Long distance caregiving, how do you manage?

Caring for a loved one from a distance has it's own set of challenges. What are some of the challenges you have faced and strategies you have used to help overcome the distance?

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I’m a long distance caregiver for my Aunt. She lives with her daughter, my cousin, about 50 miles away from me. Unfortunately my cousin is not too well organized so I stepped in to help my Aunt with her medical care about five years ago. I started
with just researching medicare/medical but then had to help her with paperwork and when I can make it, taking her to her doctor’s visits. Now I’m working on hiring someone to help her around the house. Just cleaning and making food. I can see that soon she
is going to need more help. Again my cousin is no help. I’m worried about the cost of hiring someone and how much more help I can really offer unless I move her closer to me or I move closer to her.