The Sandwich Generation: Caring for Kids, Aging Parents, and Yourself

In this episode of The Hope Table, host Erin Brinker talks with psychiatrist Dr. Ashley Zucker of Kaiser Permanente Southern California about the emotional realities of the sandwich generation—adults caring for both their children and aging parents. They explore the shifting parent–child roles when an elder moves in, common emotions like anxiety, guilt, resentment, and grief, and how cultural expectations can intensify pressure on caregivers.

Dr. Zucker shares how these changes affect teens in the home, strain marriages, and trigger old family trauma, as well as what warning signs to watch for in both adults and adolescents. Together, they discuss setting boundaries with parents and kids, recognizing when home care is no longer safe, and why support groups and therapy can be lifesaving. The episode closes with practical, realistic strategies for self-care, modeling healthy coping for children, and giving yourself grace when you can’t “do it all.

Transcript

0:09

welcome to the Hope Table. I'm Erin Brinker. Well, I am very pleased to welcome back to the show a regular guest and friend of the show, Dr. Ashley Zucker. She is Kaiser Permanente, Southern California's child, adolescent, and adult psychiatrist. She's assistant area medical director for mental health and SCPMG, Southern California Permanent Permanente Medical Group Wellness, San Bernardino County, and the regional lead for child and adolescent psychiatry. Dr. Zucker, welcome back to the show.

Dr. Ashley Zucker: 0:40

Thank you so much for having me back.

Erin Brinker: 0:43

So we have talked about all kinds of mental health issues, and specifically today we are going to talk about the sandwich generation, that is the, that is, the parents who have teenagers or young adults who are caring for their, their kids, but also caring for their aging parents, and that is a really tough place. People feel squeezed, you know. How prevalent is that here? May is Mental Health Awareness Month, and you know, talk to me about that age group.

Dr. Ashley Zucker: 1:14

Yeah, I mean, the sandwich generation is definitely a struggling age group, I would say, for sure. I mean, it's really kind of getting a lot of just workload and stress, kind of from all different directions, right? So, obviously, you've got what you have to deal with in your day-to-day at work, but then it's everything that you're trying to manage at home, and so certainly, if you're trying to manage, you know, your own children and your own family, plus also trying to manage, you know, your parents or other caregivers, or being a caregiver for, you know, folks older than yourself. Then that's just a lot on any one person. So I just think of all of the stresses that aid that age group really, or that age band, really has to deal with, and you know, I got to give them a lot of credit and a lot of grace. I'll say that,

Erin Brinker: 2:03

you know, it's interesting, because, and I, and I, my mom passed away about 10 years ago, and as, as, and my children were in their 20s, early 20s, and, and late teens, and I have to tell you, it was, it was, it was very strange. I was used to parenting my kids, but parenting my mother, as she was, her health was declining, and I hate to call it that, but it's what it felt like was really a strange dynamic.

Dr. Ashley Zucker: 2:30

Yeah, absolutely. Yes, it feels very bizarre to have the table shifted in that way, right? To be parenting or caring for the person who parented and cared for you for so long,

Erin Brinker: 2:39

and they don't necessarily appreciate that they're being parented.

Dr. Ashley Zucker: 2:42

Definitely not.

Erin Brinker: 2:45

So, from a mental health perspective, how.. how is this.. you know, how is this uniquely challenging?

Dr. Ashley Zucker: 2:51

Yeah, I mean, I think you.. you called out just one big piece of it, is that it's just a total shift in the.. in the relationship dynamic. You know, the parent is used to being the parent and to suddenly essentially become the child, I think it's just so, so challenging. I mean, if you think about, you know, how how your mom probably felt too, like that's very difficult for her to all of a sudden feel like she sort of lost her autonomy, right? And so she's navigating that change in her own life, where she's no longer able to care for herself, and obviously you know older generations have different abilities depending on their cognitive abilities to understand kind of what's happening in that space, but certainly it's this just the impact it can have, you know, on the caregiver in terms of this is the person I looked to for care and for support and now I'm the one caring for them, that's a big, you know, just mental shift, so that can certainly have a big impact,

Erin Brinker: 3:47

you know, and for some, for her, she, uh, she had a disease that took her pretty quickly, she, you know, last two months of her life were in a hospital, and then she was on hospice for four days, and then she was gone, for other people, I've, you know, friends of mine have had their maybe it's dementia, maybe it's cancer that keeps being going into remission, and then coming back, and it's this long waltz with the inevitable that is, it is really difficult, and it's exhausting. You know, how do you care for yourself while you're caring for your kids, because they still have needs and caring for your parents as they are winding down their life, you know. How do you deal with that?

Dr. Ashley Zucker: 4:27

Yeah, I mean, I think it's, it's definitely challenging, and I don't think it's appropriate to say anything, but to recognize that, you know, if we were to say,"Oh, it's easy if you just do x, we would be lying. So, right, I don't agree with that. So, I think one piece is just acknowledging that that's a difficult place for any human being to be in. I think there's something powerful about just acknowledging the situation, doesn't mean you have to love it, but just, you know, being aware that this is very, very challenging, and I think that all. Also leads to just being willing to reach out for help and to look for support for yourself, and you know, in any way that that is available to you, and so I think of just in terms of how you take care of yourself is one, recognizing the challenge, and two, being willing to share in the challenge, right, a lot of people are sort of embarrassed by the fact that they might not be able to manage it or to handle it, and so they're afraid to ask for help or afraid to admit that it's just too much for them.

Erin Brinker: 5:31

You know, I have to think some of that is cultural too. You know, that that's in some cultures that's the kind of thing that you keep in a family, and why can't you manage it? I did it with my mom, or whatever, and so there's there's outside expectations that really define how they think you are supposed to be feeling or reacting, or what you're supposed to be doing, and sometimes those, those expectations make things infinitely worse.

