Stuck in the Middle with You

The new rules of the "sandwich generation" can mean making decisions for your aging parents and meeting new demands on your time.

From the WebMD Archives

If you’re caring for an elderly parent -- or parents -- and your own children at the same time, you’re probably overwhelmed, overworked, overscheduled, and exhausted. You’re also part of a growing cultural phenomenonknown asthe “sandwich generation.”

As today’s parents have children later in life, it often means that their childrearing and other family responsibilities collide head-on with the growing needs of aging parents.

According to the American Association of Retired Persons (AARP), 44% of Americans between the ages of 45 and 55 are “sandwiched” between aging parents or in-laws, and their own children under the age of 21. Most of them have both elder care responsibilities and children still living at home.

If you’re part of the sandwich generation, how do you cope? The good news: It can be done. In fact, the AARP survey finds that 87% of sandwich generation adults are either "very satisfied" or "somewhat satisfied" with their lives. Few -- just 4% -- regard their “sandwich” families as a burden, and two out of three believe they’ve done better at caring for their parents than their parents would have expected.

The bad news: Almost half still worry that they should be doing more.

But whether you’re solidly in the middle of the “sandwich” trying to cope, or looking down the road at decisions that loom ahead, there are steps you can take now to avoid being torn between competing demands. The first step, experts say, is to be researching, asking questions and laying the groundwork for what’s to come.

Planning Ahead

Caring for an elderly parent is never easy -- emotionally, financially or logistically. But it’s infinitely harder when you are forced to react to emergencies without advance notice. Too many families don’t talk about things like power of attorney, living wills, advance directives and who should live where -- until a crisis hits.

“The elderly do not plan for getting old. They often don’t have anyone who can handle their finances and make medical decisions for them,” says Carol Abaya, founder and publisher of the elder care web site, The Sandwich Generation (www.sandwichgeneration.com). Abaya was faced with just such a situation when her father died and she began caring for her mother. “I had no legal authority to do anything for her, yet I had to take over her business and running her finances.”

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“It’s so much easier to have these discussions before there is a consequence. It’s easier to talk about health when everybody’s healthy,” says Barbara Friesner, a generational coach and the founder of AgeWise Living (www.agewiseliving.com). “Then you can start working things out, so that they are fair and livable for everyone.”

There are several separate documents that will make it much easier for you to act on your aging parents’ behalf when taking care of them:

  • A durable power of attorney, authorizing someone to sign checks, pay bills and make financial decisions on their behalf.
  • A durable power of attorney for health care, authorizing someone to make medical decisions.
  • A living will.

The National Hospice and Palliative Care Organization offers free advanced care and financial planning resources online at http://www.caringinfo.org.

It’s not an easy thing to bring up, admits Carol Bradley Bursack, author of Minding Our Elders: Caregivers Share Their Personal Stories. “It can sound like you’re waiting for them to die. But you can try leading into it by talking about yourself: ‘You know, I’m only 35, but I could be in a car accident or something. I’m going to fill out a living will.’”

Another important issue to explore with your aging parents, before there’s a need: long-term care insurance. According to the AARP, about 12 million elderly people will need long-term care by 2020, but only about 30% of people over 45 have long-term care insurance.

Less than a quarter of people surveyed came within a reasonable estimate of the annual cost of assisted living; they were even more off base when it came to the costs of nursing homes. The average monthly cost of long-term care for older people with chronic conditions and disabilities is about $3000 (as of summer 2007). A good place to start when looking into long-term care insurance is on the Medicare web site: http://www.medicare.gov/LongTermCare/Static/LTCInsurance.asp?dest=NAV%7CPaying%7CPrivateInsurance.

A Place for Mom or Dad

Make sure that when you talk over the future with your parents, you include a frank, open discussion of future living arrangements. One of the biggest conundrums for sandwich generation adults caring for aging parents is the question of where parents should live. In their own homes? With their children? In an assisted living facility or nursing home? Each choice comes with costs -- emotional and financial -- and trade-offs.

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Ideally, most seniors would like to stay in their own homes as long as they can. How do you know if that’s realistic? “Make an objective evaluation of what the parent can do for herself and what she needs help with,” says Abaya. “She needs to be able to bathe, get dressed, cook, go shopping -- all the normal activities of daily living. Identify the areas where help is needed, and then assess what resources you can bring into the home to help her stay there.”

Those resources can include other family members, neighbors, friends, church and community organizations, and in-home aides. The Eldercare Locator (http://www.eldercare.gov), a service of the U.S. Administration on Aging, can help you find caregivers in your area.

