The Sandwich Generation

~By Kathleen Bogolea, MS

Since the adoption of the National Family Caregiver Support Program in late 2000, there have been numerous news articles and points of interests written about the family caregiver and their many different roles within the family and the community. Roughly, it is estimated that American families provide 80 to 90 percent of all in-home long term care services for their aging family members, disabled adult children and other loved ones.  These services may include assistance with activities of daily living (ADL’s), medical services coordination, medical supervision, administration of medications and assistance with financial, legal, spiritual and emotional concerns.  These services are priceless and the family caregivers that provide them often go unrecognized and over utilized which can lead to great stress for the family caregiver.  In contrast, if these same services were to be provided by our national health care system, it would be estimated at approximately 250 billion dollars per year.

Recently, and of particular interest, there is a new buzz around a subset of caregivers known as the  “Sandwich Generation”.  These are caregivers who find themselves squeezed in between caring for younger loved ones such as children, and their elder parents or other elder family members.  While the Sandwich Generation is not a new form of family caregiving, these caregivers are receiving a long overdue peaking of interest within American society.

Currently, the typical American Sandwich Generation Caregiver is in her mid-forties, married, employed and cares for her family and an elderly parent, usually her mother. With this said, it is important to note that there are more and more men that find themselves in a caregiving role and even squeezed in between the generations.  It is also important to note that there is an ever-growing segment of family and sandwich generation caregivers that live in rural communities. Unlike caregivers living in urban and industrial areas, rural caregivers may find themselves removed from readily available and professionally organized supportive services and care networks.  They may also find themselves not only carrying the normal burdens that are associated with providing care for a loved one, but also they may be faced with challenges such as geographic barriers to resources and isolation from other caregivers, family members or informal supports.  This lack of service availability, care networks, and isolation from other caregivers and family members can add to caregiver stress, burnout, and depression. 

The demanding role of being a caregiver spreads across all racial, gender, age and ethnic boundaries.  Some of the common stressors that affect both urban and rural sandwich generation caregivers are:

  • How do I split my time between my children/family and my elder loved one?

  • How much of my time is too much time in each caregiving role?

  • How do you find the time for my marriage?

  • How do you find the time for myself?

  • How do I keep the generational peace between my kids and my elder loved one?

  • How do I find the resources that I need for my self and my loved one?

  • How do I combat my feelings of isolation?

  • Guilt, Guilt and more Guilt for not having enough time to accomplish all that “should” be doing. 

To counter act some of these stressors, here are some caregiver tips that may help sandwich generation caregivers along the way:

Hold A Family Meeting
At this meeting, discuss the many different caregiving tasks that need to be accomplished each day or week.  Set a task list for family members to complete each day/week.  Set mutual expectations of how the many tasks of caregiving will be accomplished.  Caregiving is often a one-person show but it does not need to be if you have family support.  The family meeting also allows for family members to participate and share in the valuable gift of caregiving and this can be very rewarding.

Communication
Encourage children and elders to communicate with one another.  During the family meeting, make sure that all family members have a chance to talk about their thoughts and feelings.

Ask For Assistance
Make a point of picking up the telephone and spending time calling resources such as your local Area Agency on Aging, a hospital social worker, a physician or church. The Internet can also be a wonder resource finding tool.  Never be afraid to ask for assistance when you need to, you may be surprised at who has been waiting to help you.

Take Time To Care For Yourself
Too often I meet caregivers who are run down and even sick because they have not taken time to care for themselves.  Sure, no one can take care of your loved ones as well as you do but you must care for yourself if you want to continue to care for your loved one.  This is not an act of selfishness, it is actually an act of great giving.

Take time every day to “check-in” with yourself, even if it is only 10 minutes.  This should be your protected time.  Enjoy this time by reading, listening to music, exercising or whatever you like to do.

  • Remember to laugh at the funny things in life.

  • Take time to be “in” your marriage.

  • Listen to your body. If your body is telling you to slow down, or that something is not right, seek medical advice.  Too often we do not listen to our bodies no matter how loudly they may be talking to us.

