Hello and welcome to awake at the wheel. So I want to start this episode by posing a question to our listeners. Just something to reflect on. So what happens when you're raising your own kids, building your career, taking care of your own health in your household, and all of a sudden your parents need care? So according to Statistics Canada, about 6% of Canadians reported that they were in a sandwich caregiving situation in 2022, which means that they were providing care both to children as well as dependent adults, typically aging parents. And this represents roughly 1.8 million Canadians aged 15 and over. Further Statistics Canada also indicates that, nearly 20% of Canadians are now age 65 or older. So this is something that I'm sure many have heard about the aging population. So that is, disproportionately higher than it was in the past. And in terms of some general contributing factors to this, in general, the aging population plus Delayed parenthood. So, the middle age demographic seems to be having kids, at a later stage. Their parents are aging, their kids are, happening later and economic pressures. So often I know that I've worked with a lot of clients lately, dealing with parents, emergencies and health issues. And they also have young kids. So I'm sure you've experienced this lately as well. Yeah. And I've counted numerous times, to patients and to friends that I've like, I don't remember this when I was younger because it wasn't natural to me. But I'm seeing so many people caught in this, as you say, sandwich generation. So yeah, it's I it seems to be an exploding factor. So yeah, and it's interesting, I remember in the early 2000 in sociology, learning that like this was coming and we learned about the concept of it in theory. But yeah, I don't think it was as much of a thing back then. And the thing that I hear the most from clients is that nothing could have prepared them for this. So even if, like they knew it was coming. The reality of it is something that they didn't quite understand. Right. Well, yeah. And I'm not sure what they read. You know, they did previous generations. I mean, one factor is they are living longer. I, you know, science, technology, health. So, you know, increases the lifespan and like and the thing is the cultural differences. So it's really hard when you're working with people, you know, as therapists, we have to be, you know, as, empathetic to people's positions and their cultures. And so, you know, so important for us not to impose our own beliefs and to be sensitive to theirs. But, you know, a lot of people I'm dealing with, they're from cultures where you don't put them in long term care. You do everything possible to make sure they stay in their home as long as possible. And that really, you know, taxes, the, you know, taxes, their health taxes, everybody. But that is a huge factor that, you know, that contributes to the stress of dealing with is dealing with them in their own home when maybe the home is not equipped or the people are not equipped to take care of them there. Yeah. And that's something that came to mind when I was preparing for this episode, was that there are so many cultural factors that I think that, people don't recognize, which compounds this already difficult scenario. Right. And I don't want to I'm going to, I'm just paraphrasing because one of my patients and, I won't say the culture, but people from the cultural recognize it said basically that, the parents obligation to the child is the first 18 years of their life, and then the child is obligated to take care of the other parent for the last 18 years, or the first of the year, 25 years or something like that. And, you know, so I've got a number of people from that background and they said similar things. I said, but that's a contract that you were you had no say in okay, like, right. So you can't be obligated to fulfill a contract that was imposed on you. So I say that if you choose to do that, that's one thing. But to be told you have to do this regard. And here's the important thing, regardless of the circumstances, if you had a and this is the problem with many of my, patients, their parent was a horrible parent. They are horrible person, in the past. And and then even in the present, they're acting the same way. So the poor, you know, the child, the adult child is subjected to misuse, abuse, mistreatment, so mistreatment, mistreatment and so on. Yet they still feel obligated to subject themselves to this abuse every single week or several times a week or every day. So, you know, that's one of the factors that we have to deal with as well. Yeah. And on the topic of culture, I think what you're describing is present in many Asian cultures and the, the whole concept of filial piety, and there's just this obligation where, you know, regardless of the relationship, the previous treatment and so on. This is your obligation. This is your responsibility because these are your parents, I think, as well. One of the challenges with this expectation is that it comes oftentimes from cultures where people lived in multigenerational homes. So there was a different set up, like physical set up to be able to support this expectation later on down the road. But, you know, in Ontario, especially with the way housing has been these days, most people are not living in homes large enough that are able to support that. So it's interesting how this cultural expectation is there. But there's pieces missing, which make it even harder to execute. Well. Exactly. And so there's a few things. And this again, the several different factors that we're going