For most modern families, moving mom or dad into your house should be a last resort, says Abaya -- and even then, only if there's space for them to have some private area of their own. But according to Susan Ito, a writer in the San Francisco Bay Area whose “Life in the Sandwich” column in the online magazine Literary Mama chronicles life with her 84-year-old mother, husband and two daughters, “sandwich” living can have its pluses. For example, her mother’s need for a schedule has had a calming influence on the whole family, Ito says.

“As a family, it’s actually been really good. We used to be chaotic about who ate when, but she needs the routine of regular meals, so we have nice family dinners,” Ito says. “There’s much more of a feeling of what it means to be a family.”

Family Triage

Bursack calls the constant juggling act of caring for spouse, parents, kids and job “family triage.” “You figure out who needs the most care, when and how, and take it off in chunks," she says. "It can be very hard: trying to be really productive at a job when you have hospice on one line and a customer on the other.”

What most caregivers forget to do, she says, is put themselves in the equation. “You have to drop the guilt and realize that you are as important as the people you’re taking care of. Be mindful when you take on another job for yourself. Don’t shove your own needs under the rug. Delegate, delegate, delegate!”

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Friesner recommends that every family caregiver squeeze out a small amount of time for her or himself every day, no matter what. “Whether it’s a bath every night where no one disturbs you, a walk in the morning where you don’t take your cell phone, or even 20 minutes at night on an online support board, you need time for you.”

Find daily activities that can keep seniors busy. Ito’s mother, who is in the early stages of dementia, attends a quilting class, a bowling league, and volunteers at her granddaughter’s school. “There’s a routine, a schedule that she can rely on,” Ito says.

Just as you organize your work, organize the process of caring for your elderly parent. “We may find ourselves bogged down taking our parents to the doctor. As they develop more and more conditions and go to more and more doctors, you’re taking off work every other day,” says Friesner. “Instead, make Wednesday ‘doctor day’: you’ll take off work that day only, and maybe you’ll have time for lunch with your parent as well. Make sure it’s not all responsibility and no relationship.”

The juggling act can be easier if you learn specific skills. “If your parent has Alzheimer’s, go to the Alzheimer’s Association. If your parent has arthritis, go to an arthritis association,” says Bradley Bursack. “These organizations have done so much research, they can teach you the skills you need. It’s not always intuitive -- love and dedication are important, but they may not be enough.” She catalogs a host of resources on her web site at MindingOurElders.com.

Tune in to the Rest of the Family

What about the other half of the sandwich -- your kids and spouse? In all the caregiving for elderly parents, you may worry that you’re neglecting the rest of the family.

“Kids have to be educated the same way as adults do,” says Abaya. “But they understand more and better than we give them credit for.” At one program, Abaya heard from a woman whose 10-year-old daughter was constantly fighting with her grandmother because the grandmother, who had Alzheimer’s, would accuse her of stealing clothes.

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“Before I could answer, a woman in the back of the room raised her hand and said, ‘I have the same problem.’ Her mother was accusing her son of stealing food. So she sat down with him and explained what Alzheimer’s was and what was going on in his grandmother’s brain, that she was sick and didn’t know what she was saying,” Abaya recalls. “The next time she accused him, he gently took her into the kitchen and opened the refrigerator door, saying, ‘Grandma, here’s all your food.’ Very simply, he defused the situation. If kids understand what’s going on, they can be very insightful and very helpful."

Last but not least, try not to neglect time with your partner. Private time together may seem like something that has to go by the wayside in the face of more urgent demands, but research shows that sandwich generation couples who make time for each other cope with the other stressors of their lives much better.

“The relationship that really seems to matter is the one with your spouse,” says Margaret Neal, PhD, director of the Institute on Aging at Portland State University, who surveyed over 300 sandwich-generation families nationwide for a book on working couples caring for children and aging parents. “It’s what many families say gets them through the tough times, so don’t neglect to nurture that relationship.”

WebMD Feature Reviewed by Jonathan L Gelfand, MD on July 01, 2007

Sources

SOURCES: American Association of Retired Persons (AARP). Carol Abaya, syndicated columnist, "The Sandwich Generation"; web site publisher, TheSandwichGeneration.com. Carol Bradley Bursack, founder, MindingOurElders.com; author, Minding Our Elders, McCleery & Sons Publishing, 2005. National Hospice and Palliative Care Association. Centers for Medicare and Medicaid Services. Barbara Friesner, founder, AgeWiseLiving.com. U.S. Administration on Aging. Susan Ito, columnist, "Life in the Sandwich." Margaret Neal, PhD, director, Institute on Aging, Portland State University, Portland, OR.

© 2007 WebMD, Inc. All rights reserved.

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