Managing Life and Caregiver Stress in The Sandwich Generation
This month’s post is coming to you a wee bit late. Much has been happening, my routine got knocked off kilter, and as the title states, my cup started to run over. This may happening with you, too, now that Spring is in full swing. Life is full, but it is also hectic.
Many of you, like me, may be in that stage of Life called “The Sandwich Generation”. That is, you are raising kids and coping with issues regarding your aging parents. The kids are in their teen years or adult years, and they still rely on you for help and guidance with schooling, finances, medical issues, or just general day-to-day coping. At the same time, your parents are shifting into their senior years and their accompanying challenges. They may be experiencing increased physical challenges, like decreasing mobility, heart problems or cancer, or mild to severe cognitive decline. In fact, 32 percent of persons over 85 have Alzheimer’s dementia alone. Even if they are mentally healthy, they may be going through physical changes. “Did you see how long it took Dad to climb the stairs to his bedroom? And he lives alone and does it every day!” your brother might say to you.
So you worry about Mom or Dad or Aunt Susan. They tell you not to, that they are “fine, and you’re being a worry wart.” Or maybe they speak from the other extreme, talking constantly about their ailments, their fears, their feelings of abandonment and anger that “young people just don’t understand.” (By the way, what I love about the seniors is that, no matter their personality, they are practically the only people who still think of middle aged adults like me as “kids”.) Either way, it’s a challenge.
With your kids growing and the adults getting more fragile, it can feel as though the earth is shifting steadily beneath your feet. You are now an “adult” in the truest sense, because when things happen, you feel deep down that the worry and fallout will be yours to handle. On top of that, you are likely balancing your own finances, career, and/or the needs and concerns of a partner. Overload, much?
Our family is what anchors and drives us, but at times, can drain us. Especially if there is a crisis going on. You do what you gotta do, true. But it’s still important to take care of yourself amidst the whirlwind.
Easier said than done, I know. But it is necessary. I often tell people what I learned in my training as a therapist, and has been proved to me time and again in my personal life: it’s like being on the airplane and they say, “Put the oxygen mask on yourself before putting one on everyone else” (because if you are passed out, you can’t help anybody). Or like filling your own gas tank before you can drive anyone else around. If your tank is empty, that’s it.
IF your teen calls you to help because they had a car accident, plus your mother was admitted to the hospital for heart palpitations, and you dealt with this during your job hours, your cup runneth over.
A segway note: These issues can be even more challenging to navigate if you yourself have challenges to your physical or neurological functioning, such asADHD (Attention deficit/ hyperactive disorder), which makes tasks like focusing, planning and organizing even more challenging. In the book, Smart But Scattered, the authors point out that a person’s weakest executive functioning skill is like the weakest organ in a person’s body, such as lungs that are prone to asthma. When stress and demands pile on, BOOM! That is the first organ to get sick, so just as a person with asthma gets bronchitis, the ADHD adult loses track of time, forgets an important meeting, or loses their iphone. In my case, my weakest executive functioning skill is organization. So when demands and stress start piling up with me, for instance, disorganization and clutter set in, and I have more trouble keeping track of my things. If you have often felt less “with it” than other people, and it seemed it is a lot of work for you to get organized, focus, prioritize, or follow through on tasks, you may want too consider getting tested for Adult Adhd. But do this when life stressors have calmed down a bit, so that the assessment can see how you do at baseline. Treatment ranges from ADHD coaching to cognitive-behavioral therapy to medication, and it can be extremely helpful in helping you with these challenges.
Even if you don’t have ADHD, life throws curve balls sometimes, especially when you in your “Sandwich Years”. But when those curve balls get more frequent or more demanding, we can start to feel burned out. We don’t know what to do first, or where to start.
All this can come to a head when you are part of that Sandwich Generation, and needs seem to come from all sides. You can feel overwhelmed or even desperate. While sinking into despair is attractive, it does not solve problems very well.
So here’s what you do:
1. Recognize and accept your overwhelm. Admit that “Your cup runneth over”, and you are on overload.
2. Get help: A therapist who has an interest in caregiver issues can help you sort out your emotions and challenges as well as help you develop coping strategies. If you are overwhelmed, this can be a great place to start.
For your elderly parents or relatives: You may consider hiring a caregiver or home health aide. For the kids or young adults: Depending on what the main challenge is with them, a sitter (child care), tutor (academic struggles) or therapist (mood issues like sadness/depression, anxiety) or doctor (medical/biochemical concerns).
