STUCK IN THE MIDDLE: COMBATTING ‘SANDWICH GENERATION’ STRESS (PT. 1)

“No one talks about how hard it is to take care of your kids, work a full-time job, and take care of an ailing parent, all while trying to keep yourself healthy.” This was posted by a Facebook friend who’s living out the challenges of the ‘Sandwich Generation.’ While neither me nor Penny are in this situation, we’re seeing a growing number of people in our lives who are simultaneously caring for elderly parents and dependent children, oftentimes under the same roof. There’s a real possibility one or both of us will become part of this group of adults since 71% are ages 40 to 59 and 64% are women. This very real possibility inspired us to dig a little deeper into the challenges and complexities of the sandwich generation, so we enlisted an arsenal of experts in the field to provide direction, advice, resources, and hope to help ease the burden on adult children who are currently stuck in the middle of this life, and to help prepare those of us who may be presented with this decision in the future.

Our focus on the sandwich generation will be a quarterly blog and podcast series. We kicked the series off with a podcast episode featuring one of our contributors, Stephanie Chan from myCareBase and Home to Home. In the episode Stephanie walks us through the important components a family needs to consider and prepare for should they be faced with this scenario - whether it's planned well in advance or presents itself unexpectedly.

This, being our first blog on the subject, addresses how to prepare yourself, your elderly parent(s) and your family for this life-changing decision and transformative day-to-day dynamic of the sandwich generation. Suzanne Asaff Blankenship, eldercare expert and author of How to Take Care of Old People Without Losing your Marbles, suggests an all-hands on deck approach.

Blankenship states, “the decision to become a full time caregiver should be made with all family members involved (near or far). No one should draw the short straw. Everyone can do something! Family members should have a full discussion with the elders involved about finances, caregiving duties, who and when the care will be provided, where the elder will live, etc. Eyes should be wide open and all vested family members should have a say in the matter.”

She goes on to say, “the decision to become a caregiver is a challenging one and should not be made lightly. Many sandwich generation caregivers are full or part-time workers.” Blankenship recommends the potential primary caregiver thoroughly search for local resources and programs that could provide assistance and support for them and their elderly parent(s) BEFORE giving up their career or reducing work hours to become a full-time caregiver. Financially, it can be a risky decision and contribute to an already sensitive and stressful situation. 

Suzanne’s Recommended Support Resources and Programs:

1. Adult day programs, usually offered at recreation centers or senior centers from early morning until late afternoon. These programs support caregivers who work and/or need a respite. Oftentimes, these programs provide meals, activities and a safe place for elders, especially elders with dementia. Some programs offer assistance with showers as well. Additionally, these centers may have care management staff that can help find support services for caregivers.

2. Investigate veterans benefits that include aid and attendance. There are income qualifications, along with the requirement that a veteran or spouse be the recipient. They can provide needed funds for homebound elders who need assistance and care.

3. Some elders can receive in-home care for a few hours per day or week. If this is financially feasible, it helps the caregiver remain employed while still being engaged with the care.

Sarah Arfeen, Chief Editor of Senior Care Corner, advises creating a harmonious and supportive environment for all parties involved and to create a safe space for the elder(s) who may be joining the family household or senior living center. “Establish an open, honest, and ongoing dialogue with your parent(s). Actively listen to their needs, desires and preferences and tune into any fears and reservations they may have. This helps build trust and ensures you understand their perspective.” Arfeen believes being upfront and forthright about expectations and responsibilities lay a solid foundation for the preparation process. “Clearly outline the expectations and responsibilities associated with the caregiving role. This ensures that everyone is on the same page. Whenever possible, involve your parent(s) in decision-making. Empowering them in the process fosters a sense of control, continued dependence and dignity. Clear and compassionate communication forms the foundation for a successful caregiving arrangement. It's an ongoing process that requires patience, empathy, and a commitment to maintaining open lines of communication.”

