Focus on Employees

Mom in the Middle: Eldercare or Childcare. Which Comes First?

By Elizabeth Mitchell

Our population is an aging one and further, the largest segment of our population, the Baby Boomers, is growing at an alarming rate.

Women are finding themselves smack dab in the middle of this aging trend. Often it is quite a dilemma for Mom. Take Grandma to the doctor or Suzy to soccer practice? Spend Sunday afternoon looking at college campuses with John or visit Dad in the nursing home? We have a tremendous amount of respect for our elders and have grown up believing that it is our honor and duty to care for our parents. But, when reality hits, women are finding the decisions they must make very difficult ones.

We call these "Moms in the Middle" part of the "Sandwich Generation," a generation of caregivers caught between the responsibilities of caring for children and caring for the older adults in the family. Quite often this responsibility is complicated by a mother's career or need to work.

There are no easy solutions to the dilemma, "which comes first?" The reality is that both come first and the "Mom in the Middle" comes last!

This is not a new phenomenon. Women have cared for aging relatives for decades. So why is it an issue now? Our lifestyle leads us to pack in activities and commitments way beyond our capacity. Coupled with the fact that families no longer live close to their relatives and relocate far from their family support systems, these trends lead to the extra stress of long-distance caregiving. And, there is the purely demographic fact that there are more older people than there used to be.

Did you know that nearly one out of every four US households is involved in caregiving to persons 50 years of age and over? Interestingly, 49% of caregivers experience depression and 69% of family caregivers, according to the Alzheimer's Association, consider frustration their most frequent emotion.

Being a "Mom in the Middle" takes an extraordinary amount of energy, patience and multi-tasking ability. There are terrific ideas and support on the Web, services and community resources. The trick is to find the ones that are just right for your situation.

This series of articles will provide you, and those you care about, with resources, tips and a tremendous amount of respect for the difficult job of being the "Mom in the Middle."

Caregivers of the Elderly: Who are they?

According to the National Family Caregivers Association, "Family caregivers are the glue that holds our healthcare system together. Eighty percent of all home care is provided by family caregivers. The market value of services caregivers provide is valued at more than $194 billion a year. That is more than the total of all spending on formal homecare and nursing home services combined. Truly family caregivers are a valuable national resource."

In a 1997 NFCA surveyed their members and found some surprising facts:

Over 75% of family caregivers are women
70% are between the ages of 36 and 65
More than 60% say they have suffered from depression due to their caregiving experience
67% say frustration is the emotion they experience most often
On the positive side, 70% found an inner strength they didn't know they had

However, the members surveyed are those who provide intensive caregiving services to a disabled or frail adult. They are the wonderful people that keep grandparents out of nursing homes and young stroke victims from being warehoused.

"The sandwich generation" is broader than this. Concern about and care for older adults is on the minds of most people over 40. Look around you. In your office or social group, I would venture to guess that the subject of aging parents comes up quite frequently. Just as younger moms take time off for work to care for sick children, "moms in the middle" often take time off work, or spend hours on the phone, dealing with elder health and eldercare crises.

And to be equitable, men certainly do this as well. Although caregiving is stereotypically a women's issue.

So because this is such a widespread phenomenon, there is considerable interest and support for the caregiver. It is on the web, in your community and in your church. It may not be within your home, however, and some marriages are quite stressed by the pull of children AND elders.

If the caregiver is able to care for herself, first, she is most likely going to be successful in the dual (perhaps triple?) role of "mom in the middle." The NFCA and others provide great tips, mainly focusing on self-care and assertiveness.

Ten Tips for Family Caregivers

Caregiving associations and counseling centers offer such sage advice as "The Caregiver's Bill of Rights," and "Ten Tips for Family Caregivers." Many of these tips are reminders that self-care comes first, that caregivers can set reasonable limits to protect their lives. Sometimes "Moms in the Middle" get lost in the role caring for everyone but themselves. Burnout happens and they are the last to realize it!

About Social Work offers you these Ten Tips:

1. Value yourself. Set aside time for yourself and refresh yourself. Think about what you value, what brings enjoyment to you and fit this in your schedule.

2. Seek support. Internet support groups, your friends and church may be an excellent resource. Many communities have Alzheimer's support groups and general caregiver support groups. Take advantage of the support that is offered. Reach out.

3. Allow others to help. It is very easy to say, "no" when others offer to assist you. If they aren't offering something helpful, make a suggestion regarding how they can help. This is a gift you can give to others. They truly want to help and sometimes don't know how.

