Most little girls have fond memories of hanging around the kitchen with their mothers making sandwiches of all kinds—bologna, grilled cheese, and let’s not forget America’s favorite, the peanut butter, and jelly sandwich. Decades later, little girls grew into women with young children and aging parents. Now they’re making sandwiches for their parents and children, and so are men.
The “sandwich generation” is a season of life when adult children care for aging parents and children at the same time. [i] It’s a stressful time where adult children caregivers need a break called respite. What is respite care for elderly and what is causing the desperate need for it? How can sandwich generation caregivers manage the triple duty of caring for their aging parents, young children and squeak in a little time to care for themselves?
Think for a moment about some of the ways that our society has changed and had a major effect on the aging population and our young adults. Here are some sandwich generation statistics to consider.
Advances in medicine and medical technology allow people to live longer. From 1900-2000, life expectancy has increased from 47 to 76 years. [ii] What societal changes have affected our college graduates and young adults? [iii] The economic instability has made it more difficult for undergraduate students and students with advanced degrees to find meaningful work that pays well. The rising costs of higher education make it difficult to attain independence because of lack of income and the burden of student loans to repay. If that is not challenging enough, post-graduate students have to contend with the high cost of living and escalating rents.
The change in these societal dynamics is motivating today’s young women to start the next chapter of their lives later than in past generations.[iv] They are more commonly getting married and having children in their mid to late 30’s—not too much before their parents are aging enough to need some assistance. These sandwich generation statistics show how middle-aged men and women find themselves caring for two generations at the same time—smack in the middle of a generation sandwich.
It didn’t take a rocket scientist to discover the phenomenon of the sandwich generation, but it did take an insightful social worker by the name of Dorothy Miller, in 1981. [v] Dorothy not only named the sandwich generation, she recognized it as a future trend and called our attention to the need for respite care caregivers for elderly people. Some sandwich generation statistics and respite care facts show us just how prevalent this movement is.
Facts and Stats on the Sandwich Generation
In 2005, baby boomers largely made up the sandwich generation. [vi] By 2014, boomers began aging out of the caregiver season of life and started transitioning into the elder phase of life. They were becoming grandparents as their children began raising up their own families.
The National Alliance for Caregiving (NAC) teamed up with the AARP Public Policy Institute in 2015 to produce one of the most comprehensive and recent studies on aging called Caregiving in the U.S. [vii] The report shows that 44% of people aged 44 to 55 have at least one living parent and at least one child under the age of 21.
American society has long held the expectation that women should be the main providers for elders and children. The Family Caregiver Alliance reports that 66% of caregivers are women. [viii] Recent trends show that more men are stepping up to the plate in the caregiving arena and the percentage of male caregivers is growing.
The Pew Research Center studied the rising financial burdens for middle-aged Americans and found some additional sandwich generation statistics. [vi] About 47% of adults aged 40 to 50 years old have a parent aged 65 or older and are raising a young child or are supporting a grown child. About 15% of middle-agers financially support an aging parent and a child. Pew also polled middle-aged caregivers about their satisfaction rates. About 31% of the sandwich generation that answered the poll said they were very happy and about 52% of respondents said they were pretty happy. Additionally, Pew found sandwich generation statistics regarding ethnic and cultural differences in the prevalence of caregiving. About 21% of Hispanics care for the older and younger set, while 8% of black families and 5% of white families fall into the sandwich generation.
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Sandwich Generation Stress is Super-Sized
In general, elder caregivers have higher levels of stress, anxiety, and depression than non-caregivers. Because of the extra hours involved in caregiving, sandwich generation stress builds in the caregiver’s body. The result produces physical problems like high blood pressure, elevated insulin levels, cardiovascular problems, and a weakened immune system.
Sandwich generation caregivers are holding down full or part-time jobs in addition to their caregiving duties. After the financial crisis of 2008, many women returned to the workforce or entered it for the first time to make up for their husband’s job loss. Many women choose to work extra hours to help make financial ends meet. While the fluctuating economic times force women to take on a larger role as financial providers, society hasn’t lightened up the expectation for them as caregivers. Many sandwich generation caregiver women feel overworked and overextended because there are simply not enough hours in the day to do all that they need to do and they aren’t getting enough help.
Caregivers acknowledge three main types of sandwich generation stress including financial stress, personal stress, and depression, because of the overwhelming responsibilities. Sandwich generation stress affects the marriage and family relationships of all caregivers because they just don’t have time to nurture the healthier members of the family.
