By Amy Yelin
March 28, 2015: I’m standing in the Durham, North Carolina airport, I-Phone in hand. I’m about to call my 87-year-old father to tell him that I’ve landed safely. It’s been more than a year since I’ve seen him. Usually he and his wife fly up for Thanksgiving, but this year, with both of them not feeling well, they didn’t. And while I’d thought about flying down sooner, I was either too busy or too financially strapped or perhaps simply too nervous about what I’d find when I arrived to follow through.
On our phone calls the last few months, I’d noticed my dad repeating himself much more than usual. This call from the airport would be no different. When he answers, I tell him I’ve landed. Moments later he asks, “What time is your flight taking off?”
“No, I just landed,” I repeat. “I’m about to get in a cab and come to your house.”
“Ah…” he says. “How was the flight?”
“Fine,” I say. “Real quick. Nice, big plane.”
A few minutes later, he asks, again, “So is your flight taking off soon?”
“I’m here, remember?”
“Ah, that’s right,” he says. He laughs at himself. His voice perks up. “I’ll see you soon then!”
“Are you sure you need to go?” my husband had asked when I told him about my impending trip. “I mean, is it really that bad? Or is he just forgetting a few things here and there?”
“I’m not sure,” I said “Which is why I’m going.”
My seven-year-old son overheard our conversation and reminded me of his concert on Friday. “I’m sorry buddy,” I said, “That’s when I’m flying out. I’m going to have to miss this one.”
“Don’t go mama,” he said, hugging me.
“But I need to check on grandpa.” He hugs me tighter and says, “Ok.”
That Friday, as I sit on the airplane, I imagine my son singing “If I had a hammer” with his second grade class. No doubt, if I were there, I’d be crying—children singing always make me cry—and just imagining the scene makes me teary-eyed on the plane. Then I think of my father, and my stomach clenches. Is he OK? And that’s when it dawns on me: I’m smack in the middle of the sandwich.
The Sandwich: What is it? A Brief History
What does the term Sandwich Generation even mean? It’s not a true “generation”—like Millenials, or Generation X, or Boomers. The term first emerged in the 1980’s, courtesy of a woman named Dorothy Miller, who published a paper titled, “The Sandwich Generation: Adult children of the aging.” The moniker stuck and made it into the dictionary in 2006.
A 2013 Pew Research Center study defines the ‘Sandwich Generation’ of today as those who have a living parent age 65 or older and are either raising a child under age 18, or supporting a grown child. Today, 71 percent of the sandwiched population is between the ages of 40 to 59 years old and, according to a 2012 AARP Florida study, there are a lot of us: approximately 20 million.
As the Pew report notes, we are a people “pulled in many directions.” Tugging at our financial, emotional and time-crunched strings are our children, our jobs, and our aging parents.
Curious if it’s always been this way, I contacted Stephanie Coontz, director of research and public education for the Council on Contemporary Families.
“This kind of sandwich situation has really only been around since women entered the workforce,” explained Coontz. “Before that you might have had people “sandwiched” in the sense that they were three generations living together under one roof -for example, in colonial times. But people didn’t live as long then and women didn’t work outside the home, so it’s different than today’s situation.”
After the turn of the 20th century, the number of extended families living together went down, dropping dramatically by the 1940’s and 50’s. Coontz references a best-selling advice book during that era, penned by a psychiatrist, that posed the question are you an old fashioned mom, or a modern mother? “Old-fashioned moms were too interfering in their kids’ lives. Old-fashioned moms kept extended families in the home,” said Coontz. “So you saw more and more people putting their parents in the new modern assisted living facilities that were cropping up in the 1950’s…and they weren’t ashamed to do so. And you also saw moms staying out of their kids’ lives.”
As she talks, I know exactly what she means. In the forties and fifties, as we all know from movies, kids just picked up games in the streets. There was no societal pressure to watch your kid every second, or help them with everything
Coontz adds, “Today’s parents feel pressured not only to stay economically and educationally competitive, but also to sign their kids up for more enrichment activities and spend more quality time with them. Add to that the fact that today’s sandwiched parents are also in the prime of their work lives and may have aging parents to take care of on top everything else and it can feel like a real pressure cooker.”
Or if we’re sticking with the sandwich metaphor, she offers, “like a Pressed Panini.”
When I get off the phone with her, my older son is standing in front of me holding my car keys and a baseball glove in his hand. “We’re five minutes late for baseball practice!” he says.
