Mastering the Middle

Expert advice to help 'sandwich generation' and 'club sandwich generation' caregivers stay healthy and avoid burnout

If you're an adult who's raising children and also taking care of elderly parents (or another older relative or friend), you're part of the "sandwich generation." Or, you may belong to the “club sandwich generation” — caring for an older adult, children and grandchildren.

According to the National Alliance for Caregiving (NAC), an estimated 53 million Americans provide unpaid care, an increase of 9.5 million since 2015. That’s nearly 1 in 5 people, or 19% of the U.S. population.

Being a sandwich or club sandwich generation caregiver can be fulfilling and bring you a lot of pleasure. But it can also be extremely challenging. With the added responsibilities and pressures of caring for both a senior and kids, you may at times feel frustrated, overwhelmed or even depressed.

These 9 tips, courtesy of Rush social worker Ellen Carbonell, LCSW, can help caregivers get the support they need to stay physically and emotionally healthy.

1. Recognize the importance of self-care.

“It’s essential to acknowledge that you have your own needs, and that your needs matter just as much as the needs of the people you’re caring for,” Carbonell says.  

Research has shown that caregiving can have an impact on both your physical and mental health. If you don't care for yourself (such as getting enough rest, exercising and doing activities you enjoy), you risk negative consequences for your own health and well-being.

In fact, according to the NAC, 21% of family caregivers report their own health as being “fair” to “poor,” an increase of 4% since 2015.

When you're not healthy, you can't help anyone else. Taking care of yourself will enable you to be the kind of caregiver you want and need to be.

2. Set manageable goals for self-care.

Don't put pressure on yourself to be perfect and make huge changes right out of the gate. Particularly if you're not used to taking care of yourself, a small step can have a huge impact.

“Think of it as carving out a little breathing room for yourself,” Carbonell explains. “It may be as small as taking a walk around the block, having a socially distant cup of coffee with a friend or reading a chapter of a good book. The key is to make sure that you’re focusing only on yourself during that time.”

If you’re not sure how to make self-care a routine, start by setting a goal for the week — one goal that supports self-care that can reasonably be accomplished. Once you choose your goal, break it down into the steps you need to take to accomplish it.

The more specific the goal, the more likely it is to happen. For instance, if you say, "This week, my goal is to take better care of myself," you might feel like there are a million things you could do to accomplish that goal. That can be overwhelming and prevent you from taking action.

But if you instead say, “This week, I’m going to go for a 30-minute hike,” or "This week, I'm going to schedule my annual visit with my primary care doctor," you're giving yourself one task — and that's far more manageable.

While it might not seem like a big deal to schedule a doctor’s appointment, Carbonell explains that there's no such thing as a small goal when it comes to better caring for yourself. You can always add another goal if you achieve your first one and feel ready and able to take on another.

Plus, caregivers are often so busy helping everyone else that they sacrifice their own doctors’ appointments. And your health can start to suffer if you're not going for regular checkups.

3. Just say "no" (sometimes).

It's important to acknowledge that you're not super-human. There are only so many hours in a day, and you can only do so much. To protect your health and well-being, it's necessary to prioritize, set realistic expectations and, when necessary, say "No."

This might mean asking for help with mom or dad in the mornings if it's really important that you take your children to school. Or telling your son hecan't do the traveling baseball team this year because you're committed to helping grandma in the afternoons.

Think of [self-care] as carving out a little breathing room for yourself. The key is to make sure that you’re focusing only on yourself during that time.

Of course, it can be extremely difficult to say, "No," especially to an older adult. There are many reasons an older adult may need your support — household chores, setting up medications or feeling lonely and wanting company. So be sensitive to what's behind their requests or need for help when thinking about how to set limits.

Try using "I" statements and speaking from only your perspective. When we're frustrated, we tend to use "you" statements, like, "You always need me to go with you to the movies. I just can't do that."

Instead, try saying something like, "I really enjoy going to the movies with you. Let's make a regular date, and I’m going to save those dates for us to go to the movies together."

When people have expectations of someone else, they may be hurt when that person doesn't meet those expectations. But it's more hurtful if you don't have that conversation and simply start saying "no" all the time because you're overextended and burnt out.

4. Accentuate the positives.

Focus on what you can do rather than what you can't do.

Instead of saying, "Dad, I can only come three nights a week," ask him to choose a day he would like you come over for a specific task. You may choose one day for a social call, for example, another to help with laundry and a third to do the grocery shopping.

That way, you’ve established together which days you'll definitely be there. Setting a schedule doesn't mean you won't visit other times. But this way, your dad won't expect you to show up every day and then be disappointed or hurt when you can't make it.

The same is true when setting limits with your kids or grandkids.