Dr. Ashley Zucker: 5:54

Absolutely, absolutely, yeah, there's a lot more pressures, right, that come from those expectations,

Erin Brinker: 6:01

so what are the most common emotions you hear from people caring for kids and aging parents at the same time, and they don't necessarily have to be sick parents, they could be just maybe that mom moved back in with you because she needs a little extra care because she fell, or she, you know, maybe is starting to have some cognitive decline. So, what are some of the most common emotions you hear from people?

Dr. Ashley Zucker: 6:23

Yeah, I mean, I think probably anxiety would be the most common emotion itself, but I think just all of the reactions that we can have to those situations, you know, there's just the stress of it all. Stress isn't necessarily an emotion, but I think it's an experience that people certainly have in those situations. I think it's the anxiety of trying to be able to manage it all and keep up with everything, and you're worrying about, am I, you know, am I doing it right for any one person, right? Am I doing the right thing for my kid? Am I doing the right thing for my parents? Am I doing the right thing at work? And how will I get it all done? And so I think that really just piles up into that, that anxiety, but certainly it can also lead to other, you know, difficult emotions. It can lead to sadness, and it can certainly lead to anger. There's a lot of guilt that can be associated, you know, with that kind of position that you're in, partly guilt that you feel like you're not able to accomplish everything, or maybe that you're failing other people, but sometimes you know to your point about especially people who may have a prolonged illness or things like that, there can be a lot of guilt about feeling frustrated or angry about the situation, and then you feel bad that you feel frustrated with the situation, so then you feel guilty, and you start to kind of tear yourself apart. So, I mean, then the range of emotions is really the whole gamut. I can't say there's just these emotions, but those are the biggest ones that I think of.

Erin Brinker: 7:53

So, I'm curious about how adolescents in a home react to grandma or grandpa. It's usually grandma, but moving into the house to be cared for, and what that means for them and their schedule, and you know, what are you seeing in your practice?

Dr. Ashley Zucker: 8:10

Well, I think it's variable, you know, every family is a little bit different. There are some adolescents who might actually enjoy it, because maybe it takes a little bit of the attention and the pressure off of, yes, they can, you know, do their adolescent separation and be more with their peers than with their, their family, so there may be some that actually like it, and then I think there can also be, you know, some teenagers that maybe are resentful of it, they feel like their whole world has been kind of upended. This isn't the life that they're used to, or you know, maybe having grandma or grandpa on the home means that they also have to take on some of those caregiving responsibilities, and they may not like that either. So, I think it again, it can be different for different people, but you know, a lot of teenagers are going to be very self-focused, which is developmentally appropriate, and it's annoying, but it's okay. Yes, but yeah, adding another person to the mix can be very frustrating for them, because that's not what they're about at that moment in their lifetime.

Erin Brinker: 9:19

Do you recommend when families are facing these kinds of questions. I mean, it's a big deal if mom has been, or dad, if your parents have been independent, and all of a sudden they find themselves having to move back, move in with you, and you're moving things around, and maybe a bedroom shifts, or maybe you know, I imagine that kind of disruption is really, it can really make an impact on a family. Do you see a lot of families coming into counseling for that, or should they?

Dr. Ashley Zucker: 9:47

They probably should, but I think it's.. it really depends on again the situation. So, it's so, so, so, so hard to generalize. But what I would say is, first and foremost, I think it's about communication. Yeah, and so if the communications not happening, and then there becomes really this sort of, you know, distress level in the family where people are constantly arguing, or you know, not getting along, and then it's starting to really impact, you know, other people's emotions or other people's well-being, or just how they're able to function in their day to day, so maybe that's school for the kids or work for the adults, those are the things I start to think about, where you might really need to seek out some more professional therapy type of help when it's really reaching us, you know, a level where it feels like I just can't manage what's happening, you know, in the dynamics of the family at this point,

Erin Brinker: 10:40

you know, it's interesting when I get overloaded, and I can't imagine I'm the only one, but when I get overloaded, I tend to get tunnel vision, so I'm really just focused on that next deadline, I'm focused on that next thing I have to do, and I don't recognize that I'm tired, I don't recognize that I'm hungry, I don't recognize that I'm snapping at everybody, I don't recognize that I'm not sleeping, you know, and that is it. Is when I get on the backside of it, it's like, oh, I go to people, oh, I'm so sorry, but you know what is what is that kind of emotional overload due to a family dynamic, and how do they work through

Dr. Ashley Zucker: 11:18

it? I mean, you described that, what happens, right? So people get snappy, they get irritable, they're less pleasant with each other, you know. Home becomes a less pleasant place to be for all of those that are there, and so it can really impact family dynamics, where home, which maybe once was the sort of relaxing safe space, can now become the very difficult and stressful space, and so I think that, that can, you know, certainly be be a challenge, you know, I think again it's really important to have that like open dialog, open communication from from the beginning, right? so if you have, you know, let's say a parent moving into the house, you know, having that dialog with the family members, you know, what might this look like? What are some things they're worried about, but I also think, you know, to just to step back from it, it takes, you know, each of us kind of recognizing some of those signs that you described over what things look like when you're getting overloaded, and being able to also, you know, even say to maybe your spouse or your partner or your kids, like, hey, if you start to notice these things, can you just like remind me that maybe I need to like eat something?

Erin Brinker: 12:30

Yes, yes, maybe you have a safe word, right? Somebody yells sloth in the middle of dinner, you know that's a safe word, right? There you go, so you know, let's dig into trauma a little bit, because you know, with a parent moving in, maybe there's trauma, if history of trauma in the family, maybe there are things that you know that, because you haven't been living in the same space, are buried deep within you, things that start bubbling up, memories, or just emotions if you don't have the actual memory of what happened, and so that adds a level of complexity to your ability to give love and care for your aging parent. What advice do you have for people who are in that boat?

