Heather Suri 0:00
This work for me, very personal. I mean, I'm, I'm a member of the sandwich generation to I've got kids from nine to 22. I've got a grandmother with dementia and memory care, I've got parents with chronic illnesses I had, and they're actually primary caregivers for my uncle who's 65 with an intellectual disability. So it's, I'm smack middle in the middle of it. And I just I love the work, I love working with other daughters and sons. But I think, you know, especially daughters that, you know, we see a lot of daughters kind of come into this caregiving type of role. Whether it's primary caregiving, they're the ones actually, you know, maybe living with parents or visiting their parents or making decisions for their parents or wishing their parents would make other decisions. You know, or secondary caregivers where we have, you know, the daughters who are maybe out of state and trying to support you know, a well spouse taking care of someone with a chronic illness. And that whole dynamic is no less stressful.

Samantha Spittle 1:16
Oh, yeah. And, yeah, other challenges you brought up so many, I feel like great examples of what people struggle with, you know, and like you said, a lot of times, the burden does seem to fall a lot on the daughters, but I know that there's lots of sons and other people that just, you know, of course, are wanting to care for their parents. But as we kind of are unpacking the shame triggers this season. One thing that I think the sandwich generation and to clarify the sandwich generation, right, it's where you're kind of in that phase of life, where you're raising your kids, you're so you're kind of in that parent of you know, and I don't even say littles because, you know, our kids need our care all the way through, you know, and so it's raising the kids up to the aging parents, you know, and helping them. And I think that, you know, I was looking at the other shame triggers we've talked about this season, and so many are, you know, we work on our own stuff and things like that. And the the interesting thing of this sandwich generation when it comes to this aging, and why I kind of has identified some shame with that is because you have your own family of origin. You know, we talked about that. Last month with parenting, we talked about kind of how much our family of origin affects how we pay our bills, raise our kids deal with our spouse. And so then you add in this where, you know, how did your parents take care of their parents, you might be wanting to do it differently. And then you just all have our own, you know, mental health stuff that we deal with, and how we kind of default to old patterns. And it's like, oh, my gosh, this just got super confusing, because when you're just living your own life, you could just do your own thing. And now you add on this whole other phase. So before we jump into all that, I would love to have you introduced yourself. And we can kind of start unraveling this.

Heather Suri 3:04
Sure, sure. Well, my name is Heather Surrey, and I own a care management practice called pathways in aging. I am a nurse by training for about almost 25 years now. And for those of you who don't know what care management is, a lot of people don't care management is care coordination. It's crisis intervention, it's guidance and consultation. We really help families build teams, navigate, problems come up with solutions that meet their unique needs. Our specialty, of course, is working with the aging community. But we actually work with people across the lifespan who are facing different kinds of medical or psychiatric challenges. So I live here in Loudoun County, got four kids, two cats. Very, very busy life, I say go to work to relax.

Samantha Spittle 4:07
Yeah, it's you have it all covered all the different phases and spans of life. And I imagined, you know, I think when we have stuff that touches us personally, and we see the need, it helps us. You know, I think that's what fuels our passion for doing things. And it sounds like you know, you having so many different areas of life kind of touched by all this that it's a natural fit right to kind of dive in there.

Heather Suri 4:32
It is. And, you know, I've worked in a lot of different areas of nursing I've Certified Hospice and Palliative Care Nurse. I've worked in long term care facilities. I've been the director of nursing for home care agency, and this work just allows me to not stay in my lane, to really use all of that experience, to you know, really Practice the purest sense of person centered care where I can really come up with unique solutions. Because every family is different. And there are so many right ways to do things. Especially we get as adult children of aging parents, we get kind of buried under this pressure of doing the right thing. You know, what is the right way to do things? And the answer is, there are so many right ways to do things. So I like helping families find the right way for them.

Samantha Spittle 5:35
Yeah, that's such a perfect segue from last month. It was we know, we talked about parenting, and it's parenting, the kids and we talked all about the right way, and that there is no right way. But you know, there's lots of ways it's what's right for you, and seen my own parents, you know, help their parents and kind of we were a long distance, you know, they're out in the MIT, they were in the Midwest, we were military. And we spent a lot of those years, and they were older, on the east coast. And so there were so many factors involved into caring for them. And you brought you said it earlier, you know, your, if your parents are making decisions, are they making the decisions you agree with, it's almost like it's that flip flop of parenting youngers, and then suddenly you kind of reverse roles with your parents, and it starts to change.