When your daughter really wants to do seven activities, and that’s not possible, tell her, "You can do four activities this year. Which are the four you most want to do?" Help her set her expectations in a positive way: The message isn’t that she’s not being allowed to do seven activities, but that she gets to participate in four.

5. Don't feel guilty about not being able to "do it all."

Guilt is a natural response that humans tend to feel whether they're actually responsible for the situation or not. Often, in both caregiving and parenting or grandparenting, people feel guilty and blame themselves for things they have no control over.

Try to focus on what your intentions are in a given situation: What was behind your actions?

If, say, you have a conflict because you agreed to attend your granddaughter's soccer game and prepare dinner for your parents during the same timeframe, why did that happen? Were you acting maliciously or trying to cause harm?

Probably not, right? Chances are, you started out with good intentions, wanting to please your granddaughter and your parents, but you eventually realized that the situation wasn't feasible — you can’t be in two places at once — and then felt stuck. If that's the case, try not to judge yourself harshly for making the decision to cook for your parents and miss the game, or vice versa.

It's easy, in those early stages of starting to set limits, to feel like you're abandoning the person. That you're not living up to what they expect or what you'd like to do for them. And you forget about everything that you are doing.

Just remind yourself, "OK, maybe I’m not going to every soccer game or cooking dinner for Dad every night, but these are all the things I'm still doing for them.”

6. Accept that the care you provide reflects your values, not the nature of the relationship.

Not all families have a history of positive relationships with each other. Sometimes, there are complex or negative feelings among family members, and there may be a history of physical, emotional and/or sexual abuse that goes back years or decades. 

These issues don’t just disappear when the need for providing care arises. In fact, they sometimes become more intense when the people involved in the caregiving situation have differing ideas about what needs to be done, and old unresolved issues can lead to arguments.

“It can help to base the care you provide on your own personal set of values. Ask yourself what matters most to you in your life. What gives your life meaning? Even if you have a difficult history with the person you care for, what you do to help can be based on who you are and what you believe in,” Carbonell explains. “This approach puts you in the driver’s seat and reduces your need to react to the opinions or preferences of those you’re caring for.”

7. Take stock of your responsibilities so you can delegate.

The saying, "It takes a village to raise a child" also applies to caring for older adults. Don't be afraid to ask for help. But to ensure you get the help you need, you must first figure out exactly what you need.

Take a look at everything on your plate: Write a comprehensive list of all your caregiving and childcare responsibilities, including noting which tasks others could potentially handle. Maybe you need to be the one to take your aunt to her doctor’s appointments, but others could pick up her groceries or medications.

Be as specific and detailed as you can with the tasks your list. If you ask a person to do something specific, they will probably be more willing to say yes or consider doing it.

So instead of "Prepare meals," write, "Cook dinner for Dad every Monday and Thursday” on your list.

“Once you have the list, you can then refer to it whenever anyone asks if they can help,” Carbonell says. “Be sure there are both big and small asks on the list so you can tailor the task to the person offering to help.”

8. Figure out manageable ways for others to pitch in.

You should always be sensitive to other people's limitations, Carbonell explains. It could be they have demanding jobs, or don't have reliable transportation, or live far away, or are already helping others, like their own kids or their in-laws. Or maybe they are grappling with their own health or financial issues.

That's where being strategic and specific with your asks can get you more positive replies. The brother who works full-time and has child with special needs is probably not the best person to ask to pick your kids up after school every day. But he may have the bandwidth to handle an online task, like refilling medications, ordering groceries or scheduling a doctor's appointment.

The key is conveying your needs in such a way that the family member doesn't perceive the situation as, "Mary is coming at me with her laundry list and just blaming me for not helping."

Instead, set the stage for the conversation to begin with how you can collaborate to problem-solve: "Let's talk about what Mom needs right now. How can we address those needs together?"

Keep in mind that you may have to compromise and learn to celebrate small wins. While you may have hoped your brother would volunteer to do more than one task, getting that task off your plate will still help you out. And maybe in the future, he’ll have more time and be willing and able to take on more responsibilities. 

9. When it comes to getting help, think outside the box.

Your informal network might actually be larger than you think — so be creative and expand your thinking. For instance, a lot of people get support from faith and school communities.

But if you can't find enough help from your informal network or don't have one that can be helpful, that's when you have to start thinking about more formal services, like federal and state agencies, not-for-profit organizations and out-of-pocket service providers.

You can also find lots of great community resources for older adults and caregivers at Rush, including the following:

  • Rush Generations – Rush's free health and aging membership program offers a range of specialized services for caregivers, including support groups, workshops and referrals to helpful services in the community.
  • The Rush Caregiver Initiative – Work with professionals to figure out the help you need to care for someone over 65 while getting the education and support you need to build a team that really works.

The essential thing to know is that you're not alone. Help is out there; all you have to do is reach out.

Related Stories