I’m tempted to tell him to pick up a game of stickball in the street, but instead I smile and apologize. A minute later, we’re running out the door.
Lucy’s Pressed Panini: It Takes a Village
Forty-five year old Lucy Van Beeber remembers her father and son playing light sabers together. It was during the period her dad was first diagnosed with bladder cancer, in 2008; also the same year her second child, daughter, Bianca was born.
“My father was grouchy a lot then,” recalls Lucy. “He had had his bladder removed and he had an ostomy bag and he wasn’t adjusting well. So there we were with the kids, visiting and my four-old son Marco just wanted to play with grandpa. He wanted to play light sabers, and so I found these wrapping paper tubes that they could use. And they played together.”
It’s a memory Lucy treasures.
Tragically, Lucy’s father’s cancer would metastasize. Throughout much of 2009 she drove back and forth from her home in Somerville, Massachusetts to her parents home in New Jersey—a four-and-a-half stressful trek each way.
“My kids have known their whole lives that my attention is divided,” says Lucy. “It’s just always been that way.”
In 2010, as her father was dying, Lucy’s mother was diagnosed with breast cancer. After her mother also became ill, Lucy was hardly ever home. Her husband took on the role of the primary caregiver to the children, then ages two-and-a-half and six.
On April 21st, 2010, Lucy’s mother had a mastectomy. Thirteen days later, on May 3rd, her father passed away.
When talking about the experience, Lucy pauses here for a moment. “That was a really tough time,” she says. “Caring for two sick parents and being away from my husband and kids. And after my father died, it was time to do everything for my mom, who had just lost her husband and her right breast. It was really hard.”
Carol Abaya, M.A., is a sandwich generation guru. She even owns the URL sandwichgeneration.com. Her personal story about caring for her aging parents was featured in a New York Times article in 1999. For the past 25 years, she has used her personal expertise gained from caring for her aging parents to help others in the same boat. Although she’s semi-retired now, she still gets calls from people all over the country with questions about how to make decisions for their parents.
Abaya is adamant about a few things -one of them being: people in the sandwich generation cannot do this caregiving thing alone. When I spoke with her on the phone, she emphasized the importance of sharing responsibilities and asking for help.
Abaya is adamant about a few things-one of them being: people in the sandwich generation cannot do this caregiving thing alone.
“It’s just like when you’re raising young kids,” she says, “and you’re organizing play dates, and carpools and you and the other parents share chores. Well, this is what you need to do with your siblings, if you have them. Split up the chores; have meetings and communicate, even if by phone. Too many times I’ve seen one sibling try to take on everything and not ask for help. And then she ends up getting sick herself.”
Studies support this advice. In her recently published book The Age of Dignity: Preparing for the Elder Boom in a Changing America, author Ai Jen Poo cites a JAMA article showing that “family caregivers, especially those who must balance jobs with unpaid caregiving, are likely to neglect themselves to the detriment of their health. Sleep deprivation, stress, depression, immune system deficiency, diabetes and hypertension are common.”
Lucy recognizes how fortunate she is to have a good support system—despite the fact that neither she nor her husband have family nearby. During the time that she was running back and forth from Massachusetts to New Jersey to care for her parents, her neighbors stepped in to help. “They would take our kids for the day, or pick them up and take them to school and activities. Or they’d bring by meals. We’ve been able to build our own support network.”
Although her brother lives in California, he also helps out. “We have a very close relationship,” she says, adding that they talk a lot and share the responsibility of checking up on their mother who currently lives alone in New Jersey and is in the beginning stages of Alzheimer’s.
“I worry about my mom a lot,” Lucy says. “I worry how lonely is she? So I call her every day. My brother and I each call her—one of us in the morning, one of us in the afternoon.”
Despite the stress and guilt that so many in the sandwiched generation feel, Koontz notes that it’s not all negative. “What I mean is -from Generation X on down- you have a generation of kids whose parents were more democratic in their childrearing and so their children feel more of an emotional obligation to care for them . That’s a positive development! It doesn’t eliminate the time, emotional and financial pressures today’s parents are under, of having to make choices between who you are paying attention to. But it can help to look at in this light: that we’re doing much more for our families than people in the past, and that’s a good thing.”
Supporting Caregivers in the Workplace: A Growing Trend
One place Lucy finds support is at her job at Boston University. “It’s a good sort of constant,” she says. “And I can talk to people who have been in similar situations.”
Lucy’s not alone in feeling this way.