Heather Suri 6:24
Yeah, we see that sometimes. But the the other lens I see that through, is that older adults in general tend to have a different calculation of personal risk. So when you know, you have lived all of these decades, and you face these different hardships, and you've gone through them, and you're in, you know, kind of the closing chapters of your life, your idea of what is risky, of what is safe, how much risk you're comfortable with is, is really kind of different. Now, when we're teenagers, you know, our perception of risk is different, too. So, you know, those things change over the lifespan. But a lot of times I see, adult kids just wish their parents would go into assisted living, they're just, you know, they want something to feel like it's in a controlled environment, they're worried somebody is going to fall and somebody is not taking their medication and, and so balancing that, you know, that that idea of, you know, what is safe, and, and what is somebody's autonomy and choice and how to kind of honor both of them is really kind of an interesting and creative work, how to find those intersections between the kids and their aging parents. To map that pathway forward.

Samantha Spittle 7:54
That was a huge thing you just said, I feel like it's something we could quickly move on from but once again, this is like very parallel to last month, where it's the autonomy, it's keeping the autonomy, and I think, I think it's so natural for us, we're controlling our kids, but when you raise your kids, it's, as they get older, you have them, they need more freedom. And it's funny how we need to be so mindful of our own, just our instinct to wanna protect them, you know, because now we're seeing them as older and, and want to protect them, but needing to remember that they are their own individual person, and they've lived a long life so that that different assessment of risk is very interesting. So I always joke that when you ever you're in a role, where you have to deal with multiple people, it's like you're a therapist, but you're not a therapist, this is not therapy at all, and I'm not. But you know, I always joke like, photographers at weddings, like they have to manage all the different people. And I feel like, that's probably very similar with you with all the roles you do. So kind of putting on your helping hat with people so that, you know, we can start thinking of these things, maybe before we're in crisis.

Heather Suri 9:06
Right? You know, it's, I mean, a couple of things come to mind with what you just said, One, I mean, talking about putting on your helper hat or, or, you know, being the in air quotes therapist, one of the roles of a therapist is not to tell you what to do is to help you find the answers that are already inside yourself by asking the right questions. And then being willing to listen to those answers and sit with them even if they're uncomfortable. So I think that's part of it. You know, adult kids, unless you're in a situation where you are a guardian or you have a loved one with very advanced dementia you You are not responsible for your parents and all of their choices. People who are, you know, have capacity, okay, so aren't aren't, don't have dementia to the point of incapacity have the right to make decisions we don't agree with. You know, the other piece that I see quite often is when aging parents didn't plan well for their aging, maybe they are not financially prepared to get the care that they need. And we have kids, adult kids who maybe are in a different financial situation, and I have daughters, you know, ready to cash in their 401 K's to pay for assisted living? Don't do that. You can do that. So that's, that's where some of this boundaries stuff comes in, around how can you find some peace with the situation as it is, the decisions that your parents made, and help guide them through the process of next steps based on what their resources are, whether it's personal resources, financial resources, how they perceive risk. It's messy, and it's hard. It is and

Samantha Spittle 11:31
you said that magic word boundaries. And I'm like, okay, like, we got to dig in there. Because right away, when you started talking about, you know, if the parents don't prepare, and the daughters like ready to cash it in, I mean, there's so much where someone else's choices how they affect us, and and it's one of those when you're not in the situation, it's easy to say, hey, it's their choice, their consequence. But once again, this is where it gets really messy with family dynamics, and your family of origin, and the guilt and the shame that gets wrapped in it all. So what does boundaries look like, you know, if you're in that sandwich generation with those aging parents,