On a positive note, some sandwich generation caregivers find a crossroads between sandwich generation stress and feeling helpful. Providing care for elders increases the intimacy of their relationships, especially when the elders affirm that they appreciate the help. Many sandwich generation caregivers find personal satisfaction in being able to help.
All caregivers have a high risk of having sandwich generation stress turn into depression. [ix] A study called, “Study of Working Caregivers and Employer Health Costs” shows that 20% of women caregivers over the age of 50 experience symptoms of depression as compared with 8% of the female non-caregivers. [x]
About 40% to 70% of family caregivers report having symptoms of depression that are clinically significant. About 25% to 50% of these caregivers meet the diagnostic criteria for major depression, according to one study. [xi]
Women hold a higher risk of having depression because of the hormonal and chemical makeup of the female body. People who care for elders with Alzheimer’s disease or symptoms of dementia also have higher rates of depression and extreme sandwich generation stress.
What Is Respite Care for Elderly and What Can It Mean for the Sandwich Generation?
We don’t use the word respite often, so what does it mean and what is respite care? The standard respite care definition describes an interval of rest or relief after doing something difficult.
What is the Respite Care Definition?
If you were to ask several different people the question, “What is respite care?” you will likely get a variety of answers because respite care for elderly can take on many forms. Respite care for elderly sometimes takes place at a nursing home, assisted living community, memory care facility, or adult daycare program. Respite care can also refer to other respite care caregivers who come into the home and care for the senior in their usual environment.
Respite care caregivers for elderly generally provide care only for a short while, which can be for a few hours, all day, or for a few days. A stay of a few weeks or a few months in a short-term nursing home or short-term assisted living facility also qualifies under the respite care definition.
Because respite care can take place in various settings, you might be wondering what is respite care like at a nursing home, memory care facility, or assisted living facility. It looks very similar to respite care definition of caregiving at home. Seniors get meals and snacks. Most respite care caregivers work for programs that have a nurse on staff to take vital signs, administer medications, and stand by to manage any medical concerns. Short-term nursing homes and short-term assisted living facilities also have eldercare activities to keep seniors stimulated and engaged like pet therapy, music, and other entertainment.
Why Do Caregivers for the Elderly Set Up Short-Term Nursing Home Care for Respite?
One thing that makes senior caregiving so exhausting is that caregivers don’t get paid time off for sick days, holidays, personal time, or vacations. It’s incredibly difficult to take a break. Senior caregivers can’t get just anyone to fill their shoes as a care provider. They need someone who is qualified and has experience in caring for seniors. Getting qualified care in a short-term assisted facility means that when a senior caregiver takes a break for vacation or refreshment, they can rest assured that the senior will get excellent care in their absence.
Respite care and short-term care in an assisted living facility can be a lifeline for the sandwich generation. [xii]
What Can We Learn from Respite Care Facts?
Senior caregivers, especially those in the sandwich generation, have demonstrated that they need respite care so badly, that researchers have taken a strong interest in studies about respite care facts.
The Pew Research report showed that senior caregivers under utilize respite care for elderly. In fact, respite care facts show that only about 12% of the caregivers take advantage of respite or short-term care in an assisted living center. This is a surprising statistic since caregivers of people with Alzheimer’s disease also said that respite care was one of the services they valued the most.
Researchers performed studies in 2009 that looked at how the financial crisis affected senior caregiving. [xiii] A study by the National Alliance on Caregiving and Evercare showed that 60% of caregivers held jobs outside of their caregiving duties. About half of them worry about taking time off work to care for a family member or friend without risking losing their jobs. About 51% of the respondents also said that the economic instability compounded the stress that they already felt over being able to care for a relative or friend.
Eldercare researchers have also expressed interest in respite care facts that show how much money elder care costs in various settings.
Older studies have shown that nursing care admissions decreased significantly when respite care increased. [xiv]. In today’s numbers, the annual cost of caring for people with Alzheimer’s disease is $259 billion dollars. [xv]
What is the Difference Between Respite Care for Elderly and A Short-Term Nursing Home?
A short-term nursing home or short-term assisted living center is not very different from the respite care definition. A caregiver may opt to use a short-term nursing home for many of the same reasons as for respite care for elderly, like taking a short break or a longer break like a vacation. A short-term assisted living stay by respite care caregivers is also sometimes used during the week for adult day care or memory care while regular caregivers go to work. More commonly, there are other reasons for choosing a stay in a short-term nursing home.