Every caregiver and caregiving situation is unique but there are always common factors which bridge these situations and caregivers together.  It is easy to become lost in the caregiving that you are providing but remember that support can come from many different sources and in many different ways.  For those of you who are squeezed in the sandwich generation please know that you are not alone and that assistance is often only a telephone call or internet site away. Your local Family Caregiver Support Program is here to help you.

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The Workbook for Older Drivers and Their Families

Do you wonder if the older driver in your family may be experiencing diminishing driving Keeping us Safe Beyond Driving with Dignityskills as a result of the natural aging process?

Has your parent become lost recently while driving on an otherwise familiar route? Have you noticed mom bumping into curbs, mailboxes, or scraping the side of the garage when she backs out? Are there unexplained scuff marks on the corners of dad’s bumpers? Has dad been involved in a minor parking lot fender-bender recently, or does he complain about being honked at all the time? Do either of them seem easily confused or more forgetful when you talk with them on the telephone?

If so, don’t panic; you are certainly not alone. The most important thing to remember is that the time to start addressing your concerns over driving is now, before “concerns” turn into “tragedies”.

Facts: According to AARP, boomers will be turning 65 at a rate of about 8,000 a day for the next 18 years! Tragically, an average of 15 people ages 65+ die in car accidents every day in the United States

The issue of taking the keys away from a parent can be extremely sensitive and emotional. Having this discussion has been likened to trying to throw a diplomatic hand grenade at your parents and the “talk” has been known to divide entire families. Adult siblings, otherwise close to each other their entire lives, can end up at war with each other (and/or with their parents) on how best to address the driving issue.

There is a solution; Keeping Us Safe has developed a workbook titled “Beyond Driving with Dignity; The workbook for older drivers and their families”.

The workbook employs a very user-friendly, uncomplicated method and is designed to be used in the comfort and confidence of the family’s home. It has been designed to remove the family’s emotion, opinion and speculation from the decision making process, and reduces everything to simple fact so that appropriate decisions can follow.

More specifically, the workbook helps the family and the older driver better recognize any deficiencies in the following dimensions:

Vision
Hearing
Memory
Reflex and reaction time
Strength and flexibility
Medications, and
Overall health concerns
“The workbook was written to help families (or professionals working with families) by providing them with a ‘roadmap to success’ in their quest to overcome the challenges of an older driver’s safety” explains Matt Gurwell, founder and CEO of Keeping Us Safe.

Gurwell adds “If driving restrictions or even a complete retirement from driving are deemed appropriate, the ‘Limit Driving, Not Living’ chapter of the workbook helps the family identify and implement alternative means of transportation for the retiring driver.”

Working through this instrument will help concerned families make appropriate driving-related decisions that are not only in the best interest of the older driver, but simultaneously find themselves in the best interest of highway safety in general. This workbook was designed to be used by the family in the confidence and comfort of their own home, most likely seated right at the family’s kitchen table.

To purchase a workbook or to learn more about how the workbook can help your family or client, visit the Keeping Us Safe website at www.keepingussafe.org . In Raleigh, NC, contact Raleigh Geriatric Care Management

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A Retirement From Driving Does Not HAVE to Equal House Arrest

~Matt Gurwell, Retired Highway Patrolman, founder of Keeping Us Safe

It goes without saying that for any of us, driving represents freedom, control, and of course, a degree of personal independence. But this is particularly true for the older driver. Here are five reasons a senior driver may not be willing to retire from driving, despite what may be obvious and quantifiable safety reasons:

1) For a senior driver, losing the ability to drive can be an obvious emotional set-back. In some cases, this set-back can be even more complicated when combined with recent losses such as the death of a spouse, a close friend, or a recent diagnosis of a serious health condition.

Imagine for a moment that only months ago your spouse of 50+ years died unexpectedly, and now your adult children are trying to take your car away from you. Or that just last week you were diagnosed with cancer, and today your family doctor compounded your anguish by suggesting that for safety reasons you stop driving, effective immediately. The recipient of all of this wonderful news would certainly feel like a tsunami of doom has just reached their beach.

