Survival Tips for the Sandwich Generation Caregiver

When Polly Shoemaker, RN, BSN, MBA, looks back on early 2016, she doesn’t know how she juggled everything. As director of clinical systems at Tulsa, OK-based St. John’s Hospital, Shoemaker already had a challenging job. But when her father’s esophageal cancer took a southward turn, she not only had to carry the logistical load of his care, but also keep up with work and family. “I don’t know how I did it, but I needed to and wanted to, so I did,” she says of her struggles as a sandwich generation caregiver.

Perhaps that’s you. Like Shoemaker, you’re feeling the squeeze of being a sandwich generation caregiver. You’re in the middle, raising sons and/or daughters while caring for an elderly parent (or other aged person). Even if you don’t have children, you may still find yourself pirouetting between the need to be at work and the need not to be there because someone else relies on you.

As Amy Goyer, a family and caregiving expert for AARP and author of Juggling Life, Work and Caregiving, notes: “When you look at the demands of your time and you’re juggling all of these things with just 24 hours in the day, it’s really difficult to prioritize and get it all done.”

Admittedly, there’s no one-size-fits all strategy for handling all the facets of your life. Yet, by being organized and engaging others, you can take care of everyone—including yourself.

Be Organized (But Go with the Flow)

Getting and staying organized are the most important survival skills for managing caregiving, says Goyer. In streamlining your schedule, you not only need to prioritize structure and routine, but also implement small steps to ease your daily duties. Phone apps, for instance, can keep you on course by organizing schedules and people.

Also, keep a contingency plan in your back pocket. Whether that means changing your goals, adjusting your schedule, tapping your backup team, or even modifying your definition of success, you want a strategy for when events don’t unfold as you envisioned. “Sometimes, we sacrifice the very good because we want the perfect,” says Goyer. “But we have to make compromises and not be resentful about them.”

Shoemaker agrees, noting that in getting her father to supplement the morning and evening tube feedings that she and her husband performed faithfully, she made sure that he had his favorite brands of nutritional drink brands so he’d drink during the day. And even when it became easier for her to write his checks, she still let him sign and even deliver them so he felt included in the process. “I finally learned that something was better than nothing,” she says. “I had to bend on some things.”

Don’t Be Afraid to Seek Help

You may think you’re the best person to handle caregiving. After all, you know the human body, understand the aging process, and are savvy about procedures and potential outcomes. Who better than you to be in charge? But truth is, you can’t do everything. Asking others to step up to the plate can diffuse the physical and emotional stress of people being dependent on you—along with the guilt when things don’t get done right. As Carol Abaya, MA, a nationally recognized expert on the sandwich generation, notes: “One of the big fallacies is that because it’s your parents or family members, only you can do everything for them. You can’t, and you shouldn’t.”

Admittedly, calling on brothers and sisters when you need all hands on deck can be challenging. A family health crisis can bring up a host of issues, not to mention uncover genuine differences of opinion. And sometimes it’s just easier to give siblings a pass because they live a distance or are grappling with their own issues.

But you do yourself no favors by discounting the very relatives who also may have a stake in this person’s health. Bringing them on board can be very helpful, even if you have to brush up on your negotiation skills. If you’re rusty in approaching your siblings, making demands, or setting boundaries, you may want to join a support group to learn from others how to assign tasks and say “no.” “Even if a sibling lives far away,” says Abaya, “you have to be able to say, ‘I need you to come and take care of mom or dad for a long weekend so that I can get away.’”

As the on-call patient care coordinator for Hospice of Central Pennsylvania, Nicole Planken, RN, knows the value of having others available when you’re caring for ill patients. She’s not only seen it in her professional life, but also as the primary caregiver for her mother, who’s partially paralyzed from a stroke post-brain aneurysm, and her mother-in-law, who suffers from stage IV lung cancer.

Planken is fortunate in that her sister and aunt are both closely involved with her mom. Moreover, she credits a caring husband who has the flexibility of being self-employed to pinch-hit with their son, her mother, and her mother-in-law. What does it take to cover everything? Although Planken credits her night shift schedule for making things work, she has a few other things in her quiver: a strong faith to keep her centered, written notes to track the minutia, and naps to stay refreshed. “I never feel like it’s an inconvenience or a burden to drop everything and do what they need me to do,” she says. “The only problem is that my life consists of many two-hour naps. I need rest in between everything. It’s my biggest challenge.”