to, I assume, roll out. Like, for example, when you have this, unequal distribution of labor and time and care, we'll talk about that as well. But the one thing, so, you know, I was in therapy, I a lot of what I do is I always help people find their values, right. How they. I'm just, you know, I frame it in some way framing, but it's others framing. I was like, who do you want to be? How do you want to live? What kind of person you ought to be. You know, what what's worth fighting for those types of thoughts. And so when my patients say my values, since I was a child, you know what the value that was instilled in me was this, you know, you know, putting your parents on a pedestal, doing everything for them, you know, treating them almost as deities and so on. So, they say, so you're asking like when I was I'm trying to encourage them to not allow themselves to get, you know, consumed by the process and burnt out. They say you're asking me to go against my values. So, you know, and so the first person who said that to me years ago, and I repeat it every single time I say, look, values can have a hierarchy. And I say, you have to make sure that your number one value is always guess what? I only yourself and your health and taking care of yourself. Exactly. And you know, and then I have to go on the whole spiel about there's a difference between self-interest and self. Sorry and selfish. And just in case, I'm not sure if we've done it before, but just, you know, I always tell people selfish, you don't care about the impact on other people of your actions or intentions. You know, I say, but if you're self-interested and you do care about the impact, then you're trying your best not to harm anybody. Then, you know, focus on self care, focus on self-interest. Sometimes. Is self-preservation right. And and then I always, I always refer to I say, what's the most important rule they teach you in, you know, in the flight attendant is doing the whole spiel. I say, right, the mask comes down like literally every single patient knows. They say, yeah, put your mask on yourself first. So you know. And I say, in every helping profession, that's the first rule is self-care. You can't help others if you're burnt out. So I say all of these things and it's, you know, I say it's not my place to do it. I say, but I'm technically giving them quote unquote permission to care for themselves first so that they can, you know, fulfill the obligation to some degree. Anyway, so that's, that's that's one of the most important things that I try to a reframing that I try to impart on everybody. And it does, you know, it does work for a lot of people. And then one other thing is a lot of the people that I'm working with, again, when from these cultures where you have to, you know, worship your parents, they say, and there's an eye opening for them. They never talked about it before, but they realize, wait a second, my own parent did not act that way with their parents. They were sometimes rude or they left them. They were hostile. Whatever they said, that's hypocritical. Why do I expect to fulfill an obligation that they didn't? So again, and to anyone listening, I'm not saying cut them off completely. I'm just saying you have to be able to set the boundaries, because if you don't set the boundaries, you will suffer and then you're locked with anybody, including your own children. Exactly. And I made note of, you know, the main things that I reflected on with clients that I work with and what they experience and the things that they feel bad about talking about when they're in this situation. I would say the most common is what you just described feeling selfish for needing space or for setting boundaries. So, definitely something that comes up often. Another that comes up is that I think that people often feel a great deal of guilt that results from maybe some resentment that comes along with those past relationships, those past dynamics, or maybe resentment of the situation and how it's taken them away from their own child rearing, their own career, their own priorities and so on. So, guilt is something that I often hear about as well. Oh, for sure. And, and I say to people, look, a famous thing, a famous, reality. More than one thing can be true at once. And, we'll go back to guilt in a second. But I say often time, that, you know, and and hearing patients be able to say it, to internalize it and to be okay with this reality, which is the parents situation as a result of their own bad decisions. Okay. Now, that's not always the case. And aging is, you know, it's not, you know, but financially and so on. And especially when they've been warned, when the, you know, the adult child says you've got to cut down on your spending. We can't live this lifestyle anymore. You're drawing from a pension or some, you know, Rrsps or something. And the parent refuses to do that. I say, look, you have to be able to say to yourself that I'm doing everything I can on my end, but if they're not, I, you know, you know. And I say to them, what is the alternative? I always try to get because what they're saying is, I wish I could do this. I feel bad for not doing that. I say, okay, well, let's play it out too. It's not for conclusions. The old, you know, and in some cases the alternative would be you would have to live with your parent 24 seven okay, and give up your job, give up your family. And I say it blatantly to them, I say, so look at this. Let's not live in a world of fantasy. I wish I could do this. Let's look at what you're really dealing with. And if you, you know, again, the alternative sometimes