Dr. Ashley Zucker: 13:15

Yeah, I mean that's certainly a very tricky situation to be in, and I think if you know there are things that are really being triggered or coming up for you, especially if they're trauma related. Those are probably things that are going to make sense to, you know, maybe talk with a therapist about. That might not be stuff that's just about, you know, having an open dialog at the dining room table. It may be a little bit more, you know, detailed or personal or nuanced, and so you know, reaching out to somebody outside of the family may actually be the better option in that type of situation.

Erin Brinker: 13:51

So, how would you, how would you recognize, because I'm thinking, you know, as you're, as you're reacting strongly to something that happens, and you get to the point where you're like, why is this bothering me so much? What is, what is this? Where is this coming from? You know, and if you're self-aware, you ask yourself those questions. Dang, I'm being rude. Why? You know, how you know what are.. what are some other early warning signs. What can.. how do you prepare for that?

Dr. Ashley Zucker: 14:23

Yeah, I mean, I think it's.. you're right, some of it takes some self-awareness, which some people are better at, that better at than others, certainly. But I think it's really knowing sort of what's your kind of baseline, so to speak. So, if you're noticing things like, you know, obviously changes in your mood, but changes in your sleep, or changes in your eating, or just changes in your energy level, you know, those can be some kind of subtle warning signs, that irritability piece, that snappy piece, that's a big warning sign, but often we don't really see it in ourselves when it's happening, it's usually. To the people around us that notice it before, before we do, right,

Erin Brinker: 15:04

right,

Dr. Ashley Zucker: 15:06

so I think it's really about just knowing, like, I just don't feel like myself, and I know that's a very vague way to put it, but there's just something to being able to differentiate between, you know, what's a normal just stressor, what's a normal, just difficult day, right. We're not going to all feel perfect and happy all the time, but if it's really, you know, perpetuating for multiple days, even weeks in a row, that's really a bigger warning sign that, you know, something else is going on, besides just like a bad day.

Erin Brinker: 15:38

It could be depression that you're not aware, it just all of a sudden, you look at yourself and say, you know, it's been a couple days since I took a shower, and you know, I hurt all over my body, and I don't know why.

Dr. Ashley Zucker: 15:48

Yeah,

Erin Brinker: 15:49

you know,

Dr. Ashley Zucker: 15:49

yep, yep, exactly.

Erin Brinker: 15:52

So, I want to talk about in something that is in the news right now a lot, and that is parental estrangement, you know where a, it's usually a child, a young adult child will decide for whatever reason that they're going to go, no, no contact with their, with their parent or a sibling, but in this example, we'll talk about parents, and then maybe that parent comes back, maybe you guys reconcile, and that's when the parent moves back in with you, but you know, talk to me about parental estrangement, and what you are, what you are seeing, and what, what you think causes that, and I'm, I'm particularly interested in, you know, are people too quick to pull that no contact trigger?

Dr. Ashley Zucker: 16:38

Yeah, I mean, I think it's such a challenging space, I think. Part of why we're probably seeing it a little bit more is a good thing, and part of it is not. Not that I'm a proponent of estrangement, that's certainly not what I'm getting at, but I think there is a recognition of being able to recognize when we need to set boundaries and protect ourselves, and so I think that that part can be good in sort of recognizing, like, this is not serving me, this is not something that's, you know, helping me to be successful in my life, and so I need to step back from it, or I need to build boundaries around it. I think where it gets, you know, really into that sort of yuckiness or bad places that a lot of people don't know how to build those boundaries and maintain the relationship, so sometimes it becomes easier to just cut the relationship off, and of course, that, that's, I don't think anyone actually wants that, maybe in some rare situations where, like you mentioned, some, you know, significant trauma or things like that are involved, and then that's kind of a different story, but sometimes people just want to avoid the conflict or trying to navigate the space, and so the just total cut off can be a bit easier in a sense, and I think that's part of why we're seeing a little bit more of that. I think also just culturally, you know, families used to like always live in the same area, at least if they didn't even live in the same household, right? There's a lot of multi-generational families that, you know, were much more prevalent than maybe they are today, and so being able to cut off from people in some ways is easier than maybe historically it had been..

Erin Brinker: 18:24

I, I wonder, you know, this aversion to discomfort is, is, I think, a problem in lots of areas, you know, you see it in the workplace, where young people, especially, because they have been protected, that the that there, there's a real aversion to discomfort, and I think you know that concerns me, and I think that breaking through that discomfort with somebody, working through that with somebody, now everybody's different, so if somebody is abusive, that's a different story, so we're talking about people, general people who are not abusive, that that real intimacy comes from working through some of that together, and so I think young people are are cheating themselves out of that.

Dr. Ashley Zucker: 19:11

Yeah, yeah, I think so. And I think to your point, it's the like the discomfort, the avoidance of the conflict, the I wasn't ever really maybe taught how to navigate spaces like this, you know, if people have not had to have those sort of difficult just relationships in their life, or you know, I shouldn't say difficult relationships, but difficult experiences within relationships, I guess I would would say, or you know, if they're not as used to even just the socialization, right? We talk a lot about, you know, what COVID did to folks, but certainly, you know, if people are having more and more of their relationships in a digital space, you know, then navigating real-life space can sometimes be more challenging if you haven't had those experiences before, with having to, you know, work through conflict with another person.

Erin Brinker: 20:00

And it is an overall lack of feeling safe to get your own needs met, that I think, and I'm not a psychiatrist, and I don't play one on TV, but you know, it seems to me that that people are afraid to have those meaningful conversations, and not that you need to talk about every little discomfort that you ever have. Nobody wants that, but if you, you know, if there's something really bothering you, you know, you can't, you'll, you won't be able to have a good marriage or other kind of relationship if you can't talk through things and get to the other side. And the same thing with parental relationships, or sibling relationships, or workplace relationships,

Dr. Ashley Zucker: 20:42

yeah, absolutely. If you're, you know, just sort of constantly avoiding that discomfort, then you never learn how to navigate, how to navigate that space, right? So, you know, I think we, you know, can think about how we sort of have, like, the helicopter generation of parenting in the, you know, very like protective sort of parenting, where you're trying to keep your kid from difficult or uncomfortable situations, which in theory sounds wonderful, right, to be able to protect your, you know, your children from that, but then when they never learn how to navigate it, then we can sometimes end up in these spaces that are, you know, extremely challenging.

