The Sandwich Generation: Facing the Competing Needs of Our Children, Ourselves and Our Parents
By Stephanie Ginensky for Connections Magazine
One of the greatest challenges faced by most people at some point in their lives is the question of how to balance and stay balanced as we face the phenomenon of caring for our growing children on the one hand, and the increasing needs of our aging parents on the other hand.
In order to address this growing phenomenon, The Benjamin Children’s Library, the Meyerhoff Matnas and Melabev invited the community to a special evening devoted to this important topic. The lecture and discussion, which took place on November 13, was facilitated by Stacey L Gordon, LMSW, who has over 20 years of experience in aging related services. For the past 16 years Stacey has worked in the field of geriatric care management, and she is currently the founder and president of Elder Options NY/Chicago, and the co-founder of Elder Options Israel. Elder Options seeks to “Change the Way We See Aging,” through community-wide programs and lectures, private consults with families and older adults, support groups for family caregivers and on-going geriatric care management,. Stacey is an adjunct professor at the University of Chicago, and lectures around the world on caregiving, planning for aging, dementia and issues of aging in the workplace.
Through personal stories culled from her many years of experience working with the elderly and on her own family’s experiences, Stacey was able to broach difficult topics, acknowledging the specific binds the sandwich generation often finds itself in, admitting that often there are no easy solutions, but offering concrete suggestions and nuggets of information to alleviate the stress that accompanies both daily care and crisis situations.
Stacey’s informative and sensitive discussion touched on several important aspects of relevance to the Sandwich Generation, ranging from the importance of recognizing when our parents need our help; distinguishing between different forms of dementia; opening a dialogue with one’s aging parents around planning for aging; making difficult choices based on respecting the wishes and needs of your parents, your children, and yourself; and finally, making use of the various resources available to you and your parents. The highlights of the evening’s discussion will be presented in a 2-part article.
PART I: Planning for Old Age
The truth is that it often seems that old age just happens. One day our parents seem fine and the next day, they (or we) are faced with one health problem after another. Along with the physical ailments, one of the first signs that our parents are aging and may need the help and involvement of their children is the observation that they seem to be exhibiting symptoms of forgetfulness. Concerns over elderly parents driving because of deteriorating eyesight might suddenly be compounded by the reality that they seem to be having increasing difficulty remembering where they parked the car or put the car keys.
Stacey pointed out that it is important to keep in mind that in contrast to the prevailing common notion that dementia is one irreversible, progressive disease, that there are actually different types and forms of dementia, some of which are indeed temporary and reversible. In fact, dementia is a symptom of an underlying illness, and not an illness itself. Signs of dementia should be taken as an indication that a trip to the doctor is in order. Among the different types of cognitive impairment discussed were:
Benign senility – This is not dementia, but common forgetfulness, often attributed to aging itself or an overworked and stressed out lifestyle, and is generally considered temporary.
Mild cognitive impairment – often seen as a precursor to Alzheimer’s disease or other dementias, although in some instances, symptoms remain stable and may even be reversible. Three factors that may contribute to the halting of progression of dementia are: a healthful diet, including many green leafy vegetables and fruits, regular aerobic exercise, and cognitive stimulation, perhaps learning a new skill or doing challenging mental activities.
Normal pressure hydrocephalus – diagnosed through a spinal tap and MRI, can be relieved through the installation of a shunt to drain excess fluid from the brain. Symptoms include disturbed gait or shuffle, frequent urination, and signs of dementia.
Parkinson’s Disease and Dementia with Lewy bodies – due to abnormalities in brain processing and subsequent deposits of the protein alpha-synuclein.
Vascular Dementia (caused by hardening of the arteries). Can potentially be slowed down by improving flow of blood to the brain
Alzheimer’s Disease– Although considered irreversible, people who suffer from Alzheimer’s have on and off days, so it is important for such people to stay as active as possible, and to stimulate brain neurons. Family members and friends are thus encouraged to overcome the natural tendency to block out people with Alzheimer’s, and instead, remain loving, engaged, and supportive of one who receives such diagnosis, encouraging them to talk about it, and to plan for their future by thinking about how they would like to be cared for when they cannot care for themselves.
Plan of Action: Advanced Directives
Whether or not our parents are beginning to show signs of forgetfulness, it is never too early to begin a discussion about planning for the future and putting into action a plan for aging. Stacey stressed the importance in understanding and respecting our parents’ decisions, and suggested several important avenues through which to ensure that their wishes pertaining to aging and dying are carried out. One practical way to broach this difficult subject with reluctant parents, she suggested, was to bring up the subject with regard to our own aging process and the steps we are putting into place now with regard to planning for our own future.
Of particular importance is the need to set into place what is known as “advanced directives.” Such advanced directives explicitly state the wishes of a person when he or she is no longer able to advocate for his or her own self and include such things as:
A Living Will, which is not a legal document, but is a directive which many hospitals accept.
An Ethical Will, in which a person writes one’s blessings and personal values. This is a gift to you from your parents, in which they communicate what they feel is the most important message to pass along to future generations.
An Appointment of a Health Care Proxy who can make end of life decisions, such as whether to implement life support and forced feeding. Stacey’s advice was to never be your parents’ health care proxy, but rather, to have a family friend, caregiver or other appointed person available to ensure that the elderly person’s living will is respected. This is a legal category, and must be notarized. For information about halachic health care proxy, see: http://www.rabbis.org/pdfs/FINAL_Revised_Halachic_Health_Care_Proxy.pdf
TO BE CONTINUED. PART II: Setting up a Support Network
Elder Options Israel (EOI) provides ongoing support groups for those in the sandwich generation, or those dealing with difficult issues they face in relation to their parent’s aging, and also on “Planning for Aging” — a specialty of Elder Options Israel. Stacey and her partners are able to consult with families to provide a hands-on guide to local and international resources, with their qualified care managers who are familiar with the particular resources available both in Israel and abroad. Information about upcoming events will be advertised through the Benjamin Children’s Library and Melabev.
Stacey and her Israeli CEO, Amos Gil, can be reached at Elder Options Israel (http://www.eoisrael.co.il; eoisrael@eoisrael.co.il). They are available for private consultations both in Israel (055-666-5170) and in the U.S. (213-973-6726).
Some of Stacey’s recent articles about aging and caregiving can be read online at:
http://www.huffingtonpost.com/stacey-gordon/