Often, the signal for in-home caregiving by family members ensues after a medical emergency or a medical crisis. These events are usually emotionally very trying for families because it’s the first time they have to come to terms with the notion that their loved one will need assistance at home. It takes a time to rearrange schedules and figure out which family members are available to provide care when it’s needed.
Older people take longer to recuperate from a medical emergency than when they were younger. As the senior begins to recover, they may not meet the criteria to remain in the hospital; yet they are not healthy enough to transition directly back home. A short-term assisted living facility may be just what the senior needs. They will have a comfortable room where they can rest that looks more like their bedroom at home than a stuffy hospital room. The nursing staff takes their vital signs and tends to their needs around the clock. Meals will be brought to them and staff will take care of housekeeping matters. Elders will also have access to rehabilitation specialists like occupational therapists, speech therapists, physical therapists, and other professionals.
Another reason that elders use a short-term nursing home is if their existing home is inhabitable for some reason. Perhaps there was a fire or flood in the home, or workmen are renovating the home. An elder may be forced out of their home due to an animal infestation or some other safety hazard that makes the home unsafe for the senior to live in it. While staying in nursing care, the senior will be safe and have all their personal and medical needs taken care of until they can return home.
Most seniors prefer to remain at home with a caregiver rather than to be admitted to an assisted living facility, nursing home, or memory care facility. Senior caregiving can be extremely difficult, and family members or the caregiver sometimes reach their limits to provide care on their own because they are struggling with burnout. At this point, caregivers may decide that it’s time to admit the senior to a nursing home or assisted living community. Taking this step might not go so well with the senior, but sometimes the senior settles into a routine once they actually get there and they like it better than they thought they might. Most short-term nursing homes allow seniors to come and live there for a short time to see if they like the staff, the setting, and all the other amenities the program has to offer.
Respite care caregivers in short-term care can also help ease seniors into a short-term assisted living arrangement. Easing them in is a little different than letting them try it out. If the short-term nursing home allows it, you could start by taking your loved one to the facility a few times a week and see how things go. If that works out fine, maybe try it for a week. Then send them every other week for a few months and gradually ease them into living there full-time.
Short-term nursing homes and assisted living communities offer all the same amenities as their full-time residents get, so your loved one will really get a feel for whether they like the surroundings and programs. When you consider that short-term assisted facilities offer restaurant meals, social activities, transportation, housekeeping services, laundry services, nursing and medication management, personal care, in-room emergency calls, and 24/7 staff, there is a lot for seniors to love about short-term nursing homes.
What is the Cost of Short-Term Assisted Living or Short-Term Nursing Home?
One of the biggest stressors for family caregivers in the sandwich generation is managing costs for their parents. While government programs and private long-term care insurance help to subsidize the costs of in-home and institutional elder care, they don’t cover all costs and family members often have to pay the difference. According to Genworth data in 2015, the median daily cost for short-term nursing home stays is around $220 to $250 per day. [xvi]
Another factor that family caregivers worry about is how long it takes to get their loved one into a facility. Every short-term assisted living facility has their own rules, so it’s best to check the rules for your preferred facility. The facility may prefer at least a few weeks’ notice so that they can prepare a room and plan for staffing. Most facilities accept seniors that are transitioning out of hospitals after a surgery or other crisis, so they might be able to do a same-day admission if you have an emergency.
Doing a same-day emergency is sometimes necessary, but be aware that fast transitions can be extremely hard for seniors, especially for seniors with symptoms of Alzheimer’s disease or dementia. Changing environments can upset and agitate them. Alzheimer’s disease causes the senior’s memory to fade out, and when their memory returns to them in a new environment, it causes them to be scared and confused.
It’s best to think things through to make things go as smoothly as possible when there’s time. The Alzheimer’s Association offers some expert advice for sandwich generation caregivers on how to tell an elder that it’s time to move to a nursing home for respite care. [xvii] Here are some tips and suggestions for what you can do before, during, and after a short or long-term move to nursing care.
A benefit to using a short-term nursing home or short-term assisted living facility for respite care for elderly is that it can ease the transition if a permanent move becomes necessary later on. The senior will already have some familiarity with the environment and staff, and the transition will hopefully be less traumatic for them.
How Respite Care Caregivers Can Have a Sensitive Conversation About Transition to Nursing Care
Communication between the senior and the family caregiver becomes extremely important when the senior is later in life. Having a conversation about transferring to an assisted living or nursing home facility is often is generally an uneasy topic to broach, even when it’s necessary. Whenever possible, start the conversation early, when the elder is cognizant and can help to make decisions about their own care. Making a move to a totally new environment is much less upsetting when the elder helped to make the decision about where they are going and knowing what parameters signaled a move. When the senior has no say or control over the move, often they feel like others are forcing the move on them, which makes it more difficult for them to have an open mind about moving.
