Many people live far away from their family or friends who need help. If you don’t live nearby, you can still provide support and assistance as a long-distance caregiver. This article provides information and resources if you find yourself in a long-distance caregiving role.

What tasks can a long-distance caregiver help with?

Long-distance caregivers take on different roles. From a distance, you may be able to:

• Assist with finances, money management, insurance claims, or paying bills
• Arrange for care management or in-home care by hiring formal caregivers such as home health aides
• Order medical equipment, medicines, and other supplies the person needs
• Serve as an information coordinator by researching information about relevant health conditions and medicines, navigating changing needs, and overseeing insurance benefits
• Help with advance care planning, such as choosing a health care proxy and preparing a living will
• Help find, organize, and update important paperwork and records
• Research long-term care options, such as an assisted living facility or nursing home

You will probably be coordinating these tasks with family, friends, or other caregivers who live nearby. Read more about sharing caregiving responsibilities with family members.

Staying connected from far away

When you don’t live close by, it may take more effort to find out what’s going on and stay up to date with an older person’s needs. Here are some strategies and technologies that long-distance caregivers can use to stay connected:

• Create a list of important phone numbers and email addresses. Keep it in a shared document or spreadsheet online and update it regularly.
• Set up a shared calendar online or in a smartphone app to coordinate with other caregivers.
• With permission, attend the person’s telehealth visits. Telehealth visits are remote appointments with health care providers often done with videoconferencing.
• Participate remotely in conference calls or video meetings with the assisted living facility team or nursing home staff.
• Help the older person learn about the features of their mobile or smart phone, such as texting and video calls.
• If the older person is comfortable using a computer or tablet, set up an email account for them and teach them how to stay safe online.

Making the most of a short visit with an aging parent or relative

Talk to the person ahead of time and find out what they would like to do during your visit. Also check with the primary caregiver, if appropriate, to learn what they need. You may be able to handle some of their caregiving responsibilities while you are in town. These conversations can help you set clear-cut and realistic goals for the visit. Decide on your top priorities — that may mean reserving other tasks for a future visit.

Because there’s a lot to do during a short visit, it’s easy to overlook simply spending time with the person and doing things together. Try to make time for activities unrelated to being a caregiver, such as watching a movie, playing a game, enjoying music, or taking a drive. Finding time to enjoy something simple and relaxing together is good for everyone.

Supporting the person doing day-to-day caregiving

In many cases, one person takes on most of the everyday responsibilities of caring for an older person. It tends to be a spouse or the child or sibling who lives closest. If you are not the primary caregiver, you can still play an important role in supporting that person.

Here are some ways you can help, even if you don’t live nearby:

• Ask what you can do that would be most helpful.
• Stay in regular contact with the primary caregiver by phone or email. Just listening may not sound like much, but it can mean a lot.
• Travel to stay with the older person for a few days so the primary caregiver can take a vacation or just have some time off.
• Arrange for regular respite care in the form of a volunteer, an in-home aide, or an adult day care program.

In time, the older person may have to move to a residential (live-in) facility, such as assisted living or a nursing home. If that happens, the primary caregiver will need your support. You can work together to select a facility and coordinate the move. The primary caregiver may need extra support while adjusting to the person’s absence and to living alone at home.

To learn more, please visit https://www.nia.nih.gov/health/long-distance-caregiving/what-long-distance-caregiving.

Almost anyone, at any age, can do some type of physical activity. You can still exercise even if you have a health condition like heart disease, arthritis, chronic pain, high blood pressure, or diabetes. In fact, physical activity may help. For most older adults, physical activities like brisk walking, riding a bike, swimming, weightlifting, and gardening are safe, especially if you build up slowly. You may want to talk with your doctor about how your health condition might affect your ability to be active.

Staying physically active: Alzheimer’s disease and related dementias

Researchers are assessing the benefit of exercise to delay mild cognitive impairment (MCI) in older adults and to improve brain function in older adults who may be at risk for developing Alzheimer’s disease. Older adults with MCI may be able to safely do more vigorous forms of exercise, similar to older adults without MCI, provided there are no other underlying health concerns.

Being active and getting exercise may help people with Alzheimer’s or another dementia feel better and can help them maintain a healthy weight and have regular toilet and sleep habits. If you are a caregiver, you can exercise together to make it more fun.

Exercising with arthritis

For people with arthritis, exercise can reduce joint pain and stiffness. It can also help with losing weight, which reduces stress on the joints.

