A typical day for many families in the United States looks like the following: make breakfast for the kids, pack lunches, take the fastest route to drop off kids at school, rush over to work, spend 8-10 hours in business meetings, writing emails, making phone calls, etc. By the end of the day you pick the kids up, drive them to their extra-curricular activities, and get back home to make dinner (while the kids are talking over you and at you). You probably spend the rest of the evening completing household chores and responsibilities. Adding to an already hectic life, a growing number of adults are now also caring for an aging parent. Many face this alone with no siblings to help out and become the sole conservator of any and all decisions related to a parent’s physical health, emotional, mental and financial well-being. With these additional pressures, these frenzied Americans feel “sandwiched.”
U.S. family members provide an estimated 80% of elder care. By 2030, there will be an estimated 70 million people over the age of 65 in the United States. The U.S. Census Bureau estimates that more than 20 million people living in the United States find themselves “sandwiched.” The “Sandwich Generation,” a term first coined in 1981, refers to the segment of the middle-aged population that provides care for both children and aging parents. This constant “juggling act” has become the norm for many families, and the long-term care dilemmas are daunting. People are living longer in retirement. Many people are getting married later and having children later on in life. As a consequence, a growing number of families face multi-generational caregiving obligations.
Caregiving: A Developmental Stage
Although many assume that caregiving is just another part of everyday adult life, it is not. To care for a parent on a daily basis, whether he or she resides in your home or elsewhere, becomes another “developmental stage.” Those caring for their parents endure an additional set of feelings and emotional states. The support group I run for adult children caring for aging or ill parents encapsulates the cumbersome beginning, middle and end stages of caregiving.
Almost all adult children experience feelings of guilt at one point or another while caring for an aging parent. The guilt comes from hoping that they are doing everything in their power to make sure their parent is both, comfortable and provided the best care possible. Many adult children worry if it is okay to send a parent to live in an assisted living facility or skilled nursing home, instead of having their parent live with them. They worry whether they are meeting their parent’s expectations and quality of care. Just as Winnicott writes about being a “good enough parent” to one’s child, adult children feel tremendous amounts of guilt and concern about whether or not they are being “good enough children” to their parents. Many caregivers admit that they feel ashamed at times for wishing they did not have to feel burdened by their parent. One caregiver group member covered her mouth during a support group meeting sharing her own guilty feelings for experiencing relief from taking a weekend off from caring for her mother. Interestingly enough, as much as adult children express their own feelings of guilt for having fantasies of time alone or “time off,” many aging parents too, feel guilty for “burdening” their children.
After a recent segment of The Home Show on 870 am radio (which aired earlier this year), where I addressed the everyday struggles that adult children face in caring for their aging parents, the calls I got were outstanding. Many were from the aging parents themselves who were profoundly touched by their children’s endless efforts to take care of them. In fact, many callers spoke somberly as they vowed that their sons or daughters were in much need of psychological support and counseling. They too, felt that they were burdening their children.
Anger & Resentment
As aging parents deal with health scares and medical issues, they may become more helpless in day-to-day proficiencies. Adult children often have mixed feelings about how to provide care. Feelings of anger and resentment often assert themselves. Whether they have to spend more money on their parents for everyday necessities or pay for some of the incoming medical expenses not covered by insurance, adult children may begin to feel overloaded. One member of the support group shared her own distress when having to purchase her mother’s wheelchair when she herself was unemployed. Maintaining a full-time job becomes difficult while taking a parent to never-ending doctor appointments or having to research assisted living facilities, nursing homes or professional caretakers. One caregiver group member shared that she had to quit her job altogether when her mother was diagnosed with Alzheimer’s disease and had to take care of her.
Anger and resentment also surfaces when an adult child revisits early parent/child dynamics and grapples with unresolved issues. Reconciling one’s emotions and feelings during a parent’s end-of-life stage, while caregiving, can either be a cathartic experience, or just as easily, a painful one. Siblings especially can become embroiled in resentment when one becomes the designated caregiver. The caregiver role typically is assumed by women. The sibling in closest proximity to the parent usually becomes the primary caregiver. Sibling rivalry or sibling absenteeism from the decision making process creates further distress within the family system. Finding resolutions that work for everyone can be extremely difficult, especially if there is no third party involved to help mediate or counsel families through this rough transition.
Fear & Loss
Fear of the unknown is increasingly scary for most adult children, especially as an aging parent’s health condition becomes increasingly erratic (e.g. in and out of hospitals). Loss may be experienced on many levels. Many adult children may feel like they have already “lost” a parent when the parent has succumbed to either multiple physical ailments and/or cognitive deficiencies due to their medical illnesses. I refer to this as Level 1 Loss. Many during this stage may begin the grieving process and wonder what life may look like as their aging parent becomes increasingly ill. I refer to Level 2 Loss when a loved one dies and leaves the physical world, which may in turn feel real and permanent, whereas Level 1 Loss may still feel surreal. Both types of loss are fraught with emotion.
Depression & Anxiety
Many caregivers feel depressed or anxious on a daily basis and report taking anti-depressant medications. Many feel a loss of identity, as if they have lost all sense of self because of the many hats they wear. Some explain feeling that they have exhausted all energy and resources and do not know where to turn. Early night waking, poor concentration, continuous fear or stomach upset, isolation and withdrawal are all signs of the psychological turbulence one may experience when trying to navigate through an aging or ill parent’s end of life stage.
The challenges that the “Sandwich Generation” faces are immense. Dealing with the demands of a job, the needs of children and spouses, and the needs of an aging parent can be overwhelming. As the baby boomer population steadily increases, it is vital that adult children be certain their own needs are addressed, hopefully with the aid of resources and support, so that they will be able to function and thrive in everyday life.