2) A senior driver may believe that if he/she can no longer drive, they will become a burden to others. This may be the furthest thing from the truth, but it becomes very real in the eyes of the beholder. Imagine for just one minute that you can suddenly no longer drive…ever. Although completely unwarranted, it is human nature to feel at least somewhat burdensome asking others for help getting you to and from your doctor’s appointments? Taking you to get groceries? Driving you to the hairdresser or barber? Taking you to visit an old friend?

3) Many seniors see a surrender of their driver’s license as an acknowledgement that their physical wellness, agility, mental sharpness, reflexes, sight, hearing or memory are beginning to deteriorate. Or that an illness or pre-existing medical condition is “getting worse”.

4) Many older drivers believe that if they give up their driving, they will have fewer social opportunities than what they are accustomed to.

5) Despite everyone’s best efforts, driving cessation can sometimes trigger depression in elderly people which, in turn can cause a noticeable deterioration in your loved one’s physical health.

There are obviously many, many more examples of the emotional distress driving cessation can cause for an older driver. The good news is; a retirement from a long and successful driving career does not have to be all doom and gloom, and does not have to be the equal of “house arrest”.

The Beyond Driving With Dignity Program is offered in parts of North Carolina.  contact, lwatral@rgcmgmt.com of Raleigh Geriatric Care Management

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Five 10-Minute Pick-Me-ups for Caregiver Stress

~Paula Spencer Scott

Having one of those days? The best antidote to stress and fatigue is to treat yourself well — even if in small doses.

 

1. Read something funny.

Laughter has been shown to trigger the relaxation response, lower heart rate and blood pressure, and even boost the immune system and ease pain. It might seem corny to dive into a comic book collection, a joke book, or a few minutes of America’s Funniest Home Videos, but the effects are real.

Not finding the funnies very funny today? Try forcing a smile. The simple act of turning your facial muscles into a smile triggers the brain to initiate a relaxation response. Bonus: Smiling tends to inspire others to smile (not unlike yawns inspiring yawns). So your smile might make your loved one a little easier to live with.

2. Crank the volume.

Music therapy is often used to calm or stimulate dementia patients, but it can have similar effects on anyone. Playing music with a strong beat has an energizing effect. Melodic orchestral or acoustic tunes can improve thinking and focus.

To get the full pick-me-up effect, raise the volume so that the music fills the room. Really listen.Create a few special playlists that you label by mood so you can match the tunes to your needs: “Happy music,” “Energy kick-start,” “Dance favorites.”

3. Take a power nap.

Ten minutes of shut-eye might not sound like much, but it can be enough to feel restorative, especially if you’ve had a disrupted night’s sleep. Midafternoon rest, when the body clock is at a natural lull, is thought to be especially productive.

A longer, 30- to 60-minute nap allows you to fall into the deep stage of sleep that’s even more restorative, but it’s harder to wake from. If you only have a short break, set a timer or alarm clock, so you don’t oversleep.

4. Pump a little iron.

Lifting free weights tones your arms and strengthens your bones — but those are long-term extras on top of the energy boost this simple (and not too sweaty) workout provides. If you’ve never used a handheld weight, start with two- or three-pound dumbbells, sold at sporting goods stores or large variety stores such as Wal-Mart or Target. Lift the weights in sets of 8 to 10 slow repetitions, increasing the amount of the weight over time.

Any quick exercise can have the same effect: running through a few yoga poses, stretching, walking around the block if you can get out of the house, going up and down the stairs a few times.

5. Write a letter.

Simmering resentment, anger, or frustration can sap energy. Psychologists sometimes use this tool to help people let go of energy-blocking ruminations: Write a letter to yourself or your loved one. Put in everything you’re feeling. Describe specific incidents. Imagine what you wish had happened instead, or what you wish for in general. (More “thank-you’s” and appreciation? More free time? Your old pre-caregiving life back?)

The act of putting your true emotions down on paper (or in an e-mail you don’t send) helps your body release them, just the way you feel better after confiding in a friend. Then, when you’re done, rip up the pages or delete that e-mail.

