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Paying the bills, maintaining the patient's home and handling insurance payments are some of the demands that relatives often face. If the patient is returning home, someone needs to assist in grocery shopping or medical needs. After families agree on a plan, they should put it in writing to avoid disagreements later, Wohlgemuth said.

At Boston Medical Center, Wohlgemuth works with an at-home team, composed of attending physicians, a geriatric clinical nurse specialist and a licensed social worker. Each specialist shares care for an elderly person receiving medical attention at home.

The geriatric clinical nurse visits the patient at home and does a geriatric assessment. Then, he or she provides care planning and case management for the patient, where contacts or referrals are made to social service agencies to provide meals, order medical equipment or home health care services, like laundry or shopping. The nurse also consults with family members to provide these services if possible.

Wohlgemuth, a geriatric care nurse, has been in practice for 15 years. "When I took this position, I thought the hospital needed to add nurses to their care plan. It's an impossible task for one physician to do."

It takes a village

"Through the efforts of the nursing staff, I feel our elderly patients' care is enhanced," Wohlgemuth said.

What is the secret to her success? "We get everyone involved-the medical staff, the community, the neighbors, plus the patients' family."

Marty Richards, a geriatric private-care manager in Seattle, also consults with long-distance caregivers. She implores family members to think of their own needs, asking them, "What are you doing for yourself?" She then suggests that they keep a phone book and resource guide handy. She reassures them by saying, "Being close means a different kind of caring experience-not bad or good, but different."

When a distant child visits, the patient often puts on his or her best front, Richards said. This often gives the visitor a false sense of security about his or her parent's health. That is why it's necessary to have a local relative or other person with whom to communicate regularly-to get the true picture.

If a parent lives in a facility, a social worker may provide this information. Richards advises families to call at a set time-when that person will not be busy.

Ask questions: "Is Mom participating in activities? What material things does she need?" Say, "The last three times I've called, Dad seemed down. Is something going on with him?"

Smith emphasizes this point, too. Families should be encouraged to be in contact with members outside the medical arena as well. Friends, relatives, church members, a hairdresser or a bridge partner can give an accurate picture of a loved one. She advises family members to give out their phone number, asking community members to contact them if necessary.

In case of an emergency, Smith said that if you're living at a distance, problems are intensified. That's why it's critical for the nursing staff to share health care information.

She advises hospitals or nursing facilities to establish an information system with each family, by asking:

• Who should I talk to in terms of problems?
• When is the best time to call?
• If a problem occurs-medical, legal or financial-how do you want to deal with it?
• How can I get written information if I need it?