| Challenge of the 'Sandwich
Generation': Caring for children and their parents by Lori Lowery Are you wishing there were more hours in the day to meet everyone's needs -- going in two directions, concerned for both your children and elderly parents? Cannot imagine how you can spread yourself around any thinner? Well, no wonder, you are a part of the "Sandwich Generation" (Dual Eldercare Providers). In Minnesota, 80 percent of all care for older adults is provided by family members, according to the Amherst H. Wilder Foundation. What is Dual Eldercare? It is euphemistically called the "Sandwich Generation Issue." Typically, these are adults in their 30s to late 40s who are not living with an elderly loved one, but are concerned and/or aiding both their children and elderly loved ones to maintain healthy and nurturing at-home lifestyles. These may include many time-consuming and logistical activities, such as transportation, doctor appointments, shopping, laundry needs, spiritual community participation, ensuring food preparation/balanced meals, encouraging socialization, life-long learning and physical exercise activities, to name a few, for their elderly loved one, plus all those for their own family. If you find you are a Dual Eldercare nurturer and caregiver, whether it is directly or indirectly for your extended family, I am preaching to the choir, that it can be a daunting, progressive, array of responsibilities and can seem overwhelming. Stereotypes & reality Many people have the notion that dualistic eldercare giving involves only those people who provide hands-on, direct in-the-home or hospice cares for a very debilitated elderly loved one in their home. If you are worrying and checking in about your parents or elderly loved ones' health, safety, economic issues, transportation needs or socialization, you are already an elder caregiver. If you are also responsible for, concerned and nurturing your own children, you are a DUAL eldercare provider. Dual Eldercare coordination & planning starts LONG before your elderly loved ones need 24-hour assisted care or are debilitated. Background data National and state statistics for the space shortage in elderly nursing homes, and long term care facilities in the next 10 years, are alarming. Daily, the news reports major concerns about the poor management of the elderly healthcare system and the shortage of healthcare providers, especially nurses. This will increasingly impact all families, as many of our elderly will live long into their 90s, in varying states of health. A high demand for facilities to provide the spectrum of in-home cares will be taxing on the already overwhelmed health provider industry. A person could feasibly be retired for as long as they were actively employed. Even though we all assume our retirement benefits will provide us medical/dental coverage or our soldiers/veterans will be assured elderly care programs and pensions, this is becoming an increasing issue of financial concern in the Congress and within major corporations. County governments are already experiencing financial constraints to fund and provide elderly social service programs. Impacts us all These issues do not only affect the elderly, but all of us who will assist and provide for them, in all areas of human needs. Aging is arbitrary and not optional. Life is a huge learning curve. Often, how we act or fail to act regarding our elder loved ones is what our children will emulate. We must become informed, develop self-sufficiency and improve our advocacy skills. Proactively maintaining the integrity of our families' cohesiveness, spiritually and communally, will encourage the relational unity needed in providing for our elders in a dignified and respectful manner. With the major Medicare changes and Social Security benefits diminishing, it is very possible people in middle income will be on very extensive waiting lists for receiving elderly homecare assistance. Even now, the social service system is greatly reducing elderly programs and these services will then need to be provided by their own families, as only the most dependent or economically challenged can be serviced by these government programs. Parenting roles Nationally, family issues concern large numbers of grandparents in their retirement years raising their grandchildren, while their adult children (who are the parents) are in long or short term crisis and unable to effectively parent. Blended family dynamic shifts include a growing proportion of late middle-age adult remarriages. People assume these "Baby Boomers" are very capable of handling all these blended family demands or role reversals. Yet, contingency planning is crucial for the unexpected medical or financial situation that could short-term displace the grandchildren, while the elder grandparents, providing the care for their grandchildren, recuperate. This may fall to the adult siblings of the absent parents to take on care-providing roles, thus again creating a DUAL care-giving role to the extended family. With foster care shortages, both elderly and children's, families assuming the government will immediately provide an answer, may not, in practice, be realistic. These are issues that need honest review and planning. Caregiver burnout Many 60 to 70 year olds are much healthier in this generation, however they are still very susceptible to multiple chronic health concerns, short- or long-term disabilities, or a critical accident. Usually, the other elderly spouse then becomes the main provider for all home management and personal cares. Elderly spouses may say they are "handling it," however, it may be adversely impacting both seniors' ability to maintain their overall health and safety. An elderly parent may feel it is their sole obligation or they are imposing on you, especially if it is a step-parent. You may think they will ask, if they need you. Remember, it is physically/emotionally both rewarding and demanding, at any age, to be an at-home nurturer and care provider. Adding responsibilities for all home maintenance, household chores and budget in the elder years, much less in this day and age of technology and consumer overload, can be too overwhelming and physically draining for many people. Senior women's health The detrimental impact on the health of senior women charged with family