is infeasible or unfeasible. So you have to make sure that you're dealing you have to accept, not resign yourself to. You have to accept the reality of this current situation and do your best within it. And if that reality is created by your parents, they unfortunately have to suffer the consequences. And everyone understands it intellectually. But emotionally is obviously a different story. And I guess I'll add to that to another layer of one's spouse then having to, you know, kind of be brought into this obligation to, execute whatever help is required. And, as you were saying, what you were saying, that popped into my mind. And I think it might have been subconsciously that I wore this necklace today. This was my grandmother's necklace. And I remember from a very young age, I know I shouldn't have memories from as far back as 2 or 3, but I do. And my grandmother lived with us, and, because she was elderly and needed care and I have some very vague memories of my mom taking amazing care of my grandmother. That was my father's mother. Again, part of it was cultural obligation, but I think that that was an ideal situation. But I don't think that that's the reality in most cases, because there probably is some degree of resentment or challenging dynamic or so on that people have to work through overcome pretty quickly. If an emergency situation comes up new all of a sudden, or a caregiver. Right. And you know, the, the in-law, dynamic. Right? You know, sometimes, hey, you know, I know with my wife and my mother, they have a great relationship. So I'm really happy for that. But, it wouldn't be fair. I would never put that burden on my wife. If she chose to do certain things, I'd be very appreciative. Right. But, you know, to expect that it would be fair. And there whether it's cultural, whether it's a family, whether it's a personal issue, that people have to recognize that because a lot of times, all the person saying they're, they're the biological child sees how much they're struggling, which I understand. And then they're expecting, you know, others to to help out, which, you know, it's a, it's a, it's a nice expectation. But you can't, you know, you can't, expect it. You can hope for it, but you can't expect it. So anyway, especially when your siblings are not chipping in or the siblings spouses are not chipping in, and then you're expecting your own spouse to rise above. Of course, it's going to fuel resentment because there's an injustice in that. And I you know, maybe we can shift to that about the, you know, the inequitable idea of, of help and care. So what what are your thoughts on that? Yeah, I think that that, again, is something that I hear over and over again is what you just described, where there is an imbalance with one sibling taking on more than the other. It seems to consistently be the case. And what's really, really interesting too, is that I find in discussing these things with clients, it really highlights the old family dynamic that existed, like in the family of origin when they were kids. So that's really fascinating to me. But it makes sense, right? And look, I always tell people and even in the best of times, whenever you get, especially siblings together, doesn't matter how old they are, those old dynamics will always come up. But when it's something like this and the old who's, you know, who's mom's or dad's favorite, and if you weren't the favorite, if you were the scapegoat or the black sheep or whatever, and you're being expected to pull your weight and so on, it can be very hard. And, you know, again, because the other people are suffering so much, they're not likely to be empathetic and to say, yeah, I know. And they may have a very different perspective. They might say, no, you were the favored one, you know, not me and so on. So it, you know, I see so much resentment and once again, as therapists for us to let them know it's okay to feel this way. And, and I always say anybody in your situation would feel that way. And because a lot of people don't want to because then it makes them feel like. And I'm going to I think I've said this before, but I will say it okay. Every time I have some of the most generous patients you can imagine, like, you know, almost as patients, most generous people. Right? And so they all say the same thing. And this is the line that I've, you know, I came up with naturally a long time ago, which is, you know, they say I didn't do it for appreciation or for gratitude, but when I'm doing this the right thing. So I always say to them, I say, I know, I always say, I know you didn't do it for appreciation, but the absence of appreciation sure is noticeable. Okay. And that resonates with everybody. And it allows them to say yeah it really sucks when you're giving, giving, giving and you're not getting the appreciation or sufficient appreciation either from the parents or from the other siblings, who for whatever reason, either they think it's your duty to do it or they're just happy that somebody is doing it right. They don't. Right? So I just do one thing like, because I always now do an analogy, and I ask patients, I say, imagine that. That's a big family dinner. Okay. And your parents, they did everything a huge dinner. Okay. And let's say you have 2 or 3 siblings, and after dinner, your parents are cleaning up. You go, no, no, sit down. We'll do that. You made this big family dinner, right? So you're cleaning up, and they say. And your siblings, take off. They go to the TV room, or they go for smoke or whatever, but they're not chipping in. I asked them, what would you do? And almost all my