 

Raleigh Geriatric Care Management www.rgcmgmt.com 

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Nip Depression in the Bud: Warning Signs to Look For

By Mary Damiano

While caregivers are defined as the people taking care of those needing help, they sometimes overlook the fact that caregiving responsibilities can take a toll on their own health.

In addition to physical ailments, caregivers are at risk for depression. Depression can strike anyone, at any age. Caregivers need to be especially aware of depression because of the great load they carry. Many caregivers work at a full-time job and take care of a family in addition to their caregiving responsibilities. They often sacrifice their own health, well-being and social life in order to do everything that needs to be done.

One common denominator among caregivers is the desire and the belief that they must do everything themselves. Often, caregivers do not ask for help, opting instead to inadvertently play the part of the martyr. This leads the caregiver to become overwhelmed and an overwhelmed person is fertile ground for depression to dig in and take root.

The great strain caregivers face on a daily basis can lead to depression. One way to stop depression before it strikes is to be aware of the warning signs. According to the Administration on Aging, here are some red flags that depression might be creeping in:

  • Sad, discouraged mood
  • Persistent pessimism about the present, future and the past
  • Loss of interest in work, hobbies, social life and sex
  • Difficulty in making decisions
  • Lack of energy and feeling slowed down
  • Restlessness and irritability
  • Loss of appetite and loss of weight
  • Disturbed sleep, especially early morning waking
  • Depressive, gloomy or desolate dreams
  • Suicidal thoughts

If you feel yourself exhibiting these behaviors, do not discount them. They should be taken as seriously as you might treat a fever that won’t go away or a persistent cough.

Below are some expert tips on what caregivers in particular can do to stop depression before it gets out of control:

Talk regularly with family, friends, or mental health professionals— it is very important that you do not isolate yourself. Join a local support group, or find one online. Share your feelings so they don’t build up and escalate into problems.

Set limits— this can be hard for caregivers, because they are used to taking on everything that needs to be done. It’s okay to say no to taking on more than you can handle.

Eat nutritiously, exercise regularly and get enough sleep— this can be difficult because of the irregular schedules caregivers must keep. But think of it this way: your body and mind are machines, and they must be properly maintained in order to function at their best. Nutritious food, exercise and sleep are the things that fuel these machines. Just as you would not let your car run out of gas, don’t let your body run out of its fuel.

Let go of unrealistic expectations— caregivers often have unrealistic expectations of themselves, and therefore push themselves to meet these goals. Accept the fact that you can’t do everything. Ask for and accept help, from friends, family and local agencies. Whatever you do, don’t be a martyr.

Keep a sense of humor— we all know that laughter is the best medicine, so go ahead and take a few spoonfuls daily. Relax with a funny movie or TV show. Put on a comedy tape to listen to while you do your chores. Find the humor in everyday things.

Raleigh Geriatric Care Management offers an Adult Children of Aging Parents Support Group.  contact: lwatral@rgcmgmt.com

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Geriatric Care Managers Explained

Geriatric care managers (GCMs) are usually social workers, psychologists, nurses, gerontologists, or others with both training and experience in a number of aspects of elder care. They can assess needs, handle crises (such as an emergency hospitalization), help place an older adult in a long-term care facility, help solve family disputes, locate community resources, or simply fill in for family caregivers at doctor appointments and assist with other daily care.

For many families, senior care planning and coordination can be overwhelming. In some cases, a loved one’s health needs are at a crisis point and there are too many decisions to make all at once. Or you may live too far from your loved one to check on her regularly. Some aging seniors are resistant to receiving care. In other situations, family conflict can be a major issue.

GCMs are like a quarterback, coordinating all the different moving parts of senior care — from logistics and scheduling to emotional support and family mediation. Their experience can guide you through the challenges you face.

 

What Geriatric Care Managers Can Do:

Assessment. When you first hire a geriatric care manager, he’ll meet with your loved one (and family members, if appropriate) to evaluate the current situation. He’ll assess your loved one’s physical environment and mental, social, and emotional functioning and independence. Based on this assessment and conversations with family members, the GCM will identify your loved one’s care needs.

