Caring for Those Who Are Caring for Everyone: The Sandwich Generation

We know about the love and strengths kin caregivers share with their families, as well as many of the challenges they face. But what about those who are doing double duty, raising children while also caring for older relatives? In this resource, we consider how we can better meet their needs.

Leanne (name changed to preserve her privacy) and her partner assumed responsibility for her grandkids 10 years ago. Those children are 16 and almost 12 and doing well. All was calm—if a household with a teenager and preteen can ever be described as calm—until Leanne’s 93-year-old mother fell, and a new layer of caregiving was added to the mix. Welcome to the sandwich generation, in which caregivers are responsible for both older and younger family members.

Another kin caregiver, Reggie, describes herself as the “sub sandwich generation”—that is, one with many layers of care. She is the legal guardian of her teenage granddaughter, recently reunited with Reggie’s adult daughter and still in need of support. A second adult daughter and her partner have temporarily moved back home. Reggie’s mother has lived with dementia for the past decade, and Reggie is her primary caregiver as well.

We asked Leanne and Reggie how social service agencies and organizations might support kin caregivers responsible for multiple generations. Here are some ideas to consider.

Ask about the family’s story, and how it has changed.

Leanne reflects on the reality that no single professional is aware of the scope of her family’s needs. Ideally, her mom’s family doctor would direct them to local resources, but the time constraints of a typical visit make an in-depth conversation difficult.

Reggie’s mom is now in an assisted living facility. Reggie remembers one of the days she realized something needed to change. She was on the phone with her mom when she got texts and phone calls from all three of her siblings: Just talked to Mom. She said she went to the doctor’s yesterday and couldn’t remember why. What’s up? Not only was Reggie taking on the bulk of her mother’s care, but she was responsible for providing family updates, a situation that wasn’t sustainable.

What Programs Can Do: Consider modifying intake protocols to include questions like Is there anyone else you’re providing care for? or What other stressors is your family facing? Periodically revisit these questions to ensure the information stays up to date.

Ask what the family needs now and figure out how community resources can be brought into play.

Both Leanne and Reggie sought help at their Area Agency on Aging, which coordinates local services for older adults and people with disabilities.

A social worker helped Reggie create a map of those in her circle who can provide help (and what kind of help). Reggie “pulled the map back out” when figuring out her next move. She plans to assign her mom’s legal and financial powers of attorney to separate siblings so that they can more easily share the care.

She also relies on the advice of friends caring for elderly parents, and the informal support of caregivers from grandparenting classes she took when the kids were younger. Perhaps most importantly, she’s asked her family members for specific help and has come up with a schedule that includes weekly interaction (lunch, a phone call) between her mom and each family member.

Leanne attends breakfast meetings for kin caregivers, as she has since the kids were young. Recently, she’s found individual counseling useful for setting boundaries with her mom, who lives alone and is committed to maintaining her independence. She identifies her mom’s current needs as meal prep, socialization, and transportation to and from doctors’ appointments. Meals on Wheels provides weekday meals while Leanne handles the transportation. Addressing her mom’s loneliness is still a work in progress.

What Programs Can Do: Help families map their sources of family and community support, and plan ways to meet the family’s needs. Meet and build working relationships with Aging Network professionals to understand how these programs work and their eligibility requirements.

Help the caregiver find outlets for self-care.

For Leanne, self-care is regular visits to the gym. For Reggie, it’s going to the movies. She’s also created routines that strengthen family connections. She reads aloud to her mom, attends hockey games with her granddaughter, and runs a family Jeopardy game via text.

What Programs Can Do: Ask caregivers what activities make them feel good. Explore ways to build these into their lives again.

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