Heather Suri 12:10
I think the what I talk to adult kids about a lot is you get to define your own boundaries. So what my boundaries look like, might not look like what your boundaries are, but you have to decide what is right for you, and not feel guilty about protecting your energy. And, and, and keeping your boundaries. Because it's, you know, we're back to that whole, you know, put your own oxygen mask on first, before you help the person next to you, you know, if you are not physically emotionally mentally healthy, it's going to be really difficult for you to help care for your parents help care for your kids. Keep your job, you know, all of those things that, you know, that we're constantly juggling. So, you know, depending on the situation, the way you implement your boundaries might be different, you know, again, it might be, you know, making a decision about finding solutions to manage your parents care within their own financial resources, it might be allowing yourself some distance if there were some difficult relationships. You know, I work with a lot of families where maybe there were relationships with parents that maybe even bordered on emotionally abusive, and then it gets really difficult when you're in a situation where now you have to care for your parents, and there's all of that unresolved stuff that can be really triggering. So it's okay to put those those those boundaries up. I get questions from adult kids a lot, how often should I visit? You know, my parent in assisted living? And they go and the parent is not kind, you know? Yeah, not nice. Maybe there's some dementia involved. Maybe there's not, you know, you don't have to go every day and absorb the abuse. You don't, you don't have to expose yourself to that. So you decide for your boundaries, and maybe it's once a week and you go for 10 minutes, and it gets ugly, then you give your person yourself permission to leave. So it's, it's about defining what's right for you and then and then respecting those boundaries that you set for yourself and honoring them and, and knowing you're entitled to them.

Samantha Spittle 14:48
Yeah. Oh, man. That's so huge. You know, I think sometimes we just need to hear this you know, you when you know, you know, you know the right thing you know, you know, boundaries, you know, you're supposed to But I think just hearing so often from someone that you know, it's okay to do what is best for you, because no one knows your situation, like you said, you, you touched upon if there's possible abuse in a family. And I mean, it's easy for people from the outside to criticize the choices you make, but they don't know, you know, the situation you're in.

Heather Suri 15:19
And building a team, I think, you know, you'd want to talk about a tip. You know, figuring out who that team is, that's going to help, you know, with your parents care, it doesn't have to all be on you, you know, it might be bringing in a home health team through the Medicare benefit, it might be connecting with the primary care provider and letting them know that you need some help. It might be through county services, the Area Agency on Aging, Senior Center, you know, there's adult day health programming, you know, that that's something that we do a lot of, of trying to help families build these teams so that there is a sustainable care system, and the adult child doesn't have to shoulder all of it. Because it's not your job to shoulder all of it. And we do that sandwich generation we make everything our job. Yeah, it's it's exhausting.

Samantha Spittle 16:22
Yeah. What are some of the things I guess the biggest struggles you see from people that come to see you and that, and I, you know, I would love for you to take this question any direction, which is whether it's, you know, the people the sandwich generation coming, whether it's who you care for, just kind of the, you know, favorite question I used to ask early on the podcast was like, basically, what do you just want people to know about what you're passionate about? Or about what you do? Kind of like the shout from the rooftop? Yeah, I wish people knew that.

Heather Suri 16:51
Oh, gosh, there's so much I wish everybody knew what Medicare does and doesn't cover something. It's kind of shocking. You know, how much we don't understand about about Medicare. But, and Medicare does not provide homecare that hourly homecare doesn't cover it. So doesn't cover assisted living. I still get questions about that. But I think some of the things that families come to me most often about that, they kind of think that they're alone. And we talked a little bit earlier about your story about feeling like they're there, they're facing something that no one else has faced, it could be driving could be that an aging parent, you're not sure. If they're safe to drive in the pain aging parent is not going to give away the keys willingly? And you know, how do you figure out the right thing to do? And then what are the tactical steps that you take? You know, someone who is having some changes in cognition, and we're not sure if it's dementia or not. And maybe the aging parent doesn't want to talk to their doctor about it, or they don't want to see a neurologist because they're embarrassed, they're feeling ashamed. And they don't want to hear what they think the answer is going to be. So how do you navigate that when you know, there's a problem, but your loved one won't get help? So that's a situation understanding the timeline of when to make a move. So do you support somebody aging in place? Do they go to assisted living? When do you make those changes and those decisions? So it's, it's, it's a lot of these things that are not clear cut, don't have black and white answers. And the answers to these questions really depend on the individual situations in the family. And it's a lot of talking and listening and understanding to find those those paths forward.

