September/October 2002

Caught in the Middle:
The Sandwich Generation

by Lettie Kirkpatrick

Although it's true that Americans are consuming fast food at an unprecedented rate, the Sandwich Generation is not about hamburgers. It's about the largest growing segment of caregivers in the nation. It's about the Baby Boomers, born between l946 and l964, who are "sandwiched" in the middle of care for children and care for aging or sick parents.

Of the 22.4 million Americans caring for aging parents, 22 percent of them are also caring for children. It is estimated thatthese families will spend l7 years caring for their children and l8 years meeting the needs of their parents.

The result is a uniquely intergenerational family mix that brings with it lifestyle complications of major proportions. A brief look at some of those affected puts real faces in the pictures.

Picture the People

· Wendy and Andrew are slightly younger than many who find themselves sandwiched, but their circumstances may be even more dramatic. Their intergenerational unit includes five generations. They returned from an overseasassignment in time for Wendy to give birth to twin girls. At the same time, Wendy's mom (who was in turn responsible for her aged mother, Wendy's grandmother), had a stroke. They also brought a struggling teenage niece with special needs into their home. And they have since added a young son to this mix.

Although they are now divided into two households, Wendy and her sister still bear primary responsibility for maintenance care in the way of grocery buying, errands, medical appointments, prescription fulfillment and transportation. Wendy's dilemma? "I struggle to find balance between caring for Grandma and my mother and trying to incorporate their care without losing our own family in the process."

· Judy represents the multitude of members of the Sandwich Generation being pulled between the needs of a parent living miles away and a job and young children at home. Her dad had a stroke, but can remain at home if someone monitors his care.

Although a brother lives closer to their father, he isn't very helpful. Judy agonizes. "My brother wants to stick my dad in a nursing home. My dad is nowhere near needing a nursing home at this stage.... If I lived there, I could dash over and help them take out trash or watch Dad so Martha (his caregiver) could spend a day out or have them over. So I'm really torn and frustrated."

· Diane's family is watching her dad fight cancer. Thankfully, her mom is able to care for him, and her siblings are nearby. So they take turns driving him for treatments, consulting the doctors and offering constant moral support. But, for her, these responsibilities are sandwiched between the demands of a full-time job, her nine-year-old's sports pursuits, a graduating senior and a married daughter.

It would be easy to look at the hard circumstances of these sandwiched families and know they could feel hopeless, angry and even victimized. Let's acknowledge some of the dilemmas and consider options and resources for Christian families who find themselves caught in the middle of caregiving responsibilities.

Biblical Directives

There are certainly biblical instructions that point us to compassionate care for aging or needy parents. The most familiar is Exodus 20:l2, which calls on children to "Honor your father and your mother, so that you may live long in the land the Lord your God is giving you."

But two New Testament passages also speak specifically to caring for our family members. In 1 Timothy 5:4, Paul indicates that "If a widow has children or grandchildren, these should learn first of all to put their religion into practice by caring for their own family and so repaying their parents and grandparents, for this is pleasing to God." And, on a harsher note, in 1 Timothy 5:8 Paul declares that "If anyone does not provide for his relatives and especially for his immediate family, he has denied the faith and is worse than an unbeliever."

However, even while acknowledging our responsibility and opportunity to offer care and provision, meeting these needs may take many forms. Choices and conflicts abound.

Considerations in Caregiving

· Type Of Care

Decisions must be made about the care environment. Options usually include:

At-home care with some assistance.

At-home with live-in care or outside day-care arrangements.

A move to the caregiver's home.

A move to a smaller, more easily monitored environment.

Assisted living in a residential facility.

Full-time care in a nursing home setting.

Any of these solutions may prove acceptable for some circumstances. There are no magic formulas when caring for relatives.

· Primary Caregiver

Someone must carry primary responsibility for decision making and contact purposes. This does not mean shouldering the load alone. Ideally, delegating duties to siblings, spouses and even older children can distribute the care.

· Sibling Involvement

When siblings are available and willing, family meetings are an ideal way to set up a fair care system. Undeniably, there are frequently conflicts and derelict siblings, but many do participate in division of responsibility.

· Communication With Care Recipient

As often as possible, include care recipients in choices regarding their care. Sandwich Generation Magazine indicates that "The worst thing sandwich generationers can do is to move into a parent's life like a bull in a china shop and take over everythingwhatever is done and whatever decisions are made must be done with the parent."

· Considering The Children

Judy isn't willing to move closer to her dad yet because her teenager wants to graduate with her class. They have already made one move in her daughter's teen years.

Wendy knows that meeting the needs of her mother, grandmother and niece has sometimes denied her children the routine and structure they need.

On the other hand, children learn great lessons in compassion and selflessness as they see their parents extend nurture and support to others.

· Spouse Involvement

Marriages can easily get lost in the time crunch of multiple responsibilities. Lack of precious time for each other, combined with infrequent communication can contribute to resentment and misunderstanding. Yet a spouse can also be a lifesaver in coming alongside a primary caregiver.

Wendy sees Andrew's most helpful roles as those of "listener, child care helper and home maintenance provider." They know team effort is necessary for their family to flourish during this time of their lives.

· Survival For Caregivers

The health of families caught in the middle in the Sandwich Generation is highly influenced by the emotional, physical and spiritual strength of the primary caregiver. For this reason, increasing attention must be focused on a support system for them. If you are a primary caregiver, consider these tips:

LET go of the guilt. Most caregivers do indeed feel "sandwiched," because they want to excel at meeting everyone's needs. Acknowledge the impossibility of the task and guard against guilt.

