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With Mayo Clinic oncologist Edward T. Creagan, M.D.

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November 23, 2007 9:58 a.m.

Dealing with the 'perfect storm'

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By Edward T. Creagan, M.D.

The thoughtful and probing comments from members of our community address the issue of self-care in times of crisis and adversity. How about this situation — the "perfect storm" for stress and why we need to marshal resources for our own survival.

You are a middle-aged professional/homemaker with your own health issues in the midst of orchestrating the bewildering healthcare options for two elderly parents who have moved back to your home community. The situation is complicated by your own two teenagers.

This scenario portrays in vivid detail the challenges and opportunities for the "sandwich generation." These are the individuals ensnared between the needs of their aging parents, their own needs, and the needs of their emerging family.

First, the needs of the elderly. Even for those of us who are relatively fit and savvy, navigating the bewildering health care system can be daunting. The task is insurmountable for the elderly if they do not have an advocate to act on their behalf.

Second, the needs and challenges of teenagers are well known to most of us and that in and of itself is a full-time job. So, then, who takes care of us and how do we stay durable in dealing with these issues?

One wise woman in this predicament shared with me the importance of friends with whom she can share some of these challenges, the importance of a massage every several weeks to reduce the tension, and the importance of a spiritual dimension providing consolation and strength in time of chaos and adversity.

A year ago April, the Dalai Lama visited our institution and spoke to the issue of human suffering. I was particularly struck by a paraphrase of his comments: "How can we be expected to care for others if we do not care for ourselves."

His words certainly apply to each of us during our times of challenge and especially to those struggling and caught between the needs of parents, their own families and their own needs.

I would certainly appreciate the input of our survivors out there who are heroically dealing with this kind of "perfect storm."

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23 comments posted

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July 10, 2008 7:17 a.m.

I came across this site because I am desperate to get any support or new information I can. I am 43 and have two children ages nine and six. My brother died 4 1/2 years ago to suicide. My mother died 1 year ago after a short 7 month battle with lung cancer with liver mets, and evetually brain, then spinal cord. Now my dad is dying from pulmonary fibrosis,CHF,and myelodysplastic anemia. These last few years been so painful. I am the youngest of five children and I work part time so I am naturally the leading care taker. I do this with honor and I am greatful for the time spent with my parents. I hope that when this hurricane ends the sea's are calm that I was an example to my children and to my husband (who has never lost anyone yet). My heart aches and mind never stops, but I hope to stay strong. Thank you for all your posts. It made me feel not so alone and gave me strength and encouragement.

- Laurie

April 23, 2008 2:58 a.m.

As my father's carer,I have learnt that 10 minutes of my time each day,is appreciated just as much as spending a whole day with him. This was difficult at first, as I used to feel guilty, not about myself, but the fact I have 4 siblings who considered it enough for them to see him once in any week. Only when I became ill did I realise that I had to stop beating up on myself. Now I am taking time at 54 to study and, have found this new outlet and the friends I have made at college beneficial to my own sense of sanity. This in itself has made me stronger and able to face any storm, perfect or not. My message to all is "Make time for yourself" in whatever way makes you happy. If your happy, those you care for will benefit better than if your stressed.

- Cath

April 15, 2008 4:26 p.m.

God bless all stressed caregivers and "sandwiched" people. Stay strong. A close friend is great.Time out for self. 75 and healthy but facing "where do we go from here?"

- Joan MN

April 13, 2008 8:44 p.m.

I as well,feel sandwiched. I have been surrounded by grief by the loss of loved ones due to cancer. My aunt who was very close to our family passed away last May, my dad a month later. Today at my aunt's burying of her ashes, I was told by my 54 year old very close cousin that she has pancreatic cancer. So sad. We are as well, retired, in our 50's trying to support our son who is in his final year of college and at a crucial time in his career re: exmas etc. He has a live in girl friend, who helps pay rent. Jobs are scarce in our area. My sister-in laws, both in their 50's once just finished treatment for bowel cancer, one agressive breast cancer. My best friend's mom is suffering with pancreatic cancer. Mom is 80 and doesn't drive. She must rely on myself and husband to help her with doctor appts. etc. Still lives in own home but finding it tough to maintain by herself. My sandwich is a "Dagwood". The pickle on my sandwich is that I have a bad back injury from a motor vehicle accident two years ago and still in treatment. I know I must stay as healthy as possible, but have lost quite a bit of weight in past 6 months and have insomnia. A day at a time, but very hard days. As well mother-in law in nursing home, has been close to death three times in past year. Family has flown home. Where do you find comfort? Who do you seek out to really help with depression? Doctors are too busy and overworked. Guess what I find the hardest is all my friends are facing challenges.

