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Are You the Ground Meat in Your Family’s Generational Sandwich? How to Reduce Your Stress.

By Kevin Smith

Are you simultaneously raising children (or tending to grandchildren), working a part or full time job and looking after your aging parents?

Are you in a constant state of overwhelm?

Welcome to the Sandwich Generation.

According to elder care authority Carol Abaya, more than 25 percent of American families are now involved in some form of parent/elder care. So if you’re among them, know that you are not alone. You now have a new role on the stage of life for which you can never rehearse.

If one or both of your parents have terminal or chronic conditions, or if they need significant help with daily living activities in their 60s or 70s, your role as The Sandwich Keeper may begin in your 40s or 50s.

Because medical technology and preventive knowledge have advanced, it’s now more likely that your parents or elder loved ones will begin needing help in their 80s or even 90s. In turn, your role as family caregiver may begin in your mid-to-late 60s and extend well into the time that you begin to rely on others.

Dr. Joanne Schwartzberg, Director, Department of Geriatric Health, American Medical Association, notes that society is faced with the first large-numbered generation that is living to be quite elderly. Therefore, there is no peer model with which to fall back on, to “tell” Sandwich Generationers and the elderly how to handle this new situation and relationship changes.[1]

For many, looking after our elderly parents is one way to 'give back' for the sacrifices they made to raise us. That’s a wonderful, perfectly natural desire.

But what happens when one or both parents mobility or health take a sudden downturn, and your role in looking after them transitions to more than one visit per day, punctuated by numerous calls to make sure nothing has happened when you are not there? What happens when your employer, frustrated at your frequent absences to tend to mom or dad, lays you off, slashing your family’s much-needed income and snuffing out your hard-won career goals?

Our medical model for geriatric care (and by extension, home care) has changed. Says one geriatric specialist interviewed by Abaya:

The evolving elder care model is no longer biomedical. It is biomedical, psychological, social, environmental and spiritual. Some factors in acute illness are biomedical. But today age related losses and other non-medical elements impact elder health.

For example, arthritis may make a person’s hands stiff, and this impacts the ability to do daily chores. A spouse dies, and the survivor may be depressed and not eat properly. Children may not call, and the elder feels left alone. So we have to look at and deal with the whole family.[2] That includes finding ways to support family caregivers, helping them reduce their physical and emotional stress by reducing the amount of direct caregiving they are responsible for.

Say your elderly loved one is having problems navigating around their home. They’ve had several falls, but thank goodness, no bones broken yet. Or dad’s had a minor stroke, but doesn’t want care from anyone but mom, who is now walking with great difficulty.

Your parents may tell you they don’t want help from an outsider. But it’s your role to keep them safe. And it’s also your right to keep your own life and family intact. Do not back down when you know they need assistance. Overtime, they will see how it makes their life easier. Also, be careful not to take away tasks or activities they can still do. Otherwise depression can set in and they will feel their life is useless.

For many Sandwich Generation caregivers, the way out of escalating stress, guilt and exhaustion is to take a team approach.

  1. Gather your brothers, sisters and all involved in mom and dad’s care together.

  2. Agree that their care must move to a higher level.

  3. Work with your parents primary doctor, or seek referrals to find a geriatric specialist that can make an assessment of your loved one’s needs.

  4. Contact a home care organization that can provide an assessment of your loved one’s living environment and their ability to perform the ADLs, or activities of daily living.

  5. You must also evaluate your elder loved ones IADLs (incidental ADLs). These include their ability to drive, shop, cook, clean, do laundry, handle finances and take their medicine properly.[3]

  6. If you have retained the services of an agency, make sure they notice conditions that have changed over time in order to make adjustments to the support they receive in their activities of daily living. One example: Your mother’s macular degeneration prevents her from replacing the batteries in her hearing aid and/or ability to choose the right medication.

  7. In coordination with your parents physician, the home care organization you select can develop a plan of care. The plan can be as simple as having a professional home aide preparing meals, shopping or doing laundry, taking your loved one out on errands or to visit friends.

  8. The plan of care may also include scheduling daily visits from a trained, certified home health aide who will help your loved one bathe and dress, eat nutritious meals, and enjoy their favorite activities: playing cards, reading, watching a favorite TV program.

  9. Finally, ease the transition: Bring in the home care organization’s nurse and home care givers to meet and get to know your parents. Set up a number of trial visits before going full-bore into more frequent visits.

  10. If a loved one has to visit one or more doctors or medical professionals due to long-term heart, sight, hearing, etc. you and/or siblings should accompany her or him to the doctor’s to directly hear their medical assessment at least once a year.

As Sandwich Generationers navigate the ups and downs of caring for their elders, they’re setting new trends. They are rightly demanding a high level of service from those they trust to care for their elders. They expect to fully participate in the process. And they’re shaping (for the better) how our elders who will eventually be them are cared for in our society.

Kevin Smith is president and COO, Best of Care, Inc. which serves Greater Boston, South Shore and Cape Cod communities with offices in Quincy, Raynham and Dennis, Mass. Best of Care’s concierge-level services include personal care services, homemakers and companions, hospice care, private nursing, nursing care management and specialty services as they relate to dementia, psychiatric and acquired brain injury care. Best of Care Inc. was named a 2014 Family Business of the Year finalist by the Family Business Association of Massachusetts. Smith is an Executive Committee member of the Massachusetts Council for Home Care Aides.

Visit, connect with Kevin Smith at or call (617) 773-5800 x 17.  Follow Best of Care on Twitter @BestofCare and like us on Facebook at


[1] The Changing Role of Health Care Professionals, by Carol Abaya, M.A.

[2] Ibid.

[3] Maintaining Elder Independence, by Carol Abaya, M.A.


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