According to Jennifer Fraone, an Associate Director at Boston College’s Center for Work and Family, “more and more employers are beginning to recognize the emotional toll that caregiving and juggling both children and elderly parents takes on their employees. It’s noticeable in terms of absenteeism from the workplace. Or employees leaving.”
Unlike childcare issues, Fraone notes that it’s traditionally been much harder to find information and support around elder care, and this is where employers can step up and help.
“The good news is that there’s been a lot of growth in the last five years toward supporting employees’ whole health, and not just their physical health. Employers are recognizing that there’s a lot more that contributes to their health care costs and productivity—so they are looking at stress in their employees in a more holistic way. They are asking how do we minimize stress and help employees cope?”
Brown bag lunches and internal support groups led by geriatric social workers are becoming increasingly more common. Some organizations now employ geriatric case managers, or specialists who help families with immediate care needs, as part of their employee assistance programs.
Flexibility is also key. The Family Medical Leave Act, a federal law, allows employees to take annual leave from work to care for a spouse, child or parent with a serious health condition. But, says Fraone, “Caregivers also need to be able to take off time in small increments to take someone to an appointment and not feel like they are going to be penalized. The more flexible an employer can be, the better. It’s all about building a culture of trust. We’re trying to help employers shift the emphasis from face time (“I can see you!”), to what are the results—what is the quality of what you’ve delivered?”
The Family and Work Institute, an organization out of New York with a similar mission, annually conducts the most comprehensive and far-reaching study of the practices, policies, programs and benefits provided by U.S. employers to enhance organizational and employee success. The results of the Institute’s 2014 study show that nearly half of employers polled now offer elder care resources.
“This is a really positive trend and I hope it keeps going,” says Fraone. “We want employers to see people as a whole person, with a whole life.”
Living Arrangements: No Easy Answers
When I arrive at my father’s house I find it cluttered but clean. Together with the help of their visiting home health aide, my dad and his wife had tidied up for me.
My father is fortunate in many ways. He has no serious health issues that we know of. He doesn’t even have arthritis–a fact that impressed a geriatric doctor I met on another flight to visit my father several years ago. He is also remarried to a woman twenty years younger. I suppose one could say that all of this makes me fortunate too, as I am not his primary caregiver.
During a phone call several months ago, out of concern for his memory issues, I’d proposed the idea of an assisted living facility.
“That’s where you go to die,” he said. He also quoted the expense. I dropped the subject.
Fortunately, over the course of three days at his house, I conclude that my father is doing better than I’d thought. Yes, he repeats himself sometimes, but he is sharp and funny and, with paid help, coping quite well on his own both mentally and physically. I can stop worrying. For now, at least.
“The goal is to empower your elderly parents,” says Abaya. “As long as they are safe and their health or finances aren’t being negatively impacted, step back and let them make their own decisions. Sometimes these might be bad decisions, but you cannot make choices for them using your own values. You need to respect their values.”
One thing she strongly advises against is uprooting a parent after a spouse dies. “Unless there’s no alternative, it’s better for them to stay where they have friends and doctors and a support system in place.”
Of course, these are very personal and difficult decisions for each family. Five years after her father’s death, Lucy’s 82-year-old mom continues to live on her own in an apartment in New Jersey, despite her early Alzheimer’s.
“My brother and I have run the gamut of how we’ve approached her situation,” she says. “I have an apartment downstairs and I’ve considered having her live with me, but it’s an urban, unfamiliar area for her, and with her Alzheimer’s that could be dangerous. Plus when I’ve said to her, ‘you are moving up here,’ she responds ‘No I’m not.’ I’d love for her to be a mile down the road so I could swing by and take her to Marco’s hockey games, or for an outing. I’ve taken her to look at assisted living facilities around here but she either doesn’t remember them or resists the idea. Right now we actually have a deposit down on assisted living facility nearby but there are no openings.”
And so for now, they wait.
Kathy Hubbard, a 52-year-old mother of two teenage daughters in Pennsylvania, knows she is one of the lucky ones in that her father is a planner.
“My parents live about 25 minutes away,” says Kathy. “My father is 77; my mother 75. They are preparing to sell the house they’ve lived in for 15 years and move to an assisted living facility.”
She explains that her grandfather (her father’s father) started having increasing dementia when he was 75. “I think for my dad, the impending move brings him enormous peace of mind. But my mom feels like she’s too young and vital for assisted living.”