Samantha Spittle 19:05
Yeah. Do you have recommendations, you know, you were talking about what happens when you notice the changes in your parents, and they don't want to bring it up. And it's funny, because, you know, depending on what your family dynamics are, I just feel like I kind of fall back into that teenage mode. You know, I can see that with my own. You know, my mom and I, when we talk, it's like, I give lots of grace and patience over here to these people. But when I talk to my mom, it's like falling back into that teenage Sam roll, you know. And so, do you have tips on kind of approaching those conversations?

Heather Suri 19:43
Yeah. And sometimes the kids are not the best messengers because you know, you've already got your back up. You know, you're you're in the teenager mode, and when you open your mouth, they hear an eight year old and so it just, you know, sometimes that doesn't work. So you What I find is trying to get the doctor involved chipping off the doctor so that the doctor asks the right questions and creates the right environment to help your loved one feel safe enough to answer honestly, sometimes if they know that there's a problem, they can ask some questions that can help guide that conversation. Sometimes, if the, even sometimes we can't even get them to go to the doctor. So maybe it's a physical therapist, maybe it's a hairdresser. You know, sometimes it's, you know, again, pulling that safety net out, you know, maybe it's a neighbor, it's somebody who can ask some questions and create that safe space to, you know, explore options, certainly care managers, we do a lot of that, you know, kind of find that way to build rapport and trust. Sometimes they need to hear it from somebody who is a professional. And again, it doesn't have to be a care manager, there's, there's, but there's often a lot of other professionals that are involved. And I'm a big believer in, in the team approach, because it just doesn't, it can get adversarial really quick. And if you're the kid, even if you're the adult kid, your parents know how to shut it down. They've got decades of experience.

Samantha Spittle 21:24
Yeah. That's the thing that these family dynamics, they don't suddenly go away, you know, it's you think, you know, that it's just, oh, we're gonna move these pieces around. But it's like, they, they're, we all are our own individual people. And so yeah, and then you, you have all those dynamics that, you know, like you said, they know how to shut it down. And, you know, I love what you said, we think, you know, we turn into our teenage selves into them were our eight year old selves, it's just, it's so so having that team approach, I think, is super important to kind of help carry that load and for other perspectives, and whatnot, too. So,

Heather Suri 22:03
and making if you have siblings that are also involved, that's another thing I see sometimes our frustrations and resentment because one sibling is kind of doing more of the heavy lifting than the other siblings are. And, you know, that's, I talk with adult kids about this all the time, because it's, it's never going to be equal, you know, whatever that word means. You know, every one member of the family has their own immense mental, emotional, physical bandwidth. Again, everybody has their individual boundaries that they get to define for themselves. And so we just have to, you know, one, be able to ask for help, sometimes we have someone doing all the heavy lifting, because they're a control freak. And they do it and they don't ask for help. So being able to articulate what you need, being able to tap into the gifts of the other family members, so that, you know, people are doing what they feel like they can do. But yeah, that's, that's another really tricky one.

Samantha Spittle 23:18
Yeah. Well, you're touching on all the things that I feel like you don't hear what I talk about a lot. And it's basically, so much of life is unpacking our own stuff, and getting to the root of our own stuff. When we deny and we try to shove all this stuff down, when there's the health crisis, or some sort of crisis later in life like this is when that just the lid is ripped off your Pandora's Box feels like it's opened, you know, we're all this stuff that you just shoved down for years and years and years. And then suddenly, this is the stage of life, it seems like where there's probably going to be a lot of all that unresolved stuff comes bubbling up.

Heather Suri 23:57
I think so. But you know, our generation and you know, my, I'm a Gen X, sir. We've had a lot of therapy generation. And I think we, we need to do things differently and prepare our kids differently. For our aging, you know, I mean, I'm a nurse and I do this care management for a living so I have these conversations with my kids a lot because I see what it looks like when people don't. But it's important to to have those hard conversations, advanced care planning, you know, what, what you what kind of care you want, what you don't want, what is most important to you, you know, these are things that we can do to help prepare our kids because aging is inevitable and it's going to happen to all of us. And I think that you know, for whatever reason, the the way society has been structured we we weren't prepared Arjuna Radiation was really not prepared. And people are living longer, you know, we have all of this medical technology, all of the advancements that we're seeing older adults live longer, but not necessarily healthier. Yeah. So that that phase of kind of frailty is much longer. Yeah. And, you know, that makes things really challenging to so having those conversations with our own kids about, about what we want, and what quality of life means to us. Will will help us and it will help them.

