For many years, Andrea Rotondo's parents took care of each other. Her father, who had used a wheelchair since 1987 because of bad knees from his military service, organized the household. For a while, he covered up the fact that his wife was slipping into dementia.
But once he suffered a serious health crisis that landed him in the hospital and in rehab for months, Rotondo and her two siblings realized that their parents could no longer take care of themselves.
From her home in New York, Rotondo undertook a task familiar to many baby boomers: organizing the care of aging parents in another city.
"Life changed instantly for them, and we had to adapt quickly," Rotondo says. "It would have been better if we'd slowly had to get them accustomed to help."
She started by contacting a senior center in her parents' Boston suburb, seeking referrals to services in the community. From those, she did interviews, checked references and choose an agency to provide home health care aides. She engaged a geriatric care manager from another agency to oversee medical issues and make spot visits.
"If you're worried about mom or dad, you need to get someone in the balance who can give you some objective feedback," says Emily Saltz, CEO of LifeCare Advocates, a geriatric care agency in Massachusetts. "That burden is emotionally more difficult when kids live at a distance."
In addition to arranging her parents' care, Rotondo took over running their household, from paying bills to having groceries delivered to coordinating medical care. That required her to get access to bank accounts and medical information, not available to children without their parents' consent.
"Once you're able to be on bank accounts and once you're able to talk to doctors, a lot of things fall into place," Rotondo says.
The geriatric care manager, who was a nurse, took her father to doctor's appointments and helped manage his complex medical needs. Her mother's medical needs were simpler, and she could often just be accompanied by an aide who tape-recorded the appointment so Rotondo could listen later.
Technology can provide some help when coordinating long-distance care. Not only can you buy aging parents medical alert buttons, you can install motion detectors that tell you whether your parent is moving around the house.
Geoff Gross is the CEO of Medical Guardian, which has expanded its services beyond medical alerts to a Family Guardian system that allows family members to monitor parents' activities via motion sensors and apps. The company continues to develop tools that will help older people stay home longer.
"My goal is to give our caregivers more visibility and insight into the activity in the home," Gross says. "It's a very basic start of what I think is going to be a more involved process. ... A lot of it comes down to peace of mind: knowing that they're up, that they're eating, that they come and go."
Rotondo mounted a small computer in her parents' home, where she could broadcast daily messages, post family photos and show the date, schedule and name of that day's caregiver for her forgetful mother. She could also listen in, though she didn't do that often after the first few months. The caregiving journey lasted about two years; her mother and father died within two months of each other in 2012.
"It's going to be hard. It's not going to be easy to care for a parent from a distance," Rotondo says. "Things won't be perfect, and that's OK. ... You just have to accept it and not beat yourself up."
Here are eight tips for taking care of aging parents when you don't live close.
Organize legal and financial issues. This is best discussed long before your parents need help. You should request access to bank accounts and health information, plus health care surrogate and end-of-life documents, trusts, wills and other documents may be needed. "It's uncomfortable to have these discussions with parents," Rotondo says.
Automate what you can. When you take over handling a parent's affairs, you're essentially managing a second household. You may need to set up online or automatic bill-paying services, auto-renewal of newspaper subscriptions, automatic prescription refills, grocery delivery -- whatever is needed to keep the home running from day to day.
Find the help you need. Start with senior centers, your parents' friends and neighbors and agencies in the community. One you get referrals, interview the managers of the companies you're considering and then check references. You can hire caregivers directly, but that means it's up to you to provide a replacement if someone calls in sick. "We lucked out and, in fact, the caregivers became friends with my parents," Rotondo says.
Consider a geriatric care manager. If you don't know your parents' town, a geriatric care manager can help you find the health services you need and assist with managing medical care. Unlike online referral services, geriatric care managers don't receive referral fees from the providers they recommend. You can find managers in your town through the Aging Life Care Association.
Use technology in a smart way. Rotondo set up a computer in the home so the caregivers could put their logs online rather than on paper, and she could read them immediately. But motion sensors alone are unlikely to give you all the information you need to help aging parents who may not be forthcoming about all their problems. "I think these all have a role to play, but I think it's important to long-distance caregivers not to fall into a trap of thinking this is a solution," Saltz says.
Visit as often as you can and encourage others to visit. Even if your parents are having all their needs met by others, they still want to see you. Plus, seeing your parents gives you a more accurate sense of how well your plan is working and what else they might need. Children who live closer but aren't skilled at caregiving or organizing can provide great joy by visiting and bringing the grandchildren. Parents' friends, other family, clergy and your old friends who live in town can also drop by.
Agree among siblings who will do what. A geriatric care manager can often help mediate disputes among siblings as well as provide a more accurate picture of caregiving. What you don't want is for one sibling to set up a system only to have a second sibling sweep in and change it. Agree among yourselves who will take which responsibilities.
Let caregivers know what's expected. Be explicit with caregivers about when and how you want to be contacted. If the toilet overflows, do you want them to call you or a plumber? Can they help your parents order takeout or do you want them to cook? Is there a specific menu plan, or is it up to them? Leave lists of providers, family members and others to call for specific issues.
More From US News & World Report