has carers. I really don’t want to help her have a shower, dry her and dress her. She now has carers four times a day - to get her up and make breakfast, to warm up a pre cooked meal, to make her a cup of tea in the afternoon and to make her a snack supper and put her to bed. She only manages at this level because one of us goes in every morning and we are round the corner in case of emergency. Homes will take people for respite care or recovery from an operation. Round here homes charge £1500 a week.

Thanks, neither of us has provided care to an elderly relative so we definitely don't know what to expect. Useful to hear that you think it's needed to have carers in even when there is someone living round the corner.

We’re in the same situation. DH has set up Alexas throughout their house so that she can shout Alexa help and it will automatically call us (she doesn’t always wear her alarm either). Then it’s carers, very kind neighbours, meal deliveries and regular visits. To be honest, it’s a PITA as we both work full time and Sunday is spent ferrying DS to his sport - we have one day off each week to catch up on stuff and just have a break. We suggested to her some years ago when FIL died that she could move to our town (we’re the only family she has in this UK country) but she refused, so now her independence is completely reliant on paid services and the goodwill of neighbours (who have their own lives to lead).

My dm had a heart op in her 80s and needed care when she first came out. We found a nursing home that offered short term post-op or post-illness care - 2-4 weeks of three square meals a day, some sorts of physio on site, and a bit of society and encouragement, to get them up and moving, as a transition back to their own homes.

It was quite expensive but worth it for the confidence-restoring benefits and general pick-me-up care.

I'm afraid I don't necessarily have any serious practical help for you but this problem is part of a much wider conversation which needs to be brought out into the open more. I volunteer for a charity providing assistance to older people and the vast majority of our work involves sorting out people who refused to sort themselves out when they could. I'm afraid that sounds blunt to the point of rude but we have found it's reaching epidemic levels - my own parents do it too. Before things reach this point serious conversations need to be had about how older people live, for their own sake and those around them.

Our charity has two major campaigns running this year. First is the 'big box' campaign, whereby you get a big, clear plastic box and make sure originals/ copies of all important documents - ID such as passports, insurances, house deeds, pensions, bank accounts, wills, POAs etc., basically anything that anyone might need to deal with that person's affairs in the event of incapacity or worse, is in the box. Part of this could also include arranging POAs - to be honest everyone should have one in case of incapacity, just to make it easier for those around them.

Secondly we have a kind of neighbourhood watch campaign, where we ask people to keep an eye on each other. If you know you have elderly or disabled neighbours who live alone, make sure you have contact details for their families, keep an eye on their routines so you're aware if something changes. Notice if their bins don't go out or are not returned, if their post is not collected. No, this shouldn't be everyone's responsibility but it's a step towards making the world a better place.

I'm not going to get into a debate about how the stubbornness of elderly people can be a large problem because I'll be accused of agism, but as an example my own parents are about to turn 80, both have long term health problems and can't get themselves around independently anymore but need regular trips to the doctor/hospital. They don't speak the language where we live so can't even read their own post, but they insist they're not a burden on anyone, that they don't cause me any trouble and that they don't need to think about how they'd live if I were not able to do everything for them. In fact they seem to think I don't do anything for them. They insist they have no thoughts about moving from a house which is completely unsuitable for them. Fortunately for them I'm happy and able to sort them out but have a medical issue coming up which will put me out of action and put the burden on others but my parents refuse to see any of it and this the problem that we (the charity I work for) are finding is an epidemic. A complete refusal to face reality.

I'm sorry to have hijacked the thread with this super long reply but a lot of us are dealing with this. I think @BookWorm45 you are doing absolutely the right thing in trying to take steps to mitigate the consequences. Build a list of contacts to include neighbours of your FIL, local age concern organisations and independent carers. Make sure someone nearby has keys or access to keys for his house - maybe a keysafe with a code. Apart from having serious and difficult conversations with your FIL about making changes to his living cirumstances I'm afraid there's not a lot more you can do.

We all need to be proactive in thinking about how we'll manage in old age without assuming someone else will always pick up the slack.

Call he council and get a needs assessment from adult social care. It will take a while but they will assess him and the house and fit grab rails, advise on walking aids etc.

They will also be able to put you in touch with recommended care agencies. If you think he could benefit from respite care, ring round and see who offers it.

I'd also fit a key safe to the front of the house so carers/paramedics can get in during an emergency.

Would he be amenable to having a daily carer come in for an hour for a chat and a cup of tea, maybe make him some lunch? It's not a bad idea to get them used to it before they really need it.

Basically try and get as much in place now. As for emergency time off, I just worked from there. Appreciate that's not possible with all jobs.

Wow thanks everyone for being so quick to reply ! So helpful to see your suggestions and experiences.

Once DM was home, she had an emergency button, which she was hopeless at wearing too.

Then we set up visits so she had a reason to get up and dressed each day. Home hairdresser, home chiropodist, gardener & cleaner a couple of hours a week, farm foods delivery. Organised a weekly community bus visit to a social centre, and a taxi trip to the shops once a week. All of them had our number if anything was wrong.