Erin Brinker: 21:23

Yes, yeah, you know, I, I think we may have talked about, you know, kind of how Gen X grew up versus how later generations, and now we're, you know, the teenagers are, are what is that, Gen, Gen Y, so that our Gen Z, rather, you know, that we were kind of feral, and the Gen X were, and you know, we had to work through the difficult conversations, we had to get ourselves into trouble, we had to work through, because we were five miles from house on our bikes, and we didn't have phones or anything back then, and so if we got it ourselves into trouble, we had to get ourselves out if there was was conflict with our friend group, friend, friends, you know, our friends, friend group, then we had to work that out too, and you know, for some they ended up fighting physically, some of them they would, you know, scream and yell at each other, some of them they would just work through it, but we, we got to figure out how to do that while we were young, and it's uncomfortable, and sometimes noses were bloodied, but you know, we didn't. We have robbed our children of that experience.

Dr. Ashley Zucker: 22:31

Yeah, if you didn't learn how to navigate the playground, right? Yeah, that certainly makes the rest of life very challenging,

Erin Brinker: 22:37

indeed. Indeed, so you know, we're you know, switching back to, to this kind of sandwich generation. It strikes me that it's an, you know, when you're caring for your ailing parents, it's a great opportunity to teach your kids about empathy. You know, talk about the adolescent experience through that,

Dr. Ashley Zucker: 22:57

through, through managing your parents, your

Erin Brinker: 23:00

yes, through the sandwich generation experience.

Dr. Ashley Zucker: 23:03

Yeah, I mean, I think it's, it's just challenging for everybody. I don't know a better way to say it, but I think you know you can, or you are at all points in your life really a role model for your children, right? And so when you are kind of working through that. I think it's also in some ways amazing opportunity to show your kids how to navigate maybe a difficult relationship or just maybe a difficult situation, and also to show them that it doesn't have to be perfect, right? Like maybe you fight with your parent who you're caring for, but at the end of the day, you still love each other and care for each other, and you know, do the things that you need to do for your parent, and they can kind of see that that conflict doesn't necessarily mean that you know a relationship is non-existent, or there there isn't, you know, something deeper and more meaningful behind just, you know, a little tiff, or a little, you know, argument about something minor, so I think there's that kind of space in there to really think through, like, how can you know I sort of show and live what I want my own kids to be able to deal with, and I think it's also okay to show them sometimes you don't handle it great, right, like none of us are perfect, so sometimes we mess up, but then what do you do after the fact? I think that's really where the, you know, the kind of educational moment comes into play, to be able to show your kids, like, the expectation is not that every one of us is perfect, it's, you know, what we do after the fact that really matters.

Erin Brinker: 24:39

Do you have any now? I understand about HIPAA and being careful of identity. Do you have any stories about the sandwich parents and their families, kind of how they managed and how they overcame, and and lived through that with grace?

Dr. Ashley Zucker: 24:55

Yeah, I mean, I can think of lots of different exams. Examples or different variations on it, you know, I can think of several patients, actually, that that I've had that are that are teenagers that are put in that position of really having to help care for the, you know, the elderly generation that's kind of moved into the house because their parent is off at work, you know, trying to have an income for the family, and so then the responsibility of care really falls on the adolescent, and that's very challenging for them. So I've certainly seen a lot of patients have to navigate through that, and then trying to nav, they're trying to navigate their, their own life and their own, you know, school or whatever they're trying to work through, too, and so you can see, though, those challenges, you know, sometimes it's not so graceful as you go through it, but you know, a lot of times after the fact, people are grateful that they got that time, you know, with their maybe their grandparent or their, their other loved one, so there can be that sort of plus side. I also have seen patients that, that really struggle after the loss of maybe that older generation that they were caring for, so definitely seen a lot of people who, you know, grandparent moved in with them, and now grandparent is gone, and they really don't know how to navigate that space, or they're just dealing with a lot of grief, which is 100% normal, but just really difficult. So, you know, it kind of plays out in a lot of different ways. I see other people who find great meaning in caring for, you know, for older generations, and kind of being in that space, and I've seen people that are sort of forced into that position where they're kind of forced to care for their parent, and it's not something that they want to do or are particularly happy about doing, but I have seen it really kind of turn things around in terms of just their appreciation for their parent in a, in a different way, and to be able to, you know, really alter maybe what wasn't a great relationship before actually becomes a very positive

Erin Brinker: 27:15

one. Oh, that's interesting, as they spend that time together and, and, and are in a vulnerable position together, because it's all very vulnerable, yep,

Dr. Ashley Zucker: 27:25

very, yes,

Erin Brinker: 27:27

wow,

Unknown: 27:27

yeah,

Erin Brinker: 27:28

so as a parent, so maybe I'm I'm doing the work like I'm going to work during the day, and and my will just say 17 year old son or 17 year old daughter is helping with grandma. What are some early warning signs that, that I could see in adolescence that it's becoming more that they than they can handle? What do I need to look out for to make sure that they're okay?

Dr. Ashley Zucker: 27:49

Yeah, I mean, it's not all that different in adolescence. I think what's trickier is that, you know, one big warning sign is irritability, and if you know any adolescents, you know

Erin Brinker: 28:00

they're pretty irritable,

Dr. Ashley Zucker: 28:01

irritable, so if there's a big shift in worsening, I should say, of the irritability, or it's looking different than sort of that normal teenage leave me alone kind of stuff, that's certainly a warning sign if they're really starting to withdraw or isolate a lot more, and that's very different than, like, hey, I want to go hang out with my friends, and I don't want to be home with you all. That's like, I just want to be in my room in the dark all the time, and I don't want to engage with people in a way that's different than they used to do, right? So, you're always looking for these changes, I think, is part of, is really the key piece of all of it, is, is there something very different than historically how they sort of reacted or responded to things. I mean, other things can be, again, like sleeping, the eating, if their grades are starting to decline, that's certainly a big warning sign that something's going on. And so those are things that I think parents should kind of be on the lookout for.