patients, because they're the generous ones. They said, of course I'd still clean up. Yeah, right. I'd be resentful. And some of them say, you know, they really speak, so I'm good to go. That is the dynamic. It's such a simple behavior, like cleaning up dinner. So it is far less important than, of course, taking care of elderly parents. But it's the same dynamic. The spirit of it is the same exact. And it helps them like really see it from that perspective. I say and say, yes, you're the person who would clean up, right? I said, I'm the same one. And I say, look, I try to speak to my siblings and try to bring them in and you know, and if they don't do it, you know, I can say, well, fine, I'm not gonna do it either. But that wouldn't be fair to my parents. So I choose to do it. And I also say, you know, I could again, I could always just piss off like my siblings and blah, blah, blah. As if I know I'm choosing to do this. I want to do it and help people reframe it, because that's the person I want to be, the kind of person. Not because I have to do it, because I want to do it to, you know, as a sign of appreciation for what my parents did, things like that. So I try to get them to reframe it that way. It does help a fair bit. But again, at the root of all of this is allowing them to fully, feel, address and process the resentment without guilt. Yeah. And that was what I wanted to go back to next is guilt, because that is something that seems to overreach a lot of what people are experiencing in this situation, whether it's guilt of not being able to, you know, fully commit to the caregiving or, guilt about how they feel about past stuff coming up. So, a way that I often will help clients frame guilt. And this doesn't always fit, but it often does is guilt usually implies that you're doing something wrong. So in this situation, what are you doing wrong? And most of the time you're like, well, nothing I'm actually doing a lot right? So that's a good way to take a step back and recognize, like there's nothing to feel guilty about. These are, you know, not great feelings, but guilt doesn't really fit right. And it's it's that's so important. I always tell people, I say that guilt, I say it's, you know, it's nature or whatever's way of, you know, making us not be total assholes, so I right, I say, so, I say guilt is good because it prevents us from, you know, being bad people. I said, however, I say that's healthy guilt. I say then anything above that and I say there's two types. I say either is completely irrational, you've done nothing wrong, yet you're feeling bad or it's disproportionate. You did something that's a little bit wrong, you know, intentionally or unintentionally, and yet you're feeling really terrible. So I go, that's what I call neurotic guilt. Anything about what you should be feeling, quote unquote. And so I say to people, recognize again, as you say, like, what am I really feeling? Why should I feel bad if I haven't, I think wrong, and then, you know, understand it on an intellectual level, at least just begin and say and be. I see the rule of guilt is I say, you can feel it, but it has to be disproportionate. Okay? And I say guilt should never with there are a few extend in a few special circumstances, but guilt should almost never make you do something that's not in your best interest. And I say that and I say, yeah, so even if you feel bad or whatever, and the example I give is like, you know, if you go on a date with someone and you feel bad, like, you know, it really didn't work out well, they weren't bad or anything, but there's no connection. Right? And you feel bad for them. You know, you know, you feel guilty because you turn them down and everything like that. I say, well, I feel a little bit bad because you disappointed them. You know, you didn't do nothing wrong. But it's okay to feel a little bit spicy, but if you go out with them every single weekend, now, you know, and a you're spending money, beer, spending time doing so you don't really want to do and see this is preventing you or impeding your ability to find something that would really match with you. I think that's not in your best interest. So again, it's a simple, harmless example that I use, and then I try to apply it, you know, to their own situation and so that they can see that. Wow. Yeah. Like wait a second. I really am not doing a service to myself by acting on neurotic guilt. Yeah, yeah. And I think that all of those feelings that come along with it can be so draining. In addition to, you know, the physical act of caring for somebody. So exhaustion is something that I hear about often as well, where there just doesn't seem to be enough energy to do all the things in one's life that need to be done. And not to jump too far ahead to our usual, you know, what can people do? But I think really being aware of self-care and the role that that plays and exhaustion and energy levels is incredibly important, because if you burn out, you can't take care of anybody. Exactly. And look, I have a number of patients doing this right now and I call them, I say, look, you're a saint, okay? And I say, and I don't blow smoke up people. That's like I'm being, you know, like I say, you're doing something I know I couldn't do, which is when you have, like a lot of them have, you know, let's say, moved in with their parent or had their parent move in with them, their elderly parent, and they're giving 24 over seven care, essentially. Yeah. They come in a few hours a day. But the fact is, and, you know, I don't need to get too graphic. But I say, first of all, I say bless the who's