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The sandwich generation: How to cope with kids and aging parents

Susan Donaldson James By Susan Donaldson James

Deirdre Tolly’s day begins at 6:30 a.m. and ends close to 2 a.m. She cares for four children under age 10 and her 76-year-old father, who has Alzheimer’s disease. Getting the kids to school and sports practice, keeping track of her father’s medications and making sure he doesn’t wander off all keep her busy. And she mostly does it alone: Deirdre’s husband is away on business three weeks a month. “I am exhausted,” says Deirdre, 40, who lives in Sea Girt, NJ. “At the end of the day, I just want people to leave me alone.”

Deirdre is one of millions of Americans who are part of the Sandwich Generation, those between the ages of 40 and 65 who are caregivers for both their children and their parents. More than 34 million Americans are unpaid caregivers for an adult 50 or over, the vast majority of which are family members, according to the Centers for Disease Control and Prevention (CDC). Of those, 28% have children or grandchildren under 18 living at home, the National Alliance for Caregiving (NAC) estimates.

Sandwichers do it all: nursing care, cooking, housework, childrearing, and helping elderly relatives with dressing, bathing and getting around. Nearly half of caregivers, according to the NAC, report financial strain and difficulty finding help of any kind. Like Deirdre, they report high stress levels and say their health suffers because they put a loved one’s care before their own. “Pretty much all day I am taking care of others,” she says. “It takes a toll on me mentally. And with the sleep deprivation, I get run down faster.”

The CDC says the greatest burden falls on women, most of whom work 20 hours a week outside the home. Such is the case with Hillary Mains, a home health aide and the mother of two boys, 4 and 9. Her 63-year-old mother, who is nearly nonverbal from aphasia, recently became one of her patients.

“It’s not easy. Life with kids, the other houses I work at, and my mom, too. But I feel it’s important,” said Hillary, 35, of Pepperell, MA. “I have always seen it as an honor to be there during the time they need it most.” Whether you’re currently a Sandwich caregiver or you expect to be in the future, this action plan will help.

1. Plan ahead.

Joe Buckheit, the founder and CEO of, argues that you should prepare to be a caregiver “before there is a crisis.” Often an adult child steps in to help an aging parent only after something goes wrong. “We lost track of dad’s goings on,” says Deirdre. “One sibling would talk to him, but we wouldn’t talk to each other.” Then they discovered he wasn’t taking his heart medication or paying his rent.

Hillary coordinated with her family early on regarding their mother’s future care. Her brother was able to renovate a living space in his basement, and Hillary agreed to be the daily caregiver.

If possible, think about how you’ll divide duties among adult family members. For instance, decide who will help manage the finances or act as backup caregiver when you are away. “It takes a bigger village to care for your parents than for your kids,” Hillary says.

2. Get organized.

Or, if you’re already pretty orderly and efficient, get really organized. Deirdre created a calendar of daily and weekly tasks, color-coded for each member of the immediate family. Review your long-term to-do list, and try to knock off one or two organizational items a week. Give priority to contact lists and information that needs to be communicated in case of emergency.

3. Communicate, then delegate.

“The number one thing is to talk to everyone about your situation,” says Deirdre, whose neighbors often invite her children to play or drop by to help. “They offer to chat with Dad for 20 minutes, so I can take a break.” Friends and neighbors can also run errands or drop off meals as needed.

Casual help from friends and family may not be enough. Even if one parent is home full-time, you may want to enroll younger children in nursery school or daycare, or arrange regular playdates.

Parents of older children should talk openly about having them pick up chores or keep a grandparent company ― and be generous in praising their contributions. “I have to be sensitive to everyone’s feelings in this new dynamic,” says Deirdre. “My kids enjoy having Pop here. And the baby, especially, loves him. But he has an attitude and the kids don’t understand. I’ve got to protect the kids, without being disrespectful to my father.”

4. Balance time and money.

If you have the means, spending money to save your sanity is more than okay ― it’s necessary. Deirdre’s father attends adult care two days a week for eight hours. “It eases the burden, and I know he’s safe and socializing,” she says. “I’d like to do more, but it’s expensive.” She uses her father’s Social Security check to offset his expenses. “Use your parent’s money first,” she advises.

5. Contact community organizations.

Your county or state Council on Aging can help you file for insurance reimbursements and point to financial aid options at adult daycare centers. Senior centers may be able to provide meals for delivery or pickup. And churches and temples are a great resource for primary or backup help ― even if you’re not religious.

6. Put you first.

And don’t feel guilty about it. Finding relief from stress will enable you to give your best to your family.

“Think of yourself as the fulcrum to keep things in balance. If you break, both ends crash,” says Carol Bradley Bursack, a columnist and author of Minding Our Elders (2005).

  • Take time to read, meditate or just walk around the block. Taking a break is as important as paying the bills.
  • Keep a journal to track your “emotional temperature.”
  • Join an online forum for support. Check out the NAC and the Alzheimer’s Association for options.
  • Understand your limitations. Be realistic about how much time and energy you have to give, and delegate when you see your plate filling up. “We are all just trying our best to balance it all,” says Hillary.
  • Allocate time for your elder, kids, self, spouse and work. “Try not to let the stresses of one relationship dampen the other,” says Hillary. 

Seek professional help if you experience signs of burnout:

  • Unrelenting fatigue not helped by sleep.
  • Withdrawing from friends and loved ones.
  • Getting sick more often. 

Contact your health plan or employer about stress management or counseling programs. Many Aetna members have access to Resources for Living, which provides counseling and financial advice by video-chat or phone. Sometimes, talking to someone who can be objective ― who isn’t a family member or close friend ― can make a big difference in how you feel.

Bursack agrees: “If you can’t remember moments when you genuinely laughed or felt happiness, or if life doesn’t feel worthwhile and you feel trapped, then find a therapist who has experience with caregivers.” (Learn about special considerations when you’re caring for a loved one with cancer.)

Caregiving is emotionally draining, says Buckheit, but when the time comes, “Stay organized. Prioritize responsibilities. Factor in self-care. Connect with fellow caregivers. And try to remain flexible.”


About the Author

Susan Donaldson James is a reporter whose health stories have appeared on ABC News, NBC News and WebMD. She now lives in bucolic Vermont, where she tries to keep up a healthy lifestyle hiking, skiing and doting on four grandchildren under the age of 3.

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