It was more about keeping her active and interested, ensuring she had someone to speak to every day. One of the family usually visited at weekends. It worked well for years.

Lilys post is spot on. The refusal of many elderly to prepare for old age is partly why hospital wards are full. I saw it regularly as a district nurse. Living in unsuitable properties and falling about all over the place. Then refusing to pay for help. It has consequences for everyone.
Make sure you have POA first of all.
Also useful to gradually introduce as much external help as you can. Cleaner, gardener, local pharmacy delivery etc, so people are regularly going through the door. Make sure he has the number of a local handyman. Age concern.
This is what we scrimp and save for all our lives, to buy in help and care as needed and not burden busy family with jobs and families of their own, certainly that living miles away. 'Providing care' is not your responsibility and surely he wouldn't let you do that anyway, it wouldn't be fair to tie you like that in the prime of your lives( barring emergencies).
It may be useful to have an idea of the local care home situation/and a preference.
What preparations has he made, how did he think he was going to manage?

So far I think there is a stubbornness about "I'm not really old and unwell yet..." going on - with some comments about other friends / connections of the same age who are now in sheltered housing / care homes etc. So I think he has a simultaneous belief that he will be totally fine for another 10 years.... while also a growing understanding that his health is not as good as it once was. It's quite difficult to assess how much he really comprehends about his own health and situation because he really doesn't like talking about it.

I totally agree with PPs about the importance of planning ahead when younger, it's absolutely something where I see the true value of it.

Absolutely agree about planning for old age and the reluctance amongst many to do so. MIL is in her nineties and hasn’t even planned her funeral - refuses to talk about it because she’s scared of death. I completely get that, but come on - her 2 children don’t speak to each other and sticking your head in the sand isn’t going to help either of them when it comes to planning it. She’s in hospital st the moment after another fall and is not happy because she doesn’t have visitors every day and the nursing staff refuse to jump to her demands. Again, if she’d moved close to us when we suggested it she could have built up a network of friends and had us on tap so she would have been able to have regular visitors now.

We used a local care home for rehabilitation for DM after planned surgery. She stayed there for a couple of weeks straight from the hospital with all of her meals provided. A couple of friends did her washing (home would have wanted everything labelled if they'd done it) and drove her to physio appointments. Then she had friends bring shopping once she was back home again. I managed to visit twice using compassionate leave - once immediately after the surgery and once when she was in the home. It wasn't cheap but there wasn't really another option.

We've also found after a later problem with an emergency admission that having local friends with a spare key is helpful - she'd given keys to me and DB, both of us 100s of miles away so totally pointless! A key safe would be better - she could give the number eg to a paramedic over the phone so they could get into her rather than being dependent on local friends but she's still resisting that one.

As for work, I'm in a similar situation. I had a chat with my line manager about what to do re the emergency admission and he was clear that in that case (it looked like life or death for a while) I should just go, let him know when convenient and we'd sort out the details later. That's reassuring. But it's definitely only for a day or two of compassionate leave and anything longer would have to be annual leave or unpaid leave which isn't practical to take. So I've begun having conversations with DM about these limitations - she last worked in an era when she got weeks of compassionate leave for a distant relative's death(?!) and struggles to get her head round what it's like now! I've emphasised that I won't be able to do any caring, that for a lot of things she'll need to talk to her friends or get someone in - it was her choice to move closer to the friends rather than to me or DB. I've suggested things like she keeps a small bag and toilet bag packed so a friend can grab it easily and bring it to the hospital.

I'm also strongly encouraging her to sort out a POA and also her paperwork as I have no idea where we'd start currently!

Good luck! It's very difficult though.

Oh and check whether they're using the electronic prescriptions thing. I discovered DM was still faffing around dropping a repeat prescription slip off at the GP, then picking it up several days later, then taking it to the pharmacy to collect! If she'd been on the electronic system the HCPs could have accessed what drugs she was taking and the dose during the emergency admission over a weekend instead of having to wait until her GP reopened.

DH and I both see a lot of this in our jobs/volunteering, and PIL have shone a light on how not to age gracefully.

We are barely in our 60s but have the following in place:

• wills
• POA - will redo these when we hit 70 giving POA to the (adult) kids rather than each other
• Advance Decision (me, pretty brutal)
• Envelopes in a safe place the kids know about with our passwords and details of bank accounts, pensions, life insurance etc
• Kids know where the original paperwork is
• Kids have explicit permission to tell us when we need to stop driving (I already know my night vision is going)
• Plans for downsizing (or at least moving from somewhere that’s all stairs to somewhere a bit flatter where a stairlift can go in)
• Good financial plans/pensions (obviously started those many many years ago!)

I’m most scared of living in enabled isolation - the current fetish with ‘independence’ and ‘strengths based approaches’ really worries me.

OP it’s hard to avoid crises, but they are easier to manage if you have some plans in place (basic understanding of whether your FIL would be self-funding for care or would qualify for paid care is an excellent start). Good luck.

