America’s Sandwich Generation, men and women in their forties to sixties with both aging parents and children to care for, is one of the fastest growing populations. This group of people often find themselves stuck in the middle of trying to juggle a hectic schedule that includes caring for parents experiencing a decline in health, keeping up with adult children as they struggle to “make it on their own” and begin their families, and managing the financial and emotional stress that arise throughout these circumstances. This alone is a lot for one person to handle and often leaves little time for self-care and nurturing a relationship with your spouse. 

8 Things the Sandwich Generation Should Know to Help Ease the Stress of Managing the Care of Mom, Dad, the Kids…and Themselves

By Kim Miller, BSN, MSN, CMC – Aging Life Care Association™ Member

How does one work a full-time job, raise a family, care for parents who are living with medical complications, maintain a healthy intimate relationship, and have time for stress management and stress relieving activities? The following 8 tips provide suggestions and information to help you cope with these demands and provide a way for you to move gracefully forward into your Golden Years.

TIP 1: It’s never too early to start planning.

The moment is now and the options are many. From making room in your budget now to prepare for the costs involved with aging parents and growing children to delaying the downsizing of your home to reviewing the benefits of long-term care insurance, there are many ways you can help yourself by planning now for what is in store. Rather than feeling suddenly overwhelmed in the face of difficult decisions, seek advice from financial, medical, and qualified professionals to help shore up your financial and physical resources. There are many professionals in the legal and financial sectors that specialize in elder care and long-term care planning.

TIP 2: Don’t make any assumptions and trust your instincts.

Recognizing when to seek advice is key. Early signs of feeling like you’re squeezed in the middle can be identified by simply noting if you have asked yourself the following questions:

  • How can I spend time with my children and help my parents every time they ask?
  • How many hours in a day are too many spent in the role of caregiver?
  • How do I fit in time for my marriage?
  • When was the last time I sat down?
  • Why do I feel so isolated?

It’s important to recognize when you begin to feel stretched too thin. Listen to that voice inside and seek the advice of a professional. This is especially important for women who often assume they should know about caring for the aging in the same way that they instinctually know about childcare. Everyone ages differently and every situation is unique. It’s impossible to know in advance how to handle the needs that will arise. It’s best to not assume anything.

TIP 3: Don’t try to go it alone. Seek expert advice and assistance.

Don’t be ashamed about feeling overwhelmed or ill-prepared. This is the case for most of us. There are a wide variety of services and professionals available to help you. A great place to start is to find an Aging Life Care Professional™. An Aging Life Care Professional is typically a nurse or social worker who has expertise in the aging process and the issues that may arise. An Aging Life Care Professional can assess all aspects of your unique situation and help you develop a plan that will meet your aging parent’s needs over time.

Ultimately, someone may need a geriatrician, psychiatrist, or lawyer. There may be a need to provide personal care by a professional. All of these individual providers are focused on a particular service while an Aging Life Care Professional can partner with you to coordinate the care your aging parent needs. Many people feel that this is a job for them to do on their own because they know their parent the best, however, this can be overwhelming. Partnering with an Aging Life Care Professional allows you to extend your reach in caring for you parent while remaining in balance with the other factors in your life.

You can find an Aging Life Care Professional™ by searching aginglifecare.org. You can also contact your local Area Agency on Aging, which can give you information about programs, services, and facilities available right in your community.

TIP 4: Bring them to the table and let them keep their seat at the head.

Talking with mom and/or dad about seeking assistance or advice about how to care for them can often feel daunting. It challenges the typical roles of parent and child. Even though they are aging, the need to be the parent and to feel in control does not fade away and can often become even more present. The first step is to recognize this fact, accept that it will be challenging and then move forward with respectful nurturing and loving care. The rest is artful conversation and psychology.

Here are some considerations when approaching your parents about needing help:

  • Give them the sense that they are the employer, even when they are not and that this is something that your parents will be managing. Try referring to them as a consultant. Find something in the home that they have been frustrated by and suggest that the person will help them make a plan to solve the problem.
  • Explain to your parents that this is someone who will be helping you (their child) by assuring your peace of mind that they are safe. This keeps you in the position of the child who needs help, and the sense that the parents are still needed to support you.
  • If the above are not successful, then it may be time to bring in an expert like a well-respected physician, lawyer or financial advisor who will then provide a prescription for the geriatric care manager.