In the new year, new you four part blog series we rolled out in January, one of our blogs centered on life and financial planning. As stated in that post, this is a unique time for midlifers whose parents are still alive, because not only do we need to ensure we implement these vital measures for ourselves, we may also be in the role of overseeing the life planning wishes and estates of our parents. We’re at the “sandwich phase” of life where we become advisors, advocates and caretakers for our parents, while also putting our own affairs in order, alongside raising children and perhaps even grandchildren.

Jackie Pettus, founder of Habitudes, a personal record keeping platform, knows this all too well. The inspiration for Habitudes came when Jackie’s lifestyle changed from that of a young apartment dweller to a first time homeowner and eventually a family of five. Realizing that both her family and her advisors would need quick access to vital personal records in case she or her husband at the time became disabled or died, she started using a little spiral-bound notebook called "What My Family Should Know." she updated it faithfully by hand for years until she had crossed out so many entries the notebook became almost unusable. Habitudes was born from her recognition that she needed a more dependable personal record keeping system.

Pettus believes the first step to prepare for the sandwich generation is to get your (and your parents) life and estate planning in order. “It's awkward for adult children to ask their parents for the personal and household information they would need in order to care for them,” Pettus says. “They might as well say, "Mom and dad, you're either going to die or need me to take care of you soon. How about making it easier on me by gathering all the information I'll need." Instead of this harsh approach, our record keepers make asking and obtaining this vital information easier and more streamlined.”

Emergency Information and What My Family Needs to Know are comprehensive personal record keepers on the Habitudes site. They are downloadable, customizable and simple to use and include information people can use while they are perfectly healthy, not just in case someone becomes incapacitated or dies. Pettus recommends the adult children download and enter their own data into these documents and give copies to their parents, opening the door to invite mom and dad to do the same and begin a mutually beneficial dialogue on end-of-life planning.

According to Stephanie Chan (myCareBase), many families are inadequately prepared when it comes to the topic of life planning, particularly incapacity planning and the identification of substitute decision makers. “This is a topic that is very important to discuss and consider prior to a crisis or a decline in a parent’s cognitive function,” Chan said. She provides some specific questions to ask your parents for incapacity and estate planning:

1. Does your parent have an updated will and are the named executors still the right people going forward? Is there a designated backup if the primary executor is unavailable? Do any changes in the will have to be made to account for changes in assets, beneficiaries or tax-saving strategies?

2. Does your parent have a power of attorney? A power of attorney names someone to make financial and legal decisions on behalf of the parent should the parent no longer have the capacity to make those decisions for himself or herself. The power of attorney must be granted while the parent still has mental capacity.

3. Does your parent have a healthcare representation agreement? This document is called different things in each province but essentially it names someone to make healthcare decisions on behalf of the parent. Sometimes a healthcare representative agreement co-exists with an advance care directive that outlines the parent’s wishes on certain healthcare matters.

Chan emphasizes that there are a number of things the person named as power of attorney should do to prepare for the role. “First, have a conversation about your parent’s wishes. When they get to the point of needing care, how strongly do they feel about staying in their current home versus downsizing to a smaller home or even moving into a care residence? How open would they be to receive home support to enable them to continue living in their own home? Second, familiarize yourself with your parent’s assets and liabilities so that if you have to take over their personal affairs, you would know what to do (e.g. are there mortgage payments or other debt payments that have to be maintained, what are their other monthly bills, where are their investment accounts and bank accounts, do they have pensions, etc.). Gathering this information while they can still provide it is much easier than scrambling for it later,” Chan points out.

Another vital aspect for preparing to become a sandwich generation caretaker is costs. Jennifer Drake, an account executive at the United Disabilities Services weighs in. “Sit down and discuss any additional costs that may be associated for additional care such as home health aides or assisted living. See if it fits into the amount of money your parents have saved. They may not be able to afford those costs and if you’re not able to or willing to supplement the costs, government programs may need to be researched.”

Stephanie Chan expands on costs and budgeting, providing a broader context. “Lifestyle changes are inevitable for everyone as they age. Being pro-active and planning ahead makes a huge difference in the quality and number of options available at the time a decision has to be made, and financial budgeting for eldercare is a major factor.”