care can be seen in a recent study published by the Harvard School of Public Health and in the November 2003 issue of the American Journal of Preventive Medicine. Higher than normal heart risks were associated with senior women caring for ailing husbands nine or more hours per week. This increased risk of heart attack is also linked to those senior women who provide nine or more hours per week of comprehensive care-taking to their grandchildren. At this stage of life, transitions become more prevalent and disconcerting to seniors. The possibility of losses associated with diminished physical abilities or autonomy, being more socially isolated, changes in home environment, community or increasingly having peers, family or friends who are passing away, can add to the spiral of caregiver burnout. Think about your own lifestyle. Many people do not reach out for help until it has gotten almost unbearable. Where are these people going to turn in the future? Most people know someone who actively is the primary family eldercare provider or has a major advocacy role for an elderly loved one. Many elders, while they are noticeably mentally or physically impaired and not fully autonomous, may not be disabled or impaired enough for medical insurance or Medicare to provide payment for intervention, services or long-term care placement. For those in this vulnerable stage, changes can occur at any time. With the tremendous space shortages in low- to middle-income Senior care facilities and availability of care providers, if the Elder Care facility of choice has a lengthy waiting list or the Senior has chronic individual needs and requirements, these elders may seek to turn to family members for their personal care, support and household management. Eldercare support groups Most of these people are so active in caregiving roles it is difficult to be able to find the few local Dual Care Provider support groups, much less attend them. In rural areas, it is also a large concern for the amount of travel time to and from a meeting, especially in the winter months. For many people, they are not comfortable in an organized support group and prefer more personal attention to share their individual concerns. Those populations that are humanistic and view the life cycle as sacred, predominantly heritage's rooted in the communal villages, ancestral clans and tribal cultures that have integral and respected places for their elders will be at an advantage in the coming years for positively impacting the quality of life for their elders. They have much to teach and share with us in maturing our society's current "youth oriented" disposable, judgmental, pluralistic and self-serving societal value systems regarding our vulnerable populations. Many faith-based senior caregiving/healthcare agencies and non-profit organizations, such as the United Way-sponsored senior services, have begun the pre-emptive outreach for families to get connected to multiple homecare-based networks for dialoging about delivering an in-home eldercare spectrum of services and respite before a family crisis. Encouraging the family to realistically address the future self-care deficits and needs ensures that the senior may enjoy as independent a lifestyle as possible, with some delegated tasks/chores or assistance being addressed before they become homebound or must radically adjust their lifestyle situation. Reconnecting to spiritual communities and personal faith practices for renewal, reassurance and support can empower families to cope constructively with stress and thrive in embracing unconditional, selfless, loving relationships and reflect on the aging process in a gracious, humble, "service toward others as ourselves attitude" versus falling into the trap of wallowing in the possible personal resentments the role reversal of an emotionally/socially/financially or physically dependent elder loved one or sets of parents may evoke. When to seek help If there are multiple, complex, disrespectful or dysfunctional dynamics surrounding the extended family/friends interactions with the elder loved ones and how they are coping with their life situation, it is often wise to seek out professional guidance and support, as soon as possible. Actively addressing issues that may impact the elders' personal health, safety and finances or creates conflict, should a crisis occur, is essential. Often, during a crisis or under stress, an elder loved one may need individual assistance in filling out paperwork/forms, decision-making or personal affairs resolutions. This can be impartially facilitated with many various professionals and may relieve much of the angst in people's unspoken or unresolved feelings regarding multifaceted situations in many families. Remember, we are never alone in navigating life's course. Be heartened by choosing to act on making positive changes where only you can and it matters most, in your own life. Everyone has gifts, and for those who are limited in their nurturing time or abilities, they have much to supportively offer actual hands-on care providers in many different ways. If you are the friend or extended family member of a Dual Eldercare Provider, reach out to provide encouragement and validation for what they do. This can be very uplifting and make a huge difference in someone's hectic day. Even sending silent positive thoughts or prayers toward the situation can be of great help and inner comfort for those experiencing grief, losses and fear. We are all aging and one day may need to rely on our families and friends or be an Eldercare Provider ourselves. Empowering ourselves by gaining knowledge and creating several realistic long- and short-range plans of care and optimal lifestyle management will benefit everyone in having as much autonomy in their retirement years as possible. Lori Lowery, R.N., is a nurse educator/clinician in practice more than 20 years, who also shares the life experience of being a Dual Eldercare Provider. E-mail her with questions or interest in using this article in a newsletter or facilitation of a Focused Discussion Group on Eldercare or Dual Eldercare Providing. E-mail LWRYSBytheGrove@aol.com or call (651) 768-9114. Copyright © 2004 Lori Lowery |
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April 2004 |
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