Erin Brinker: 29:00

What do you do when grandma's parenting style is very different from your own, and all of a sudden grandmas is reacting to your child in a way that you find pretty negative, that they think is quite normal, but you find negative. How do you deal with that?

Dr. Ashley Zucker: 29:15

Oh, that's a really tough one, for sure. Yeah, I don't know that I have the perfect answer for that one. I definitely have a lot of patience where I see that, that they're, and sometimes it's even amongst like spouses where they have different parenting styles, but yeah, you throw, you know, grandma and grandpa into the mix, and yeah, it's just, it's just very challenging, I would say. I mean, a lot of parents certainly express a great deal of frustration with, hey, I'm trying to, you know, enforce these rules or these boundaries, or, you know, I'm trying to exercise these things that we've talked about in our, you know, in our appointment, but then I've got Grandma coming behind and undoing all of it, right, and so that can certainly be very, very challenging.

Erin Brinker: 30:00

Of that,

Dr. Ashley Zucker: 30:00

I mean, I think again it's about communication, but that's easy to say, very hard to do. So I wonder, how do you caveat in there?

Erin Brinker: 30:08

How do you set boundaries in your own home with your parents, dealing with your children?

Dr. Ashley Zucker: 30:14

Yeah,

Erin Brinker: 30:14

you know, it's, it's because I, you know, mom moves, mom and dad move back in the house, all of a sudden you're 16 years old again, right? But you're not, you're 45

Dr. Ashley Zucker: 30:27

Yeah, yeah. I mean, sometimes it's just being like, you know, hey mom, I love you. I know you're trying to help, but you know, I really am trying to do things this way, and I would love if you could help support me in, you know, navigating this, and you could back me up in terms of how I'm, you know, how I'm parenting, or maybe it's we seem to have a different approach to this. Can you help me understand your approach, and maybe we can find some common ground, because I feel like we're sendin different messages to

Erin Brinker: 31:00

Sally, you know, maybe some ways. Oh, sorry to interrupt. No, go ahead. That's fantastic. I'm wondering if Sally, depending, let's say that she's 17, because that was the example, yeah, would Sally need to be a part of that discussion?

Dr. Ashley Zucker: 31:15

Not necessarily. I think she could, but she certainly doesn't have to be, and in some spaces maybe she shouldn't be, maybe it's a, you know, just a parent to parent, parent to grandparent conversation that's had without Sally in the room, just to say, you know, hey, I've really been struggling with navigating this space with Sally, and I'm feeling, you know, that we're sending her mixed messages, and I want us to get on the same page and be on the same team. Let's talk about how we do that, right? Sally doesn't have to be a part of that conversation.

Erin Brinker: 31:49

So, what is this? You know, Mom and Dad are one of them moving into your house. How does this impact a marriage?

Dr. Ashley Zucker: 31:58

Yeah, that's a tough one too. I think it can be very stressful on a marriage. Certainly, I mean, it's just if anyone in a relationship is stressed that impacts the other person in a relationship, of course. You know, sometimes, too, this happens not only in these situations, but you know, even if you're really stressed out at work, you know, you can't erupt at work, so you erupt at home, where it's safe with your loved ones, right? And so sometimes things get taken out on our spouses that you know may not be fair to them, and so I think that's something to just, you know, really be aware of. I think it's, you know, really important that people sit down and talk through with their spouse, with their partner, before the parent moves in. You know, what are some things that we're worried about, or what are some ways that we're going to make sure that we don't lose our relationship in this? Maybe it's like you talked about the safe word for dinner - sloth means time out, and let's go meet in the kitchen and talk this through without grandma, you know. So, trying to, I think, trying to think ahead in some ways can be very helpful. Obviously, you can't predict all of it, and so I think also making sure that you're really carving out that time to stay a couple is important too, so it's kind of like what you had to do when the kids were little, like you got to carve out date night and time for yourselves, and that can be really hard to do, but it is really important because you don't want your, you know, relationship to suffer at the cost. You really need your partner in this with you, because it's going to be challenging for all involved, you know.

Erin Brinker: 33:43

You know, I think about when the kids are little, and that is the most difficult and stressful time in a marriage. And this sounds like this is this is kind of on par with that. That's that's a lot.

Dr. Ashley Zucker: 33:53

Yeah, yeah, it can be sort of part two, I guess, act two of that situation, but maybe you learn something from going with it, going through it with your kids, like what really helped at that point, probably not a bad thing to maybe spend some time reflecting on that, and that might help you anticipate where some of those stressors might be, or might come from, and what you might be able to do to work through

Erin Brinker: 34:18

it, so How do you know when you've hit your limit, like you are, you're at capacity, and that maybe it might be time for dad or mom to go in assisted living or something, where there's more memory care, or somewhere where that they can be there 24/7 and part of navigating that, as is the guilt that goes along with it. Can you talk about that a little bit?

Dr. Ashley Zucker: 34:40

Yeah, I mean, I think first and foremost about safety, right? When we're really talking to when it's gotten to that place where you just can't navigate, I think one, there's the place that you just can't navigate because of the just the stress of it all, or just being overwhelmed by it, but there can also be a point where you're trying to do everything possible. You just can't maintain that safety in that space for, you know, the person that you're caring for, and I think if you can reflect on the safety, that can help a little bit with some of the guilt. I think everybody, you know, wants to be able to stay in their home or to keep their loved one in their home and not necessarily have to, you know, put them in a facility or utilize a facility, but recognizing, you know, this is no longer a place where I can keep them safe, and so, for you know, their good and their well-being, it's really time for me to look into what are some other resources where I know that my loved one will be fully cared for in a way that I just am not able to do it, and so I think that again it's like, where's that safety piece is sometimes helpful in alleviating that that guilt, and I think also just recognizing, you know, what are the other options for help, maybe there's like home health that can come in and care for a parent for, you know, a certain amount of time a week, or things like that, but if you really maximized out all those possibilities, maybe it's, you know, really appropriate to be looking at another place for your, your loved one to be.

