Sandwich Generation

285- sandwichAny way you slice it, caring for children and aging parents is a lot to manage—but it can offer rich rewards.

By Laurie Wertich

When Sue Morrison was young, she watched her parents care for their aging parents and remembers thinking to herself that when she grew up, she didn’t want to live anywhere near her parents. Now—all grown up—the busy clinical social worker and mother of two school-aged children good-naturedly chuckles at the reality: she lives about 15 minutes away from her elderly parents and spends a great deal of time caring for them.

“It’s funny now,” she says, “but the truth is I would be really upset if I didn’t live near them. It would be horrible if I weren’t around to take care of them.”

In Sue’s case, caring for her parents means different things at different times. Sometimes it means driving them to doctor appointments or taking care of their lawn—but other times the caregiving becomes more involved. When Sue’s 83-year-old mother had open heart surgery, she had to spend a couple of months in the hospital—and that meant Sue’s 88-year-old dad came to live with Sue and her family.

“That was really hard,” she recalls. “My dad is great, but it was challenging. I was spread so thin that I barely had a chance to talk to my husband during that time period.”

Sandwiched

At times like that, Sue is so busy juggling her counseling practice, her kids’ needs, and her parents’ needs that there isn’t a whole lot left for anything else. These competing responsibilities leave her smack dab in the middle of the sandwich generation— a growing group of people who find themselves “sandwiched” between their kids and their parents. The group faces the daunting task of simultaneously raising children and caring for aging parents.

The rise of the sandwich generation is due in part to two other trends: longer average lifespans and more women choosing to have children later in life. (The pregnancy rate for women ages 40 to 44 has increased steadily since 1991.1) Those trends combined mean that more people—and women especially— are faced with double-duty caregiving. If aging trends are any indicator, this scenario will become more common.

In the past decade, the total population of the United States has grown at a rate of 9.7 percent. In contrast, the population of people over age 65 has grown at a rate of 15.1 percent, and for those over age 85 it is a whopping 29.6 percent.2 The aging population means an increase in the need for caregivers. About 65 million people in the United States are serving as unpaid caregivers for a family member, according to the National Alliance for Caregiving.3 And about one-third of these are also raising children.

Profile of the Sandwich Generation

There is no textbook definition for adults who qualify as members of the sandwich generation—but in general the group comprises middle- aged adults in their forties and fifties who have a living parent over 65 and are still raising kids under the age of 18. Once the domain of baby boomers, the sandwich generation is now mostly composed of those from Generation X (those born between the early 1960s and the early 1980s).

According to research from the Pew Research Center’s Social & Demographic Trends project, nearly half (47 percent) of those currently raising kids have a parent over age 65 who requires care or may require care in the future.4 Women bear the brunt of the workload—in fact, they are twice as likely as men to handle the caregiving.

Double-Duty Caregiving

Women charged with dual caregiving may not know the statistics, but they do know that it is a juggling act. In fact, many of them may feel like circus performers trying to keep too many balls in the air.

“It is very difficult to organize one’s time to attend to the needs of children and parents, so people end up feeling stretched in two directions,” explains Barry Jacobs, PsyD, director of Behavioral Sciences at the Crozer-Keystone Family Medicine Residency Program and author of The Emotional Survival Guide for Caregivers: Looking after Yourself and Your Family While Helping an Aging Parent (Guilford Press, 2006).

Dr. Jacobs is a family therapist who specializes in issues related to family caregiving; he also has hands-on experience as a member of the sandwich generation—he moved his mother nearby to provide better care for her while his two children, teens at the time, were still living at home. He says that no matter the details of the sandwich scenario— whether long-distance, nearby, or in-home—people need to know that it is going to be a challenge.

The challenges aren’t just about time management, though that is a big one. “Sandwichers” are also up against logistical, financial, psychological, and physical stressors. “This is hard work. There is going to be strain. Things are not going to go perfectly, and you are not going to please everybody all the time,” says Dr. Jacobs.

The unique circumstances of particular family scenarios mean that the challenges for those who find themselves caring for their kids and their parents at the same time vary quite a bit: If you have very young kids at home while also caring for your parents, your responsibilities are going to be different from those of parents of teens; the kind of care you provide your parents will no doubt change as their age and health challenges increase; and whether or not you work outside the home will also be a factor in how you manage your family and your time.