4. Become an expert. Learn all you can about the condition or illness you are dealing with. Learn about aging issues and insurance. Become a knowledgeable consumer of your community's social service and health care systems. Knowledge is power!

5. Reflect on the positives of the relationship. Remember why it is you are taking care of your aging parent or relative. Take time to reflect on the times this person was a significant and giving force in your life. Renew the love and feelings you have. Sometimes the difficulties of the caregiving role can get in the way. Look at old photo albums and, if possible, reflect and recollect with your loved one.

6. Learn to involve and delegate. Your teenagers and other family members can benefit from learning about aging, and about their aging relative. Work with them to develop a respect for their family member and an interest in them. Help them to find ways to spend time with their relative and to assist by preparing meals or making gifts for special occasions. Give them the gift of the good feelings they will have when they, as well, can help. I would venture to guess that the person you are caring for, or about, has other family members, neighbors and friends. Reach out to them and let them know how they can help. Then delegate, and let go.

7. Don't give up on your significant relationships. Your involvement with an aging relative may be time-limited. Who do you want to be there after your loved one dies? Will you return to an empty home and to support systems that no longer remember you? Don't let your significant relationships deteriorate. Keep lines of communication open, and take time to be with important people in your life. If you do, they will be there for you after your caregiving time has ended.

8. Be in touch with yourself. Don't get so busy you cannot take time, at the end of the day, to reflect. Watch out for signs of burn-out and depression. Consider discussing issues with your physician or seek out professional counseling if you have symptoms of depression. Be aware of increased use of anti-anxiety medication or self-medication through alcohol. Think about your own health and mental health and get help if you see a less than healthy change.

9. Stand up for your rights! There is legislation that protects you, your role and time off from work for caregiving responsibilities. There is legislation that provides insurance and funding for the things and care your loved one needs. Band together with others who understand to protect these rights. Write to your legislators when advocacy organizations suggest it.

10. Last but not least, maintain your spirituality. When all seems insurmountable, take a moment, get in touch with your spirituality and unload your burdens. Whether its prayer or meditation, spirituality can keep you going and guide you toward the light.

Your Marriage

Many "Moms in the Middle" are also wives and partners. According to an article on the Senior Care Web site, "Being a caregiver for a senior family member or friend is very demanding and time consuming and sometimes, can put stress on the caregiver's marriage. The caregiver has to divide his or her time up between his or her spouse and the senior (and sometimes children), which may result in less quality time with the spouse and may lead to feelings of neglect and resentment."

Feeling pulled in several directions is difficult, but integrating a new, and dependent, family member into your household can be even more difficult. While having your aging relative live with you may seem the best thing to do, families need to prepare themselves for the adjustments. Remember, the person you are bringing into your home is used to being head of their household. How will it be for them to adjust to not being in charge?

An article in BlueSuitMom.com describes what a caregiving situation in a household can feel like:

For the better part of the past five years, Helen Zebrowski and her husband, Bill, have cared for first her father, and then his mother. It is, according to Helen, a matter of course that they would take family members into their homes.

"There are times when it's difficult," Zebrowski concedes. "You have to make sure the meds are done, that there's special food in the house, the dressings are done. But if there's love in the family, it manages."

As with most issues in marriage, the Zebrowskis in the article above are doing well. Theirs is a partnership. The couple make decisions about caregiving together and share in the caregiving role. This is the ideal.

Sheri and Bob Stritof, About.com's About Marriage Guides, have a wealth of resources listed to help with marriage issues. They lead their resource listing off with, "Deciding which has the highest priority can tear a marriage apart when having to make decisions regarding kids, parents, and themselves." They offer some excellent advice for surviving in a intergenerational household:

Take care of yourselves and do what you need to do to stay healthy. This includes having some fun and living life to the fullest! Don't put your lives on hold.
Don't neglect your marriage. Make time for one another.
Be practical. You can only do what you can do. Don't overload yourselves either emotionally, physically or financially.
If you have boomerang children returning home, make sure all your expectations have been shared. Call them to be responsible adults even though they are living in your home.
If you decide to have an aging parent live with you, again, share all your expectations. Remember that your parent can and probably wants to have responsibilities in your household. Let them be involved, productive members of the family.
Protect your privacy and time alone as a couple and as individuals.
Realize that any unfulfilled dreams may cause problems in your marriage.
Talk about these with one another.
Don't be afraid to ask for help from community and governmental resources.
Start talking now about the possibility of someday being part of the Sandwich Generation.
How do you think you would handle it?

