The Customized Sandwich Generation
By:  Jennifer A. Johnson, Esq. and Scott Tolan

The term “Sandwich Generation” has been around since 1981 when a woman named Dorothy Miller coined the term essentially to describe those individuals who were taking care of both their own children and providing some level of care for their aging parent(s).

Since that time, numerous books and articles have been written about the subject from various perspectives.

This particular piece will extend the metaphor to discuss the specific components involved in the sandwich generation concept as though they are actual parts of a sandwich. The goal here is to give the reader a clear-cut understanding of what aspects must be considered when one takes on the role of sandwich provider in this case from the specific standpoint of assisting in care for the aging parent.

Creating the Sandwich You Want
The Financial:  Figuratively speaking, the bread forms the outer layer of the sandwich and is the driver for which all other sandwich decisions are made. That is, the financial resources available in each individual situation largely determine the flexibility for building the rest of the sandwich.

So, for example, if resources are available to afford specialty, artisan bread then chances are the aging parent will get the benefit of private pay in-home care or housing in a respected congregate care facility such as an independent or assisted living residence. If, conversely, white bread is all that can be afforded, then likely the family will be forced to cobble together an in-home plan of care that involves any number of family members and friends with little or no private pay care involved. On the residential side, often the options are limited to Medicaid providers at the skilled nursing level.

The Personal:  For those taking on the greatest time commitment for providing care for an aging parent or parents and also trying to fulfill his/her own parenting obligations, finding time for self, which we refer to as the cheese of the sandwich, is an important part of maintaining balance in life. For many this can be a huge struggle. The amount of direct care that needs to be provided to the older adult (which often goes back to the financial ‘bread’ of the sandwich) will help determine whether one can enjoy the benefit of a specialty cheese, i.e. carve out time for a structured activity of some type on a regular basis or be forced to economize with American cheese and find 15-20 minutes a day just to reflect and “breathe.”

One’s Own Health:  Hand in hand with caregiving responsibilities can often be health problems that the caregiver develops as a result of the burdens on him or her. Caregivers need to develop their own set of health practices which may include the consumption of some meat in their sandwich, e.g. maintaining fairly expensive health club memberships or similar set-ups or they can choose to go the less expensive vegetarian route in developing their own routines to maintain the healthiest sandwich possible.

Career:  Adding a job of any kind to the sandwich mix , in this case condiments, can be a double-edged sword. For some, a job can provide enough extra income to “tip the balance” in terms of the amount and quality of care the aging parent/parents will be able to receive. A job may also afford some emotional and psychological benefits for the caregiver that gives him/her a role outside of the sandwich. However, jobs can be a tipping point for caregivers by adding too much to their sandwiched lives and leading to an even messier sandwich.

Family: The final component of the sandwich involves “warm” versus “cold” options. Caregivers often find it difficult given all their competing responsibilities to maintain supportive relationships both with their own immediate family and also with their extended family (e.g. siblings), if any are involved. At the same time, it can be a big challenge to stay on positive terms with one’s aging parent(s) given that the caregiver may need to make unpopular decisions in providing care to them.

The ideal is to serve the sandwich “warm” — where all parties, including one’s own immediate family, extended family (if any), and the aging parent(s) all have a stake in the creation of what the individual sandwich looks and tastes like, so that all can benefit from its content on a regular basis. Alternately, when the sandwich goes “cold” for too long, (i.e. neglect occurs in any parts of the system), it can quickly become unpalatable for those involved.

The five components outlined above tend to be those faced most commonly by sandwich caregivers balancing their own family responsibilities with those posed by their aging parent(s). The perfectly-balanced sandwich will look different for every family, but every sandwich should have some part of all five elements.

With effective planning, support, and some financial resources, caregivers can create a customized sandwich to meet the needs of their particular situation.

Scott Tolan is a care manager for Life with Dignity, a St. Charles, IL based company that specializes in advocacy, life/care planning and power of attorney/private guardianship for a wide variety of individuals. For more information about the services offered by Life with Dignity, you may reach them at 630-549-0654.