Most of us don’t reflect on the challenges of the “Sandwich generation” until we receive the phone call which sounds something like this: “We have your mother here in the ER with a broken hip and she’s asking for you.” It’s the middle of the night, your children are asleep and as you awaken, you are simultaneously thinking of racing to the hospital to be with a frightened, sick parent and wondering how you will arrange for the children to get to school in the morning.  This is a moment universally dreaded.  Yet, as we explore the responsibilities of stress inherently connected to this time of life, moments of gear intimacy, compassion and opportunity are revealed.
The Sandwich Generation traditionally refers to people in middle adulthood who have commitments both to help their children mature into and/or thru adulthood and to help their elderly parents as they deal with issues of later life.  Carol Abaya, a journalist and expert in this field, coined the term “Club Sandwich”-meaning those in their 50’s or 60’s, sandwiched between aging parents, adult children and grandchildren OR those in their 30’s and 40’s, with young children, aging parents and grandparents.  Whichever kid of sandwich you are, the challenge is to understand the needs and feelings of your particular family, educated yourselves about the issues, and develop a practical plan.  It sounds daunting and in fact it is!
Back to the story line, SCENE2: Mom has had surgery to pin her fractured hip, has put in her 90 days in rehab and is now back in her home with out-patient physical therapy, nursing, social work and a home health aide for a few hours daily.  In a few weeks these services will be completed.  What’s the plan? Who will do the shopping and cooking, manage medical appointments and medication, oversee social activities,  transportation, etc?  By the way, what is the status of mom’s finances? Does she have a durable power of attorney, health care proxy or health directive? These are most likely issues not yet addressed.  It’s now time to talk to mom.
Meanwhile, mom is worried and upset about her unsteady gait, feels intermittent pain, has difficulty keeping her thoughts in order, is irritable and depressed at times and is fearful about the future. The trouble is she’s not admitting to any of the above.  “Thanks dear but I don’t need your help. Really, I ‘m doing fine.” In fact, she’s probably having difficulty with the most simple of tasks-opening a jar, washing her hair, answering the door.  You probably realize exactly what is going on, and that lonely realization becomes one of the first dilemmas for the sandwich generation to address. On the one hand parents want to maintain their independence and identity as strong and healthy people.  They often deny their vulnerability in an effort to resist becoming a burden to their children.  Their behavior may become argumentative and stubborn.  On the other hand, some parents, in an effort to maintain their former level of independence, become overly demanding and dependent, blurring the boundaries between parent and their adult-child.
The Sandwich Generation is not the parent of the parent. This role is typically thrust upon us and not well understood or rehearsed.  The Sandwich Generation is now challenged to manage their own desires to provide the best care for loved ones, establish boundaries and manage personal feelings.  The conversation may begin with a complaint to a friend that the children are fighting constantly and you’ve been arguing with your husband.  It may not be obvious to you how deeply you’ve been struggling.  It may not be obvious to you that rushing to help mom get dressed after you get the children to school and then rushing back when she needs to you to pick up a new prescription has been wearing you down both emotionally and physically.
Your new, complicated role will have reverberations within your own family.  Multi-generational responsibilities can increase the vulnerability of one’s marriage.  In our fast paced and multi-tasking world, it is often the case that we’re all stretched far too thin.  Having open and honest conversations with a spouse will enrich a relationship by revealing intimate thoughts, feelings, memories and stories of family caregiving.  These conversations can strengthen a marriage by uniting parents in a problem solving venture: How do I share my time between my children/family and elders?  Where do I draw the boundaries in each caregiving role? How do I cope with feelings of isolation and guilt for feeling like there is never enough being accomplished? How do I find the resources needed to provide care? And very importantly, how do I find the time to ensure my own well-being?  Conversations with children can be equally enriching.  As our children see us care for parents and be caring in this new role, they have a MODEL for handling responsibility.  They see us in this new role and begin to realize that we are not only their mom or dad but a helper to others.  They learn to advocate for their needs:  “You can drive grandma to their doctor but I need you to help me with my science project before dinner!”  They may even help us problem-solve:  “I think you need to get someone else to drive grandma”.  This teaming-up with our family is in itself a rewarding model.
