The Sandwich Generation: Caring for children and aging parents

Huntsville, Ala. - Born in 1976, I always considered myself part of Generation X.

But in December 2011, I entered another generation. The Sandwich Generation.

That's when my grandfather, the man who raised me, was officially diagnosed with Alzheimer's. At the time, my son was less than a month old.

The Sandwich Generation is an inclusive club. Over the years, it's welcomed everyone from Gen-X'ers to Baby Boomers.

Millennials - your invitation is coming.

The term dates back to at least 1981, used in a research paper by Dorothy Miller, a professor of social work at the University of Kentucky, Lexington.

Today, the Alzheimer's Association estimates more than a quarter of dementia caregivers, roughly 4 million, are part of the "sandwich generation" - providing support to not only an aging parent but also children under the age of 18.

It's a peculiar, heartbreaking, and occasionally beautiful, place to be.

Christy Todd, Gail Bundow and Julie Carlyle are there, as well.

I met them when I began researching this story on the Sandwich Generation.

Frustrated by the lack of quality adult day care services for her mother, Christy Todd left her job as a corporate executive to start ChristyCare in Madison.

The senior day care service, which offers half-day, full day and drop-ins, opened last year. At the time, Todd's daughter was entering her senior year of high school.   Todd says her daughter understands her mother's need to take care of "Nanny." Now a student at Auburn University, she even spends her breaks volunteering at ChristyCare - where clients are treated like treasured family members. Music, art, birthday parties, games. The goal is socialization and engagement.

"When I see these people in here so happy and the transformation that takes place in here and how they engage... it's like beautiful moments every day in here."

That's what drew both Julie Carlyle and Gail Bundow.

Carlyle's mother, Joann, is 82 years old. A former teacher, Girl Scout leader and all around active person, dementia may have robbed her of her memory but not her drive.

Joann moved in with her daughter, a nurse and mother of three older boys, a year ago.

Carlyle says, "you miss the old-fashioned mom, the mom you remember but you want her to have some quality of life and sometimes we can't offer it."

Joann now comes to ChristyCare on a regular basis, where she's both a client and a volunteer - helping her friends there with the tasks that are now beyond them.

Bundow's mother, Lorraine, also moved in with her about one year ago. A former emergency room doctor, wife and mother of two teenage boys, Bundow says it was a family decision. Still, there have been adjustments for everyone, including her sons.

"Around the house, things had to change some. Not because those were the rules, it's just because they knew it was right. So, my house was always the house where everybody would drop in, spend the night, I'd have extra kids all the time. The boys kind of self-monitored that. The friends they'd invite over, they tell them, 'Grandma lives with us. When you walk in say hello and give grandma a hug.'"

And while Bundow works hard to keep family life as normal as possible, when bundling "Grandma" up to go to high school football games and other family outings, stress is inevitable.

"You're trying to manage not just your immediate family but your whole family. You might have siblings remotely that are concerned but not yet there to help you. You have your kids that, of course, demand your time and your attention and your resources... and you're trying to come up with a happy medium or combination to make everybody happy and you can't. There's not enough of you to go around. So one of the things that was very hard for me at the beginning but I had to learn was - ask for help. You can't cut yourself in enough pieces to be everywhere at the same time."

We interviewed a renowned geriatrician, Dr. Laurence Solberg, about the issue of stress in the Sandwich Generation. Dr. Solberg is the Chief of Geriatrics at the University of Florida College of Medicine. In 2014, he conducted a study on caregiver stress, with a focus on the Sandwich Generation.

"We found it really does increase the stress level that they were feeling and with that, they simply did not take care of themselves as much."

It's hard to find time for your own doctor's appointments, when you're busy shuttling mom, dad and children to theirs but Dr. Solberg says self-care is critical. These extreme levels of stress can lead to depression, anxiety, blood pressure problems and cardiovascular issues.

He also urges all adult children of aging parents to talk with their mothers and fathers about end of life care. It may be a tough conversation but knowing ahead of time can be crucial in a crisis.

"We try to do that with advanced directives in the clinic, so that we know what the patient desires and wishes are even before, sometimes before the family knows and we can say, 'I've taken care of your parent for a couple years and every year, they've told me they don't want to be kept alive on a ventilator. They don't want to be tortured basically with lots of, you know, interventions, lines and dialysis."

Dr. Solberg's other piece of advice? Find out what local resources are available before you need them.   In North Alabama, TARCOG (Top of Alabama Regional Council of Governments) is a good place to start.  The organization can put you in touch with the Area Agency on Aging, which offers a wide variety of services to help the caregiver.

Outside TARCOG's service area, the Alabama Cares Program can also put you in contact with help, include temporary respite care or a brief respite from care by providing "personal care, homemaker services, adult day care and other services requiring a skilled helper in the home."

The program also provides on a limited basis: incontinent supplies, minor home modifications, assitive technology, home delivered meals, emergency response alarms, nutritional supplements and transportation.

To get in touch with your local agency for this program, call 1-800-AGE-LINE (1-800-243-5463).

If your loved one is suffering from Alzheimer's or another form of dementia, the Alzheimer's Association can provide a wealth of support. The Huntsville office of the Mid South chapter serves most of North Alabama.

Your local CASA may also be able to provide some needed services. More information about CASA of Madison County may be found here.

Bottom line? Be proactive. Have the talk with your parents. Dr. Solberg recommends people start thinking about Advanced Directives in their 60s. He also recommends children attend some of their parent's doctors appointments to get a sense of what's happening with their health.

Julie Carlyle, Gail Bundow and Christy Todd echo that, urging other adult children of aging parents to be proactive. Watch for any sign they may be in need of help.

As Todd says, "they're able to pull things off... whether they have dementia or they're just frail or they're sick or they're taking care of each other's spouses or they're alone. But they're able to pull it together for their kids and say, 'I'm fine.'"

"We're so busy and, once again, that's where the sandwich generation comes in... that we're like, 'okay, I hope Mom and Dad are good. That's good. Ya'll look good,' and we're in and out. But really, we have no idea when they shut that door and we go off, the things they're struggling with."