The Sandwich Generation Needs Help Now More Than Ever: Heres what We Can Do

My husband never expected to be a caregiver.

Unfortunately, hes not alone.

Like 1 out of every 10 adults in the United States, my husband is now part of a demographic called the sandwich generation adults who are raising children under the age of 18 while simultaneously caring for elderly parents.

The challenges of being sandwiched

The sandwich generation was first identified in the early 1980s as an underserved population facing unique challenges and considerable stress.

And that was long before the boomers started retiring, before life expectancy increased to todays levels, and before adults began to wait longer to settle down and start families. All of these factors have added complexity to the sandwich generations circumstances.

Journalist and eldercare advocate Carol Abaya dubbed this more intricate multi- generational interdependence the club sandwich generation.

How is sandwich generation caregiving unique?

Caregivers of the sandwich generation can experience many benefits: more time with family members, stronger intergenerational bonds, and children who see caregiving modeled by their parents and who can also take part when appropriate.

Simultaneously, theres more responsibility, greater financial burden, and, at times, devastating stress.

I just dont really ever think youre ready to parent your parents, says Erin Creighton, 40, of Wilton, Connecticut.

Creighton is the mother of two girls, ages 7 and 2, whose job as a marketing director went remote during the pandemic. She appreciated her parents choice to retire in North Carolina: It offered more opportunities to enjoy outdoor activities and to escape the tough Connecticut winters.

But when ischemia caused damage to her mothers short-term memory function, there was an unexpected and significant decline.

It was sudden it was like one day she was fine and then the next she wasnt, says Creighton. Its hard. I feel like a part of her is already gone, and there was no time to even address that. Because now we need to address her current reality.

There is this phenomenon where middle-aged people are being called upon to raise children, which you have to do anyway, but also grandchildren, and then care for parents, and sometimes grandparents. Phillip Rumrill, PhD

Addressing her mothers condition is like a second job. Creighton was worried that her mother wasnt getting the level of care that she required in North Carolina, so she moved her mothers neurological care to Connecticut, where she could help oversee it.

She attends all neurology appointments and navigates the online medical system on her parents behalf. Since her parents prefer to commute to Connecticut for appointments rather than move from North Carolina, Creighton must also spend swaths of time in North Carolina out of necessity.

I still have two little kids, and a job, and a husband, and a house here that need and deserve my attention, she says. When describing her emotional state, she doesnt mince words: Im a total mess. I dont even know what help would help me right now.

How has the pandemic impacted the sandwich generation?

COVID-19 has been an extraordinary stressor for caregivers, but especially for those in the sandwich generation, who are more prone to stress, anxiety, and depression than the general population to begin with.

Parents had extraordinary responsibility caring for children at home 24/7 while implementing school curricula, or at least overseeing their childrens engagement, says Sara Qualls, PhD, professor of aging studies and director of the Gerontology Center at the University of Colorado.

At the same time, they often were the primary source of provisions and social connection for isolated aging parents who could not venture into the community.

Once schools reopened, parents of school-aged children had to grapple with the stressful decision of sending their unvaccinated children into crowded schools or losing out on in-person education. If children returned to school, they brought home more risk to the most vulnerable, elderly family members who needed care.

For many multigenerational caregivers, that meant not seeing their elderly parents at all even while trying to provide care.

Once COVID happened, I could not go to my parents, because the kids were in school, says Divya Kumar, 45, of Jamaica Plain, Massachusetts. Kumars mother had a neurodegenerative condition that caused a slow decline and eventually took her life in May 2021.

With her parents residing over 2 hours away in Connecticut, Kumar was worried that she wasnt getting the necessary information to fully understand the reality of her mothers circumstances.

Kumars father didnt have the medical vocabulary to report back on the specifics of her mothers condition. And even though Kumars mother had been a practicing physician her entire career, her speech was deeply impacted and she became difficult to understand.

I just dont really ever think youre ready to parent your parents. Erin Creighton

When her mother first got sick, Kumar who is a licensed clinical social worker and a certified perinatal mental health professional tried to attend doctor appointments in person, but the pandemic further complicated the situation.

Not only did Kumar worry about possibly bringing COVID-19 into her mothers home by being in close proximity with her children (ages 12 and 14), but her kids schools COVID-19 precautions made visiting her parents difficult.

If Kumar went to see her parents, her whole family had to provide negative PCR results to the school before her children could return to class. At that point in the pandemic, when testing was still new, PCR results took several days to come back, which wouldve necessitated her children being out of school for many days at a time.

Kumar supported such precautions, but it was still heartbreaking. I think the hardest thing is that I wish I could have been more present for my parents and for my mother, she says.

The pandemic has hit sandwich generation caregivers especially hard, says Sarina Issenberg, LCSW, a psychotherapist in Philadelphia who runs a caregiver support group. Issenberg cites suspended services, such as adult day cares and senior centers, as well as the decreased numbers of in-home health aides due to fears of health risks for both aides and patients alike.

On the opposite end of the spectrum, similar challenges exist with child care, as record numbers of day care workers and teachers leave their professions. Sandwich generation caregivers end up feeling the pinch on both sides.

Working and not working as a sandwich generation caregiver

For many caregivers, the pandemic has also made working impossible.

Jessica Grace, 43, of Long Beach, California, had been a performer and a teaching artist prior to the pandemic. But with COVID, I couldnt really do that and be at home with my two kids, she says of why she left the workforce.

