Sandwich generation spread thin

While deployed at Harding Field during World War II, South Carolina Marine Charles G. Edwards met Ouida Odom, whose “Rosie the Riveter” patriotism swept her from Laurel, Miss., to the Capital City to work on airplanes. Even before the war ended, the two married and settled in Baton Rouge, where Charles soon began a 30-year career at Exxon.

As children of the Depression, the couple worked hard to provide their three daughters with a stable home and a college education. Kind-hearted, creative and industrious, Ouida and Charles anchored both their family and community. Well into their 80s, Charles reigned as the family’s consummate fixer-upper and sang in the church choir; Ouida remained an immaculate housekeeper and played bridge regularly.

Due to advances in medicine, older Americans like the Edwardses expect to live not only long lives, but healthy, active ones. In fact, Americans age 85 or older represent the fastest-growing segment of the population.

While they may feel forever young at age 85 or 105, most seniors must eventually rely on someone else to perform daily tasks to maintain their home and health. In anticipation, many middle-aged boomers invest in long-term care plans to assure they have the resources to live independently for as long as possible.

What is the best kind of long-term care insurance? A daughter. The second best? A daughter-in-law.

So says not only conventional wisdom but statistics. One in four American families are involved in care of the elderly. Family caregivers provide $300 million per year in direct care and support. That figure is not surprising, since 90% of long-term care is provided by families and only 5% is delivered in nursing homes and other facilities.

Furthermore, “Seventy-six million people in the U.S. are Baby Boomers caught between aging parents and dependent children,” says Priscilla Allen, associate director of LSU Life Course and Aging Center.

“The majority of caregiver (responsibilities) falls on one sibling—usually a daughter or daughter-in-law. Then, these women have the disproportionate challenge of raising kids.”

Financing the care of individuals with ever-lengthening lifespans is tricky. Admittedly, 24-hour care is expensive, and even occasional hospitalizations can quickly drain bank accounts.

Still, Sunrise Assisted Living’s Sally King pleads for reason. “I once spoke to a son who wanted his 90-year-old mother’s funds to last for 20 years. You have to focus on the individual and give them quality of life for their lifespan.”

Fortunately, there are resources and options available for seniors at various income levels, with a certain percentage of nursing home beds designated for Medicare patients.

Between attending to the needs of the older and younger generations, the members of the “sandwich generation” are spread thin.

As the main ingredient of a multi-generational “club sandwich,” Ouida and Charles’ daughter Carolyn Edwards Rice frequently finds herself in a jam. Besides helping care for her 85-year-old mother, Rice works to maintain a home, a job and good relationships with her husband, three children and six grandchildren.

“Sometimes, I think I need to join a support group, but I don’t. When would I (have time) to do that?” she admits with a laugh.

Rescuing childhood heroes

While nearly everyone from great-grandmothers to the postman is brimming with advice on child-rearing from conception to college, Rice says, “No one prepares you for your parents losing their independence.”

Luckily, some families, such as Rice’s, are astute enough to pick up subtle signs and anticipate the need for intervention. “There comes a time when (older parents) can no longer prepare healthy meals, mow the grass, go to the grocery and do all the things necessary to own a house. To be independent becomes more difficult,” reflects Rice.

However, many adult children remain in denial until a fall, accidental overdose, car wreck or other dramatic event brings the situation to the attention of social workers, doctors or other professionals.

Even in the face of overwhelming evidence, siblings sometimes resist taking charge of their parents’ affairs. “These are the people who always told you what to do when you were a child,” says Rice. “They don’t want you to take care of them; they don’t want you to be the boss.”

Sentiment can stifle even the most sensible adults from becoming proactive. “People are really struggling (with this issue),” says Sally King, executive director of Sunrise Assisted Living at Siegen. “As children, we see our parents as heroes. But there comes a time when we need to reverse the roles. You have to deal with who that person is now.”

Recently, at the family’s request, King assessed an elderly woman in her Eunice home. “It was like leaving a five-year-old to live alone,” she says sadly. “People are not neglectful. They believe their parents are doing OK—especially if that is what the parents tell them. But I advise everybody: Don’t wait until it’s too late.”

