Episode 10: The sandwich generation: How family caregiving impacts health & longevity

July. 4, 2023 |  25 mins

Join host Brent Bishop as he chats with Lycia Rodrigues, a caregiver support manager from Victoria, British Columbia. They will discuss the “sandwich generation” and how family caregiving can impact health and longevity. 

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You are listening to the Beyond Age podcast series.

Brent:

Hi, and welcome to Beyond Age, a Manulife exclusive podcast where we chat with experts to uncover the truth about holistic health and aging to help keep you living healthier for longer, no matter your age. I'm your host, Brent Bishop, and today I'm joined by Lycia Rodrigues from Victoria, BC. She's the caregiver support manager at Family Caregivers of British Columbia. Today we'll be discussing the sandwich generation, how to care for caregivers and how caregiving impacts health and longevity. Welcome Lycia.

Lycia:

Thank you. Very happy to be here with you and very happy to share.

Brent:

So great to have you today. This is such an amazing and important topic to cover and really looking forward to seeing what you have to say. But maybe before we get into that, give us a little bit of background on yourself and why you got into this field.

Lycia:

Sure. Yes. I've been working with seniors and family caregivers more than 10 years, and I'm very passionate about creating more wellbeing strategies and creating more innovative activities for making sure that family caregivers are involved with more wellbeing opportunities. You know, there is a quote that I always like to share, and it really aligns a lot with my life. It's a quote from Rosalyn Carter and she says that there are only four kinds of people in the world, those who have been caregivers, those who are caregivers, those who will be caregivers, and those who need caregivers. Wow. And many people ask, wow, why are you so interested and so passionate? And I always like to share a personal story. When I was 14, almost 15, I had a major health transition because of that situation. I had family caregivers that were with me, and the only reason I am here with you alive is because I had family caregivers, my mother, my siblings, neighbours, they're all helping me to recover from a brain aneurysm.

Brent:

Oh wow.

Lycia:

Yeah, it was very serious. They were my major support, like helping me with every single step of my recovery. I was very young, but what I experienced was very similar to a stroke, was very similar to what many seniors experience in their maybe seventies when they're eighties. So because of that situation, I knew that my career, my profession would be supporting people in that same situation. In Brazil, I decided to become a psychologist and I start working the hospital. And my major work there was mostly with families and people experiencing major health transitions. I decided to move to Canada; the last almost 20 years I've been here working in the gerontology area, but mostly with family caregivers.

Brent:

Well, it's such an important role and I love to hear when people are in a career that the passion and the meaning is there because they've had a personal experience. Thank you for sharing that.

Lycia:

Yes. Sure. Yes.

Brent:

I've heard people refer to the sandwich generation and at first I'm like, what does that exactly mean? You know, maybe you can tell us a little bit about what it is and what stress factors or challenges that people in this situation might face?

Lycia:

Yes, Brent. It's very complex. So the way we define sandwich generation are family caregivers providing care for parents most of the time older adults. And at the same time they have young children. They're also taking care of their kids or their family. So that's why sandwich, it's both.

Brent:

Right in the middle.

Lycia:

And these statistics in Canada shows that 20% of family caregivers are sandwich generation. So it's a big number. And most of them are also working full-time. So you can imagine the stress related there, right? They're juggling working, they're juggling family and they're dealing with their parents experience dementia or stroke or something that requires a lot of home care support. And they are dealing with financial stress, right. Because they need to deal with all that and they sometimes need to hire private care support and they're navigating with a healthcare system that's so complicated sometimes.

Brent:

I can imagine.

Lycia:

The first major challenge is the emotional stress. They're dealing with uncertainty. Many people don't plan to become caregivers. It's so much for them to deal with.

Brent:

I have friends in that situation. It's a real challenge for them and it's a balancing act really, you know, to try to manage everything. Absolutely. And then the double sandwich. So that's where, for instance, you know, people in their sixties are taking care of their grandchildren so that the adult children can go to work and they're also taking care of their own parents in their late eighties and nineties. So I can't imagine how difficult and how challenging that can be. What would that group of people experience being in that double sandwich scenario?

Lycia:

Yes. It's a very good question because also what we call like mixed caregiving, they are not just caregiving for, they're mixing all the caregiving there. What we observe in many people that are dealing with this situation, they need to manage the transitions. Most of them, they're dealing with issues of aging. So they're dealing with a parent who had a fall, unfortunately falls happen. And that can be the beginning of, you know, a journey of caregiving after fall.

Brent:

I know the statistics pretty high on falls and even falls in mortality.