who do a good job. The ones who are doing, you know, let's say, crappy jobs that nobody else would want to do, literally copy when you're wiping an adult, you know, like, you know, like seniors diverse. And I say that, I say to you, you know, your own parent. And I say, I say like, that's really loving. I don't think I would be able to do that with my parent. Right. Like, I'm sorry, that's just it's I can't wrap my head around that. I see you do that. I see that make that puts you on such a in my eyes. I say like I put you on a pedestal for for doing that. So, you know, and again, I know you're not doing it for the recognition, but I say, but it's just, I say, you deserve to know how great of a job you're doing and that your parent is damn lucky to have something. And you know, again, because apparently not always express it. Okay. Or they might express it one day, but then the next moment they're acting, you know, in a way that's not, you know, not the nicest. Whether they have dementia or Alzheimer's or the just nasty. Right. Like so it's such an unrewarding position that the people are putting themselves in. But like I said, I mean, it deserves all the recognition and all the, you know, the admiration. It is noble position. Yeah. And I think what comes to mind, actually, as you're saying, that is perhaps individuals who find themselves in a situation like this should be cognizant of what their love language is and what their parents is, because sometimes, you know, one feels that words of affirmation would make it feel worth it. But if that's not a way that their parent, delivers love, it's if it didn't happen before, it's probably not going to happen now. Right? Yeah, that is very important okay. And again, they don't like to talk about it because I don't do it for that. But again the absence of it really is telling and noticeable. So yeah yeah yeah. So as far as what people can do about this I mean I think we've, we've given some ideas in terms of emotionally speaking, what can be done. And then of course, I would always recommend speaking to a therapist and being able to just work out some of the emotions, because sometimes they're oftentimes in these situations there isn't a solution. But understanding and recognizing what you're feeling while you're feeling it is incredibly important. But I think from a practical standpoint as well, my understanding is that at least here in Ontario, there are a lot of like grants and supports and programs that aren't really well advertised. But I would assume that in other parts of the country as well, there's probably a lot of assistance that can be accessed. So really like doing some research and finding out what's out there can help to relieve some of that pressure. Well, yeah, I mean, and I can help in that regards better than Google. And finding out what sources are what resources are available. But let's not give false hope. Whatever resources are available, it's never enough. People really are struggling. It's having those really difficult conversations. If you have siblings with the siblings, okay. And recognize that when you are talking to your siblings about these issues, as we alluded to earlier, you're going back to childhood dynamics. You're not to adults talk in your 50s or 40s or whatever. Now it's like the teenager or the children dynamic, you know, as like, that's just the reality. And you have to recognize that because that's going to inhibit you if you're the younger sibling and you always had difficulty talking to the, you know, your older sibling for something like this, right? It's going to make it, you know, even harder, amplifies it. Yeah. Yeah. So just recognizing all of that recognize, you know, the right finding people within either the family or family friends or in-laws or somebody who if you're getting some if there is someone who's being difficult, do you know who can maybe try to communicate with them and so that you, you know, again, you're marshaling as many resources as you can because it can be very daunting. And then of course, financial factors. A lot of my patients, they are well-off. And so their parents are, you know, luckily they can get some of the best levels of care. But there are many people who don't have that options. And it's like finding out what the you know, what your options are and, and doing it soon because our long term care, programs in Ontario are not very good. They really are not. So. And we can try, you know, we're not going to go into the details, but let's just say it's a messed up system like it really the way it's set up, it is really messed up. It's you have to get lucky to get to a good place, but start doing that research as soon as you can. So we have a list of 3 to 5 places where, you know, that you're going to your parents going to get the best care. If it comes down to that and being honest with yourself. And yeah, nobody wants to put their, you know, parent. So it's something nobody many people don't want to put their parent in a long term care facility. But again what is the alternative. And it really sometimes comes down. I say, are you going to give up your career and your family to become a 24, seven hour caregiver? It just isn't possible. So your parent may not be happy, but at least they're going to be safe and you hope they'll be taken care of again. If you do your research and find a, you know, a better facility that you know then than you might otherwise find. So yeah, and I guess to that point, I will agree, the system is completely messed up. But, on the bright side, I think so many people who go into that line of work do genuinely