Flexibility exercises such as upper- and lower-body stretching and tai chi can help keep joints moving, relieve stiffness, and give you more freedom of movement for everyday activities.

Strengthening exercises, such as overhead arm raises, will help you maintain or add to your muscle strength to support and protect your joints.

Endurance exercises make the heart and arteries healthier and may lessen swelling in some joints. Try activities that don’t require a lot of weight on your joints, such as swimming and biking.

If you have arthritis, you may need to avoid some types of activity when joints are swollen or inflamed. If you have pain in a specific joint area, for example, you may need to focus on another area for a day or two.

Physical activity and COPD (Chronic Obstructive Pulmonary Disease)

If you have COPD, talk with your healthcare provider or a pulmonary therapist to learn what he or she recommends. You may be able to learn some exercises to help your arms and legs get stronger and/or breathing exercises that strengthen the muscles needed for breathing.

Pulmonary rehabilitation is a program that helps you learn to exercise and manage your disease with physical activity and counseling. It can help you stay active and carry out your day-to-day tasks.

Exercising with type 2 diabetes

For people with diabetes, exercise and physical activity can help manage the disease and help you stay healthy longer. Walking and other forms of daily exercise can help improve glucose levels in older people with diabetes. Set a goal to be more active most days of the week, and create a plan for being physically active that fits into your life and that you can follow. Your healthcare team can help.

A few easy steps to be more active:

• Stretch during TV commercial breaks.
• Walk around when you talk on the phone.
• Take more steps by parking farther away from stores, movie theaters, or your office.

Exercise and heart health

Your heart keeps your body running. As you grow older, some changes in the heart and blood vessels are normal, but others are caused by disease. Choices you might make every day, such as eating healthy, maintaining a healthy weight, and aiming to be more physically active, can contribute to heart health. Inactive people are nearly twice as likely to develop heart disease as those who are active. A lack of physical activity can worsen other heart disease risk factors as well, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity. Being physically active is one of the most important things you can do to keep your heart healthy. Aim for at least 150 minutes of moderate-intensity aerobic activity a week.

Exercising with osteoporosis

Weight-bearing exercises, which force you to work against gravity, such as walking, jogging, or dancing three to four times a week, are best for building muscle and strengthening bones. Try some strengthening and balance exercises, too, to help avoid falls, which could cause a broken bone. Doing these exercises is good for bone health for people with osteoporosis and those who want to prevent it.

Exercising with chronic pain

Most people living with chronic pain can exercise safely, and it can assist with pain management. In fact, being inactive can sometimes lead to a cycle of more pain and loss of function. Talk to your doctor about what exercises/activities might be right for you. Each type of exercise—endurance, strength, balance, and flexibility—has its own benefits, so a combination may be best.

Exercise can help you maintain a healthy body weight, which may relieve knee or hip pain. Putting on extra weight can slow healing and make some pain worse. Remember to listen to your body when exercising and participating in physical activities. Avoid over-exercising on “good days.” If you have pain, swelling, or inflammation in a specific joint area, you may need to focus on another area for a day or two. If something doesn’t feel right or hurts, seek medical advice right away.

Quick tip

Pain rarely goes away overnight. Talk with your doctor about how long it may take before you feel better. As your pain lessens, you can likely become even more active.

To learn more, please visit https://www.nia.nih.gov/health/exercise-and-physical-activity/exercising-chronic-conditions.

Knowing what matters most to your loved one can help you honor their wishes and give you peace of mind if they become too sick to make decisions. Unfortunately, only one in three people in the United States has a plan for their future health care in place. There are steps you can take to help your friend or family member navigate future medical decisions — and to be prepared to make decisions for them, if needed. This is part of advance care planning, which involves preparing for decisions about future medical care and discussing those wishes with loved ones.

How to start the conversation about advance care planning

One of the best things you can do as a caregiver is to discuss your loved one’s care and treatment preferences in advance. Starting the conversation early is especially important if the person has been diagnosed with a condition that affects their cognitive health, such as Alzheimer’s disease or another form of dementia. Here are some ways you might start the conversation:

• Start simple. Talking about specific medical treatments or decisions can be scary and overwhelming. Instead, try asking about any concerns they may have, what decisions they may need to make, and who they might trust to make decisions for them.
• Share what’s important to you. Your loved one may feel more comfortable discussing their preferences if you talk about what matters to you, as well.
• Remind them why it’s important. Talk about the benefits of having these conversations and creating an advance care plan. By documenting their wishes, they are more likely to get the care they want, and it can also help loved ones feel less burden, guilt, and depression.
• Try to be understanding. After a recent diagnosis or health change, it can be overwhelming and difficult to discuss future health care needs. The person may feel more comfortable talking with someone else such as a doctor or someone in their spiritual community. You can also encourage the person to think about their potential needs and plan to discuss them another time.
• Keep the conversation going. Listen carefully to what the person says and encourage them to continue sharing.