A place of guilt

Whether they volunteer for the role or are drafted by default, many family caregivers’ initiation involves a decision mired in family controversy and fraught with emotion.

Discussions usually result in shifting a senior’s responsibilities (such as cooking, driving, bill-paying or managing a home) to a child or professional.

Approximately three times a week, board certified internist and hospice/palliative care specialist Dr. Brian Gremillion meets with caregivers who are weighing the benefits of in-home care, assisted living and nursing homes.

“It’s a very difficult conversation to have,” Gremillion says. “All families come from a place of guilt and try to bring a mentally or physically disabled person into their house.”

However, it’s usually unrealistic for one individual—especially someone with children—to provide the daily services rendered by a staff of 10 nursing home or assisted living professionals like those at Sunrise—including two trained nurses, two aides, transporters and cafeteria and laundry workers.

Even with the best of intentions, Gremillion says, “What usually happens is caretaker burnout in six months, a year, two years. It’s rare that a child can do it for a longer time. Twenty-four hours of full-time care takes a toll mentally and physically.

“With a sick caregiver, the patient is not medically safe,” he says. On occasion, the doctor has called Elderly Protective Services to investigate whether a patient is receiving appropriate care from a home-based caregiver.

Professional assistance may be necessary; yet, it never supersedes the role of family. “Once (the facility’s staff) takes care of the relative’s activities of daily living—toileting, feeding, teeth brushing,” Gremillion says, “that leaves time (for the family) to take care of the patient’s social and mental health.”

When the body begins to fail, King says, “It becomes more important than ever to nurture the spirit. To do that, (the senior) has to be around other people.”

Implications for all generations

No matter the final decision, the change in the family’s balance of power and financial and living arrangements has implications for all generations.

Five years ago, the elder Edwardses considered moving into assisted living. For the sisters, the concern was not only the loss of their childhood home, but depriving their parents of the life they had envisioned after retirement.

Reluctantly, Ouida and Charles decided to try assisted living for 90 days.

During the transition, “They would go and just sit in the house,” Rice recalls. “They mourned the loss of their home. The older you get, the more hard it is to pull up roots.”

Nonetheless, the new apartment’s advantages were hard to ignore. “You know it is safer for them,” says Rice. “They can relax and do what they want to do every day because meals, housekeeping, etc., are taken care of.”

After Charles’ death in 2008, the security, amenities and company of the other residents and staff provided by assisted living became even more important to Ouida and her family.

Consumed by care

Even once a parent is settled medically, fiscally and physically, the caregiver’s daily tug-of-war continues:

Who’s going to tell Dad he can’t indulge in a pint of ice cream every night because he’s a diabetic? Do you reschedule Mom’s weekly hair appointment to attend your son’s baseball game? Can you afford to pay a private-duty nurse for your uncle and your daughter’s college tuition? Who’s going to visit Grandmother or be responsible for her care if you go on vacation?

“It’s difficult. Our real sanity is to visit, play Scrabble, to see Mother smile and laugh and enjoy life,” Rice says.

“But I would love to spend more time with my grandchildren,” she continues. “They’ll want to be with Mimi for only so many years, then they’ll be off doing their own thing. I want time for my grown kids, and I keep one grandson a couple of days a week.”

So, it’s easy for sandwich generation caregivers to become completely engulfed in their responsibilities. “If you don’t balance, you can get totally lost and consumed in the care,” explains Rice, “and you can’t do anything else. There is this constant need, and it can be so demanding. You’ve got to set limitations.”

Rice appreciates the willingness of her sisters and their families to share the responsibilities. “If I didn’t have two sisters,” she says, “I don’t know what I’d do—a lot of praying.”

Others aren’t so lucky. The typical family scenario involves a local caregiver daughter, parents and siblings who are absent—either because they choose not to become involved in daily decision-making, or they live out of town.

“Frequently, those siblings have the largest bark and expectations that are hard to meet,” she says. “It’s easy to judge from far away. And, the parents tend to glorify the (uninvolved) siblings. That causes a lot of animosity between the (caregiver) child and parents, which leads to a lot of frustration.”

So, King says, “That’s why it’s so important for family (and facilities) to emotionally support caregivers.”

Click here to read KaraLe Causey’s take on the changing elderly demographic.