Caring For Aging Parents Back Home: The Expat Dilemma
Explaining Case Management and more
Sue Lane
Finding the perfect home and top schools can be the primary focus when organizing a family transfer overseas. Then all too quickly, there are the final goodbyes and messages for safe travel, prosperity and good health.
But with so many demands and last minute tasks requiring completion, the needs of those that may be left behind, particularly our aging parents, can sometimes be forgotten.
Fortunately for many expats, their parents remain fit and well. However, for some, the equilibrium of daily life abroad can suddenly change if you are not prepared. For example, how does… |
What Can You Do?
Distress, frustration and remoteness associated with being geographically separated can be overwhelming when an unexpected change in health and wellbeing occurs to an aged parent. Participation from afar may require decisions for acute medical treatment, finding alternative accommodation or identifying appropriate medical, allied health or home support services within the complexities of homeland health systems. Often the practicalities of long distance caregiving are not viable due to the maze of services, which may be across different jurisdictions and accommodation settings.Â
Evidence-based research shows an additional complication, where most families do not discuss preferences related to medical treatment or lifestyle decisions in advance. Typically, family members have different thoughts of what is best when faced with crisis decision-making, and most siblings have little idea of their parent’s wishes for future medical care or living arrangements.
Case Management
To ease this problem, there is an evolving group of health professions, who provide care coordination and management services to fill the gap for absent family members. Essentially, these roles assess, plan and coordinate care and lifestyle needs, manage living environments, monitor ongoing wellbeing, check for risk, advocate preferences and provide liaison.
The name given to such health services can vary from country to country, but generally speaking the term case management (case managers) is commonplace and should produce a helpful web search.
Case Management Suggestions
If you are (or plan to be) an expat, it is a good idea to contemplate the following case management suggestions. At all times, remember to acknowledge the uniqueness of your family and the possible uncertainties and challenges your parents face in their life phase.
Be aware that it is not uncommon for parents to be adamant and refuse support until the last minute, whereupon everyone is plunged into a crisis. For success, your parents must be central to any process of identifying issues, solutions and therapy viewpoints. If parents are resistant, try to express the peace of mind it will provide to the family as a whole if support strategies can be identified prior to your departure.Â
As a family unit you may like to consider:
1. Engaging a Case Manager to visit your parents. As your eyes and ears, a case manager will make sure your parents are in good health and monitor any ailments. If seemingly well prior to your departure, a one-to-two monthly visit may be sufficient to provide reassurance. This can also ease any concerns that your parents might have, because they will then have access to a trusted, on-call person, who can facilitate timely management of health issues or household incidents and curtail the possibility of unmanaged problems exacerbating. In consultation with your parents, you can establish communication preferences between the case manager and family members, including the possibility of webcam sessions involving your parents.
2. Identifying Needs and Planning Ahead, which is commonly known as Advance Care Planning. This is a process whereby personal wishes for future health care are planned and recorded in advance. A family meeting is often the best way to collect this information. Such discussions amongst family can be difficult and some may feel ill at ease deliberating about a phase when their parents’ health may decline. If it makes discussions easier, consider engaging the expertise of a case manager to facilitate this meeting and guide the collection of pertinent information. For success, encourage participation by all family members and acknowledge the dynamics of sibling rivalry, responsibility sharing, dominating opinions, financial capacity and how these may influence the outcome.
The Family Meeting
With or without a case manager, it is a good idea to have a family meeting to discuss your parents’ wellbeing. At such a meeting, allow your parents to feel in control (according to their level of competence), and ideally you would be wise to discuss:
• Collection of contact details – such as doctors, treating hospital, dentist, other health professionals, lawyer and accountant;
• Power of attorneys – for medical, financial and lifestyle;
• Diagnosis, current medication and treatment information;Â
• Personal preferences for current and future healthcare;
• Living environment, household management, maintenance issues and contacts;Â
• Social support, networks and lifestyle preferences; and
• Emergency contacts, a crisis response plan and contact preferences. |