Yes, these services cost money, but this is money that helps your sanity and strength. A good place to go for help with eldercare issues can be the Human Resources Office at your job. They can often tap into your EAP (Employee Assistance Program). You’d be surprised at what they can help you find by way of help. Even if you don’t have an HR Office, check with your health insurance company about options such as care managers.
They can provide assistance for more complex medical issues with your child, teen or young adult. They can help you tap into the kind of help you might need. Your spouse, A trusted friend, neighbor or a relative that might be able to sit with you or family if you feel like you are needed in two places at once, and you need some coverage.
In accessing professional eldercare help, one of the best things my family did when my own father developed Alzheimer’s was to employ a Geriatric Care Manager. His care manager not only knew how to relate to him, but she knew the local services available such as Adult Day Care.
Support groups can also be helpful. The Alzheimer’s Association offers support groups for caregivers, where you can get good information and support from others who understand what you are going through.
3.Slow down and break it down.
Sounds nuts, right? “How do I go take a break when Mom was just hospitalized and my kid is ill?” Let me put this another way. I don’t mean plan to go on two-week cruise with no help for Mom the second a crisis or emergency is over. I mean, slow down how you are able. Watch a funny show with tea. Sit with a friend. Get your bearings, and break these big things down into smaller manageable tasks, day by day, or hour by hour.
4. Set limits.
This is where a good therapist can help. Oftentimes we get so caught up in taking care of our loved ones’ issues that we lose sight of two things:
a. The difference between a crisis and an emergency, and
b. The difference between a need and a want.
A crisis means your relative is definitely having a hard time with something, whether it is their health, their dinner, or car trouble, and that problem is bigger than the help available to cope with it. Mom is dropped the dinner, it is in a mess in her kitchen, and she calls you sobbing. She is mobile, she is fine, but very upset. Of course this distresses, but she her life or well-being are not at risk at the moment. It stinks for her to have to wait, but if something else more pressing is happening, she can, if needed.
Danger to life or health- and I mean, imminent danger, is an emergency. Trouble breathing, chest pains, or a home on fire. These are emergencies. Someone is at risk of dying or being severely injured if the situation is not handled.
If you feel you are being hauled into crisis scenarios a lot, this is a good indicator that more help is needed for you and/or your loved ones. You may need more in-home help with Mom. She will likely refuse, at first. As may your son, with getting a tutor even though he is failing classes. But one of my favorite advice columnists, Carolyn Hax, said something to the effect of, “You don’t get to drive someone nuts while you refuse help.” Some crises may need to occur wherein you can’t be there, and then they may begin to shift their thinking. Limits, by the way, are not the same thing as walking away or not caring. Limits mean clarifying what you will or won’t do. Limits are proactive, rather than reactive.
If your are dealing with the second situation, true life-or-death emergencies, a lot, I’m glad you are reaching out for help. Heed the advice of medical, law enforcement or mental health professionals in that case. You may need a more intense level of help for your loved ones that you alone cannot be expected to provide.
(What a great phrase! It isn’t mine, but it’s too good not to share.) When things don’t get done, and stressors continue, chronic stress can set in. you can begin to believe you are not doing things well enough. That if you were more “put together”, all of this crap wouldn’t be happening to you. Well, guess what? That is your brain wiring playing tricks on you with automatic negative thoughts. You tell yourself this enough, and you will start to believe you are “a loser”. But here are other truths that are being ignored, here: Look at how much you HAVE done, and are still standing. And think of how much worse things would be without all that you have put in place. Better yet, how much you are doing to advocate for your family. And yes, you may have put in a service too late, missed an important phone call, etc. Observe that thought, and forgive yourself. Over and over.
6. Savor the moments.
I’m not saying, ignore the hard stuff. I’m saying, every once in a while, you’ll have moments that are funny or touching. When my Dad was senile, he was able to hug me without a sarcastic joke attached, which was odd but kind of nice. And we were able to watch Puppy Videos on YouTube together, and simply enjoy it. Of course I still missed the person he had been, and that disease made me angry for what it took from him and us all. But the person he had been before would have had no patience for such cutesy stuff. So we had some very sweet moments during his illness that I am grateful for.
The Sandwich Generation on Vacation
You can employ the above strategies even when doing positive, fun things with multiple family generations. I am learning through trial and error, what limits to set and what help to get for annual family vacations.