Lycia:

It really happens a lot. And at the same time, if they're senior, they probably have a partner who also have chronic illness. Many people who are dealing with diabetes, for example. They need to manage the medication. They need to be on top of, you know, the treatments and healthcare. And sometimes, like you said, they have grandchildren that they need to be responsible for. Yeah. So I talk about emotional stress. One of the major ones, the financial stress is a big one. Why? It's because many people stop working. We don't have a lot of financial support for family caregivers at this time in many provinces. We have set stories here of people who stop working. They use other savings. Like we don't have an allowance that would help caregivers to have a monthly allowance so they can completely be involved with the care of their parents.

Brent:

I can imagine how stress just escalates. I mean, one, you want to be able to provide the time for your caregiving, and then secondly, if you've ran out of your savings or you don't have something that can at least help you along the way, that the stress has got to be pretty high. So, you know, there are caregivers and there's the being cared for kind of two different sides of it. And you know, starting with the caregivers, you mentioned some great things there. You know, what specific impact would you say that the sandwich generation would have on their health and longevity?

Lycia:

We work in that area a lot. We have a lot of research in that area that shows that most of people that start in caregiving in the sandwich generation, what happens is that there higher number of chronic illness with this population. Mental health is a big one. So if they're caregiving, if their a senior generation, they probably have a chance to develop more, for example, depression or anxiety, all those mental health issues. Research also shows that sleeping problems in that population is a big one. And we all know that sleeping is one of the major things. So because of this problem, they're probably going to have other issue regarding other chronic illness. For example, diabetes happen a lot because also their eating changes a lot because they probably don't have the resources, the time, the opportunities to plan. So that's a major problem. Even injuries, physical injuries, because sometimes they're providing a lot of personal care, like transferring their parents from wheelchair to bed or taking a bath or taking shower. It causes a lot of issues in terms of physical injuries. So that's another problem.

Brent:

Yeah, that's interesting. I'm glad you mentioned that. Cause I wouldn't have necessarily thought automatically that the injury risk would be higher, but it makes complete sense. Of course. It's a lot of responsibility. Listen, I have one child and my parents are pretty self-sufficient still, so I can't imagine having to manage all of that. What about for those being cared for, you know, the older generation themselves, the situation, like how does it impact their health and longevity?

Lycia:

Yeah. So for those that are cared for, what we know is that the more support they have from family, from friends, their chance of their life expectancy and their health. But unfortunately our society is very challenging because many people here in Victoria, for example, there's a name that we call here. We have a lot of what we call orphan seniors. The orphan seniors are those who have zero family support, zero community support. They are very isolated.

Brent:

Well, I guess even from the social standpoint, right? Because as we know, that's a critical thing for your mental health and longevity too.

Lycia:

We see also more positive outcomes for those who still have some connections. And caregivers are essential partners. I always like to share that; here in BC, and this is a common statistic for all of Canada, 80% of care is done by family caregivers. It's not by hospital, it's not by doctors, it's not by nurse, it's by family caregivers.

Brent:

Wow. 80%.

Lycia:

Because they are the ones dealing with all the social opportunities, like you said, which is a big thing for health. And they are the ones dealing with all medical management. So they are essential partners. We always like to talk about that because unfortunately our society, the caregivers are a little bit invisible.

Brent:

I know what you mean.

Lycia:

Here in my work, that's what's all about is making sure our community understands the role, the important role of family caregivers, making sure our healthcare system understands more and include family caregivers as part like, you know, we tend to call patient centred care, but here we are very strong about saying patient family centred care.

Brent:

Wow. I think it can be taken for granted. You know, how important that role really is. Let's shift a little bit. The pandemic, obviously it's impacted caregivers. Maybe give a little bit of information on how you feel based on your experience it has impacted caregivers and now that people are going back to work, you know, kids back to school, how is that shift affecting these caregivers?

Lycia:

You know, Brent, caregiving became harder during COVID and after Covid, and why? There are many reasons, but the major reason was because of the lack of support experienced during all those years. Like they had before. And it's true today because the shortage of staff in the healthcare system. So for example, here in BC, during Covid, many caregivers were not able to access what we call home care support. Like, you know, someone coming to their home, providing some support for their parents, doing some personal care. So they were doing more than before. It was very stressful. That's one of the major reasons. The other reason was also because of, again, financial stress, money to pay for services that were free before. So that was one of the major issues. And also because they were not able to have any community or any family.

So they were doing everything really 100% alone, which is so hard. And here I want to share one issue that happens all over Canada. Many caregivers were not able to see their parents or their spouse in long-term care. For a long time, they were the major support of those people, and suddenly their parents lose all that. So they're still dealing with trauma because of that. Because imagine if you're not able to see your parents dying and you're not able to be there during the process. It's terrible, isn't it? So I think we are all trying to recover from traumatic situations of Covid, and caregivers especially. And it's huge, this transition, and because there's fear too, right?