LOOK after yourself. Self-care means finding a way to have free time, eating well, getting some physical exercise and participating in an activity that brings energy and joy.

LET others share the load. Share with immediate family what your specific needs are. Whether it's help with meals, yard work, repair needs, financial assistance or an afternoon off, others can help. Take the initiative in locating support groups and resources that can offer encouragement, information and assistance such as respite care (see resource sidebar pg. 19).

LOOK for the blessings (and the smiles). Humor and a positive attitude go a long way toward emotional survival in difficult days. My grandmother lived in our home for three years. Her hearing difficulties often provided some hilarious moments. She once told our pastor that we had taken our children to see Cat on a Hot Tin Roof! We had actually been to an outdoor production of Fiddler on the Roof!

LET God love you all. Sometimes surrender of your circumstances can bring real victory. When Pat was sandwiched between her mom's Alzheimer's disease and her three young children, she remembers, "I quit resenting the interruptions and accepted my circumstances. At some point I ceased striving so much and began resting in God. At some point I began to trust his sufficiency for my life and the lives of Mother and Daddy and for the lives of my husband and three children as well."

Pat's own long journey has ended. But her wise words offer a great deal of hope to those still "caught in the middle":

"I believe with all my heart that after time and seasons are no more, eternity will prove that the challenging trial of sandwiching the care of parents at the same time as meeting the needs of a young family was what really made us a family, after all, and continues to conform my children, my husband and me into the image of Christ. So... I suppose I would have to say that two decades of caring for my mother with Alzheimer's disease was a gift."

Lettie Kirkpatrick has been published in numerous publications and lives in Cleveland, Tennessee.

Pointers for Parenting our Parents Speaker Grace Chavis cared for her mother-in-law and her parents in the last years of their lives. She offers pointers for those in the role of caregiver for their elderly family members. · Allow them to be independent as long as possible. Wait until they are ready to move, or it is imperative. · Give them private space wherever they live. · Give them responsibilities. There is a dignity to contribution. Ms. Chavis' parents washed dishes. My grandmother treated us to a meal out and prepared simple meals for herself. She also gave my children lots of hugs! · Give them patient, loving care. · Accept conflicts as normal -- they will happen. · Accept role reversal (parenting your parent). · Be willing to relinquish them when death beckons. · Give them your prayers. One daughter writes about praying for her mom: "I wake at night and ask God for one more day of grace that will enable Mom to feed and care for this child-man Dad has become. She needs the strength and courage only God can give." I would also add: · Give them hugs! Physical touch is a desperate need for our seniors. David Oliver states that "A kind touch transmitted through the holding of knowing and understanding hands can often be a sufficient expression that God still loves us."

Challenges and Stresses of the Sandwich Generation Career: Those in mid-life are usually at the peak of their careers with greater demands and responsibilities. The male/female ratio has changed dramatically. Seventy-five percent of family care was provided by women in the past. A new survey shows that the split is now more even: 56 percent female, 44 percent male. Older Parents Mean Older Grandparents: People are living longer today and are waiting longer to marry and have children. In turn, their parents become grandparents later in life and due to failing health, may be more of a hindrance than a help in dealing with their grandchildren. Aging Parents: Work/Family Directions Inc., a Boston-based consulting firm, estimates 22 percent of the American population has eldercare responsibilities while raising their own families. Young Adults: More children are living at home while attending college because of the high cost of education or returning home because of the difficulty of handling financial responsibilities on their own. Raising Grandchildren: Due to divorce and single parenting, more parents find themselves raising their grandchildren, while they have to care for their aging parents. Financial: Forty-three percent of the caregiving families has an annual household income of under $30,000. Americans are incurring debt at a rate that is 4 1/2 times greater than their savings rate. With Social Security and pension plan difficulties, baby boomers will need to be more responsible for financing their retirement. But just as they need to be saving for retirement, they may be faced with financing their child's education, at the same time they are helping their aging parents. Physical: Having full-time jobs while caring for their aging parents, their own children still at home or who have returned home and not taking care of themselves cause many caregivers to become sick themselves and suffer from exhaustion or "burn-out." Emotional: Many suffer guilt when they can't meet the needs and/or demands of parents, spouses, children and responsibilities at work. -- PT Editors

Resources for Families ORGANIZATIONS: National Family Caregivers Association (NFCA) l0400 Connecticut Avenue, Suite 500 Kensington, MD 20895-3944 l-800-896-3650 E-mail: Info@nfcacares.org Website: www.nfcacares.org   The Center For Family Caregivers P.O. Box 224 Park Ridge, IL 60068 l-847-823-0639 E-mail: denise@familycaregivers.org Website: www.familycaregivers.org   Children Of Aging Parents l-800-227-7294 BOOKS: My Turn to Care by Marlene Bagnull Thomas Nelson Publishers, l994   Aging is a Family Affair by Doug Manning In-Sight Books, Inc.   Caring for the Caregiver by Gary L. Harbaugh Alban Institute PERIODICALS: Celebrate Life American Life League P.O. Box l350 Stafford, VA 22555-9986   Mature LIving Lifeway Christian Resources l27 Ninth Avenue North Nashville, TN 37234-0ll3 E-mail: Matureliving@lifeway.com   The Sandwich Generation (online) Carol Abaya Website: Sandwchgen@aol.com   Caregiving (newsletter) Lifeway Christian Resources l27 Ninth Avenue North Nashville, TN 37234   Caregiving (newsletter) (See The Center For Family Caregivers) Website: www.caregiving.com

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