If the person is open to creating an advance care plan, you can provide them information on how to get started. It’s possible your loved one may not want to put a plan in place. Still, talking to them about their preferences can help you prepare for future decisions. You may also be able to help prepare in other ways, for example by getting important papers in order.

How to serve as a health care proxy

Most people ask a close friend or family member to be their health care proxy. A health care proxy is typically responsible for talking with doctors and making decisions about tests, procedures, and treatments if a person is unable to speak for themself. The types of decisions a proxy can make should be outlined clearly in the durable power of attorney for health care, a legal document that names the proxy.

If someone has asked you to be their health care proxy, it’s important to consider whether the role is right for you. You may have to discuss sensitive topics, make difficult decisions, and advocate on the person’s behalf. Ask yourself:

• Can I honor this person’s wishes and values about life, health, health care, and dying? Sometimes this can be challenging if your values are not the same.
• Am I comfortable speaking up on the person’s behalf? It’s okay if you don’t know a lot about health care, but it’s important that you are willing to ask questions and stand up for the person.
• Are you comfortable dealing with conflict? A proxy may need to uphold the person’s wishes even if other family members, friends, or loved ones don’t agree.

If you have agreed to be someone’s health care proxy, consider these tips:

• Talk to the person about their values. Learn what matters most to them when it comes to life, health care, and dying.
• Learn about their current and future health concerns. The more you understand their wishes, the more prepared you will be to make decisions for them when the time comes. Ask if they have any plans in place, like a living will, and walk through it together.
• Ask for a copy of their advance directives. This often includes a living will and durable power of attorney for health care forms.
• Keep a copy of important information. Make sure to have contact information for the person’s health care providers and family members.
• Ask about other considerations. For example, is there anyone other than the medical team that you should talk with when making decisions? Are there spiritual, cultural, or religious traditions the person wants you to consider?
• Continue the conversation. Have conversations each year and as major life changes happen, such as a divorce, death, or change in their health.

Even when you have a person’s decisions in writing and have talked about their wishes, you may still face difficult choices or not be able to follow the person’s wishes exactly. Try to reflect on your discussions and do your best to honor the person’s wishes to the extent possible.

Learn more about the role of a health care proxy.

• What to do when your loved one can no longer make decisions

If your loved one can no longer make their own decisions, you may need to make decisions on their behalf. This can be difficult if you haven’t discussed their preferences before. Even if you have, there may be unexpected situations and decisions that arise. Talking with close loved ones and the person’s health care team can help you prepare and feel more supported when decisions arise. Try to:

• Talk to family members, friends, or others who know the person well.
• Think about how the person lived their life. What values and wishes did they express in the past? What did they find most meaningful in life?
• Talk with the doctor and health care team about what to expect and the types of decisions you may need to make.

Learn more about making decisions for someone at the end of life.

Tips for navigating the health care system

When a person becomes too sick to make decisions for themselves, family members and caregivers may need to navigate the health care system and find ways to advocate for their loved one’s care — especially if a proxy was not named. Use these tips:

• Ask questions. If you are unclear about something you are told, don’t be afraid to ask the doctor or nurse to repeat it or to say it another way.
• Make the person’s wishes clear. Share copies of the person’s advance directives and the proxy’s contact information with the health care team, nursing home staff, or others caring for the person. If the person is still living at home, you can put this information in a colorful envelope near their bed or on the fridge for emergency responders.
• Write down contact information. Ask for a specific person on the medical team that you can contact for questions or if the person needs something.
• Choose one person to make health care choices. Deciding on a main point of contact for the medical team can help everyone stay more organized, coordinate upcoming appointments, and manage medications or changing medical needs.
• Keep family members looped in. Even with one person named as the decision-maker, it is a good idea to have your family agree on the care plan, if possible. If you can’t agree, you might consider working with a mediator, a person trained to bring people with different opinions to a common decision.
• Try to decide on an end-of-life approach. When it becomes clear the person is nearing the end of life, the family should try to discuss the desired end-of-life care approach with the health care team. This might include hospice care. Discussing the options and making decisions as early as possible can help with planning.
• Remind the health care team who the person is. Remind them that the person is not just a patient. Tell them about the person. Share what they were like, discuss the things they enjoyed most, and post pictures in their room.