Brent:

Yeah. It doesn't change immediately, right after, of course. I'm sure there's a lot of continuation of these stressors. I mean, it's such a multi-layered stress concern because of Covid, you know, having the resources pre-Covid, having very little resources after, and the isolation and everything that you spoke about.

Lycia:

The isolation was a major issue because care is already a very isolating thing. It's still here. So it's still a process of recovering I say.

Brent:

Exactly. We're going to take a quick break and we'll be right back after this message.

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Brent:

Welcome back to Beyond Age. So maybe you can tell us more, because of your specific role in helping caregivers as a caregiver support manager, what are some stress relieving tips that you could give us that you'd recommend to caregivers and people in the sandwich generation so that they can actually take better care of themselves?

Lycia:

Yes. We provide a lot of information and emotional support. We have a support line to help caregivers, what we call a caregiver plan. So they kind of have like a roadmap, making sure they are taking care of themselves too. Not just the person they're providing care for. The major area of our support is bringing them back to what matters to them. Sometimes they decide to stop work 100%, but later on many times they called and said, oh, I wish I could continue working a little bit, a few hours, because my work was meaningful for me. Caregiving is a meaningful thing of course, but you also have something else in your life besides caregiving.

Brent:

I think that's a really important factor that, you know, you have to make sure you have your own health, living for a purpose, that type of thing. In order to do the best for others.

 Lycia:

Letting them know that it's important to make sure they're connecting with meaningful opportunities for them as individuals, what really is important for their wellbeing, for their health. And we start with them. We actually listen, everything we do is about listening to their current situation and to bring them to more awareness about what really matters for their health. And we are here to provide emotional support and helping caregivers to become aware about their situation. Because many caregivers, they say, I'm well, I'm well, but they're burning out!

Brent:

They may even look like they're doing well from the outside. But you know, at some point there's, you know, damage that could be done if you're not taking care of yourself.

Lycia:

Yes. What's really happening for them. So after they become more aware, then we start exploring. What kind of support, what kind of activities do you think you could start implementing? The other area that I work in a lot is with our support groups. We have a lot of peer support groups, making sure that they are part of a network of support so they don't feel alone, making sure they know they can call us for support. They can come to our support groups to meet other people in the same situation and they don't feel guilt, because there's so much guilt in caregiving. There's so much guilt by not doing enough, you know, by not being there. There's so much guilt by not being a good mother because I'm taking care of my parents. Or guilt about not being a good employee because I'm not doing my work because I'm taking care of someone.

Our support group is a place of no judgment. It's a place of sharing and people help each other about experience and there are a lot of positive outcomes. The other area that we also work a lot is education. To prepare for the uncertainties. A caregiving plan so they know more about resources before the crisis happens. It's important. So that's another area. And we have a lot of educational materials. We have our newsletters, and these are important resources they can use. The other area I work in a lot is making sure caregivers have a voice. You know, their story matters. So we like to share these stories. Every time we go to a public health meeting, anything that they can bring their voice, we bring caregivers to share their stories. And there's a lot of empowerment there because they feel like, yeah, my story matters. They want to change things there. We need to change things for caregivers all the time.

Brent:

I'm sure it's, I mean, extremely helpful to, in any situation, I'm just thinking of some certain situations. But in any situation, and particularly in this as well, if you're able to sit down and share with other people who have had similar experiences, I think that can help relieve some guilt. Bring the awareness and be like, you know what? Wow, I'm not the only one. And think it could be very positive for somebody's health. What should society as a whole be doing to ease the pressure on the sandwich generation and these caregivers? Is there anything that in your experience, you think could be of help? I'm sure there's a lot.

Lycia:

That's a very good point. Yes. In our society, I think we mentioned that caregiving is very invisible. And many caregivers, they see themselves not as caregivers. They see themselves as, I'm a daughter doing what daughters are supposed to do. Right? I'm a wife, or a husband, and I'm doing what a partner is supposed to do; but they're also caregiving. So I think that identification is the first thing. Making sure we are learning to identify ourselves as caregivers. And in our workspace, it would be great if we had more awareness about, oh, this person providing care for parents, they need some time off. You know? They need to take a break. So it's all about being aware about how stressful it probably is and how demanding; it's more than full-time work. So I think awareness is the best first thing in our society. And understand more about the lack of resources that we still have in that area. You know, like I said before, that would be great if we had more policies around financial support. Because then they would be able to provide care and not have to deal with so much extra stress. I think we tend to do so many things alone in our society here. I come from a Latin background and things are different in other cultures, like Asian cultures or Latin American or African cultures, where there's more of a village perspective. We talk about that - like when you have a child, oh, it takes a village!

Brent:

It takes a village. Yeah.

Lycia:

Right? It takes a village. It's a lot. And we need to ask for help. I think many caregivers are so afraid of asking for help and reaching out.