Her father’s penchant for planning means she and her sister also know what’s in his will; they know about his assets, and she says, “We have the combination to everything.”
This puts Kathy’s mind at ease. As does the fact that her parents chose to get rid of much of their stuff before moving out. “One of the greatest fears I had was that my parents would leave me and my sister with a huge house to clean up. I know that happens a lot, and they went through that with their own parents…and it was tough. I’m so very grateful to them for take the initiative to do this.”
But by no means is this whole experience easy for Kathy. Her mother is depressed and “needs a lot of emotional support,” so Kathy talks to her every day. “I’ve been spending the last two years both helping my parents move out of their house while helping my exceedingly anxious 18-year-old daughter get her brain around that she’s going to college. We went to look at schools and she had a panic attack. It’s been a tough process. And I feel like I’m constantly bouncing from one anxiety-ridden thing to another.”
For another perspective, Kathy refers me to her friend Robin Colodny, who lives in Kathy’s same town of Bala Cynwyd, PA. Robin is working mom with a 16-year-old daughter and an 11-year-old son, and her mother lives with them.
“She invited herself to come live with us three years ago after she’d had enough of my stepfather and wanted to be closer to her family,” says Robin. “Really she wanted me to move back to Florida, where I’m from and where she was living. But I wasn’t going back.”
Robin repeatedly states that she’d like to put her mom in “a time out.”
Of course, these are very personal and difficult decisions for each family. Five years after her father’s death, Lucy’s 82-year-old mom continues to live on her own in an apartment in New Jersey, despite her early Alzheimer’s.
“In her own mind, I think she thinks she’s asking for so little, but to me, it feels like she expects a lot of service. And she expects it instantly. And constantly.”
One of the bright spots of having her mom live under the same roof seems to be the relationship between the grandmother and her grandchildren
“My son gets along beautifully with my mom,” Robin notes. “When he’s interested in interacting with her. Sometimes he’ll play the saxophone and she’ll be his audience. Occasionally they’ll play a board game like monopoly. She worships my kids.”
Abaya points out that teenagers, who often need their parents attention even more than younger children, can get lost in the shuffle when parents are also caring for aging adults. Robin’s own experience highlights this when she says, “My mom takes up most of my time and energy. That’s where I really feel the sandwich…my daughter could use more of my attention right now, and I can’t really spend the time with her. I have to deal with my mother.”
She adds that to the extent her kids can help out, they do. But, she says, “They can’t do the things that exhaust me: The taxes. The financial stuff. The insurance stuff. Taking her to medical appointments.”
When I ask her if she thinks they’d be getting along better if they didn’t live together, she says, “Yes. Without question.”
The potential for tense family relations isn’t necessarily stopping generations of families from moving in together, however. According to the Census Bureau’s 2012 American Community Survey, more than 4.3 million U.S. Family households—or one in 20 nationwide—were made up of three generations living under one roof. Part of this phenomenon can be explained by looking at the large number of grown children who moved back in with their parents during the recession. While the economy has improved, members of the “boomerang generation” aren’t necessarily moving out any time soon.
Whether these families are happy or stressed—or perhaps a little bit of both—only they can say.
Caring Across Generations: An Antidote to the Sandwich?
Sarita Gupta lives in the Washington D.C. area with her husband, five-year-old daughter, and her elderly parents. Shortly after her father was diagnosed with Alzheimer’s, Gupta asked her parents to sell the house they’d lived in for forty years and move in with her.
“It was the hardest conversation I’ve ever had with my parents,” she recalls. “But they agreed.”
Gupta is happy to have her whole family under one roof, but like others who are sandwiched, she’s often overwhelmed by the responsibilities of caregiving and trying to navigate the current system to find appropriate resources for her father. “You really have to seek out information,” she says. “It’s like a second job. And it feels like everyone is struggling with these issues, and with accessibility and affordability of care.”
Gupta’s unfortunate “expertise” in this area serves her well as co-director, with Ai Jen Poo, of Caring Across Generations, a national movement to “change the way we live, age and care in America.”
Poo, a MacArthur Genius Fellow, is also Director of the Domestic Workers Alliance. Several years ago, she noticed that a large number of housekeepers and nannies were asking for training in elder care because their employers were requesting that they also take care of their elderly relatives. She and Gupta then got an idea: how could we bring both individuals and families together with the direct care workforce to craft a different future? This was the seed for Caring Across Generations, which officially launched in 2011.