Erin Brinker: 36:20

It's really hard, so I, you know, have had family members who, a couple, where, where one of them got Alzheimer's, and he was adamant that he didn't want to go into home, and it wasn't until it was, it was genuinely dangerous for him to be at the house, because he would light a burner and walk away, or, you know, do something else, where he just, he just couldn't remember, and it was, you know, walk outside the front door, or maybe want to drive somewhere, or then it becomes scary, but his, his wife joined a support group for caregivers, because that, that was really helpful to her, and I think they helped her get to the point where she recognized, yeah, I no matter what I do, I'm not going to be enough.

Dr. Ashley Zucker: 37:02

Yeah, yeah. No, I think again, it's that reaching out piece, right? So support groups, I think, are a great resource for people who are in that kind of sandwich caregiving generation, because nobody else understands it if they haven't really lived through it. But you can also learn a ton of resources from support groups as well, right? So, and sometimes the resource is just recognizing, yeah, it's time to move on to this next step, you know. So, I think those things are really important to make sure that you're reaching out to other people who maybe are going through it or have gone through it before, and that can be, you know, really helpful,

Erin Brinker: 37:42

certainly in alleviating the guilt, because she loved her husband, and she wanted to be there for him, and take care of him, as she had promised to do, and she had reached a point where everybody around her was also saying, you can't do this anymore, because we could see the toll on her, there's a tremendous toll for the caregivers,

Dr. Ashley Zucker: 38:00

yeah, yeah, absolutely. It's, I think, it's just very difficult to be in that space where you know you've probably had a loved one that says, like, when I get old, just make sure you don't, you know, put me in a home, or you know, they've made these comments, but then the reality of the situation is that's the only safe place for you to be. Yes, and I think that managing that guilt is so, so difficult, and that's where getting that support from others is really important, so that you, you can have that reassurance that what you're actually doing is really in the best interest for everybody, and that you know as much as you feel guilty about it, you really shouldn't, because you are doing what's in, you know, what's best for all.

Erin Brinker: 38:46

So, let's talk about perfectionism, you know, for the perfect being the enemy of the good. You know, how does that find its way? Like, you've always been super bomb, you've shown up, you go to all the games, despite working full time, you, you know, that you get the daughter to the school to get, or get to the shop to get her prom dress early. You make sure she has her nails done and her hairs down. I'm thinking of all the little things that, Bob, that moms do for teenagers, you know. How does, how does this kind of load impact the way parents show up for their children,

Dr. Ashley Zucker: 39:22

yeah. I mean, I think it's certainly for someone who's a perfectionist, it can be very, very challenging because they feel like they're failing, right? And that's where, yeah, you know, sort of terrible sense of self and that guilt can all come from where you're like, I used to be able to do all these things, or everybody expects me to be able to manage all of this, and I'm, you know, kind of ruining the image that others around have of me, but I think the reality is that most of us are pretty understanding that no one person can do it all, and that you shouldn't have to, and you know. Being able to recognize that you're not going to be able to keep all the balls up in the air all of the time is something that I think needs to be sort of better stated throughout life, not just when you're at this like sandwich generation, right, but the parenting piece of being the perfect parent too, you know, I think that's a very, we put a lot of pressure on people to have this perfectionistic outlook, or from the outside looking in looks perfect, right? But when, in fact, you know the perfect person may actually be quite unhappy, and so I think it's recognizing that no one of us can be absolutely perfect, and that we can only do what we can do, and sometimes you have to prioritize, and sometimes you have to let some things fall, you know, or fall off,

Erin Brinker: 40:51

you know. It's interesting talking about being the perfect parent. Sometimes I wonder, you know, parent parents are so focused on being the perfect parent for their kids, they basically turn them into their kids' staff, so that they, that they, you know, have flipped it, so that they now work for the children, because that child's happiness, quote unquote, becomes the most important thing, which is a terrible thing to do to a child, and the terrible thing to do to yourself.

Dr. Ashley Zucker: 41:16

Yeah, absolutely. I think it's, you know, so important that you, you know, maintain your yourself through it all. I think you're right. People kind of fully give of themselves to their children, which is wonderful in theory, but you're actually not necessarily doing the best thing for your child if you're not still able to have your own life and have your own world, right? I mean, what are you teaching your kids if all they see is that I should just give all of myself to the next person and not do, you know, what they want to do for themselves, I don't think any of us would tell our children to do that, but you know, do it for them, right?

Erin Brinker: 41:54

Do you know? Have you read the book, The Shel Silverstein book, The Giving Tree?

Dr. Ashley Zucker: 41:59

Yes, of course.

Erin Brinker: 42:00

Okay, people love that book, and I gotta tell you, it makes me so profoundly sad, because the child, as he's growing up, just takes, takes, takes, takes, takes until the tree is nothing but a stump. The tree has nothing left, and that's not that, that's not the standard, you know.

Dr. Ashley Zucker: 42:19

Yeah, I just heard somebody else talking recently about the story, saying the same thing. It's, you know, used to always be sort of, oh, it's this beautiful book, and then you sort of really stop and think about it, and yeah, you're really supposed to destroy yourself to just give everything to someone else. I don't know that that's the message we want giving our children,

Erin Brinker: 42:41

and it's unhealthy for everyone. If you love your kids, you, you have boundaries, and you help them have boundaries, right?

Dr. Ashley Zucker: 42:47

Right. Yep, absolutely. And how does it serve your kid if you're just a stump now, right? Like,

Erin Brinker: 42:53

right,

Dr. Ashley Zucker: 42:54

you gave everything, and now there's nothing left that's not very good either.