TIP 5: Sharing is caring. Incorporate your family into the daily mix.

As corny as it may sound, a family meeting can be a great way to get everyone onto the same page about priorities and responsibilities. It provides the opportunity for everyone to share what they are going through and develop strategies to help meet everyone’s needs. It is an opportunity to discuss the caregiving needs, household chores and scheduled tasks to be accomplished on a daily and weekly basis. Bring a pad of paper and make a “to do” list for each person. Don’t forget that your close friends can also be a part of this meeting – the more, the merrier!

TIP 6: Anticipate and address the questions of children and grandchildren.

Even when they don’t ask, your children are likely wondering why their grandparents are more forgetful (especially about remembering their name, etc.), why they need assistance getting dressed, or why someone is coming to help them each day. It is important to educate your children, even at an early age, about these normal parts of life. You can also assure your children that grandma may not remember things but she still loves them. Explain that she can’t express herself but she is still thinking about them. There are many books available for children of all ages to help them better understand topics such as memory problems, feelings of sadness, death and so on. These books will allow them to acknowledge the sadness while also realizing the importance for grandma to have people around her who love her and can take good care of her. Additionally, the books can help you approach the delicate, difficult and sad parts of decline as well as finding the good parts worth celebrating about getting older.

There are many books available for children of all ages to help them better understand topics such as memory problems, feelings of sadness, death and so on. These books will allow them to acknowledge the sadness while also realizing the importance for grandma to have people around her who love her and can take good care of her. Additionally, the books can help you approach the delicate, difficult and sad parts of decline as well as finding the good parts worth celebrating about getting older.

TIP 7: Speak with your employer.

Many employers are familiar with or sympathize with the demands that are involved with being a part of the Sandwich Generation and are willing to work with you to keep you working for them. Since you never know until you ask, make an appointment to discuss the different ways your employer may be willing to accommodate you. Some companies allow you to work from home, adjust your hours or change the days of the week that you are in the office. It is also becoming more common for employers to offer brief periods of leave so you can attend to unexpected family matters. Your employer likely has an Employee Assistance Program (EAP) that may be able to help you access resources or provide you with support.

TIP 8: You are not the last or the least. Make time for number one.

Since we know stressors can contribute to and lead to health problems of a mental and physical nature, start out on the right foot and make time throughout the week for you. While it is essential to build important things like exercise, regular sleep, and healthy eating into your schedule, there is also no shame in giving yourself the opportunity to continue your hobbies, favorite pastimes, friendships and even alone time. Maybe you won’t have as much time for extracurricular activities as before, but just several hours a week can elevate your spirits and do a world of good for your health.

Here are some suggestions for keeping in touch with your sense of well-being:

  • Take 10 minutes a day to sit down, listen to music, meditate or even just close your eyes.
  • Keep your marriage on the priority list and add a weekly activity for just you and your spouse to enjoy.
  • Give laughter a chance and enjoy the funny moments that life brings along each day.
  • Try to set aside one hour a day for something you love to do like reading the paper, taking a walk during your lunch break or calling a friend.
  • Look for the ways that providing care enhances your relationships with your family and affords a sense of satisfaction.
  • Listen to your body and learn to recognize when it is telling you to slow down or that something is not right. It’s very important to immediately take action, take a break and seek medical attention when necessary.

No matter how much the above might seem like an indulgence, doing any or all of them can help save you from hitting the proverbial wall. Once you are at the point of burn out it is very easy to wind up sick which often happens when constantly being the caregiver and never the care recipient. To help avoid reaching that run down state, remember to check in with yourself on a daily basis.

In the end, it is good to remember that you are the most qualified person for taking care of yourself. By helping yourself stay strong and healthy, you are ultimately helping your family and parents by remaining available and capable for the challenges that live in the middle of that very tightly squeezed sandwich.