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Spend Sunday afternoon looking at college campuses with John or visit Dad in the nursing home? We have a tremendous amount of respect for our elders and have grown up believing that it is our honor and duty to care for our parents. But, when reality hits, women are finding the decisions they must make very difficult ones. We call these "Moms in the Middle" part of the "Sandwich Generation," a generation of caregivers caught between the responsibilities of caring for children and caring for the older adults in the family. Quite often this responsibility is complicated by a mother's career or need to work. There are no easy solutions to the dilemma, "which comes first?" The reality is that both come first and the "Mom in the Middle" comes last! This is not a new phenomenon. Women have cared for aging relatives for decades. So why is it an issue now? Our lifestyle leads us to pack in activities and commitments way beyond our capacity. Coupled with the fact that families no longer live close to their relatives and relocate far from their family support systems, these trends lead to the extra stress of long-distance caregiving. And, there is the purely demographic fact that there are more older people than there used to be. Did you know that nearly one out of every four US households is involved in caregiving to persons 50 years of age and over? Interestingly, 49% of caregivers experience depression and 69% of family caregivers, according to the Alzheimer's Association, consider frustration their most frequent emotion. Being a "Mom in the Middle" takes an extraordinary amount of energy, patience and multi-tasking ability. There are terrific ideas and support on the Web, services and community resources. The trick is to find the ones that are just right for your situation. This series of articles will provide you, and those you care about, with resources, tips and a tremendous amount of respect for the difficult job of being the "Mom in the Middle." Caregivers of the Elderly: Who are they? According to the National Family Caregivers Association, "Family caregivers are the glue that holds our healthcare system together. Eighty percent of all home care is provided by family caregivers. The market value of services caregivers provide is valued at more than $194 billion a year. That is more than the total of all spending on formal homecare and nursing home services combined. Truly family caregivers are a valuable national resource." In a 1997 NFCA surveyed their members and found some surprising facts: Over 75% of family caregivers are women 70% are between the ages of 36 and 65 More than 60% say they have suffered from depression due to their caregiving experience 67% say frustration is the emotion they experience most often On the positive side, 70% found an inner strength they didn't know they had However, the members surveyed are those who provide intensive caregiving services to a disabled or frail adult. They are the wonderful people that keep grandparents out of nursing homes and young stroke victims from being warehoused. "The sandwich generation" is broader than this. Concern about and care for older adults is on the minds of most people over 40. Look around you. In your office or social group, I would venture to guess that the subject of aging parents comes up quite frequently. Just as younger moms take time off for work to care for sick children, "moms in the middle" often take time off work, or spend hours on the phone, dealing with elder health and eldercare crises. And to be equitable, men certainly do this as well. Although caregiving is stereotypically a women's issue. So because this is such a widespread phenomenon, there is considerable interest and support for the caregiver. It is on the web, in your community and in your church. It may not be within your home, however, and some marriages are quite stressed by the pull of children AND elders. If the caregiver is able to care for herself, first, she is most likely going to be successful in the dual (perhaps triple?) role of "mom in the middle." The NFCA and others provide great tips, mainly focusing on self-care and assertiveness. Ten Tips for Family Caregivers Caregiving associations and counseling centers offer such sage advice as "The Caregiver's Bill of Rights," and "Ten Tips for Family Caregivers." Many of these tips are reminders that self-care comes first, that caregivers can set reasonable limits to protect their lives. Sometimes "Moms in the Middle" get lost in the role caring for everyone but themselves. Burnout happens and they are the last to realize it! About Social Work offers you these Ten Tips: 1. Value yourself. Set aside time for yourself and refresh yourself. Think about what you value, what brings enjoyment to you and fit this in your schedule. 2. Seek support. Internet support groups, your friends and church may be an excellent resource. Many communities have Alzheimer's support groups and general caregiver support groups. Take advantage of the support that is offered. Reach out. 3. Allow others to help. It is very easy to say, "no" when others offer to assist you. If they aren't offering something helpful, make a suggestion regarding how they can help. This is a gift you can give to others. They truly want to help and sometimes don't know how. 4. Become an expert. Learn all you can about the condition or illness you are dealing with. Learn about aging issues and insurance. Become a knowledgeable consumer of your community's social service and health care systems. Knowledge is power! 