Erin Brinker: 42:58

No. So, how does caregiving, so sorry. What do kids often notice when parents think they're hiding stress? Like, how transparent should you be with your kids about your own stress? Should you be talking about what you're going through with them, since you're kind of doing the journey together?

Dr. Ashley Zucker: 43:17

Well, I think parents think they're much better at hiding things from their kids than they really are. Kids are pretty smart, they pick up on a lot. They are, so I don't think anyone should assume that they're successfully hiding everything, or maybe anything, from their kids. I do think it's really helpful to talk it through, talk it out loud. I think it, again, it's role modeling for your kid, like, hey, this is really difficult for me, and this is what I'm doing to try to navigate through it. Or you probably noticed that, you know, mom's been a little bit snappier recently, and I think it's because I've been really stressed out about that. You know, I think if we can really think through, like, what would we want, what would we, what advice would we give our kids if they were in that situation? What would we want them to do, and then how do we actually role model that for them? I think that's a really great sort of frame of mind to have through this. Would you tell your kid, or just keep it a secret from everybody around you, and don't talk to anybody about what you're struggling with? No, you certainly wouldn't, right? So that's a frame of mind I find helpful,

Erin Brinker: 44:23

indeed. Indeed, the flip side of that is you don't want the kids to be worried, oh, mom's falling apart. I don't want to overshare, because you, you really do have to, you and your, your spouse, if you have one, have to make sure that the ship is sailing correctly, and your kids have to see that you are that you're kind of holding it together, so how do you walk that line?

Dr. Ashley Zucker: 44:45

Yeah, it is definitely a balance. Yeah, if you're just completely falling apart, and then your kid sort of feels like they have to become the parent, that's not a great place to be and be in either. But I think sometimes what can help avoid that is the early sharing, right. I'm really stressed out. I need to take a minute, like mom's got to go lay down for five minutes, I'll be right back, or I've got to walk away, or you know, showing them that you're sharing with them that you're experiencing some kind of negative emotion or negative space, and then doing something with it, and role modeling that, I think, is really important. Sometimes we can't help but fall apart. So, again, I don't want people to feel like they have to be perfect at this either. But you're right, you also want to create that safe space for your kid to know that, you know, hey, I can feel really bad right now, but I'm still going to get you to school tomorrow, I'm still going to pick you up from this, or I'm going to get you to that party, or whatever it might be, so you're right, you've got to navigate that balance there too. If things are getting to the point where you really feel like you can't, that's another big sign that maybe it's time, you know, to seek out some professional help, because that's not where we want anyone to be.

Erin Brinker: 45:58

No, you know, I.. I.. it's. it's one thing to tell your kid, you know, I'm having a rough night, I need an attitude adjustment, give me 20 minutes, and it's another thing to fall apart completely, and you know, and not be able to show up at all for your kids,

Dr. Ashley Zucker: 46:13

of course. Absolutely, yeah.

Erin Brinker: 46:15

So, wow, so what role does modeling healthy coping? We've kind of talked about it, but coping play for kids when you're modeling that healthy coping skills.

Dr. Ashley Zucker: 46:31

Yeah, I mean, I think it's everything, but you're, I mean, you're teaching your kids how to navigate their own challenging times in their future life. I don't think we always recognize how much our kids pick up on it's not just like, oh, they see it or they hear it, but how they internalize it. I think we under acknowledge, I guess I'll say, and so sometimes I don't think we're thinking, oh, I've got to role model this out, or I've got to do this just so, so my kid could then say, 'Oh, mom, I noticed when you got really stressed out, you were able to step away and take a break. Your kid's probably not going to be able to, probably not right, but they are internalizing it, and I think that's, you know, part of what's important to recognize is there's some, some learning being being had there that isn't necessarily overt, and so just being able to know that you know, I just try to take care of myself is teaching my kid how to take care of themselves. I'm not telling them how to do it, I'm just doing what I need to do for myself, and hoping that that's something that they'll take on, knowing, oh, well, when I was growing up, this is what you did when you got upset, so that's just normal, you know.

Erin Brinker: 47:49

I wonder, you know, we, so we have to give each other grace, and I think that that having those conversations is important. What about structure and routine? You know, they say that for adults, too. Healthy hygiene, sleep hygiene is about every time, every time, about the same time every night, you start winding down, and you have a ritual, maybe, that you know, you go in and wash your face, and brush your teeth, and you, you know, feed the animals, and put the dogs out, or whatever your, your routine is, you know, is it important to keep that structure in place during this, during the transition to having a parent move back in with you, what difference does that make?

Dr. Ashley Zucker: 48:29

Yeah, I mean, I think structure and routine is super important for people of all ages. I mean, that's, you know, our bodies are kind of trying to always reach that, you know, homeostasis, or that kind of perfect balance, and the best way to do that is to have that routine and that structure, so we all kind of know what's coming, right, all parts of our sort of being, both our brain and our body. I think when you're moving into a stressful situation, in particular, then it's even that much more important, because you have to make sure you're still meeting your basic needs, and that's really what you know structure and routine is meant to accomplish, is that you're able to take care of the things that are most important to take care of, like eating, sleeping, getting some exercise in, whatever it might be, right. So I think that that's really important, but at the same time we can't lose flexibility, right? If we're so rigid in our routine and our structure, then when something interrupts that and that creates stress or anxiety, that's not good either, right? So I think one is having routine and structure with flexibility, and if you're shifting into a new space, say, you know, say a parent is moving in, you may have to rethink what that routine is. That routine might change, and so, how do you build in a new routine? You know, changing your routine isn't necessarily a bad thing, as long as you've kind of established that new one. But I will also just throw in the caveat that it's really good every once in a while to have no routine. No, structure, and just enjoy yourself.

