The sandwich generation: Caring for aging parents while raising kids

Reduce stress by knowing where to look for help

With her mother in and out of hospitals since Tracy’s second daughter was born, and with the first still a baby, Tracy Gillick has spent much of her adult life smack in the middle of the “Sandwich Generation.”

Dorothy A. Miller, MSSW, a social worker, coined the term to describe women in their 30s and 40s acting as primary caregivers for their children and their parents.

“Adult children of the elderly, who are sandwiched between their aging parents and their own maturing children, are subjected to a great deal of stress. As the major resource and support for the elderly, this group has a need for services that is only beginning to be met by the helping professions,” Miller wrote in a paper for the National Association of Social Workers in 1981.

Though her father continues to work full-time at 76, Gillick’s mother has been housebound for 10 years. It’s been Tracy’s responsibility to shuttle her to medical appointments, deal with bills and insurance, and hire caregivers.

“You try to be everything to everybody, but somebody always gets the short stick,” Gillick said. “A lot of times it was my kids.” One time Gillick’s 16-year-old had to go to court alone for a speeding ticket because her mom had to be at the nursing home to learn how to transfer the immobile grandmother.

“You do what you have to do,” she said, “but it takes a toll on you.” For Gillick, whose mother-in-law also needed care in recent years, doing what you have to means getting up at 4 a.m.; “I can sleep when I’m dead.”

Gillick’s firsthand experience now informs her work as director of Caring Companions, a program of Easter Seals in Manchester.

“Caring Companions can go in and assist when family can’t be there, so they don’t have to worry, even if just two hours a day, or once a week,” Gillick said.

“This is a huge bonus to someone trying to care for someone else 24 hours a day. They can go shopping, see friends, get their hair done.” Clients of Caring Companions include a lot of widowed women, veterans, and some couples.

Stress on top of stress

Things are even more complicated if you have a child with special needs or chronic illness, if you’re ill, or if a parent has dementia.

Keliane Totten is vice president of community engagement at Concord Regional Visiting Nurse Association, which serves 40 communities. The CRVNA, the largest home health and hospice organization in the state, offers home care from infants to elders, and gives presentations for caregivers.

“Community health programs rotate throughout our service area,” Totten said, “so people don’t have to travel to Concord. This saves time, and makes help more accessible.”

Programs such as memory-loss support groups and the Memory Café provide an opportunity for caregivers to bring their relative with dementia. While caregivers learn about resources and enjoy peer support, the elders participate in engaging activities and socialize.

There’s a six-week program for caregivers of older adults, “which gives participants powerful, evidence-based tools,” Totten said, including resources for self-care.

There’s also a maternal/child health program for pediatric patients.

Caring Companions has four different programs for dementia care, depending on the level of care needed. They also help with people with strokes and traumatic brain injuries, and other high medical needs.

 Gillick noted that dealing with someone with dementia can be particularly challenging: “Caregivers can really come to their wits’ end and get burned out. They need help to cope.”

There are free webinars online at the Caring Companions website with tools for caregivers, but you have to contact them to get the password.

Caregiver, heal thyself

Totten said one of the hardest things for people caught between caring for a young family and elders is taking care of themselves.

Because it’s easy to get overwhelmed and neglect your own health and well-being, “self-care is very important. You need to protect your sense of self, take time to do something that brings you joy,” Totten said.

That means prioritizing and including yourself in day-to-day health care needs. Easier said than done, right?

“Being organized is extremely important, since there are only so many hours a day. Look at your time and how you’re spending it,” Totten said.

Another important thing is being willing to ask for and accept help when you need it. “Ask yourself, who might be able to help me accomplish this so I’m not overwhelmed? Asking for and accepting help is a challenge for many people, but so important.”

Can siblings do grocery shopping or pick up prescriptions? Can someone do the cleaning or the yard work?

“Take care of yourself first, or you’re not going to be good for anybody,” said Gillick. “That’s a difficult thing for people to come to grips with. They feel guilty and they shouldn’t.” It’s the “put your oxygen mask on first” analogy. She makes the gym and yoga a priority for her own well-being.

Is paid family and medical leave in our future?

The Family and Medical Leave Act is a federal law that allows eligible employees to take up to 12 weeks of unpaid leave for serious health conditions, to bond with a new child, or to prepare for military deployment. Your job is “protected,” meaning you can return to your position after the leave. The FMLA affects employers with at least 50 employees who worked at least 1,250 hours in the past year.

That means that 41 percent of the workforce is left out, and millions of Americans can’t afford to take time off without pay.

In New England, we’re ahead of the country: Connecticut offers longer leave; Vermont and Maine apply the FMLA to even smaller companies; and Rhode Island offers paid family and medical leave.

Granite State companies with at least six employees must allow eligible employees to take time off work for a disability relating to pregnancy, childbirth, or related conditions, and their jobs are protected. Also, health insurance can be continued while on leave, for the same cost. Employees may also take up to 26 weeks of unpaid leave in a year to care for a family member in the military who is injured.

Thanks to a U.S. Department of Labor grant, the state Department of Employment Security, the Carsey School of Public Policy at UNH and the New Hampshire Women’s Foundation are working as a team on research to start the conversation about what paid family and medical leave insurance might look like.

One hypothetical model has it working like insurance, with employee-paid payroll deductions as a percentage of their earnings. The median income in the Granite State is about $66,000 a year (2014). According to Kristin Smith, a family demographer at the Carsey School of Public Policy and research associate professor of sociology at UNH, the model shows that for approximately $5 per week, an average worker could possibly get up to two-thirds of their salary for a number of weeks to care for a seriously ill spouse, child or parent, or for their own extended illness.

Author J. Heymann, in Why America’s Working Families Are in Jeopardy, said paid family leave promotes family well-being, especially for children and seniors. It also lets dads get more involved, and lowers infant mortality rates.

A survey last winter shows that 82 percent of NH adults support paid family medical leave.

Mary Ellen Hettinger, APR is an award-winning reporter, editor and writer, and accredited public relations professional.