The pain of choosing who needs help the most is something familiar with most sandwich generation caregivers. Vulnerable elders need advocacy, assistance and often a great deal of time. Our children need the same. What happens when the needs of the two generations clash? We have to make painful choices. It's very, very hard. I know because I did it for years.
During my two decades of elder care I was raising two children, one of whom has multiple health problems. My sons were quite young when I started with the first of my elders, my neighbor Joe. The boys enjoyed going next door to hang out with Joe. Joe was entirely deaf, so the kids learned a great deal about communicating with someone who couldn't hear. They found Joe funny, and generally didn't mind when I was next door with Joe.
There were times, however, when my younger son, unable to fully grasp Joe's need for me and balance it with his own, had problems. He was often home sick. On those days, I tried to run back and forth and give them each time. Naturally, had my son been so ill I couldn't leave him alone at all, I would have left Joe a note and told him I couldn't visit that day. But it wasn't often that clear-cut. A sick child wants a lot of attention and sympathy. Most generally want, even if they don't need, their mother's entire attention all the time.
Needy Elders and Needy Children - Who "Wins"?
A lonely elder can be just as needy. How do we choose? What do we do? As years went by, my children naturally grew older, but my son still had many days home from school and many doctor appointments. My older son, of course, had needs too. My elders in need of care multiplied.
Joe died after five years of care, but my childless aunt and uncle, my in-laws and my parents all grew to need help. Some of the help was intense. I was often torn between the needs of generations, and I'm sure each generation suffered some loss because I couldn't be everywhere at once.
I know I suffered a great deal of guilt. But I did my best and that was all I could do. Did my children's mental health suffer? Who can say? My youngest son's health issues certainly weren't caused by my giving care to elders. And I do believe both of my children learned about giving of oneself to help others as they watch the elder care in action.
Yet, I'm sure my youngest son, with his child's view of life, felt depressed at times, when I had to run off to get Grandma to the emergency room. He knew I was needed elsewhere. He was a "big boy" about it. But I suspect that he didn't fully understand why I had to leave.
When a Parent Needs Care
Spouses of people who develop early on-set Alzheimer's often have a unique challenge, in that it's not an elder whose care needs take precedence over the child's needs, but a parent. The same, of course can happen if a parent develops Multiple Sclerosis or some other serious illness. I wrote about this in the article "The Sandwich Generation: Caring for Multiple Generations."
The teen years can be difficult in the most "normal" households - whatever normal is. Add to the general angst of any teenager the rigors of a parent who has a disease that sets him or her apart from "normal" parents, such as one would find in a household where early on-set Alzheimer's disease is present, and this upset and confusion could be enough to send a teenager into clinical depression. Of necessity, when one spouse is ill, the other spouse becomes the caregiver to the sick spouse and will have less time for the teen.
Outside Help May Be Needed
It's important that the well spouse in these situations be tuned into the needs of the teen, and get outside medical help for the child if there is any clue it's needed. Teenagers often don't talk to their parents about their anxiety or feelings of being ignored. These same teens may not feel comfortable talking with peers about their "weird" parent. Other kids think their parents are weird, but that's only normal parental weirdness - not bizarre behavior caused by a disease such as Alzheimer's. This is a lot for a child of any age to cope with alone.
School counselors should be clued in to what is going on at home, so that teachers and counselors can be on the lookout for danger signs. Even parents of friends should be alert for signs of depression in affected children or teens.
The mental health of children is at risk when one parent cannot give full attention to the needs that arise. This is not to say elders or sick spouse needs aren't high priority. Nor is it an attempt to lay guilt on anyone - we do enough of that ourselves. It's just a warning to be extra alert to the needs of our children when we are also consumed with needy elders.
Outside help may be needed for a family to get through this difficult time. There is no shame is asking for this help, and it may be a lifesaver. It's hard to do everything alone.
Published On: May 17, 2010