When you have made a final decision that it’s time to transition your loved one to a facility, you’ll need to communicate the news in a loving, sensitive manner. Try to remember that even if you’ve had previous conversations about moving to a facility, the progression of Alzheimer’s disease and dementia may not allow them to pull up previous planning. Here are some helpful strategies for having that difficult conversation.
As a senior caregiver, you know your family member best. Think about the normal routine and the daily schedule and determine if there is a time of day when the elder typically tends to be in a calmer state. Is there a time of day when there are little or no outside distractions? Does the person enjoy having their daily home health nurse, doctor, or social worker come in to see them? Your loved one may take the news better with a trusted professional present. At a relaxed and comfortable time of day, gently explain to your loved one why it’s time to make the move and where they will be going. Help them understand that you have exhausted all other potential care options and that without making this move, you can no longer keep them healthy and safe.
Do your best to reassure them that you are not abandoning them and that you will take a strong role in overseeing their care. Try to comfort them by explaining that you will do your best to make their new space feel like home and that you will visit often.
The Alzheimer’s Association recommends that you be completely honest with your loved one about where they are going. Beating around the bush by saying you are just taking a ride or visiting a new place sets the stage for your loved one to mistrust you. It’s also important to communicate with the elder about whether the stay is temporary, permanent, or just a “look see.” This is the best approach to helping them have an open mind so that they will be willing to form relationships with staff and engage in some of the program’s activities.
Do your best to prepare for your loved one’s reaction to the news. There’s a good chance that people with memory issues will be upset and resist the news. They may even blame you and resent you for causing the move to come about at this time.
Try not to take it personally. Remember that you thought through your decision carefully and that you always give your loved one’s best interests and quality of care a top priority. It’s best to acknowledge the senior’s feelings of rejection and abandonment if it becomes an issue. Be as patient as you can and help the elder work through their feelings, reminding them that they are a valuable part of your family and that you love them. Encourage them to express any dissonant feelings about making the move. Avoid arguing with them about it, which only serves to put them on the defense.
Don’t overthink it or continually bring the matter up—just make it part of the normal conversation if it comes up. When the subject comes up, take a positive approach to it. This is a good opportunity to talk about which personal belongings they’d like to take with them to their new home. Expand the conversation to talking about the other people they will meet at the new facility and how their routine may be different. Other matters that will be particularly important to them are how much privacy they can expect to have and how often family members plan on visiting them. To the extent that it’s practical, allow them to get acquainted with aides, therapists, social workers, and nursing staff at the new facility.
It’s common to focus so much on the elder’s transition to a nursing facility that you don’t realize how much this change will affect you as well. Transitioning your loved one to a facility will bring you some relief, but it also creates new worries. It helps for family members to get acquainted with staff by sharing stories and photos of their loved ones prior to the transition. Share some of your loved one’s personal history and favorite interests. Pass along any caregiving tips that you’ve learned along the way.
When the move is for short-term nursing or assisted living, visit often in the beginning and have honest conversations about when the elder can return home. If they are adjusting quickly, it might signal a conversation about turning short-term assisted living into a permanent move.
Respite Care for Elderly Benefits the Sandwich Generation Caregiver Significantly
Many caregivers fight a continual inner struggle with feeling like they’ve failed when they try to do everything themselves. It’s important for sandwich generation caregivers to recognize that they’ve taken on huge responsibilities caring for two generations of family members at the same time. To successfully manage both, sandwich generation caregivers need to accept that they need to schedule time in their busy lives to take care of their own physical and emotional health.
Sandwich generation caregivers will also benefit by being willing to accept help from others. If you haven’t asked, “What is respite care?” it’s time to get acquainted with it. When it comes to the health and safety of someone you love and care about, it’s one of the most responsible actions you can take. Be kind to yourself and don’t cave to other’s perceptions that you need to do it all alone.
Acknowledge that you’ve been through a lot and practice self-compassion. There’s no need to judge or criticize yourself mercilessly. Practicing self-compassion means affirming your worth and that while things are not always perfect, you are doing the best that you can.
Listen to your caregiver’s intuition and be willing to implement the same kindness, understanding, empathy and compassion that you have for your loved one towards yourself.
[xi] Zarit, S. (2006). Assessment of Family Caregivers: A Research Perspective
[xiv] (Kosloski, K. and Montgomery, R.J.V., 1995)