Long story short: there is no formula for this situation—everyone is making it up as they go—but there are some common issues to expect.

  • Logistics and time management. Simultaneously juggling the demands of kids and parents can be a challenge. Dinner, homework, shuttling kids to activities, and tending to an elderly parent who needs special care—all require time and energy. “The situation requires a lot of time commitment when life is already full and there is no time to spare,” Dr. Jacobs explains.
  • Financial impact. Sometimes caregivers need to spend money on things like home health aides, home renovations, medical equipment, or even adult day care for parents suffering from dementia. What’s more, many caregivers end up taking a financial hit from missed work due to their caregiving responsibilities.
  • Balancing a career and caregiving. The time and the energy required to help care for both children and parents can have an impact on your professional life. Women in the sandwich generation often find that their career suffers as a result of their dual caregiving responsibilities.
  • Impact on marriage. Doubleduty caregivers can see the stress of their situation become a factor in their marriage—when crunched for time and money, physical health and relationships can falter. “My husband loves my parents, and he is a really good sport about the situation, but our schedules are tight already, so when my dad was here, we were like ships passing in the night,” Sue explains. “That adds more distance. When you don’t feel connected, you don’t feel intimate.”

The Emotional Toll

There is no question that dual caregiving takes an emotional toll. “Family caregivers as a group have high rates of depression and anxiety,” says Dr. Jacobs. “There is a chronic sense of guilt. When people feel like they are doing too many things and not doing any of them well, they feel guilty.”

Sue recalls feeling superstretched. “I felt like I wasn’t doing enough for anybody—not for my children, my dad, my mom, or my husband. I spread myself so thin that I didn’t feel like I was being successful or effective anywhere, and that didn’t feel very good,” she says. “The worst part was the guilt. I would get tired and irritated—and then I would feel guilty for being irritated.”

Dr. Jacobs says that it is important for caregivers to make peace with imperfection and cut themselves some slack. “The worst thing I see caregivers do is beat themselves up—sort of like they’re rubbing salt in their own wounds,” he says. “They are just taking a tough job and making it more difficult.”

Self-Care Is Key

The best way to avoid the guilt, exhaustion, and other challenges that can accompany dual caregiving is to be proactive—which is sometimes easier said than done, especially when the caregiving situation happens suddenly.

Dr. Jacobs encourages his clients to take the long view and develop a plan. He says that caregivers need to do two things before moving forward. First, develop an understanding of the aging parent’s medical situation and its likely trajectory over time. This will help them create a short-term and a long-term plan. Second, he suggests that caregivers define what they are willing to commit to and also what they are not willing to commit to.

“You are not required to do everything,” he insists. “You are required to be a loving child and ensure your parent’s safety, but you do not have to do it all.”

Dr. Jacobs says that being a double- duty caregiver is sort of like running a marathon—and caregivers must learn to pace themselves. A marathoner who goes out too fast or skips a water station is doomed to fail. So it is with caregiving. “Caregivers cannot throw themselves full throttle into caregiving,” insists Dr. Jacobs. “They need to learn how to replenish themselves along the way.”

Self-care should be a priority. Some people benefit from meditation or yoga, while others swear by a 20-minute walk. “You have to take the time for yourself even if you feel like you can’t,” Sue says. “I should have done more to take care of myself.”

She says that it is imperative that caregivers get rest—because the exhaustion can be overwhelming. She also says it is important to communicate about your experience and feelings. “Let people know that you’re tired so they don’t take your mood personally,” she suggests. “Tell them: ‘Just because I’m quiet that doesn’t mean I’m not happy to see you. I’m just really tired.’”

Siblings in the Sandwich

While we all like to think we have outgrown our old sibling rivalries, they often resurface during stressful times—but a little planning can go a long way to defuse any friction.

Dr. Jacobs often reminds siblings that what they do and how they treat each other while caring for their aging parents will have long-term repercussions— not just for the parents but for the siblings after the parents are gone.

He recommends that siblings have a meeting at least every three months—ideally in person. These meetings provide siblings an opportunity to regroup and assess the current situation and discuss short-term and long-term needs. Sometimes it is important to include the physician— especially if the siblings disagree about a parent’s condition.

Once all the siblings have a common view of the current situation, they can develop a plan and divvy up responsibilities. Dr. Jacobs notes that the distribution of responsibilities does not need to be equal, but everyone needs to contribute in some way.

