"I had the feeling that all wasn't well with my father," Claire Milne recalled.
It was Christmastime in 2003, and Milne had flown from her London home to visit her 82-year-old father in Maryland. Milne noticed that her dad struggled to stay upright as he walked -- early signs of a mysterious neurological condition.
Over the next four years, Milne, 56, would travel across the Atlantic every few months to watch over him, standing by during hospital stays, offering support as well to her ailing stepmother.
She helped arrange electronic payment of their bills. She helped them think through the pros and cons of moving into an apartment. She made sure her siblings were up to date on the latest health news.
"I don't think of it as a duty," Milne, a telecommunications consultant, explained shortly before her father died last month. "I think of it as what I want to do."
Like Milne, millions of adult children now find themselves faced with the challenge of caring from a distance, a problem that has a peculiarly modern side. Medical advances keep the elderly alive longer than ever, and the globalized economy enables their adult children to pursue careers hundreds or thousands of miles from home.
Americans over 85 are the fastest-growing segment of the population, according to the National Institute on Aging. This group -- which will include increasing numbers of parents of the baby boom -- is expected to swell to 21 million by mid-century from 4.2 million in 2000.
Yet distant children are often in no position to help. In a further modern twist, an industry of local care coordinators is emerging to bridge the gap between far-off relatives and aging parents who may be overwhelmed by the labyrinth of medical and other services designed to help the aged and infirm survive in their own homes.
Even now, "we don't have enough geriatric case managers to go around," said Cheri Lattimer, executive director of the Case Management Society of America, a group composed largely of healthcare professionals.
As many as 200,000 workers, including nurses, social workers and family therapists, may be devoting at least some of their efforts to helping old people and their younger relatives confront a maze of support services, she said.
A new website is devoted to issues of caring from a distance: www.cfad.org.
"There will only be an increasing need as the boomers come into the senior population," Lattimer said.
Care managers often employ nurses, social workers and counselors. They typically assess a troubled situation, then make referrals or help arrange needed services, including personal care or professional guidance.
Such coordinators may continue to monitor a household, serving as "eyes and ears" for far-flung family members.
"We had four calls from children this week," said Bunni Dybnis, director of professional services at LivHome Inc., a Los Angeles-based company that coordinates care for struggling seniors.
Dybnis and others note that it is often during a holiday visit or other infrequent trips home that an adult child notices an unsettling change.
Packets of prescriptions lie unopened on the counter. A once-immaculate house is unkempt. A cool-headed individual is suddenly given to erratic swings in mood. Sometimes such details might flag a decline, perhaps the result of Alzheimer's disease or other chronic woes.
"What's it like in the refrigerator?" asked Elinor Ginzler, a specialist in long-term care at AARP. "Is there food in that refrigerator, and is it fresh? . . . It's that kind of recognition while you're visiting that all may not be as well as it was in the past."
For relatives, that may be when life becomes more complicated. About 7 million family members in the U.S. regularly travel at least an hour to assist ailing relatives with transportation, errands, help around the house and other tasks, according to AARP.
For Milne, long-distance caring required a flurry of eight-hour trips across the Atlantic. The catalyst was seeing her father go outside to pick up a newspaper. "Whereas previously he would have just walked out and picked it up, he was extremely cautious and was worried about falling," Milne recalled.
Ultimately, Milne, two half-brothers and a stepsister played roles in keeping the older couple independent, though she took the lead when it came to supporting her father.
"Though I live so far away, I have a kind of natural leadership role in all this for being the big sister."
In other situations, scattered family members may rely on the emerging local care coordinator industry to help with arrangements they can't handle from far away.
"I thought about moving back to Los Angeles, but it's very difficult when you've made your career somewhere else," said Evelyn Kahan, 61, a teacher who lives near Monterey. Kahan's 86-year-old mother started having memory problems four years ago.