Engage Your Employer

If you’re like other nurses, you want to function at your best, even if you’re exhausted from navigating the demands of sandwich caregiving and work. You may be surprised that your employer has resources to help you maintain your good health as a person and staffer.

For instance, any time employees at Johns Hopkins University in Baltimore, Maryland need help in navigating any challenge that might affect their performance, Meg Stoltzfus, a lifespan service manager in the Office of Work, Life, and Engagement, or her colleagues, get into the mix. They provide referrals outside the institution as well as link people to various short- and long-term internal services. If school is unexpectedly cancelled, for example, the office is Johnny-on-the-spot with a “manning” service to facilitate temporary childcare at home. “We want to help employees make sure that their loved ones are getting the care that they need at home,” says Stoltzfus, “so that when they’re at work, they’re not worried or distracted but completely focused on the job.”

Whatever gold mine your human resources department yields, consider yourself lucky if you have flexibility in your job. Shoemaker, for instance, not only has an understanding boss, but she also didn’t need to be tethered to her desk when her father needed her most. As head of the clinical arm of her hospital’s IT function, she could use her laptop almost anywhere her dad was at the moment. Moreover, even though she had a two-hour commute in ferrying him to his radiation treatments, the sessions were at St. John’s so she was close at hand. Shoemaker also was confident that her husband and others, including a hospice nurse and aide, had her back at home. “I knew I had the support when I needed it,” she says.

Bring Along Your Children

Although you don’t want your children to feel shortchanged because you’re caring for Grandpa or Grandma, you also need them to buy into what you’re doing and what needs to be done. Obviously, age makes a difference as to expectations. But if they’re old enough for chores, they’re old enough to understand that in helping out, they’ll have more time with you.

“It’s important to sit your children down, explain what’s going on, and get them involved in the caregiving,” explains Abaya. “You need to say, ‘This is what I need from you, and this is what I then can do for you.’”

By tag-teaming, for instance, Shoemaker and her husband were able to cover her dad’s needs and still keep up with their son’s various activities, from academic meets to livestock showings. But they also were confident that at 12, Ethan understood the situation and could roll with the punches. He had seen his beloved “Papa James” change and knew that for the present his mother had to reprioritize the three men in her life. “For now,” Shoemaker says, “Dad had to be our primary focus.”

Save Time for Yourself

With time at a premium—and someone else’s vulnerabilities in your mind’s eye—your personal priorities and favorite pastimes likely take a back seat. However, attending to your own physical and emotional needs is not selfish; it’s simply good sense. You need to refuel routinely, especially when you’re expending emotional and physical energy in giving. “People feel guilty taking a little time and doing those little things for themselves,” says Goyer, “but it’s really just a practical issue. You have to do it, or else you won’t be able to care for others.”

Obviously, streamlining your routine and bringing resources to bear can help you make room for your personal priorities. But it’s not enough to say that you’re going to join an exercise class or take a long weekend. You want to plan so that it happens. Whatever the activity, plug the date in your app and keep it. “Scheduling is really, really important,” Goyer says.

Shoemaker, for example, is an avid walker who hikes the Susan G. Komen 3-Day Walk for the Cure every November. Even during the course of her father’s illness, she penciled in time for herself. But it wasn’t until his death in February that she finally could spend a lazy afternoon without worrying. Although Shoemaker struggled at first with the concept, today she’s at peace. “I’d take my dad back in a heartbeat,” she says. “But I know that he’s in a better place. It’s OK to be relieved.”

Final Thoughts

In the din of activity, it might be difficult to think of the positives in being a sandwich generation caregiver. But experts suggest that no matter the challenges, you’ll find them. Perhaps you’ll parlay an improved relationship or gain new perspective on yourself or this person.

For instance, even though Planken prays continually for guidance, strength, and wisdom in helping her mother navigate her struggles, she’s still impressed by the woman’s upbeat attitude. Even when Planken has had to point out how very lucky they all are that she’s alive with her mind, memory, and speech intact, it’s her mom who renews her daughter’s spirit. “My mom has always been very optimistic, and I’ve seen it clearly,” she says. “She calls me daily just to let me know that she wiggled her finger and feels incredibly better. She’s so thankful.”

As for Shoemaker, she learned that being a sandwich generation caregiver involved two versions of care: addressing her dad’s physical needs as a skilled nurse along with his emotional needs as a loving daughter. In merging the two versions, she not only kept her father comfortable, but also where he wanted to be—in their new house. “He had his dignity,” she says. “He knew he wasn’t alone in an institution. He was where he was loved.”