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In our Capital Hill neighborhood, young children and their parents are a very visible members of our community.  Almost any time of day, if you take a walk in the neighborhood, you see babies or toddlers out with a parent or babysitter or kids on the way to and from school. Less visible in our community are the elderly family members - those with limited mobility or who may be ill and mostly confined to home. 

At any given time, roughly one in five of us are providing informal care for an elderly or ill family member.  Most caregivers are women -- and most have jobs in addition to caregiving.  The accumulated stress of being a caregiver to an aging parent and simultaneously parenting young children -- literally being sandwiched between the generations -- is both seriously underestimated and under-acknowledged.   

It is easy for the person trying to care for an elderly parent and raise children to begin to feel guilty because they think they should be able to provide better care despite all the other things they have to do; lonely and frustrated, because all the time they spend caregiving may hurt their social or professional life, and exhausted when they go to bed at night from trying to manage it all. 

The Stress in the Sandwich
Here are the results of a study by the National Association of Social Workers on women in the sandwich generation:

1. The sandwich generation is emotionally overwhelmed by responsibilities.  These include not only caretaking, but also parenting responsibilities, housework responsibilities and a job. Studies have found higher levels of depression and anxiety among caretakers than the general population.
2. The sandwich generation underestimates the emotional and physical toll of providing care to an aging loved one.  This includes the toll on their own health, the emotional toll of providing care, as well as the stress on their marriage or partnership.
3. The sandwich generation is not prepared for shouldering the burdens of an aging parent’s care. This includes not being prepared for the cost of paying for care of an aging relative, and not being prepared for care-planning and end-of-life planning.
4. The sandwich generation reports not feeling very happy but often do not seek help for a variety of reasons.  They are more likely to experience symptoms of depression, have higher levels of stress hormones, have a weaker immune system response to flu, and have long-term medical problems.  Part of the reason caregivers have more medical problems is because they are less likely to get needed medical care, get enough sleep or enough physical activity.

Take the Sandwich, Hold the Stress
Margaret Neal and Leslie Hammer, in their book “Working Couples Caring for Children and Aging Parents” developed a model of coping strategies for the sandwich generation.  In this model they look at decreasing the demands and increasing the resources for caregivers in three areas:  behavior, emotion and cognition.  Below is the model, with some examples.

One important point for caregivers to remember - never dismiss your feelings as “just stress.” Caregiver stress can lead to serious health problems and needs to be addressed in an active and problem-solving way.  Try not to feel guilty that you are not a “perfect” caregiver” -- just as there is no perfect parent, there is no such thing as a “perfect caregiver.” Just do the best you can.  And remember that while caregiving can be challenging, it also has its rewards -- giving back to the one who parented you for so many years and having the opportunity to develop a stronger relationship with an aging parent.

A Model of Work-Family Coping Strategies for Sandwiched Couples