SCENE 3: COMMUNICATION with mom. The Sandwich Generation knows that there is time to hire help in the home, install rails in the shower and provide private transportation to medical appointments and book club meetings.  Mom is sure that although unsteady, she is safe alone at home and can’t afford the added expenses.  She doesn’t realize she’s arrived at the rainy day and in fact it’s pouring!  For most of us admitting to depression, dependence, confusion, anger about loss, and fear of the future is not welcome.  But chances are, mom is feeling some, if not all of the above.  On top of this she may be resentful of your new role as child/parent.  Navigating these stormy waters and establishing a respectful dialogue will depend on openness, flexibility and remaining positive.  As with a marriage and children, hopefully it will be possible to ride the rapids together, and during the journey become more intimate.
Question:
My dad had a stroke four months ago and is now living in his own home with daily assistant from a home health aide.  He has become very demanding of my time and gets angry with me easily. This is a big change and it’s troubling me deeply.  We’ve always been close and I would like to keep it this way.  At the same time I have 3 sons who expect me to continue coaching soccer and a wife who is feeling neglected.  How do I do it all without feeling so guilty and frustrated?
Answer:
There are several important issues which you have raised.  First of all your dad’s stroke may have affected not only his physical status but his cognitive and emotional capabilities as well.  A lowered frustration threshold, impulsivity and easily triggered anger are sometimes associated with neurological changes caused by a stroke.  Conferring with his neurologist may be helpful to both your dad and yourself in understanding these changes.  Open and honest conversations will be extremely helpful in identifying subtle personality changes and ways in which to work with them.
Another issue is taking a look at your support system and finding ways to take pressure off yourself and your young family.  For example, extended family or siblings who live far away may be unable to visit and assist frequently but may be able to plan scheduled visits, provide respite for you, manage finances and/or provide daily telephone support to your father.  He will begin to see that support can come from many sources and loosen his tight grip on you.
A critical issue is your well being both physically and emotionally.  Especially during times of stress, maintaining personal schedules for exercise, rest and play are key to coping with increased responsibilities.  The Sandwich Generation labors feverishly to manage family and professional demands but often struggles to provide the same attention to personal needs and feelings.  The guilt and frustration that you mention are certainly common feelings for the Sandwich Generation, but containing and coping effectively with them is crucial.  This may be an appropriate time to consider adding counseling to your professional support group.
Question:
Several months ago my elderly father called me in a confused and disoriented state.  He had recent surgery for colon cancer so I assumed it was related to that.  Unfortunately this is not the case.  Although he has many clear moments, my dad is increasingly unable to manage himself in his home both physically and mentally.  He refuses to leave and I am unsure how to proceed.
Answer:
Most senior citizens have strong attachments to their homes and communities.  It is not only their memories but connections to neighbors, shopkeepers, religious institutions, nearby friends, recreation, etc.  Giving up those bonds means giving up many important and long term relationships as well as relied upon daily routines.  Seniors instinctively understand the meaning and value of these connections and cling to them, often beyond their ability to manage independently.  The Sandwich generation learns quickly that parents easily trade the security and safety of a supervised setting for the comfort, familiarity and sense of well being of home.  This can be a great source of concern and worry.  Yet your father’s wish to remain in his home is understandable and a thorough assessment of his abilities and needs is a first step in this decision making progress.  Engaging his neurologist and other doctors who know him well in this conversation will be helpful, as will assessments from his homecare team and social worker. The second step is to visit assisted living facilities as well as nursing homes which offer progressive levels of care.  Both routinely offer dementia units. You may want to make the initial contacts yourself and later bring your father if a facility appears to be a possible good fit.  It is important that your father is involved in the dialogues concerning his plans, that he is helped to accept his limitations, and that the legitimacy of his dilemma be acknowledged.  His participation in the process, to the extent of his mental capabilities, will help ensure the best possible plan is put in place.  Plan A may work for a few months or a few years.  Stay on your toes and be flexible!
Lynn Evansohn, L.C.S.W. Email: Lynn718@aol.com