There may also be people in your community who can help you navigate the health care system. Some hospitals have a patient advocate or care navigator, or you may consider working with a geriatric care manager.

To learn more, please visit https://www.nia.nih.gov/health/advance-care-planning/advance-care-planning-and-health-care-decisions-tips-caregivers-and.

Which vaccines do older adults need?

As you get older, a health care provider may recommend vaccinations, also known as shots or immunizations, to help prevent certain illnesses.

Talk with a doctor or pharmacist about which of the following vaccines you need. Make sure to protect yourself as much as possible by keeping your vaccinations up to date.

COVID-19 vaccines

COVID-19 is a respiratory disease that causes symptoms such as fever, cough, and shortness of breath. Older adults are more likely than younger people to get very sick from COVID-19. The disease can lead to serious illness and death.

Studies show that COVID-19 vaccines reduce the risk of getting this disease. The vaccine will also help keep you from getting seriously ill or having to go to the hospital if you do get COVID-19. We are still learning how effective COVID-19 vaccines are against new variants of the virus. Read more about COVID-19 vaccine effectiveness.

The Centers for Disease Control and Prevention (CDC) recommends that older adults stay up to date with COVID-19 vaccines, including booster shots. Read more about COVID-19 vaccines from the CDC.

The COVID-19 vaccine is available at no cost in the United States. Contact your local health department or visit Vaccines.gov to find out where you can get vaccinated.

Flu vaccine for older adults

Flu — short for influenza — is a virus that can cause fever, chills, sore throat, stuffy nose, headache, and muscle aches. Flu is very serious when it gets in your lungs. Older adults are at a higher risk for developing serious complications from the flu, such as pneumonia.

The flu is easy to pass from person to person. The virus also changes over time, which means you can get it again. To ensure flu vaccines remain effective, the vaccine is updated every year.

Everyone age 6 months and older should get an annual flu vaccine, but the protection from a flu vaccine can lessen with time, especially in older adults. Still, you are less likely to become seriously ill or hospitalized with the flu if you get the vaccine. A flu vaccine is especially important if you have a chronic health condition such as heart disease or diabetes.

Ideally, you should get your vaccine by the end of October each year so you are protected when the flu season starts. It takes at least two weeks for the vaccine to be effective. However, if you have not received your flu vaccine by the end of October, it’s not too late — flu season typically peaks in December or January. As long as the flu virus is spreading, getting vaccinated will help protect you.

There are flu vaccines designed specifically for older adults. The CDC recommends that people age 65 and older receive a higher-dose flu vaccine or an adjuvanted flu vaccine (one with an additional ingredient called an adjuvant that helps create a stronger immune response). These vaccines are potentially more effective than the standard flu vaccine for people in this age group. Talk with a health care provider or pharmacist about which vaccine is best for you.

Medicare will pay for the flu vaccine, and so will private health insurance plans. You can get a flu vaccine at a doctor’s office or local health department, as well as at many grocery stores, drug stores, and pharmacies. Flu shots may also be available at other community locations, such as schools, religious centers, and workplaces. The ingredients of a specific vaccine are the same wherever you receive it.

RSV vaccine for older adults

Respiratory syncytial virus (RSV) is a common virus that usually causes mild, cold-like symptoms. However, older adults have a higher risk of developing severe symptoms if they are infected with RSV. The illness can be particularly dangerous for people who have chronic diseases or a weakened immune system. Older adults who get very sick from an RSV infection may need to be hospitalized, and the illness can even be life-threatening.

RSV vaccines are available to protect older adults from the serious health problems that can occur with RSV infection. The CDC recommends that adults 60 years and older talk with their health care provider about whether they should receive the RSV vaccine. Like the flu, RSV infections are most common in the fall and winter months, so consider getting vaccinated before RSV season starts. However, you can benefit from the RSV vaccine at any time of year.

You can get the RSV vaccine at a doctor’s office, your local health department, and many pharmacies. Medicare Part D and private health insurance plans may pay some or all of the cost. Check with Medicare or your health plan for details about coverage.