- C. Kearns

March 7, 2008 2:16 p.m.

Is there a good web-based support group of sandwiched caregivers? I desperately need a place to vent, ask questions, get advice, but mostly feel not so alone. I also wish there was an on-line assessment tool that would match your loved one with the best living arrangement. My 87 year old mom is too healthy for Assisted Living, but may be too confused for an "Active Senior Community." I'm an adopted only child, so am her entire world. I'm also married and have four kids of my own, ranging in age from 13 to 24 (who has mental issues), so we don't have room for her to live with us. Our small town doesn't have a gerontologist, and my mom's Family Practitioner says she "doesn't have Alzheimer's," but doesn't diagnose her condition as anything else. I think she might have Mild Cognitive Impairment. Let me know if there is (1) a web-based support group, (2) on-line assessment tool for living arrangements, (3) treatment for Mild Cognitive Impairment. Thanks!

- C.B.

February 22, 2008 12:52 p.m.

1. Do they have a residents bill of rights? Do they adhere to it? 2. Trustworthy - Do they do criminal background checks on all their employees? Is it a reputable state licensed agency? What have the surveyors cited them for? Have citations been corrected in a timely manner? 3. Trained - What type of training is required to be hired? Ongoing? Are there licensed nursing staff supervising? Who has access to, sets up, administers meds? Do they require annual CPR, first aid, vulneralbe adult trainings? Do they have an MD overseeing the facility? 4. Activities - Do they have a formal activities program? Does it include both indoor and outdoor activities? 1:1 and group? Do they offer things to keep residents minds stimulated and bodies active? 5. What is their mission statement? Would the staff place their loved one in that center?

- Lori

February 22, 2008 12:39 p.m.

6. Space - How many people to a room? More than one common area? Facility completely accessible - ramps, showers, toilets? Privacy - How do they ensure both physical and records (HIPAA) privacy? 7. Nutrition - What are their menu plans? Are they created/reviewed by a registered dietician? Cooked by a kitchen staff (lg facility) or with all staff (sm fac.) cooking? Is there variety? Fresh foods? Choices or say in menu planning? Are residents able to assist in prep or cooking? 8. Do the other residents appear content? Happy? Are there esthetic touches - bird atrium, fish tanks, fountains, plants? Can residents assist in the care - watering plants, feeding fish? 9. Transportation - Do they? If so, in what, by whom, for what purposes? Do they ensure staff have valid licenses and insurance? 10. What is their protocol in case of emergency or death? I hope this helps you in starting a dialog with your mom's center. Please post how it turns out. Thanks much.

- Lori

February 22, 2008 12:23 p.m.

Connie ~ My top 10 1. Do they have a residents bill of rights? Is it adhered to? 2. Trustworthy - Do they do criminal background checks on all their employees? Is it a reputable state licensed agency? What citations have they received from the state surveyors and have they corrected them in a timely manner? 3. Trained - What type of training is required to be hired? Remain employed? Do they have licensed nursing staff supervising unlicensed staff? Who has access to, sets up, administers meds? Do they require annual training for CPR, first aid, vulnerable adult? Do they have a doctor overseeing the facility? 4. Activities - Do they have a formalized activities program? Does it include indoor & outdoor activities? 1:1 and group? Things to keep residents minds stimulated and bodies as active as possible? 5. Their viewpoint - What is their mission statement? Would everyone working there place their loved on in their care? I will continue on a 3rd post.

- Lori

February 22, 2008 12:08 p.m.

Connie ~ A few years back, I worked for a Home Health Care Agency, both out in the field as an aide & LPN and in then in the office coordinating benefits either with insurance co. or county social workers. Additionally, my 91 yo grandma has been a client of theirs for 20 years. During my time with them, they began providing assisted living services in apartment complexes and elderly foster care services in homes they purchased. I just retired from my job as a director of an adult foster care home providing services to developmentally disabled adults. So I have viewed caregiving from several angles: personaly with my grandma; direct caregiving for others; indirectly by authorizing services and directly/responsibly for hiring caregivers and creating the "goals" my dd cosumers would work on based on criteria set up by our state / county. With that, I have a few questions for you. What type of ltc center is it? What state are you in (I am in MN)? My top 10 follows in a n

- Lori

February 15, 2008 11:02 a.m.

After three years of being the sole caregiver for my mother, I have placed in a longterm care center approx. 2 blocks from my home. I spend as much time as possible with her which has helped with her transition. I am really interested in knowing the "must have" care that you want for your family member. Because of my interest in training the center has asked me to address the caregivers and I would like to see if OUR top 10 list of "must haves" matches what the care givers think is the top 10 list. I'd really appreciate responses.If you are interested, I'll share what the care givers say. Connie

- Connie