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Sunday September 24, 2017

The Sandwich Generation Caregivers are faced with daily challenges

Posted on: August 28th, 2016

Keisha Springer, 43, is an occupational therapist in the Atlanta, Ga., area. Approximately five years ago she moved her 89-year-old grandmother from Marion, Ind., to Atlanta to live with her. Her grandmother had been diagnosed with vascular dementia and needed assistance. Eight months prior to this, Keisha’s mom moved in during a major life transition. So, her mom became the primary caretaker for the grandmother and Keisha became a caretaker for both. Most of her days began with getting her grandmother up, dressed and fed after a night with at least two bed and/or bathroom checks. She would then get herself ready for work. After working approximately eight hours at a nursing/rehab center, she would rush home to relieve her mother or a sitter from their duties and resume the care for her grandmother. However, when financial resources and social support ran low, the decision was made to transition her grandmother to the long-term care facility where Keisha is employed. Then, her eight hour days became 11½ hour days. She takes her lunch so she is close by because she is most familiar with her grandmother’s routine and rituals that keep her the most cooperative. Lunch breaks are a luxury, but she has finally recognized she needs to take her scheduled days off. She will tell you that despite the fact that she’s not married and does not have children, the myth that her life is somehow easier and less demanding is a far stretch from the truth and at times an insult. She will tell you that unlike a child who would typically get better after a common illness she knows that with each stage her grandmother will digress and her grandmother’s needs will continue to grow. She will tell you that she often sacrifices time for herself and her interests to relieve her mother, explaining that she “needs” her mother to stay as healthy as possible, for obvious reasons.
The dynamics of Keisha’s life is what Carol Abaya refers to as an “open-face sandwich.” Abaya, a leading pioneer in the study of “the sandwich generation,” shed light on a social phenomenon that goes beyond anything edible. She provided a comprehensive look at what appeared to be a social dilemma and most definitely a personal one. Donna A. Miller created the term in 1981, but Abaya expanded on it and coined two additional categories; the “open-face sandwich” and the “club sandwich.”
The “traditional” sandwich refers to adults caring for their dependent children, as well as aging parents. People like Keisha in the open-face sandwich category are those who are primary caretakers of any aging family member. The club sandwich refers to those individuals in their 50s and 60s who care for aging parents, adult children and grandchildren; or adults in their 30s and 40s with young children, as well as grandparents and great-grandparents.
Contributing factors to these trends include adults living longer and the economy. While adults are aging, a volatile economy has lengthened the time it takes for those leaving the nest to reach financial independence – resulting in them staying home longer or moving back in. Regardless of the reason, the results of adults sandwiched between generations can be felt financially, emotionally and socially. Caregivers are faced with the challenge of caring for others while caring for themselves – finding calm in the midst of what may often look and feel like chaos.
Some of the challenges include limited caretakers. So often the primary care becomes the sole responsibility of one person or one family unit. Equally taxing as financial responsibility are the physical and emotional demands. Many adults struggle with coming to terms with role reversal. For some adult children, it is difficult to see parents as vulnerable. Other issues include poor self-care plans and lack of understanding regarding the aging process.
The aging process so often brings greater demands, making it imperative that caretakers are proactive in their self-care. Some strategies that can be beneficial are:
1. Utilize your resources – Don’t be afraid to ask for and accept help.
2. Be specific about what you need and do not need.
3. View your doctor’s appointments with the same importance you view your loved ones’ appointments.
4. Have a system in place that helps you stay organized.
5. Communicate with your parents while they are healthy about their wishes, health care, important documents, etc.
6. Learn to say “no.”
7. Take breaks.
8. Find something you enjoy and make time for it.
9. Spend time with people who support you.
10. Laugh

1. Miller, D. (1981). “The ‘Sandwich’ Generation: Adult Children of the Aging.” Social Work 26:419–423.
2. Abaya, C. (1995). Sandwich Generation. Retrieved from
3. Parker, K., & Patten, E. (2013). The sandwich generation rising financial burdens for middle-aged Americans. Pew Research. Retrieved from

By: Valerie Fields, licensed professional counselor for the state of Mississippi; program coordinator and counselor for the North Mississippi Medical Center Employee Assistance Program