The movement aims to provide a potential solution to the sandwich—or at least greatly ease some of the pressures that we sandwiched folks face. They recognize that the current long-term care system is broken. As Poo writes in Aging with Dignity: “There is no question that we are failing today’s families. Our current system is a holdover from another time, when life expectancy was around sixty years and dementia was rare…looking at the total landscape of our economy, it’s clear that the system cannot hold if so many adults between the ages of thirty-five and sixty, traditionally considered the peak of a person’s productivity, are stretched so thin.”
The movement aims to provide a potential solution to the sandwich—or at least greatly ease some of the pressures that we sandwiched folks face.
If that’s not enough, there’s another problem—what Gupta refers to as “a silver tsunami” heading our way. By 2030, due to the aging Boomer population and medical advances that help people live longer, about one in five Americans will be older than sixty. The Census Bureau projects the baby boomer population to total 61.3 million by 2029, when the youngest of that generation reaches 65.
“There will be millions needing care in the decades to come,” says Gupta. “Add to that a recent AARP study that notes 90 percent of seniors want to age in place—in their homes and communities—and there could be a real care crisis heading our way that affects all of us. We want to get in front of the problem now and build a new care system that respects people’s desire to age in place. “
The movement is tackling the issue on four fronts: cultural change work; local, state, and federal policy advocacy; online campaigning; and field activities and civic engagement—currently with a broad coalition of 200 organizations.
“Caregiving is deeply undervalued in this country,” Gupta says, ” and we want to change that. We also want people to embrace multigenerational relationships and shift how people view aging in this country.”
These are certainly no small tasks, but the organization is coming up with creative ways to bring people together around these issues, including reaching out to Hollywood screenwriters to talk about how they might think about these themes in their films. Last year they also organized a concert in Harlem in honor of Grandparents Day, inviting musicians from the millennial generation (born approximately between 1980 and 1992) to play the music of their grandparent’s generation.
“These are two huge populations: the millennials and the boomers,” says Gupta. “And we’re looking for ways they can work together to change the conversation on care…think about how powerful it would be if they were advocating together?”
On a federal and state policy level, the organization is moving the needle on some of their issues. For instance, they’ve been working with the Obama Administration on changing the home care rule to ensure that domestic workers receive at least minimum wage and have overtime protections in place. And, according to Gupta, they’ve been very successful in sparking conversations on the state level.
“States are on the front lines of this issue and we want them to take on the issue of care in meaningful ways.” She cites Medicaid expansion in Ohio and Maine’s “Keep Me Home” initiative as two examples.
“Maine is the oldest state in our nation demographically,” she says. “They’ve really taken this issue seriously. ‘Keep Me Home’ is just the beginning of how they want to address the issue of care moving forward—including building new environmentally friendly senior housing, along with providing new supports for seniors, and reassigning the reimbursement rates of the Medicare system to cover home-based care. So there’s opportunities like this, at the state level, that are moving across the country.”
There is no doubt that she is passionate about this mission. She points out that we are a nation of “doers,” and refers to a passage in Poo’s book, that reminds us how at one time in this country we didn’t have indoor plumbing:
“We made a decision to create a system to have water in our homes. Why can’t we think about care in this way? In a systematic way. How can we build a “careforce”? Homecare workers would be good preventive medicine and save costs for families. There is a lot of opportunity here—not just a crisis. Let’s look at it this way. We want something different and we’re confident that we’ll get there.”
Listening to Sarita makes me feel a bit better about the future, for my own family and for Lucy’s, and Kathy’s and Robin’s—and all my friends who are also trying to juggle childcare, elder care, and work. While we may not see many of these changes come to fruition in our own parents’ lifetimes, at least there is hope for our children, who will have to grapple with many of the same issues we are facing now if things don’t change.
“I don’t ever want to be a burden to my kids,” Lucy said in her interview with me.
I feel the same. And I bet I’m not alone.
So I’m holding out hope that Gupta and Poo’s vision of a “careforce” in this country becomes a reality. Something needs to change.
Amy Yelin’s essays and articles have appeared in The Boston Globe, Literary Mama, The Mid, The Manifest Station, The Gettysburg Review and other publications. Her humorous essay “Once Upon a Penis” is included in the anthology Mamas and Papas: On the Sublime Art of Parenting. She is also Managing Editor of SolLit: A Magazine of Diverse Voices and she teaches writing at Grub Street in Boston.
Click here to meet Amy and learn more about the writing of this feature story.
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