5. Reflect on the positives of the relationship. Remember why it is you are taking care of your aging parent or relative. Take time to reflect on the times this person was a significant and giving force in your life. Renew the love and feelings you have. Sometimes the difficulties of the caregiving role can get in the way. Look at old photo albums and, if possible, reflect and recollect with your loved one. 6. Learn to involve and delegate. Your teenagers and other family members can benefit from learning about aging, and about their aging relative. Work with them to develop a respect for their family member and an interest in them. Help them to find ways to spend time with their relative and to assist by preparing meals or making gifts for special occasions. Give them the gift of the good feelings they will have when they, as well, can help. I would venture to guess that the person you are caring for, or about, has other family members, neighbors and friends. Reach out to them and let them know how they can help. Then delegate, and let go. 7. Don't give up on your significant relationships. Your involvement with an aging relative may be time-limited. Who do you want to be there after your loved one dies? Will you return to an empty home and to support systems that no longer remember you? Don't let your significant relationships deteriorate. Keep lines of communication open, and take time to be with important people in your life. If you do, they will be there for you after your caregiving time has ended. 8. Be in touch with yourself. Don't get so busy you cannot take time, at the end of the day, to reflect. Watch out for signs of burn-out and depression. Consider discussing issues with your physician or seek out professional counseling if you have symptoms of depression. Be aware of increased use of anti-anxiety medication or self-medication through alcohol. Think about your own health and mental health and get help if you see a less than healthy change. 9. Stand up for your rights! There is legislation that protects you, your role and time off from work for caregiving responsibilities. There is legislation that provides insurance and funding for the things and care your loved one needs. Band together with others who understand to protect these rights. Write to your legislators when advocacy organizations suggest it. 10. Last but not least, maintain your spirituality. When all seems insurmountable, take a moment, get in touch with your spirituality and unload your burdens. Whether its prayer or meditation, spirituality can keep you going and guide you toward the light. Your Marriage Many "Moms in the Middle" are also wives and partners. According to an article on the Senior Care Web site, "Being a caregiver for a senior family member or friend is very demanding and time consuming and sometimes, can put stress on the caregiver's marriage. The caregiver has to divide his or her time up between his or her spouse and the senior (and sometimes children), which may result in less quality time with the spouse and may lead to feelings of neglect and resentment." Feeling pulled in several directions is difficult, but integrating a new, and dependent, family member into your household can be even more difficult. While having your aging relative live with you may seem the best thing to do, families need to prepare themselves for the adjustments. Remember, the person you are bringing into your home is used to being head of their household. How will it be for them to adjust to not being in charge? An article in BlueSuitMom.com describes what a caregiving situation in a household can feel like: For the better part of the past five years, Helen Zebrowski and her husband, Bill, have cared for first her father, and then his mother. It is, according to Helen, a matter of course that they would take family members into their homes. "There are times when it's difficult," Zebrowski concedes. "You have to make sure the meds are done, that there's special food in the house, the dressings are done. But if there's love in the family, it manages." As with most issues in marriage, the Zebrowskis in the article above are doing well. Theirs is a partnership. The couple make decisions about caregiving together and share in the caregiving role. This is the ideal. Sheri and Bob Stritof, About.com's About Marriage Guides, have a wealth of resources listed to help with marriage issues. They lead their resource listing off with, "Deciding which has the highest priority can tear a marriage apart when having to make decisions regarding kids, parents, and themselves." They offer some excellent advice for surviving in a intergenerational household: Take care of yourselves and do what you need to do to stay healthy. This includes having some fun and living life to the fullest! Don't put your lives on hold. Don't neglect your marriage. Make time for one another. Be practical. You can only do what you can do. Don't overload yourselves either emotionally, physically or financially. If you have boomerang children returning home, make sure all your expectations have been shared. Call them to be responsible adults even though they are living in your home. If you decide to have an aging parent live with you, again, share all your expectations. Remember that your parent can and probably wants to have responsibilities in your household. Let them be involved, productive members of the family. Protect your privacy and time alone as a couple and as individuals. Realize that any unfulfilled dreams may cause problems in your marriage. Talk about these with one another. Don't be afraid to ask for help from community and governmental resources. Start talking now about the possibility of someday being part of the Sandwich Generation. How do you think you would handle it? © Sound Options, Inc.
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	Updated: May 15, 2007