Today, it is not uncommon for family members to live in different cities and states. Sometimes parents move away from the homestead to retire to a more appealing area. Sometimes the children move away to "make it on their own."

Many families handle these long-distance relationships well.  That is, until something happens to disrupt the parents' independence.  A fall in the middle of the night, a short- or long-term illness, a hospitalization or a stint in rehab can all disrupt the status quo.

Which can create a difficult situation for adult children who do not live near their parents. Some support can be provided over the phone, but some tasks require an in-person presence.  Being miles apart can also mean being unfamiliar with agencies that help older adults and other community resources. In these situations, feelings of frustration, helplessness, guilt and anger are common in both the adult children and the parents.

There are a number of steps that distant adult children can take to avoid certain problems in the first place.  Be prepared:

• Know the necessary information. Before a crisis occurs, work with your parents to collect necessary medical, financial, and legal information. Make a list of their doctors and medications, insurance information, assets, Social Security numbers, etc. Keep their relevant agencies and resources bookmarked on your computer, and become familiar with what is available -- before you are in need!

• Make another list. Again, before a crisis occurs, identify family, friends, clergy, and others who might help your parents in the event of an emergency or urgency. On your next visit, introduce yourself to neighbors and friends, and keep their phone numbers and addresses. They can become a source of support and information in the future.

• Assess the situation. On your next visit, look for health or safety problems in your parents' life. Professional consultants are available to help elders and their family members decide when an older adult needs assistance.  They can provide information on local resource, give advice on how to fall-proof the house, etc.  A Geriatric Care Manager can be a tremendous help is assessing and supporting an elder's needs (The National Association of Geriatric Care Managers can help you locate a geriatric care manager near your parents at www.caremanager.org)  Just remember to involve your parents in the assessment of their needs, so they don't feel like you are doing something "to" them.

• Don't avoid legal planning. Advance legal planning is the best way to avoid uninformed or desperate decision making.  "Conservatorships, while often necessary when a bad situation deteriorates, often can be avoided with legal planning," say San Diego Elder Law Center attorney Philip Lindsley. "It is best for parents to sit down with an elder law attorney, ideally with their children present, to discuss options for the future -- before there is a crisis.  Wise planning can work through the 'what ifs' and avoid painful and difficult decisions down the road."

After a need arises, there are ways to :make the situation more manageable from a distance:

• Gather information. Determine with your parents, and other family members and physicians, what help they need. Look for community services that help. You can get information over the phone and the Internet.

• Be sensitive to your parents' views. Although dealing with these issues can be frustrating, it is important for your parents and yourself that you maintain a positive focus. Explain that the services will help them remain independent. Explain how the services work. Sometimes it is helpful to have someone your parents respect recommend the service, such as a trusted physician, clergy member or friend.

• Take care of your own needs. Learn and use coping skills for your own health and well-being.  Get support or counseling, and take time for yourself. Accept that you cannot and should not try to be everything to everyone. Ask for help when you need it. Most importantly, give yourself credit for doing the best you can.

• Treat siblings well. One of the greatest sources of both comfort and stress can be dealing with siblings at a time of parents' need. Of course we all have mom and dad's best interest at heart, but siblings do not always view their parents' needs through the same glasses. Sometimes remote siblings are dismissive of the picture that local children paint of mom and dad's needs.  Yet, sometime distant children pick up on problems over the phone or during a visit that the local siblings don't see or deny.  Local children can feel put-upon and under-appreciated.  Remote children can feel out-of-the-loop and critical.  Do your best to maintain open communication with your siblings and other family members.  Try to create an environment that "we are all in this together" to keep your parents' needs in the forefront.

Caring for an elderly parent can be stressful for families. Siblings may disagree over how to provide care or where a parent will live, and if these squabbles escalate into a guardianship battle, it can cost the family thousands of dollars. To avoid this, lawyers have begun drafting sibling agreements (also called family care agreements).

If a parent becomes incapacitated and can no longer take care of him- or herself, questions can come up between siblings over where a parent should live, who should manage the parent's money, and who will assume primary caregiving duties. A sibling agreement can address these issues and provide consequences if the agreement is not followed.

Sibling agreements are not meant to replace a trust or a power of attorney. Instead the agreement can complement these valuable estate planning tools by providing guidance for the trustee or the holder of the power of attorney. The following are some examples of topics an agreement might cover:

• Which sibling has primary care of a parent and how caregiving duties will be divided among siblings

• Whether a sibling will be reimbursed for caring for a parent

• Where the parent should live—with a child, in assisted living, in a nursing home?

• How to decide whether a parent should move into a nursing home

• How the parent's money will be managed

• Whether the siblings will contribute financially to the parent's care

If the siblings can't reach an agreement, a geriatric care manager or mediator can help draft the agreement.  Mediators can also help if one of the siblings breaches the agreement. Consequences for breaching a sibling agreement could be losing a power of attorney or a reduction in inheritance.

To find a qualified elder law attorney near you who can help you draft such an agreement, contact that website of the National Academy of Elder Law Attorneys (www.naela.org), or in San Diego, Attorney Philip Lindsley at the San Diego Elder Law Center (619-235-4357, or www.sandiegoelderlaw.com.

To read an article on these agreements in the Dallas Morning News, click here.

For a USA Today article on how caring for an elderly parent can strain sibling relationships, click here.

According to news from the Alzheimer’s Association, final test results will soon be released for a new drug designed to attack the underlying cause of Alzheimer’s disease.  Research is underway on the first of a whole new generation of drugs that might offer hope to those with a mild to moderate form of the disease.

Current medications temporarily help with the symptoms of Alzheimer’s.  The new drugs are designed to slow down, or even reverse the disease itself.  The initial results of the first drug, called Alzhemed, look promising.  The final results will be released as early as this month.

Today, 5.1 million people in the United States have Alzheimer’s disease.  Since the greatest known risk factor for contracting the disease is age (the longer a person lives, the greater the possibility), experts warn that we might be facing an Alzheimer’s epidemic as medical advances help people live longer and Baby Boomers advance toward age 65.

For more information, see the Alzheimer’s Association at http://www.alz.org and the Farber Institute for Neurosciences at http://www.jefferson.edu/fin