Chan lays out some cost considerations:

1. Home safety modifications and safety equipment – As one ages, certain modifications may be needed inside the home to keep it safe for the senior. Common modifications include swapping out a bathtub for a walk-in shower and installation of grab bars in the shower or around the toilet. Consider improving the lighting inside the house and ways to make the stairs safer in order to reduce the risk of falling. A stairlift chair may be needed at some point to help a senior get from one floor to another.

2. Mobility aids – Mobility aids include canes, walkers and wheelchairs. For the most part, canes and walkers are affordable and shouldn’t cause too much of a financial hardship. However, wheelchairs can be expensive. One option rather than buying a wheelchair outright is to find a supplier offering rentals, which will save you from the large upfront cash outflow.

3. Home support and personal care expenses – Most seniors want to remain living in their current home for as long as possible but in order to do so, they must accept some form of home support or personal care assistance. There are many variables which influence home care costs, including the source through which a person is hiring a caregiver, what kind of care is needed and the number of hours needed daily or weekly. Do some research and talk to others you know who have gone through the experience.

4. A move into a seniors residence or care home – an eventual move into a retirement residence or care home will give rise to a new monthly expense as most residences are on a monthly rental basis. Depending on the location, type of residence and level of care needed, the range of costs can vary widely, so it is best to do your research, tour some residences in person, and perhaps even do a trial stay.

“Don’t forget to sit down with your financial planner and ask him or her to create a forecast, allowing for expenses to increase over time to make sure that the costs do not overrun your parents’ financial resources,” Chan stresses.

Lastly, I’m sure just reading this post has increased your heart rate and may already have you stressed out. It’s so important you care for yourself and make sure everyone involved feels heard, validated and remains mentally strong while carving out preparations to take on the caregiver role. Emily Zeller, Licensed Marriage and Family Therapist, and owner of Zeller & Co. Therapy emphasizes taking advantage of any help you can get, including therapy. Zeller shares, “One way to be proactive and make sure everyone is on the same page is to attend family therapy (at any time during the decision making process and after the action plan has been executed). A marriage and family therapist can provide additional support for making these important decisions by creating space to have difficult conversations. There will likely be differing opinions and mixed emotions around this life stage and caregiving decisions. It can be beneficial to have someone help you sort through complicated dynamics and promote effective communication and conflict resolution. Having a third party involved in these conversations allows everyone to have a better understanding of what to expect in the future, allowing the changes to be more manageable and successful.”

Zeller encourages caretakers to be honest with themselves about their preparedness, who they can lean on, and where they can access professional support. “Many caregivers feel additional stress (including grief) that can be draining both physically and emotionally. Watching your parents age and require more care from you can be hard to witness. The additional tasks and emotional toll that caregiving causes could lead to depression or anxiety. Make sure you are taking care of yourself; you cannot pour from an empty cup! Take advantage of any help you can get. Don’t undervalue the importance of having other players on your parent’s caretaking team. Whether that includes other family members or hiring help, make sure you are not the only person dedicated to their care or you will burnout. Consider joining a support group or going to therapy for yourself, so you can feel less isolated and more connected with other people experiencing the same stage of life. A lot of things are unpredictable and having a steady support system to navigate the journey can be highly beneficial.”

We’ve written a number of blogs on self care and wellness. I recommend a recent post Penny wrote on whole wellness and the first blog in our new year, new you series to level up your wellness in 2024 if you’re looking to insulate yourself from anxiety and depression or keep you from, as Suzanne Asaff Blankenship puts it in the title of her book, losing your marbles!

We would love for you to add to the conversation and begin an open dialogue on the sandwich generation in the hopes to foster community and a safe space for adult children to share their challenges, but to also feel seen, heard and not alone. Our next blog on this subject will come out in the spring and will focus on adapting to life after you and your family have committed to caregiving for your parent(s) or another elderly family member. In the meantime, remember, in everything you do, you’re WERTH it.

~Maya & Penny