The term "sandwich generation" was coined by social worker Dorothy Miller in 1981, to describe women in their 30s and 40s who were the primary caregivers for their young children and their aging parents. The reality today is that the sandwich generation includes both men and women, ranging from their 30s to their 60s.
According to nonprofit association Aging Life Care, America's sandwich generation is one of the fastest-growing populations. "This group of people often find themselves stuck in the middle of trying to juggle a hectic schedule that includes caring for parents experiencing a decline in health, keeping up with adult children as they struggle to 'make it on their own' and begin their families and managing the financial and emotional stressors that arise throughout these circumstances."
A 2013 Pew research report found that 47 percent of adults in their 40s and 50s have a parent age 65 or older and are either raising a young child or financially supporting a grown child (age 18 or older). Around 1 in 7 middle-aged adults is providing financial support to both an aging parent and a child.
Iris Waichler, co-author of the award-winning Role Reversal: How to Take Care of Yourself and Your Aging Parents, is one woman who knows exactly what it's like to be sandwiched between a young child and an aging parent. Her father had two major health care crises, the first a brain hemorrhage at age 90, when Waichler was 55, and her daughter was 9, followed by a bout of pneumonia at age 96, when Waichler was 61 and her daughter 15. Both times, Waichler — a licensed clinical social worker and advocate for health awareness and caregiver support — was with him daily for several months, arranging his outpatient therapies, attending his therapy sessions, acting as a conduit with her siblings and offering emotional and moral support whenever it was needed.
Waichler pinpoints the following burnout symptoms for the sandwich generation: lack of sleep; increased anger and depression; increased feelings of guilt; unrealistically high expectations of yourself as a parent, spouse/partner or caregiver; an inability to focus on tasks; increased isolation from meaningful relationships; and an inability to say no.
Help and support is available to caregivers from their local Area Agency on Aging and state Department of Aging, as well as organizations like Aging Life Care Association, Alzheimer's Association, Ethnic Elders Care Network and National Alliance for Caregiving. Additionally, the following tips are definitely worth remembering:
1. Create collaboration, not confrontation
"Ideally have a candid conversation with the elderly parent before they have a medical problem or memory deficits, asking what type of help they would like when it is needed," said Waichler. "Do they want to stay in home or would they consider moving if frequent or daily help is needed?"
2. Create a roadmap
Getting proper legal documents in place can help make decisions about health care if your parent cannot. "Create access to information on their insurance and assets so you understand what help is covered and what they will need to pay for," advised Waichler.
A mobile file to be shared with your siblings can really streamline the caregiving process. Lisa Laney, who has a master's of social work and is owner of Mountain Area Premier Care Navigation in Asheville, North Carolina, recommends including all important contacts for your parents, such as neighbors, in-home aides, doctors, care managers, pharmacists, attorneys, CPAs and financial advisors. "Create a shared calendar that is accessible at all times, and all those with access can update appointment times when they are going to visit, etc.," suggested Laney.
4. Build a support network
Identify other family members, friends or health care professionals that offer you respite when needed. "It allows better balance of time as parent and caregiver," said Waichler.
"Share the load," agreed Laney. "Be realistic in a division of duties — one sibling manages the caregiver schedule, one manages communication with medical professionals, one is the liaison with the care manager, etc. Consider hiring a service to manage the finances."
5. Keep the kids involved
Provided it's kept age-appropriate, kids should be included in discussions about their grandparents' decline and how they can contribute in their own way, such as using their digital skills to play card/board games from afar, helping to prepare meals to be frozen ahead of time, etc. "Keeping them out of the information loop tends to bring about confusion and fear," warned Laney.
"Having honest conversations with the children can make a huge difference," said Jan Welsh, owner of Special Care for Older Adults LLC, in Cincinnati, Ohio. "How you handle this will help your children establish attitudes toward aging. Talk about being respectful and helping. Depending on the condition of the parent(s), there might be a way to positively involve the children in the care without disrupting the household."
6. Identify a confidant
This could be a relative, friend, chat room support group or health care professional — any person you can turn to who will be there to listen to your concerns.
7. Include yourself in the care plan
Caregivers are the worst at taking care of themselves. Create time and space for you to do something that brings you joy and consider professional help if you feel overwhelmed. "It's a tremendous transition in life to see your parents decline while at the same time enjoying the growing up of your children," said Laney. "You will benefit from having a counselor help you through the roller-coaster ride."
Taking care of your kids and aging parents at the same time can indeed be a roller-coaster ride. But it can also be a rewarding, transformative experience. "I would say all caregivers have universal moments of helplessness, grief, sadness and an inability to sleep," said Waichler. "But caregiving also causes extraordinary moments of intimacy and closeness. This was certainly my experience with my father."