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Wednesday, November 17, 2010

Sandwich Generation Shaah Tova 2010

The Sandwich Generation – Facing the Challenges

My husband once asked his senile father, "Who am I?" My father in law replied, "You're my Daddy." My husband retorted, "I'm not your Daddy. I’m your son." At that, my father in law paused for a moment, smiled and said, "What difference does it make, as long as we love each other?" Mrs. G.  

"One morning, after I finished getting my mother dressed and ready for daycare, she kissed my hand and said, 'I love you, Mommy.' After she left, I cried." Mrs. P.

The dictionary defines the Sandwich Generation as "a generation of people who care for their aging parents while supporting their own children." Like the peanut butter and jelly, they're the middle, and they're the ones keeping it all together. How do they cope?

@@ The Hierarch Never Changes

Rebbetzin Rivka Friedlander, a teacher, parent education counselor and family therapist points out that although on a practical level when a child becomes his parents' caretaker the roles become reversed, the hierarchy never changes. Even while insisting, for example, that a parent eats his breakfast or takes his medicine, we must never forget whom we are dealing with and make sure to show proper respect.

But how does one maintain the appropriate kavod while still remaining firm? Rebbetzin Friendlander points out that after Moshe Rabbeinu threw the Luchos down, the shattered pieces were placed, together with the second set of Luchos, inside the Aron, the holiest place in the Mishkan. "Elderly parents are like the shattered luchos. Although they are but a shadow of their former self, they are holy and must be treated as such."  

Mrs. Leah Abramowitz, director of Shaarei Tzedek's geriatric center and founder of Melabev, community clubs for the eldercare, gives a few practical tips. "Even while taking control, try to let your parents feel that they are in charge, that they are the ones making the decisions, this way they'll maintain their self dignity. If, for example, a parent must be moved to a nursing home or into the one of the children's homes, you can ask them if they'd like to move on Sunday or Thursday, or if they prefer the bed next to the window. Let them feel that they have a say in their daily lives. Ask questions like, 'Would you like me to feed you now, or in fifteen minutes?' or 'Do you want to see the doctor this week or next week?'"

The doctor insisted that my elderly mother needed air conditioning. But she viewed air conditioning as an unnecessary luxury – a waste of money -  and would not hear of having it installed. One day we asked her, "When would you like the workers to install the air conditioner – Thursday or Sunday?" She wasn't thrilled (although later on she was!), but at least this way she felt that she had some control over the situation. Mrs. L.

"Emotionally, it's really difficult hard for children to make that switch," Mrs. Abramowitz points out. "The initial emotion is denial, sometimes even anger. People ask themselves, "Why is this happening to me? My father was such a tzaddik, such a lamdan, and now he is demented. My mother was such a tzedekes, and now she is totally wrapped up in herself." There's also a lot of self-blame and guilt. People wonder, "I should have taken her to the doctor earlier. Why didn't I spend more time with her when she was healthy."

"It was painful to see my mother—my mother who had always done so much for me and my family- completely dependent on us for every little thing. I went through the entire gamut of emotions, denial, grief, guilt, and yes, even anger, until eventually I came to acceptance. Mrs. P.  

Denial grief, guilt, anger; all these emotions are part of the grieving process, and it's completely normal to feel grief while watching our loved ones lose their independence. Allowing oneself to feel these emotions is the first step toward making peace with the situation. 

Once a person has accepted that these emotions are normal, what tools can he use to get through them and reach a state of acceptance?

@@ Emotional Support

Everyone I spoke to emphasized the importance of emotional support. It could be a spouse, the children, siblings, or a close friend, someone with whom they could honestly share their feelings with and discuss their fears and worries. Sharing the pain is the way to stay sane!

Mrs. G. cares for her elderly father-in-law, a brilliant man who, thanks to Alzheimer's, is a shadow of his former self. "When my father-in-law first came to live with us," Mrs. G. recalls, "a close friend told me, 'Call me when you feel that it's too much for you to handle. I'll listen without judging.' Just knowing that she was there for me was a tremendous support."

A supportive family is an absolute must. Caring for an elderly parent can be extremely stressful and time consuming. If the care is minimal – visiting regularly or running errands, it's difficult, but still possible. But if it involves caring for a parent in one's own home, without the backing of one's family, it's bound to fail.

Mrs. K's ninety year old mother lives in the apartment above her. Her mother needs almost constant attention, and she finds herself running upstairs at all hours of the day and night. "My older kids are really supportive, both emotionally and physically. I could never manage without them. Just the other morning, for example, my mother buzzed me on the intercom to let me know that she needed me – but my youngest – a Down syndrome child – needed my help to get ready in time to catch the school bus. My teenage daughter heard what was going on and took over, so that I could go upstairs. I don't know what I would have done if she hadn't been there to bail me out.

"I'm grateful that my kids are so accepting. I have one friend whose children were so jealous of the attention their mother was giving to their grandmother that she had to find a different solution. She had no choice, it was destroying her family – but she was overwhelmed with guilt afterwards."