Vaccines to help prevent pneumonia

Pneumococcal disease is a serious infection that spreads from person to person by air. It often causes pneumonia in the lungs and it can affect other parts of the body. Older adults are at higher risk than younger people of getting very sick or dying from pneumococcal disease.

The CDC recommends that all adults age 65 and older get pneumococcal vaccination. This vaccine helps protect you from getting a serious infection, including pneumonia. There are multiple forms of the pneumococcal vaccine: Talk to a health care provider to find out which is best for you. You can also visit the CDC’s Pneumococcal Vaccination webpage to learn more about the types of vaccines that are available.

Medicare will pay for the pneumococcal vaccine, as will many private insurance plans. You can get the vaccine at a doctor’s office, your local health department, and many pharmacies. Pneumococcal vaccines may also be available at other community locations, such as schools, religious centers, and workplaces.

Tetanus, diphtheria, and pertussis (whooping cough) vaccines

Tetanus, diphtheria, and pertussis are diseases caused by bacteria that can lead to serious illness and death.

• Tetanus (sometimes called lockjaw) is caused by bacteria found in soil, dust, and manure. It can enter the body through a deep cut or burn.
• Diphtheria is a serious illness that can affect the tonsils, throat, nose, or skin. It can spread from person to person.
• Pertussis, also known as whooping cough, causes uncontrollable, violent coughing fits that make it hard to breathe. It can spread from person to person.

Getting vaccinated is the best way to prevent tetanus, diphtheria, and pertussis. Most people get vaccinated as children, but you also need booster shots as you get older to stay protected against these diseases. The CDC recommends that adults get a Tdap (tetanus, diphtheria, and pertussis) or Td (tetanus, diphtheria) booster shot every 10 years. Ask a health care provider when you need your booster shot.

You can get the Tdap or Td vaccine at a doctor’s office, your local health department, and many pharmacies. Medicare Part D and private health insurance plans may pay some or all of the cost. Check with Medicare or your health plan for details about coverage.

Shingles vaccine for older adults

Shingles is caused by the same virus as chickenpox. If you had chickenpox, the virus is still in your body. As you get older, the virus could become active again and cause shingles.

Shingles affects the nerves. Common symptoms include burning, shooting pain, tingling, and/or itching, as well as a rash with fluid-filled blisters. Even when the rash disappears, the pain can remain. This is called post-herpetic neuralgia, or PHN.

The shingles vaccine is safe, and it may keep you from getting shingles and PHN. Healthy adults age 50 and older should get vaccinated with the shingles vaccine, Shingrix, which is given in two doses. (Zostavax, an earlier shingles vaccine, is no longer available in the United States.)

You should get a shingles vaccine even if you’ve already had chickenpox or the chickenpox vaccine, or if you don’t remember whether you had chickenpox. You should also get the shingles vaccine if you’ve already had shingles or received Zostavax. However, you should not get a vaccine if you currently have shingles, are sick or have a fever, have a weakened immune system, or have had an allergic reaction to Shingrix. Check with a health care provider if you are not sure what to do.

You can get the shingles vaccine at a doctor’s office, your local health department, and many pharmacies. Medicare Part D and private health insurance plans may pay some or all of the cost. Check with Medicare or your health plan for details about coverage.

Travel vaccines

Check with a doctor, a pharmacist, or your local health department about vaccines you need if you’re planning to travel to other countries. The vaccines that are required and recommended are based on your destination, planned activities, and medical history. Sometimes multiple vaccines or doses are needed. It’s best to get them at least four to six weeks before you travel to allow time to build up immunity and get the best protection, particularly from those that may require multiple doses.

Contact Medicare or your private health insurance plan to find out whether they cover the travel vaccines you need. You may be able to get some travel vaccines from a local health care provider. Others are available from health departments and travel medicine clinics. For more information, visit the CDC Traveler’s Health website or call its information line at 800-232-4636.

Vaccine safety and side effects

Vaccines are very safe, and they can help keep you from getting serious or life-threatening diseases. The most common side effects for all these vaccines are mild and may include pain, swelling, or redness where the vaccine was given.

Before getting any vaccine, talk with a doctor or pharmacist about your health history, including past illnesses and treatments, as well as any allergies. A health care provider can address any concerns you have.

It’s a good idea to keep your own vaccination record, listing the types and dates of your shots, along with any side effects or problems.

To learn more, please visit https://www.nia.nih.gov/health/immunizations-and-vaccines/vaccinations-and-older-adults.