If one sibling provides the bulk of the hands-on caregiving, perhaps another can pitch in with other chores such as housework and yard work. Siblings who live far away may be able to contribute financially or to relieve the primary caregiver periodically for a vacation. Another sibling might be instrumental in communicating with medical professionals or managing the parents’ finances. The bottom line: everybody can do something, and it is up to siblings to create a plan that works for everyone.

Long-Distance Caregiving

Long-distance caregiving is tough but not impossible. The best way to make it work is to communicate clearly with the caregivers on the front lines and ask them how you can be helpful.

“Not all help is helpful,” Dr. Jacobs jokes.

Often long-distance caregivers are overwhelmed with guilt—and this drives them to be overly assertive and sometimes downright bossy with the caregivers on the front lines, which serves only to alienate people. Instead, caregivers who are not local should aim to ask for specifics, pitch in from afar, and show up whenever possible.

Prioritizing the Kids

“A caregiver’s first responsibility is to her children, not to her parent,” Dr. Jacobs says. That can be a tough pill to swallow for women who feel pulled in two directions, but it is important to prioritize. Communication is key. Women need to communicate with their kids about how they are feeling about the dual caregiving situation. They also need to communicate with their aging parents about their priorities.

“Sometimes the aging parent has to take a backseat to a child’s needs,” Dr. Jacobs explains. “That’s okay. Most aging parents don’t need perfection; they need good enough.”

The parent/teacher conferences, sporting events, performances, and other commitments are important— caregiving shouldn’t trump them. The same goes for family life in general. Dr. Jacobs insists that there need to be times when the aging parent is not involved and the nuclear family is on its own. “It’s important to preserve family life as much as possible,” he says. “Caregivers need to take time with their spouse and children without the aging parent’s involvement.”

The Upside of the Sandwich Generation

Double-duty caregiving is challenging, but there is an upside. It is an opportunity for families to come together and for kids to learn about family values, sacrifice, and empathy.

“When I moved my mother near me, my kids felt they were going to lose something in the process, and I think they did because some of my energy went elsewhere,” Dr. Jacobs recalls. “But what they gained is a greater appreciation of what family is. They stepped up in different ways to take care of their grandmother. I think it was gratifying for them, and they learned something about life in the process.”

Sue has seen similar benefits for her kids. “I think this has made my kids more empathetic,” she says. “They are really great with my parents. They’re very considerate.”

In the end, caring for an elderly parent while raising kids can be  incredibly stressful, emotional, and exhausting—but it can also be rewarding. In Sue’s case, she doesn’t want to imagine the day when her parents are not around. “Instead of dwelling on what happens when they’re gone, I’m just going to enjoy the now,” she says. “I’m just going to enjoy them while they’re here.”

References

1. Ventura SJ, Curtin SC, Abma JC. Estimated Pregnancy Rates and Rates of Pregnancy Outcomes for the United States, 1990–2008. National Vital Statistics Reports. 2012;60(7). Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_07.pdf. Accessed March 21, 2014.

2. Werner CA. The Older Population: 2010. 2010 Census Briefs. Available at: http://www.census.gov/prod/cen2010/briefs/c2010br-09.pdf. Accessed March 21, 2014.

3. National Alliance for Caregiving in collaboration with AARP. Caregiving in the U.S.: Executive Summary. November 2009. Available at: http://www.caregiving.org/pdf/research/CaregivingUSAllAgesExecSum.pdf. Accessed March 21, 2014.

4. Taylor P, Parker K, Patten E, Motel, S. The Sandwich Generation: Rising Financial Burdens for Middle-Aged Americans. Pew Research Center Social & Demographic Trends. January 30, 2013. Available at: http://www.pewsocialtrends.org/files/2013/01/Sandwich_Generation_Report_FINAL _1-29.pdf. Accessed March 21, 2014.

Caregiving Strategies

  • Develop an understanding of the medical situation.
  • Create a short-term and a long-term plan.
  • Define your commitments.
  • Enlist help for other tasks.
  • Build a supporting team (and compile a list of names and contact information).
  • Make self-care a priority.
  • Enlist emotional support via a counselor, social worker, or support group.
  • Take breaks to prevent burnout.
  • Make peace with imperfection.