Oh and a keysafe!!!!!

You'll have to train him to wear the button at all times INCLUDING at night in bed. So its on him if he gets up at night for a pee. AND USE IT. I recommend occasionally testing it when you're there.

I was the first responder for a very independent neighbours call-button and it took ages before she used it properly. We had one incident where she wasn't wearing it when she fell; another when she was wearing it, needed help in extreme pain at midnight but daftly "decided to wait till morning so as not to wake you". When she had a big stroke at night , thank god she was wearing it and used it. But it had taken years of mean nagging to make sure she always had it on (especially in the shower etc).

Have a spare key to his house; one for you. One kept by a neighbour who is willing to keep an eye out ; just
discreetly checking that the curtains open and shut every day, chimney is smoking, milk bottles taken in etc. Make sure a neighbour has a note of GP or SW and your contact numbers. It's also useful to have all the contact numbers posted in a prominent place inside the house.

One issue we had was when suggesting a key safe my elderly ma checked with her insurers who totally ruled it out…

Some great practical tips on here - for us (similar situation to you - 2 children each living at least 2-3 hrs away and not able to provide help except in an emergency) it took around 2 years of tough conversations. What made the difference ultimately was the pandemic - which put a stop to her social life - and a need for 2 separate ops, which she has recovered from but which also left her frail.

This was a better and safer wake up call than a fall, but it still took a crisis for her to decide in her own mind that something needed to change. She had a carer, cleaner and gardener as well beforehand.

She finally agreed to look at sheltered accommodation and is now in a brilliant place. A key factor was getting her to go round and see places - initially she was really snooty about them but gradually realised that the residents were not all dribbling idiots. The Richard Osman books were also a great help - they nicely glamorise retirement living so well worth investing in the set for your FIL!

In my experience getting them to wear the emergency button does not mean they will actually press it in an emergency . My parents passed earlier this year but on the couple occasions when they should have done they did not use the button . I was about 5 hours away .

How we controlled the situation was by phoning daily at a set time and by having a key safe and also a friend and neighbour with a key . The neighbour would pop in once a week and both times it was them that called an ambulance when they could see evidence of a fall . The people opposite kept an eye on whether curtains were opened.

My parents would not move closer to me and in reality that is the only way I could really keep them safe .

When things did go wrong we were very much dependent on the NHS and if they had left hospital Local Authority organised care . They both went down hill quickly and passed quickly and unexpectedly

If you can persuade your relative to come closer to you that is the best way though I can 100% understand why my Dad was insistent on staying in his own home.

sorry if this sounds rather bleak but unfortunately this was my experience of how it paned out

there is a stubbornness about "I'm not really old and unwell yet..."

I've seen a couple of old single and very independent rural friends come to grief after just ONE quite minor incident had a devastating knock on effect that instantly changed their lives and took away all independence, choice and decision making.

  Living in glorious isolation /up a hill with lovely view  is wonderful until you are alone and can't drive or walk and there's no bus, then its impossible.   By then it's too late to start househunting for a downsize because you 're not mobile enough to go viewing  them.

Planning ahead  and making changes before you need them is the way to go.

So pleased to see everyone's replies and there's a lot to work through there, some suggestions I'd not come across at all - so thank you all !

What sort of area does your FIL live in? My mother is 82, has lived on the same street for decades, so has neighbours who all keep an eye out for each other, even though they are mostly equally elderly. I don’t have too many worries at the moment even though me & siblings all live far away. I think if there was a health emergency one of us would be able to work remotely from her house for a while.

On the other hand, a friend’s father lives in an isolated rural area with no near neighbours which is a totally different ball game.

OP - my mum was recently in care home for two weeks after a hospital admission, it's known as respite care if that helps.

SharpLily as you have posted, do you know of how to get help to an elderly person quickly, apart from 999?

we've got neighbours who can go but I am two hours away and stuck as mum doesn't need daily care but ideally someone nearer who can go if there's an emergency. All ideas gratefully received. I also feel really bad about neighbours being stuck with it.

I am looking to move nearer but had that fall through once already.

Nothing official, no. It's a case of relying upon the goodwill of friends and neighbours close by. Which I don't really approve of, to be honest. By all means everyone should look out for each other but I don't think it's fair to ask others to commit to too much.

Sharp I don't feel it's fair to them, no. They suggested the emergency button and that they would be first contact, otherwise I don't think we'd have done it. I was vaguely aware of it but they pushed for it as their mum has it.

I won't say "don't approve" as it's not always possible to live near parents but I do tell mum very specifically not to bother them.

they call or pop every day when I'm not there. Not that we ever asked. One hospitalisation, they said "why do you worry, we love her like family" but I feel that must have limits. Also, if they move, we are stuffed!

Anyway, trying to move nearer again.....fingers crossed it works this time.

To be clear, in theory, the longest anyone would have to wait with her is 2 - 3 hours, 3 being if I was really unlucky with transport.