Ten years ago, when Mrs. R's father-in-law moved in with them, he was in the beginning stages of Alzheimer's. Today, he's completely demented and needs constant care. "It's easier for me," Mrs. R explains, "as I'm not so emotionally involved. It's much more difficult for my husband; after all, it's his father. My husband wouldn't have been able to bring his father to live with us if I hadn't been completely supportive of his decision. But it's not just the emotional support; my day completely revolves around my father in law's needs."

@@ One Day at a Time

Even with the family's support, taking care of an elderly parent can be exhausting both physically and emotionally. "It's important," explains Mrs. Abramowitz, "to take it one day at a time. You managed today. That's great. You'll worry about how you'll manage tomorrow, tomorrow." 

Mrs. G: "At first we had no idea what we were getting ourselves into. But we took it one day at a time, and we're still taking it one day at a time.

"In some ways it's gotten easier. In the beginning he used to wander – one time he even walked out of the house! To keep him safe at night, we had to lock him in his room. It was very difficult for my husband. He felt so guilty. But we had no choice. It was either that or sending him to a nursing home. Today we don't have that problem - he's confined to a wheelchair.

"We never committed ourselves to taking care of my father-in-law until the end. We make limits, and then end up stretching those limits. At first we said that we'd continue until he needs diapers. Then, when he needed diapers, we said that we'd continue until he couldn't walk anymore. I don't know how long we're going to continue taking care of him, but the knowledge that there is a limit – even if we keep on stretching that limit – makes it much easier for us to cope emotionally. In gladly crossing borders that we never thought possible, we are growing in ways that we never dreamed of."

Mrs. L., who cared for her both her mother-in-law – who had Alzheimer's - and her mother – who remained mentally alert until the end – found that focusing on the immediate priorities, rather than worrying about what will be tomorrow kept her sane. "I was constantly weighing what would be the correct thing to do at any given moment. There were often a clash of needs, and I'd have to decide which takes precedence. Obviously a medical emergency is more pressing than a bedtime story, but most of the times the decision was not so clear. Although I felt that I was being stretched in many directions, I focused on the here and now, rather than worry about the future."

@@Time Out

Mrs. Abramowitz emphasizes the importance of the caregivers having time for themselves. "It's important to take care of yourself, to make time for yourself. If you become run down, either physically or emotionally, everyone, including the person you're caring for, will suffer. Find an outlet. If necessary, hire a babysitter. Go to visit your grandchildren, listen to a stimulating shiur. If you neglect yourself, you'll ultimately neglect everyone."

Mrs. G takes advantage of small increments of time to pamper herself. "Most of my day is taken up around my father-in-law; just feeding him can take an hour and a half – three times a day! So I take mini breaks to read a book or work on a puzzle. On the rare occasion that my husband and I do go out alone, we tell ourselves that this is our vacation, even if that 'vacation' is nothing more than running errands together."

@Hakaras Hatov

It is only after we've become parents ourselves that we begin to appreciate all that our own parents have given to us! Those memories can help us to cope.

Mrs. K recalls, "My mother came to help me after I had a baby– and she was already in her seventies! When she was healthy she'd take my kids to the park, invite them for Shabbos. When I was a child, her life revolved around me. Now my life revolves around her. Now that she's not able to take care of herself, I'm glad to be able to give back to her something of what she gave us."

@You've won the jackpot!

In the eseres hadibros, the mitzvah of kibud av v'eim is put in the same side as mitzvos bein adam l'makom, mitzvos between a person and the Almighty. When we show kavod to our parents, we are showing kavod to Hashem! "It's not always easy," says Rebbetzin Friedlander. "But remember that you've won the jackpot! Not everyone merits such a wonderful opportunity. It's a tremendous zechus.

"In her book Mountain Climbers, Malky Feig tells the story of an angry taxi driver who was complaining to the dispatcher about how his customer was keeping him waiting.  The dispatcher asked one very pointed question; 'Is the meter on?' We have to remember that the meter is running; that there is a reward – and a great one at that – for fulfilling this mitzvah properly."

When MRs. L's mother first moved to Israel, Mrs. L purchased a book about the mitzvah of kibbud Av v'Eim. "I bought the book because I wanted halachic guidelines. I discovered that every time I did something for my mother, even something as mundane as bringing her a glass of water, I was doing a mitzvah d'Oreisa! Eventually we ended up taking care of both my mother and mother-in-law. With two bubbies living with us, we were adding up mitzvos right and left! That realization helped me to get through the inevitable challenges."

  • * *

"Our generation needs to open their eyes to reality and be grateful that we have elderly people to care for." Mrs. K.

When I was growing up, most of my friends were children of holocaust survivors who never knew their grandparents. Living in a time of relative peace, we are privileged to have an older generation to emulate, and, when necessary, to care for.  Ashreinu, mah tov chalkeinu…

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