Mastering the Middle

Expert advice to help 'sandwich generation' caregivers

Healthy Aging & Caregiving

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.

These 9 tips can help caregivers get the support they need to stay physically and emotionally healthy.

1. Recognize the importance of self-care.

The first step is understanding that you have your own needs, separate from the needs of those you're caring for.

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.

2. Celebrate small accomplishments.

Don't put pressure on yourself 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. Set 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.

3. Just say "no" (sometimes).

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.

4. Learn to set limits.

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.

Try 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.

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.

5. Accentuate the positives.

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 the message is not, "We're taking away three activities," but, "You get to do the four activities you enjoy most."

6. Don't feel guilty about not being able to "do it all."

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.

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 youare 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.”

7. Take stock of your responsibilities so you can delegate.

The saying, "It takes a village to raise a child" also applies to caring for older adults. Don't be afraid to ask for help. But to ensure you get the help you need, you must first figure out exactly what you need.

Take a look at what is actually on your plate. Think it through and write a comprehensive list of all your caregiving and child care responsibilities.

Be as specific and detailed as you can with the tasks your list. If you ask a person to do something specific, he or she will probably be more willing to say yes or consider doing it. So instead of "Prepare meals," write, "Cook dinner for Dad every Monday and Thursday."

8. Figure out manageable ways for others to pitch in.

You should always be sensitive to other people's limitations. We must acknowledge that just as we're trying to set limits for ourselves, it's OK for other people to set limits, too.

That's where being strategic and specific with your asks can get you more positive replies. The brother who has an 80-hour a week job and a child with special needs is probably not the best person to ask to pick your kids up after school every day. But he might have time to call the pharmacy twice a month to refill your Mom's prescriptions.

The key is conveying your needs in such a way that the family member doesn't perceive the situation as, "Mary is coming at me with her laundry list and just blaming me for not helping."

Instead, you want to set the stage for the conversation to be, "Let's talk about what Mom needs right now. These are the things Mom needs. How can we work on this together?"

Keep in mind that you may have to compromise. Will your brother agree to do one small task? Yes. Would you like it to be more? Absolutely. But is it better than nothing? Yes.

Hold onto those wins even though they might seem small. Getting one task off your plate is still one less thing you have to do. And maybe in the future your brother will have more time and be willing and able to take on more responsibilities.

9. When it comes to getting help, think outside the box.

Your informal network might actually be larger than you think. So be be creative and think outside the box. For instance, a lot of people get support from faith and school communities.

But if you can't find enough help from your informal network or don't have an informal network, that's where you have to start thinking about more formal services, like federal and state agencies, not-for-profit organizations and out of pocket service providers.

You can also find lots of great community resources through the Rush Resource Centers. And learn more about aging and caregiving through Rush Generations, Rush's free health and aging membership program.

The essential thing to know is that you're not alone. Help is out there; all you have to do is reach out.

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