Samantha Spittle 25:41
Yeah, that's something that I feel like, I believe I said this, before we started recording with my own parents, you know, my grandmother lived till 98. And so I saw my mom, you know, care for her and do it long distance and needing to travel a lot. And they also, you know, they helped out with my dad's parents, but I was, you know, a young teenager, when they went through all of that. And so I was, of course, in the throes of being a probably 15 1415 year old. And it just, it was one of those things that as I got older, and I had kids, and I just saw the stress on my mom and everything, we had a lot more conversations about it. And I think it's something that, and we talked about what it was like, when my dad's parents were, you know, got when they were older and got sick and whatnot. And it's all this stuff that I remember thinking, I had no clue that I mean, just this whole idea of the sandwich generation. And I just had no clue my mom was going and my dad was going through any of that stuff, because of course, I was just living my life. And I just remember feeling grateful that I was able to have that perspective shift. And we were able to, you know, have some conversations of, you know, how to make some different choices that we you know, choices that she would want to make, or we you know, we would make and whatnot, because I realized, it's just, yeah, if we just don't talk about it, it's kind of you just keep on keeping on you do it the way the previous generation did it. And I think that's a big thing, too, is people are changing, you know, where they live, and how they travel and whatnot, not being tied to the same place. And like you said, living longer and, and all the challenges it presents. So as we kind of wrap up, what are some of the things that you know, I know that working with someone like you, especially if you're in crisis mode, you know, it's to pull in someone to kind of help make sense of this all. So of course, if someone's in crisis mode, that's a great solution. If you're not in crisis mode, and you're in this sandwich generation, what are some things you can kind of start talking about with your parents to kind of prepare?

Heather Suri 27:45
So, you know, let's start with the basics, first legal paperwork, you know, if are their powers of attorney in place, if not, let's get those done. Let's get it done. Now, when everybody's calm, and everybody's healthy. And make sure that you know, the designated person for health care decisions that that that paperwork is, is signed and done, I have so many families who had it drawn up and it never got signed, or they did it 25 years ago, and a look at it. And you know, it's now out of date. So good to have that adult kids should have an electronic copy of it. So that if you need to zip it over to a hospital, or especially if you live out of state, there's nothing worse than needing to prove to the hospital that you're the power of attorney, and then having to physically go to your parents home and search through a file cabinet to try to find that piece of Yeah, so do that when things are called. The other thing that I would recommend that can be a barrier is Get, get on, get a joint account, get your name as a signer on with one of your parents, it can be really difficult if you need to access funds for care. So maybe you need to bring in homecare, maybe somebody needs to go to assisted living something happened quickly, to get all of the documentation, the letters from the doctor to take to the bank with your power of attorney and even then sometimes there can be delays. So the fastest thing to do is to be a signer on your parents account. And once your signer on there, you can forget about it. You don't have to worry about it, but when it's needed, it can just you know be such a stress reliever, and then advanced care planning have the conversations with your parents about about what kind of care they want. If there is an emergency, talking about aggressive interventions, talking about intubation, talking about tube feeding, those types of things. These aren't decisions that we want to have to make in a crisis, we want to have had those conversations early and often. So that when adult children are in the situation where those decisions are made, they are carrying out their parents wishes, not making the decision for them, there is a huge difference between the two. And it is so it's already an emotionally loaded, difficult situation. But it is so much easier to be to carry out somebody's wishes than it is to make a decision for them.