Erin Brinker: 50:04

Weekend, exactly, exactly. So, you talked about self care. You mentioned self care, and you know the self care that you see on the internet is you're having a spa day, or you're whatever, retail therapy,

Dr. Ashley Zucker: 50:18

or whatever, you know, and if you've got no time or space or just anything for anything extra in your life. How do you work that in? Yeah, I mean, I think it's super important to remember that self-care does not have to be something expensive. It doesn't have to be something that takes a lot of time. In fact, the best self-care are things that you can do in just the little moments or little increments, even throughout your day, so sometimes it's just listening to your favorite song, or just takein a five minute break, or maybe it's just going outside and taking a walk around the block, or you know, these things that are just very easy to access, but again, don't take a lot of money, they don't take a lot of time, they don't take a lot of resources, because those are also the self-care practices that you're going to be able to actually one implement, but two, do routinely, right? If your only way to take care of yourself is to go to, you know, the spa for the day, you're not going to be able to do that all the time, right, right, right, right. You know, how do you find these things that are easy to kind of implement, you know, any time of day? I think is are the best self-care strategies for sure. There may still be some that are a little bit more, you know, time-intensive that are very important to you, but maybe mapping out how do I do those once a week, right? But I have these little ones that I can do daily, or you know, something to that effect.

Erin Brinker: 51:48

I think that's, you know, you and your spouse can lean on each other. If your spouse likes to play golf, giving him or her space to do that, and then asking for space to do your thing in return on a different day, you know, if that, I think that would work, you know, if that's something that you can lean on each other for.

Dr. Ashley Zucker: 52:06

Absolutely, like from, you know, three to four, you go do whatever you want, from four to five, I get to go do whatever I want,

Erin Brinker: 52:15

right? Somebody hit some balls, or whatever,

Dr. Ashley Zucker: 52:18

right, whatever it is. Yes, whatever it is.

Erin Brinker: 52:21

So, um for some, for someone listening who knows that they need support, but feels overwhelmed, and I'm going to tell you, like, for me, if I'm feeling overwhelmed, it's usually I get that feeling late at night, or I wake up at 3o'clock in the morning and go, I can't do this anymore, so it's not exactly the best time to be picking up the phone and calling someone, but for someone listening who knows they need support but feels overwhelmed, where should they start?

Dr. Ashley Zucker: 52:46

Yeah, I mean, I think there's there are so many resources out there, so I think if it's during the day, if it's not late at night, like you're talking about, I think being able to even just start with your primary care doctor can be a great place, they'll have a ton of resources, whether it's connecting you with, you know, a mental health caregiver, or you know, a therapist, a psychiatrist, whatever is appropriate, or they might have just more like social resources, or they might be able to even access additional resources, like, you know, sometimes our social workers at Kaiser are able to connect people to support groups or other resources that might be really, really helpful when it's that like late at night, which is honestly the time that most people struggle. Yeah, when there isn't anything available, that's when I think some of our technology actually can be the most helpful, so I think of, you know, there are a lot of apps out there that can be really useful, that can be things like they have, you know, relaxation techniques, or like meditation videos, or things that you can listen to, or there are also places where you can access, like, virtual care, and sometimes that's at any time of day, sort of, depending on what the resource is. So those things are accessible at kind of off hours, but I think also, you know, recognizing I'm not starting to do so well at nighttime, maybe I should look up some stuff ahead of time, yeah. Or right now I'm having a really difficult night. Tomorrow morning I'm going to call my PCP, and like setting a plan for yourself the next day can also be really helpful.

Erin Brinker: 54:33

What if you don't want medication, and so you're, you're, which you may need, but your brain isn't there yet, but you know you don't want medication, you say I'm not going to call because they're just going to want to give me drugs, and I don't want to be on any antidepressant. Is there.. do you.. what do you tell them?

Dr. Ashley Zucker: 54:50

Well, I mean, there are tons and tons of treatment options that have nothing to do with medication for our mental health, so that's usually what I talk about. Is there? There's, you know, a lot of ways that we can really make a big difference in your mood, in your anxiety levels, in your mental health, that don't necessarily involve medication. You know, medication has a time and a place, but that's not something that everybody needs, and it's not always something that everybody is interested in or looking for, and so being able to really explore the alternative options out there, like talking to a therapist, and there's, I mean, there's billions of types of therapy there are, and you could go on and on with all the types of therapy, but I think you know, again, getting connected to that first person, or that first connection point, and so, like, when I say things like, talk to your PCP, I don't mean talk to your PCP about starting meds, I mean talk to your PCP about, you know, do they have a therapist they recommend, or how do you get a therapist appointment, you know, the beauty of Kaiser is you don't need to talk to a PCP at all, you can go straight to a therapist, not everything is, you know, is set up that way. So, I think it's also about the talk therapy part of it, can be a really, really powerful form of treatment that I don't think should be overlooked.

Erin Brinker: 56:15

Well, that is, that is excellent. So, we are completely out of time. Dr. Ashley Zucker, it's always a treat to have you on the show. How do people find you at Kaiser Permanente?

Dr. Ashley Zucker: 56:27

Well, I hide a lot. No, just kidding. I mean, you can find any mental health resource. Probably the easiest way to go is first to go to our website. So, kp.org is always a great place to start. You can certainly look me up there, but we've just got a plethora of mental health options, which are available not just to our members, but actually to non-members as well. So, I'd encourage folks, whether they're KP members or not, to start with kp.org because we got a lot of stuff on there that can be really, really helpful, including some virtual webinars, which are accessible to our non-members too.

Erin Brinker: 57:07

Excellent. Well, Dr. Ashley Zucker, thank you so much for joining, joining us today. And I know it's Mother's Day is in the past, but happy belated Mother's Day. Thank you very

Dr. Ashley Zucker: 57:18

much.

Erin Brinker: 57:18

Same to you. Bye. Well, that is all we have time for today. Thank you so much for spending this time with me. I'm Erin Brinker. You've been listening to The Hope Table. Have a great week, everyone.

Unknown: 57:33

Bye.