Brent:

Yeah. That would be a big one. And do you think it's just, you know, from a societal standpoint that as caregivers we don't want to seem like we can't handle it? Or just maybe the guilt as well as being part of it?

Lycia:

Completely agree. There's a lot of guilt there. And you know, we have some norms in our society that we need to be independent. It's about dealing more with our limits and recognizing that we can't do everything alone and isolated. We need to reach out for help. And there's a lot of shame in guilt when we are not following these norms, I think.

Brent:

It makes complete sense.

Lycia:

I am very passionate about trying to change this idea. Every time I talk with a caregiver, we have a framework that's called circle of care. We talk about that with them. Make sure you have a circle, like a team, you know, of people with you. It can be two friends, or one friend, that can help you once a week. Or just going for a walk with your father. So you can have a time for yourself.

Brent:

Yeah. No matter how you look at things. We always operate better as a team and being collaborative. And I think that's a very critical point that you made. Have you observed any positive impacts on health and longevity as a result of the sandwich generation, you know, with multiple generations living with and or interacting with each other?

Lycia:

Oh yes. Yes. There's a lot of research there. And again, talking about longevity, we go back to, you know, place like Japan for example. It's a place that there's more like a village kind of idea. Vut in that village, there's more intergenerational opportunities, because the grandparents or older members of that community, they are not 100% alone. They have other leaving the same area or you know, other countries. Like I'm from Brazil. In Brazil, I lived with my great Grandpa for a long time. He was living the same household. There's a lot of benefits for both generations because the kids, they learn about aging. And for the older generation there are a lot of benefits and there's so much research about the cognitive benefits of being with young kids or younger generations because they keep active.

Brent:

Keeps you young.

Lycia:

Yeah, they keep teaching. It's a beautiful thing about having as a mentor, they are older and they still have strong values and that's a very positive aspect of longevity.

Brent:

Yeah. And you know, keeps your brain function high as an older person and you develop, I'm sure very effectively as the younger person learning. What about common misconceptions about family caregiving that need to be debunked in your mind? And is there any common knowledge that's still rooted in fact?

Lycia:

Yes. I think we kind of formalize it, and it makes it harder to change things and to improve things for caregivers. I think it's important to change the idea of that's the role of, for example, they are supposed to do everything for their partner with no one else around. No one else involved. There's so much privacy, it makes harder for caregivers to reach out for help.

Brent:

Right. So making that shift, that mental shift of realizing that look, you know, as we said, it takes a village and you know, you can't necessarily do everything yourself and maintain your quality of health to be able to be as effective as you think you're being.

Lycia:

It's a culture shift.

Brent:

Absolutely. Listen, I know we're getting close to the end, but maybe we can give the audience two key takeaways from today about the sandwich generation and best practices for family caregiving in general.

Lycia:

So I always like to mention that caregiving is also very positive for many people because many times it's the only time they have to have meaningful, long connections with their family members that sometimes they were not there before.

Brent:

That's a good point.

Lycia:

So there are very positive aspects to that. And we hear from many caregivers that for the first time, they hear the favorite music of their parent. So there are beautiful areas about that. So the best practice we have in terms of increasing their wellbeing is increasing connections, making sure they are not alone. Don't do this alone. That's the key message. And that's why we always encourage them to call for more emotional support. When you run together, we can go further. When you are alone, maybe you can go a little bit faster, but when we are together, we can go further.

Brent:

That's important. When we're talking about health and longevity, you want to go further, not necessarily faster. So that's great. So two main key points would be, you know, understanding just how positive caregiving can actually be. And then the other obvious one. But it is super important. I think it's just like you said, the connection, you know, making sure you're not doing it alone and having those connections.

Lycia:

And the awareness. Brent, we always bring caregivers to the awareness about how they're doing, what's going on, you know, because there's a lot of denial because of guilt. The awareness about, how difficult perhaps that situation probably is.

Brent:

Right. Right. So important. Do you have a website or something that people can go to?

Lycia:

We do, yes. It's www.familycaregiversbc.ca

Brent:

Amazing. Thank you so much, Lycia. I really, really appreciate your time with us and I'm sure the audience does as well, wealth of information. So thank you again for sharing your expertise on this important topic.

Lycia:

Thank you. I'm so pleased to be here and I appreciate that opportunity.

Brent:

Well, that's it. And this one's a little bittersweet as it's the final episode in the Beyond Age series, Manulife's exclusive podcast. And for those just tuning in, I encourage you to listen to the entire series available wherever you hear podcasts for a holistic experience on living healthier for longer, from nutrition to sleep, to exercise to self-care and more. And last but not least, don't forget to visit our website manulife.ca/LiveHealthier for more tips, videos, and content from Manulife that can help you live healthier for longer, no matter your age. It's been such a pleasure. I'm your host, Brent Bishop. Take care everyone.

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