Plan of care. Once the assessment is complete, the GCM will make recommendations about the types of care your loved one needs. He’ll meet with you to review these recommendations in detail and get your feedback. He’ll note recommendations in a written plan of care. As care progresses or as care needs change, the care manager will note progress in the plan of care and make updates as needed.

Coordination of services. A geriatric care manager can be as actively involved in the care of your loved one as you need him to be; be sure to clarify expectations at the outset. Most GCMs know all the senior care providers in your area and are well prepared to help you find the best match for your loved one. You can expect him to help you find agencies to provide in-home care, hospice, or skilled nursing care, as well as to coordinate the comings and goings of the caregivers. If your loved one needs residential care, the GCM will help you find the best assisted living or nursing home that meets your loved one’s needs and fits within your budget. Some GCMs will also help with day-to-day care for your loved one — picking up prescriptions, taking your loved one to doctor appointments, or visiting for regular check-ins.

Family support. GCMs also provide invaluable support to family members as they cope with a loved one’s decline or illness. They can help smooth communication and mediate disagreements.

Ideas, products, and innovations. GCMs are always on the lookout for new types of services and tools to make caregiving easier and to help keep your loved one safe. Many will be able to tell you about new technologies, tools, or aids that help your loved one maintain independence and mobility for as long as possible.

caring.com

In Raleigh , NC, contact: Raleigh Geriatric Care Management. www.rgcmgmt.com lwatral@rgcmgmt.com

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Driving Retirement Does Not Have to Equal House Arrest

 

It goes without saying that for any of us, driving represents freedom, control, and of course, a degree of personal independence. But this is particularly true for the older driver. Here are five reasons a senior driver may not be willing to retire from driving, despite what may be obvious and quantifiable safety reasons:

1) For a senior driver, losing the ability to drive can be an obvious emotional set-back. In some cases, this set-back can be even more complicated when combined with recent losses such as the death of a spouse, a close friend, or a recent diagnosis of a serious health condition.

Imagine for a moment that only months ago your spouse of 50+ years died unexpectedly, and now your adult children are trying to take your car away from you. Or that just last week you were diagnosed with cancer, and today your family doctor compounded your anguish by suggesting that for safety reasons you stop driving, effective immediately. The recipient of all of this wonderful news would certainly feel like a tsunami of doom has just reached their beach.

2)  A senior driver may believe that if he/she can no longer drive, they will become a burden to others. This may be the furthest thing from the truth, but it becomes very real in the eyes of the beholder. Imagine for just one minute that you can suddenly no longer drive…ever. Although completely unwarranted, it is human nature to feel at least somewhat burdensome asking others for help getting you to and from your doctor’s appointments? Taking you to get groceries? Driving you to the hairdresser or barber? Taking you to visit an old friend?

3) Many seniors see a surrender of their driver’s license as an acknowledgement that their physical wellness, agility, mental sharpness, reflexes, sight, hearing or memory are beginning to deteriorate. Or that an illness or pre-existing medical condition is “getting worse”.

4) Many older drivers believe that if they give up their driving, they will have fewer social opportunities than what they are accustomed to.

5) Despite everyone’s best efforts, driving cessation can sometimes trigger depression in elderly people which, in turn can cause a noticeable deterioration in your loved one’s physical health.

There are obviously many, many more examples of the emotional distress driving cessation can cause for an older driver. The good news is; a retirement from a long and successful driving career does not have to be all doom and gloom, and does not have to be the equal of “house arrest”.

Keeping Us Safe provides services to both older drivers and their families across the United States. You can visit them online at www.keepingussafe.org or call toll-free at (877) 907-8841 for more information.  In the greater Raleigh area, contact Lauren Watral, MSW from Raleigh Geriatric Care Management at 919-803-8025.

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Filed under adult children of aging parents, Alzheimer's Disease, care giving, dementia, driving retirement, elder care raleigh nc, Geriatric Care Management, Having a conversation, long term care planning, NC, Raleigh, senior care, senior driving, Seniors and driving