care. So yeah, if you can find the right place that is adequately staffed, your loved one could be really well taken care of. And, you know, while there is a lot of emotion that goes into that decision, got to consider other things that you're responsible for in your life as well. And if you feel guilty for, you know, putting them, let's say, in long term care or some type of I mean, there's different degrees. Long term care is kind of the the side from hospice care, I guess kind of the end of the line. And people say and start sadly the right you know, the statistics are there. Once a person goes in their lifespan, you know, starts whatever trajectory they're on before it's all starts to fall, okay, for most people, but there's different levels of care and different costs involved and everything. But what I was going to say was, whatever, if you're not able to take care of them yourself and you put them in some type of facility, you feel bad about it, then do everything you can to visit them more often than you know you might otherwise visit. Like that's a way to help assuage the guilt. And if they're miserable every time and they're upset and they're resentful and, you know, and they try to guilt and everything like that, take it. Okay, that's that's a small price to pay, you know, for making a decision that might be the most practical and feasible. Okay. Because the alternative, again, would be, you know, I'd rather, feel guilt then take care of someone 24 seven and throw all my entire life away to do that. So we've been talking a lot about, you know, when there's challenging, dynamic and challenging past relationship with parents. But what we're not really focusing on, which I think warrants some more discussion, is what about when there's a really positive relationship and this happens, or when one views their parent in a really strong light and watching them deteriorate in this capacity can be so, so difficult sometimes. And yeah, and that's what a lot of my patients are dealing with. So either it's like, you know, dad was this young, big, strong man. And just to watch him physically deteriorate and not be that image that they had, is so difficult or intellectually, whether mom or dad that they were so sharp and everything. Then just to see that decline, it does a number on on the person and you know, and some people handle it better than others. And so having the if you're if you're not that person who's suffering in this way, having the empathy and the compassion and just, you know, hearing them out, letting them basically process the grief because they are losing the person that they remember, they haven't lost them physically, but who they were, their identity, who, you know, again, we're talking a healthy relationships here. It's it's devastating because they you know, they never they may never have really passed the stage of, you know, they're not Superman or superwoman like they were always like that in their eyes. And now in a, in the most dramatic ways, they're having this total shift in identity and how they perceive them. And it you know, it almost robs them of the sense of security, like even though they're an adult and they can be a professional, they can be very, you know, successful and everything still is that, you know, that kind of an unconscious belief that, you know, if mom or dad is, you know, is there or they say it's okay or, you know, they're doing fine, the whole world is fine. So, yeah. Yeah. Yeah. And this, this role reversal, I think can be really confusing to people. And, to your point, grief. I think oftentimes people associate grief with the ultimate loss. But no, grief is happening throughout this entire process because you are grieving the loss of what your parent was. And I suppose the eventuality that's to come. Right. And it's the loss of who they were. It's also the loss of this dynamic because people becoming the caregiver, they actually embrace it like they want to now give back. I mean, this is at the beginning before it takes its toll on them, right? But for other times it is like, again, like, yeah, I don't want to be that caregiver. Not because they're selfish, but rather because this, you know, this illusion of if my parents are good, the world is good. So having to flip that around it, you're losing that role in that dynamic and and the security that comes along with it. That's just. Yeah. And that that is the reality. So to our listeners, let us know if you've experienced something like this. What are some of the things that maybe people don't know? Are the realities of these situations? Let us know in the comments. And I'd say just one other thing. And we were talking about the people themselves, but the people around them, you know, spouse, family, you know, even adult kids, like, you know, the adult kids, adult kids. Yeah. I would hope that, you know, it's so easy for us to kind of, like, avoid these ugly realities because then we don't have to worry about it. And more importantly, we have to do anything about it. Right. But I'm hoping that people would say that, you know, one day I, you know, I don't want to be in the, position where my kids don't want to do things for me and so on. So, you know, or my parents are bitter with me and everything like that. So if you're in a position to help, I hope that people will hear this. They will see the suffering around them and they will try to step up, you know, a little bit just to, you know, to ease the burden of the people who are the most hands on. Absolutely. So on that note, until next time, keep your eyes on the road and your hands upon the wheel.