Samantha Spittle 30:38
Yeah, you do the work for your kids, if you're in that situation, you know, you figure out what your wishes are you and you write it all down, and you get it all put together. So because we can't, of course, make our parents do that, if you're kind of in that sandwich generation, and you're, you're helping, you can't make them do that. But of course, we could do that for our kids. And that's something that, you know, I'm grateful that my parents have done because I would not have thought to ask many of these things. And, you know, and I know, my even when they talk to me about it, I'm kind of in that place where I'm like, Lulla, lulla. Like, I don't want to think about that.

Heather Suri 31:14
But it's you know, you can get into not denial, like really, really quickly. And it's self protective. You know, I understand it this is you know, and again, this comes back to just how our society handles aging, and nobody wants to get all their shame attached to aging, there's, you know, talking about guilt, too, and, you know, we're so attached to our productivity, about what I do in American culture. You know, that's, that's the first thing we ask people, What do you do? What do you do? It defines us. And so when we age and we're not able to do our identity can be fractured. And it's, you know, so yes, having these conversations with family early and often can make this a lot

Samantha Spittle 32:12
less painful. Yeah, and thanks for commenting on that. I think that is, that's such a big reason why it's so hard to talk about, because we don't want to think about all those. All those feelings that get brought up with that, but, you know, it's worth it. I mean, just like when we talk about therapy, and do it all the work of our growth and healing, it's, you know, there's a lot of stuff that I think there's opportunity to for relationships and whatnot to have healing and repair to is if you kind of can start these conversations when it's not in a crisis mode. You know, maybe there could be some opportunities to for families to come together, you know, and not have it be areas of stress to be pulled apart either. So, well, any closing thoughts, Heather, for, you know, helping kind of bridge this gap is as you do professionally, but everyone, no matter pretty much where you're at in life, it is going to be part of your life.

Heather Suri 33:03
Yeah. I mean, just, you know, again, a message to the, to the adult kids out there, you know, who are doing this, it's hard. You know, you're you're doing the best you can and that's enough. And, and, you know, it's okay, to not do it all yourself, it's okay, to get some help.

Samantha Spittle 33:29
Thank you for that encouragement. And I think sometimes we all just need to know that. Doing our best is always enough. And it's gonna look different from each person. So I appreciate your tips, your insight, and how can people get in touch with you, Heather?

Heather Suri 33:44
So my website is pathways in aging.com. On there, you'll find my phone number, you can book a consultation online, you can reach me by email. I work with families all over the country, of course in person here in Northern Virginia, but virtually from everywhere else. So love to get to know you and get to know your family situation and see if I can offer you some help.

Samantha Spittle 34:12
Awesome. And I would love to have you clarify too because we didn't totally touch upon it. We kind of jumped into kind of helping start unraveling this whole sandwich generation. What exactly do you do? So how can you help families specifically?

Heather Suri 34:27
Sure. So we help families really in four ways. One, through assessment and planning. So for folks who aren't in crisis, we can come out to the home and we look at the medical and the cognitive and the nutrition and we look at the legal and the financial. We really look at every aspect of aging and help families make a plan and give them some specific resources that will help. We also help families who are in crisis. So if somebody is in the hospital, if you've ever had an older loved one in the hospital, you know that the day they're admitted, they're already planning the discharge, and then you get handed a list, pick a nursing home for rehab, you know, it all happens really fast. We can help make sure that your loved one gets into the best place available. We know who's good at what, you know, we can help make that, you know, give you the information you need to really make informed decisions during that discharge plan are also available for consultation. I do one hour consultations, virtually at a discounted rate just to tackle these. What about the driving? You know, what do we do about a power of attorney situation? Or what do we do about a possible dementia diagnosis? So we work with families that way, as well.

Samantha Spittle 36:02
That's great. Thank you so much. I know that, especially in crisis, it's nice to have the help before crisis, which is why I love getting to meet people like you and share your insight because I think that that just can make a huge difference. But especially or I should say, and especially though in crisis,

Heather Suri 36:19
and I've got a great team of nurses and social workers all over Northern Virginia. So we're, we're here. We're ready.

Samantha Spittle 36:29
Awesome. Well, thank you, Heather. I appreciate your time and insight, and I know that you're helping lots of families and so I appreciate you taking the time today to chat.

Heather Suri 36:38
All right. Thank you so much, Samantha for having me on.

Transcribed by https://otter.ai