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Health Information Mastering the Middle - Part 1

For "sandwich generation" caregivers, self-care is as important as tending to the older adults and kids in your life.

If you're an adult who's raising children and also taking care of elderly parents (or another older relative or friend), you're part of the "sandwich generation."

While not all older adults need assistance in their later years, America has an estimated 65.7 million family caregivers who are, on average, 48 years old.

Being a sandwich generation caregiver can be fulfilling and bring you a lot of pleasure. But it can also be extremely challenging. With the added responsibilities and pressures of caring for both your parents and your kids, you may at times feel frustrated, overwhelmed or even depressed.

In part one of this two-part interview, Kate Krajci, LCSW, a social worker with Rush Health and Aging, explains why saying, "No" can actually be affirming. Why you shouldn't beat yourself up for not being able to "do it all." And why carving out "me time" is an absolute must.

Q: Why is it so important for caregivers to take care of themselves?

Krajci: Research has shown that caregiving can have an impact on both your physical and mental health. If you don't care for yourself (such as getting enough rest, exercising and doing activities you enjoy), you're heading down this road of potentially having negative consequences for your own health and well-being.

And when you're not healthy, you can't help those other people in your life — your parents and kids. So look at it as, taking care of yourself will enable you to be the kind of caregiver you want and need to be.

Q: What if you don't have a lot of time to devote to yourself?

Krajci: One thing I always stress is that you don't have to be perfect and make huge changes right out of the gate. Particularly if you're not used to taking care of yourself, a small step can have a huge impact.

Start by focusing on one aspect of taking care of yourself. I often work with people on setting a goal for the week — one goal that supports self-care that can reasonably be accomplished. Once you choose your goal, break it down into the steps you need to take to make it happen.

The more specific the goal, the more likely it is to happen. If you say, "This week, my goal is to take better care of myself," you might feel like there are a million things you could do to accomplish that goal. That can be overwhelming and prevent you from taking action.

But if you instead say, "This week, I'm going to schedule my annual visit with my primary care doctor," you're giving yourself one task. And that’s more manageable.

While it might not seem like a big deal to make that appointment, there's no such thing as a small goal when it comes to trying to better care for yourself. You can always add another goal if you achieve your first one and feel ready to take on another.

Plus, caregivers are often so busy helping everyone else that they sacrifice their own appointments. And your health can start to suffer if you're not going for regular checkups.

Q: How can you keep from feeling overwhelmed when you have so much on your plate?

Krajci: It's important to acknowledge that you’re not super-human. There are only so many hours in a day, and you can only do so much. To protect your health and well-being, it's necessary to prioritize, set realistic expectations and, when necessary, say, "No."

This might mean asking for help with Mom or Dad in the mornings if it's really important that you take your children to school. Or telling your daughter she can't do the traveling soccer team this year because you're committed to helping grandma in the afternoons.

Just know that you don't have to go it alone. There are lots of community resources available. Or there may be a different way to get extra help from family and friends if asking for help hasn't worked in the past.

Q: How do you set limits without hurting your parent's or child's feelings?

Krajci: It can be extremely difficult to say, "No," especially to an older adult. There are many reasons an older adult may need your support — household chores, setting up medications or feeling lonely and wanting company. So you need to be sensitive to what's behind their requests or need for help when thinking about how to set limits.

I recommend always using "I" statements, or speaking from only your perspective. When we're frustrated, we tend to use "you" statements: "You always need me to go with you to the movies. I just can't do that."

Instead, try saying something like, "I really enjoy going to the movies with you, but I'm not able to do it as much as I used to. Let's make a regular date, and that's the date I'm going to save for us to go to the movies together."

When we have expectations of someone else, we're going to be hurt when that person doesn't meet our expectations. But it's going to be more hurtful if you don't have that conversation and just start saying "no" to movies all the time because you're burnt out.

It's better to be honest up front and say, "I enjoy doing this, but I'm not able to do it as often." It's the least potentially hurtful option.

Q: So you should emphasize the positive instead of the negative?

Krajci: Exactly. Focus on what you can do rather than what you can't do. Instead of saying, "Dad, I can only come three nights a week," ask him which days he would like you come over, either for a social call or to help with specific tasks, like doing laundry or grocery shopping.

Then, you can establish together which days you'll for sure be there. Setting a schedule doesn't mean you won't visit other times. But this way, your Dad won't expect you to show up and then be disappointed or hurt when you can't make it.

The same is true when setting limits with your kids.

When your daughter really wants to do seven activities and that’s not possible, tell her, "You can do four activities this year. Which are the four you most want to do?" Temper her expectations, but in a positive way. So it's not, "We're taking away three activities," but, "You get to do the four activities you enjoy most."

Q: Even when you know, intellectually, that you have to say "No," you may still feel guilty about it. How can you keep the guilty feelings away?

Krajci: Guilt is a natural response that humans tend to feel whether they're actually responsible for the situation or not. Often, in both caregiving and parenting, people feel guilty and blame themselves for things they actually have no control over.

My advice is, try to focus on what your intentions are in a given situation. What was behind your actions?

If, say, you aren't able to go to your daughter's soccer game because you're helping your parents after a full work day, is that really your fault? Were you acting maliciously or trying to cause harm by not attending the game?

Probably not, right? Chances are, you started out with good intentions and eventually realized that the situation wasn't realistic — you couldn't be in two places at once — and then felt stuck. If that's the case, try not to judge yourself harshly.

It's easy, in those early stages of starting to set limits, to feel like you're abandoning this person. That you're not living up to what they expect or what you'd like to do for them. And you forget about everything that you are doing.

Just remind yourself, "OK, maybe I’m not going to every soccer game or cooking dinner for Dad every night, but these are all the things I'm still doing for them.”

Coming in March: Part 2 of the interview, in which Kate Krajci, LCSW, gives advice on how to ask for caregiving and child care help — and where to find it.


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Please note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.

If you enjoyed this article and are not already a subscriber, subscribe today to Discover Rush Online. You'll receive health information, breaking medical news and helpful tips for maintaining your health via e-mail. To subscribe, send an e-mail to DiscoverRushOnline@rush.edu.

February 2014
 

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