Caring From Afar

SEVERAL MORNINGS A WEEK, Marti Kotin Mirken calls her mother, Yadeh Kotin, in Hollywood, Fla. The 79-year-old Kotin suffers from emphysema and was hospitalized earlier this year with a collapsed lung. On a recent morning, all Mirken got was a ceaseless, nerve-racking ring. By late afternoon, after repeated unanswered calls, Mirken, in Boston, and her sister in New York were on the verge of panic. They didn't find their mother until evening. She'd been hospitalized in the middle of the night after calling 911 and complaining of shortness of breath. Kotin was never in serious danger, but the anxiety attack that triggered her breathing difficulties had engulfed the whole family. ""We're very close to my mom. We want to care for her,'' says Mirken, a divorced mother of four. ""Still, it's hard. I work, I worry about my children and I worry about my mother, who's 1,500 miles away.''

It is the growing dilemma of our age. In an increasingly mobile society, grown children seldom live down the road from Mom and Dad, and often they're more than a time zone away. Of the estimated 25 million Americans who serve as caregivers to an elder, more than a quarter are doing it long distance. And that number is expected to grow as more baby boomers take on the heart-wrenching task of mothering and fathering their parents. Today the array of services available to seniors is dazzling, from home health aides to community-living facilities. The choices may seem overwhelming, but as offerings increase, so do the resources for sorting them out.

Instead of nursing homes, seniors are increasingly choosing either assisted-living facilities or continuing-care retirement communities (CCRCs). The former, which charge anywhere from several hundred to several thousand dollars a month, offer residents meals and housekeeping and help with basic tasks, such as dressing and bathing. CCRCs offer a wider range of living choices, enabling tenants to move from apartments to nursing facili- ties within the same complex. They're pricier, too: for a one-bedroom apartment, entry fees alone run as high as $87,000, with monthly rents of $1,000 and up.

Despite these options, many seniors--even those confined to wheelchairs--prefer to stay in their own homes. As a result, home-health-care services are booming. The number of certified home-care agencies has nearly doubled since 1989; but many others lack any certification, and state regulations governing them vary widely. Even with the best intentions and regular phone calls, it's difficult to monitor the quality of care. A recent federal audit, for example, concluded that 40 percent of home visits paid for by Medicare were unjustified. ""There's a wide margin for fraud and abuse,'' says Donna Wagner, author of the National Council on the Aging's recent study ""Caring Across the Miles.''

When Matthew Jampol's 76-year-old mother was released from a California hospital two years ago, Jampol, who lives in Florida, took the hospital's recommendation for a home-care worker. But when Jampol visited her several months later, he found ""the place was dirty, the food was rotting and she didn't look good at all.'' So he turned to a so-called geriatric-care manager (GCM), an on-site family proxy who can arrange and oversee services. Jampol's choice, Senior Care Management of Beverly Hills, Calif., selected a competent home caretaker and even persuaded Mrs. Jampol to attend a senior-day-care program. ""She's happy and enjoying life,'' says Jampol.

GCMs don't come cheap. Their fees range from $50 to $150 an hour. ""Geriatric-care managers are a bridge to information,'' says Wagner--""but they're a toll bridge.'' Still, they are a godsend for many families who feel guilty that they're too far away to offer their parents much more than emotional support. Mary Barringer, a GCM in Springfield, Ill., recently helped a 90-year-old woman make a flight from Chicago to Atlanta for her granddaughter's wedding. ""We'll shovel the walk; we'll get the house painted,'' she says. ""Whatever needs to be done, we'll do it.''