Recognize you feel overwhelmed: The last few family trips were fun overall, but I have felt exhausted or returned with back pain or a sprained shoulder. This is because I took on way too many physical tasks than I realistically should have. I had had fun, as well, but I’d like to curb some of the physical strain. I’d like to return from trips with my body more intact.
Get help: I am so over the type of trip I did in my college years, like sleeping overnight in train stations with all my belongings on my back. And now that I am in the Sandwich Generation Years, I am even tired of the “self-catering” part of self-catering rentals. I don’t want to be cooking so often, changing bed sheets or nagging others to do it. Sometimes it’s worth the quality of life to pay for extra services, like a travel agent to help coordinate flights and hotels. Or getting a hotel with more amenities like regular cleaning services, transportation, room service/restaurants within walking distance, or an easy-to-access location, if it means a bit more rest and less stress. Next time, I will definitely get this help. And to me, this is not selfish, or at least, if it is, it is good selfish. We need to allow ourselves to do what helps us feel more rested, not more irritable, if it is within our means.
On that note, we can, no, we SHOULD ask for help from our family members. Ahead of the trip, discuss what tasks are expected from everyone, with the main goal being a fun, manageable time. List the tasks, and ask, who chooses which ones? Put it in writing, have everyone sign it, and if things are not done, refer back to the list for accountability. But again, be realistic, and still book the kind of trip that will not make this too energy-consuming for you.
Slow down. Sometimes, the packed itinerary that jams in a million tours, trips and activities can be too much. I want some days to be open and unplanned, and again, this helps me rest, so I have more mindful, positive energy for others. I now build in some time for this, and I opt out of some hikes, activities, and such. Even with very young children, you can opt to hang back with them at the hotel or a kid-friendly venue.
Set limits. While sitting at a pizza parlor on our vacation, we got to chatting about The Next Trip. This was amusing to me, given that we were only halfway through the Current Trip, but hey, we get caught up sometimes. Some family members thought that our next extended family trip should be to Hawaii. I nixed that immediately. With elderly relatives, I have decided that my limit is 4 hours of driving OR 3 hours of flying to get to our destination, maximum. I feel that the fatigue of long drives/flights, plus the possibility of health complications with elderly relatives is not worth it.
On that note, don’t be everybody’s personal chef, maid, cleaner, itinerary planner, ALL the time, because then you will ALSO be everyone’s Grump. You’re entitled to your share of moments of grumpiness, yes. Vacations in new places with new routines do add some stress. But if that becomes your “style” of relating when on vacation, chances are, things need tweaking. Adding a “Sandwich Generation Takes a Break” day is important. The benefit if your kids are teens is that, they can step up and do a few of those things here and there.
Yes, some people will be disappointed, but sometimes we need that flexibility from others. Sometimes even the adults may have the fantasy or belief that they will be helpful or not cause problems. I believe that they have good intentions, but still, we need to be realistic. For example, your Dad believes he’ll be able to handle that hike up the mountain, but he can barely manage the stairs, so you may need to put your foot down (no pun intended) on the idea of the Island with the Big Mountain and find something more low-key that your teen can still enjoy. And my awareness of Mom’s back issues meant that I said, “No way are we doing a 10-hour flight”. Even a spouse who is usually supportive may not recognize the risk in such a long flight. But I held my ground. And you know what? They got it. Sometimes they need to hear the “no” from us. That’s our right to assume as the main “focal person (or people, if you are partnered)” that coordinates everyone’s experience.
Forgive yourself relentlessly.
We had an issue with our house rental while on vacation. I hadn’t foreseen running out of garbage bags, so I did not clean up the way I would have. Plus the owners had not left a checklist of what they expected or wanted. This resulted in dissatisfaction on both sides. After all was said and done, our family took responsibility for what we had not done, but protocol indicated they should have left us a checklist. The whole incident made me realize that house rental without help is simply too much for us to oversee on multi-generational vacations. But rather than self-blame, I’m looking at it as a learning experience, and making changes in the future.
And remember, most of all to savor the moments. This is something you can do on vacation that is much harder to do (but not impossible) when you are coping with the daily demands in Part 1 of this post. I am aware as we get older that our time with the older relatives is limited. Sometimes that helps me remember that snafus may occur, even with these steps. I’m glad that we can do these family trips and are creating those memories. I just want to stay somewhat sane in the process, and so the above strategies can really help. Hopefully, they will do the same for you. With that in mind, may you get the support you need if your cup runneth over.