A Guide for Mature Living: Raising Children While Caring For Aging Parents
SUSAN FITZGERALD for The Columbian
Wednesday, May 19, 2004

It's an increasingly common scenario: Celia is a 42-year-old woman with teenagers, a husband, a job, and an 80-year-old
father with Parkinson's Disease who can no longer live alone.

A few generations ago, this family of five children, plus spouses and grandchildren, would have banded together to take
care of Dad. Today, the extended family is spread out over two coasts. The responsibility seems to fall to Celia
because she is the only daughter, and lives closest.

Even if she could quit her job to take care of Dad at home, there are substantial challenges: Dad is 6'4," and can't
get out of a chair or go to the bathroom without help. Much of the emotional energy that now goes into her
relationships with her husband and children get diverted to Dad and his needs. Nobody feels they are getting enough of
Celia's attention, and she feels guilty there isn't more of her to go around. Meanwhile, she's last on the list for
attention, and her own health suffers.

Welcome to the Sandwich Generation.

While generations of families taking care of each other is the traditional way of most cultures, the blessings of
modern medicine that confer longer life have collided with a generation that has deferred childbearing in an economy
that requires two jobs where one used to suffice.

Set these elements in a highly mobile society that values independence above almost everything else, and
intergenerational caretaking poses daunting challenges to families, finances and relationships.

Why now?

Celia and her family have a lot of company: In 2001, the American Association of Retired Persons (AARP) conducted a
survey of Baby Boomers aged 45-55 and found that two in 10 report they experience the stress of being sandwiched
between older and younger family members needing their care. Additionally, three in 10 report stress stemming from the
responsibility of caring for a parent or in-law.

Since generations of families have always taken care of each other privately, it is important to examine why this
tradition has become such a public issue that it gets a catchy nickname and a lot of publicity.

Experts point to several convergent trends:

* When the "Greatest Generation" of those who lived through the Great Depression and World War II was born, life
expectancy was about 50 years. Now they can expect about 20 more years, thanks to medical advances in management of
diseases that used to have higher fatality rates, such as heart disease, diabetes and cancer. Many live even longer:
There are an estimated 4 million people past the age of 85.

* While our elders are living longer, many are sicker and require more care, especially those with Alzheimer's or
Parkinson's disease.

* The children of this generation, the Baby Boomers, often delayed childbearing, so that now while they are still
raising their children, they may be faced with physically fragile parents who also need their help.

* The combination of living longer, with medical help, is a one-two punch that drains our elders of financial
resources, increasing their dependence on government and family assistance.

The University of Nebraska Medical Center, which researches Sandwich Generation issues, has identified policy areas
that need to be addressed, from flexible workplace options of caregivers who must meet both parent and childraising
demands, to the simple need for information and referral services for caregivers who don't know where to get help.

Help available

One agency already exists to address elder care issues, and it has taken up the challenge of connecting the Sandwich
Generation with help.

"We are a family caregiver resource set up just to help people," said Pat Janik, director of the Southwest Washington
Agency on Aging. The agency serves a five-county area from its Hazel Dell office, and is one of more than 650 such
agencies around the country that help people find and access assistance for elder care.

"People get in touch with our information and assistance office," said SWAA program manager Kristrun Grondal, "and we
go through the options. We'll work to put together a care plan. The long-term care system is pretty complex and
piecemeal."

Case managers from SWAA will evaluate both recipients' and caregivers' needs, provide ongoing planning, and can help
caregivers access assistance such as:

* Determine when they are eligible for state subsidies for family caregivers in the recipient's home.

* Home modifications for the mobility-impaired, such as raised beds, showers and toilets, plus ramps, wider doors, etc.


* Occupational and physical therapy in the home to enhance mobility and quality of life.

* Respite care and adult daycare, to give caregivers a break.

* Six-week classes to teach caregivers how to manage practical things like turning a person in bed, dealing with
emotional issues that arise, and taking care of their own health.

* Support groups of caregivers.

"Even asking for help is something people have to learn," Janik said.

While elder care has enough inherent difficulty, the Sandwich Generation is in a particular squeeze.

"It is a real challenge because they're trying to do both jobs," said Janik, of being both a good child to their
parent, and a good parent to their child.

If raising a child takes a village, the village also comes in handy for helping elders, but the village is an outmoded
concept for many Americans.

The University of Nebraska Medical Center reports that as much as one-third of the U.S. workforce has the
responsibility for caregiving of older relatives, often as not who are 100 miles away, or more.

"We've grown into living really far apart," said Janik. "It's not mom living next door anymore. Then it's deciding
whether to move to the parent, or moving the parent who doesn't want to move."

Even groups that have retained a strong tradition of close extended family living, such as Hispanic and Asian citizens
born outside the U.S., feel the strain of trying to get ahead, while trying to take care of children and elders.
According to the AARP survey, members of these groups are more likely than non-Hispanic whites to have responsibility
for elder care, to provide a higher level of care, and yet feel more guilt about "not doing enough."

Enough or not, there is a loose network of groups and agencies to help Sandwich Generation caregivers like Celia learn
and do what they can.

"The Agency on Aging is the first resource we refer people to," said Jason Erskine, of Washington State AARP's
executive council. "They are fantastic." Additionally, AARP has free brochures and website information for caregivers
to address issues from financial "literacy" of care-giving to stress.

In addition to its own services, the Agency on Aging has a local network, too.

"We rely heavily on social workers, hospitals and disease-based special groups like Alzheimer's Association and the
American Heart Association," as allies in the field, said Grondal, and to afford caregivers some group support.

Families like Celia's will have difficult decisions ahead, even with classes, support groups and agency assistance, and
though love is limitless, caregivers are not.

"You wish you could be everywhere, be perfect," said Grondal, "But you have to learn your limitations."

Resources:

Southwest Washington Agency on Aging
Phone: 694-8144
http://www.irccv.org/swaa

Case managers help care-giving families assess their needs and find assistance. It hosts an annual Family Caregiver
Alliance Conference, this year in October.

AARP:
http://www.aarp.org/wa

U.S. Department of Health and Human Services
http://www.aoa.dhhs.gov

National Council on Aging
http://www.ncoa.org

SOURCE: The Columbian, WA
http://www.columbian.com/05192004/seniors/146513.html

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