About the author: Kim Miller, BSN, MSN, CMC is a Certified Care Manager at SeniorBridge, a national health care company offering individually tailored care management and home care services. She has over 30 years of experience as a nurse, with 16 of those years as a nurse practitioner. Email Kim at kmiller@seniorbridge.com or follow SeniorBridge on FacebookTwitter, and LinkedIn.

Top 10 Questions to Ask a Family Child Care Home Provider

Family Child Care (FCC) is provided in the caregivers home and typically includes children of a variety of ages.  Usually, only one caregiver is present to provide care all day.  It is important to find the right FCC for your child and here are the top 10 questions you should ask.

1. How long have you been in business?

2. What is your experience and background?

3. How long do you plan on continuing operation?

4. Name at least 3 things you like about being a FCCH provider.

5. What don’t you like about being a FCCH provider?

6. Why do you do this job?

7. Is your CPR/First Aid current?

8. What is your discipline policy?

9. Do you have an Emergency Care Plan? Ask to see it.

10. Have any complaints been filed against you in the past year?

8 Red Flags: Beware in Child Care


When searching for child care there are many things that need to be taken into consideration. Below is a quick list of 8 red flags that impact the quality of care provided.

Staff-child ratio not posted in the center classroom
Each classroom should have the staff-child ratio posted on the wall where it is easily visible. Watch for facilities that over enroll children and then bounce them to other rooms or operate out-of-ratio.

High staff turnover (center-based care)
Ask what the staff turnover has been in the past year.  The statewide average is about 30%. You want your child to have a consistent, stable caregiver.

Many complaints filed against the facility
Use Division of Child Development website: (http://ncchildcaresearch.dhhs.state.nc.us/search.asp).  Look at past history—under the DCD Visits tab—as well as most current. Pay close attention to the number of complaint investigations. A high number of complaints, whether they are substantiated or unsubstantiated can tell you a great deal about the quality of a facility. Also, pay close attention to the Actions Taken tab.

Lots of baby furniture in the infant room or FCCH
Look for lots of open floor space. Young children need “floor and explore” time and should not be confined to walkers, swings, bouncy seats, saucer seats, jumper seats, and cribs for the majority of the day.  If there is a lot of equipment it is a sure sign that it is being used!

Babies constantly crying, crying for long periods
This can indicate that children may only be receiving basic, custodial care. Infant care is very demanding and having enough staff to provide adequate care is critical.

Teachers standing over children or sitting in rockers or chairs
Caregivers should be interacting with children. This means they sit on the floor and play, sing, read books, and engage children in activities to stimulate their language, growth, and development.

Language—negative or positive?
Listen to the language coming out of all classrooms. Do you hear loud voices, harsh tones, and negative statements? OR Do you hear teachers speaking to children in a positive, encouraging, respectful manner?

Unhappy sounds
Listen for the sounds coming out of the classrooms. Is there laughter, noise, and happiness?  There should be.  If not, keep on looking.


Cost of Child Care

Child care costs are usually second after your monthly rent or mortgage.  There are many factors to consider when searching for child care: your budget, the type of care, quality of care and location.

Today we will focus on cost.  Your budget will obviously dictate what type of care you may be able to afford. Nanny care is the most expensive type of child care.  Dependent on your location rates can be $15-$20 per hour or more for one child and increase with additional children.  

Center based care is typically more expensive than a Family Child Care Home (FCCH), because obviously they have more overhead and operating expenses.  There are usually more children per classroom in center based care and they are the same age.  FCCH's are typically limited to 5 children or less, so there is a variety of ages together.

There is also Relative Care - where a family member provides care for your child - and that is usually a lower cost, negotiable, and sometimes even free!

Keep in mind that you pay tuition even if your child is sick or you go on vacation.  Some facilities will offer a break on fees for vacation or waive them all together for a specific time frame once a year.

Most facilities also charge a registration fee, either a one-time or annually.  In some instances, both.

Bottom line - no pun intended - if you are expecting or are just now going to start using child care be sure to analyze all of your costs.  Including your gas, meals, clothes, time and other miscellaneous expenses that will be incurred when you go back to work.

Happy searching!