Grace had also started taking care of her in-laws who live in nearby Los Angeles after her father-in-law suffered several heart attacks and loss of vision in 2019. She supports them in numerous ways, including doing their taxes and bookkeeping, helping them with the computer, and putting up their Christmas decorations.

And those responsibilities piled on when the pandemic hit and her in-laws were essentially cut off from the outside world.

Im a really good case scenario for this being workable. But I have been completely taxed by it. Anna Haley

Its a job, but its an unpaid job, says Grace. I dont have time to do it all. Everybody needs you, and you feel like you cant just fully put yourself into what you want to do. So Im not sure when Ill have that time [] to focus on my career.

Career implications and financial repercussions for those caregivers forced to stop working are highly individualized but could very well be lasting and irreparable.

On the plus side, the pandemic has provided certain benefits for caregivers with white-collar jobs, who were afforded more time at home and more flexibility with work, as in Creightons case (the marketing director whose mom has ischemia).

Anna Haley, PhD, 52, associate professor at the Rutgers School of Social Work in New Brunswick, New Jersey, is acutely aware of the privilege of her flexible working conditions, as well as her job security and access to other resources.

Throughout the pandemic, Haley tried to support her partner in managing the care of his elderly parents and adult daughter, all of whom were in nearby New England and experiencing chronic, life threatening conditions.

Simultaneously, Haley was caring for her own children a high school senior living with her half-time in New Jersey, and a 20-year old college student in Canada, who has acute insomnia and requires significant support.

Im a really good case scenario for this being workable, says Haley, who has considerable flexibility and autonomy over her schedule. But I have been completely taxed by it.

She adds, My heart is pre-emptively broken for people who dont have this level of flexibility.

What sandwich generation caregivers can do

Caregivers kind of become whats referred to as the hidden patient, says Debbie Oberlander, LCSW, a psychotherapist in the New Jersey tri-state area who runs a support group for caregivers.

The physical and emotional toll that they suffer really gets overlooked because theyre so focused on whom theyre identifying as needy.

So, how can sandwich generation caregivers get the help they need? The mental health professionals weve spoken to offer the following suggestions for those who arent sure where to start.

1. Prioritize self-care

Caregivers often lack the time to seek out self-care or to figure out where to fit it into their very busy schedules. Yet, without it, the spinning plates will crash, says Qualls.

Oberlander agrees. While youre deserving [of self-care] even just for yourself, in fact, you are really doing it for your loved one, for whom you are taking care, she says.

Thankfully, many resources have emerged online to provide support and services that, pre-pandemic, required in-person visits. Qualls points to online resilience training courses, apps for meditation, and telehealth therapy.

2. Dont underestimate the benefits of therapy and support groups

Oberlander also suggests that, if caregivers are feeling overwhelmed, counseling can help them figure out how to prioritize whats necessary, and what might be deprioritized. A support group or therapist who understands and can empathize with the caregiver experience can also be beneficial.

People need to know that they are being heard, that they are being recognized, says Paul Cohen, LCSW, a psychotherapist who counsels sandwich generation couples. Support is sacrosanct, he says.

3. Build a support network

You need a team, confirms Donna Benton, PhD, associate professor of gerontology at the University of Southern California and director of the USC Family Caregiver Support Center. Thats going to help you.

She suggests that the support team doesnt need to be immediate family: It can be friends, physicians, neighbors, religious leaders or even the local grocer!

4. Ask for help, ask for help, ask for help

Ask family and friends for assistance and support, says Oberlander, who emphasizes being specific. People arent mind-readers, and we shouldnt assume that somebody knows what you need.

If caregivers dont know where to begin to ask for help, Benton recommends creating an I wish list. Any time that you are feeling frustrated and you think to yourself, Oh, I just wish somebody could make me a meal, or I just wish somebody could have taken mom to this appointment, write down that specific thing.

Then, when someone offers help, or when you need to ask for help, you can pull out your list and pick an item.

5. Take breaks, physically and mentally

Benton advises that mental breaks help caregivers build resilience, and suggests activities such as meditation and yoga, which actively calm the mind.

Even in the shower or when walking the dog, Benton suggests that caregivers try to actively be in the moment rather than thinking about caregiving or other stressors. Issenberg offers a similar prescription: Take a break. A lot of them and regularly.

6. Take advantage of resources for caregivers

There are numerous external resources and government programs that can be incredibly helpful, such asthe USC Family Caregiver Support Center that Benton directs.

We provide comprehensive services for family caregivers, and what that entails is coming up with individualized care plans for the family caregivers. The services offered include legal help, emotional support groups, and more, and theyre all available at low or no cost.

Caregiver and eldercare resources vary by state and municipality, so caregivers should research or even cold call their local agency. Rumrill suggests sourcing a geriatric social worker via the local agency, who can help guide the caregivers family through the available services and benefits. They can do as little or as much as you and your family needs, says Rumrill.

What each family needs is undoubtedly unique, which is what makes sandwich generation caregiving so complex and challenging.

As I consider my husbands circumstances and the advice from all of the experts to sandwich generation caregivers, I can hear him downstairs preparing a birthday dinner for my family. He still needs to call his father. He hasnt exercised or showered. And so many other things on the list.

Support is sacrosanct. Its time for me to close my laptop and to give him a much-needed break. Lots of them. And regularly.

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