The Sandwich Generation: Caring and Coping

You love and respect your parents.  You never expected to reverse roles with them, yet now it seems you take care of them more each day.  Join the club.

By Candace Plotsker-Herman

Witness this Thursday evening scene:  eight-year-old Yael’s fever just skyrocketed to 104°, Jeremy is late for his SAT review course and Rachel is whining for dinner.  A friend calls to ask if two extra guests can sleep over this Shabbat.  David hopped a late train from the office and calls to be picked up from the station.  For the tenth time that hour, Sarah must decide whose needs to attend to first.  Sound familiar?  Maybe.  Except that Rachel is Sarah’s 65-year-old mother-in-law and an Alzheimer’s victim.

Welcome to the sandwich generation:  a growing generation of middle-aged baby boomers who thought they had paid their dues when they changed diapers, soothed chicken pox itches and coped with new drivers.  Once, they thought choosing pre-schools was difficult.  Now, they read college applications with one eye and nursing home applications with the other.  They feel tired, overwhelmed, inadequate and guilty — on the good days.

Is the sandwich generation merely a ’90s buzzword for an age-old challenging stage of life?  Yes and no.  Previous generations did not face this responsibility to the same extent because people simply did not live as long.  Most of today’s families will eventually struggle with these questions:  Should they care for their parents at home?  How much care-taking should they personally undertake?  How can they resolve guilt?  What are the halachic parameters of “Honor thy parents”?

Honoring your parents includes caring for them, but supervising their care may well fulfill the requirement.  Dr. Michael J. Salamon, a noted gerontologist, director of the Adult Developmental Center, Inc., in Hewlett, N.Y., and author of Home or Nursing Home:  Making the Right Choice, says, “My understanding is that the halachic mandate to care for your parents is clear, but it does not mean that you must do the actual physical work yourself.”  Rabbi Moshe Lieber, author of a halachic guide to the mitzvah of honoring one’s parents titled The Fifth Commandment, explains that depending on the situation, children should indeed enlist the help of siblings, hired assistants or appropriate facilities.

Long Distance is Not “The Next Best Thing to Being There”

Long distance exacerbates difficult situations.  Rebbetzin Miriam Lehrfeld, who has been rebbetzin at two Miami Beach congregations with significant elder populations over the past 40 years, explains that many people retire to Florida planning to golf, bask in the sun and entertain visiting grandchildren.  Years later, the picture may grow bleak.  Their children, who have grown accustomed to visiting them via Ma Bell, don’t know when closer attention becomes needed.  It is essential for children to visit and to observe carefully:  Is Mom’s pantry filled?  Is the apartment as clean it used to be?  Does Dad have stains on his shirt because he can’t see them?  Are they taking required medications?

When long distance care is unavoidable, one option is to hire a local social service agency.  Aides can help with tasks such as shopping and dressing as well as with more specialized care.  “However,” Rebbetzin Lehrfeld points out, “at times it is necessary for the parent to move closer to the children.  Elderly and sickly parents need an advocate.  This is especially true in medical situations.  Often the sick person does not comprehend a doctor’s instructions.  True to human nature, many doctors often treat patients with more attention when they have to account to an interested, caring child.”

Home, Assisted Living or Nursing Home:  the Jewish View

Most experts agree that it is best for elderly (but healthy) parents to live in their own homes, while children or paid workers assist with errands, cooking, etc.  It is important to provide assistance without assuming control.  Too much care, if unwarranted, can be confining. Rebbetzin Lehrfeld, who appreciates the importance of this concept, could easily shorten her grocery trips by shopping for her 91-year-old mother-in-law.  Instead, she picks her up and takes her along — providing only the necessary help.  However, if living alone is not viable, families must choose home care, assisted living or nursing home care.

It’s crucial to consider many essential factors.  Some salient issues include your professional responsibilities, your home’s layout, your children’s ages, the availability of home health services such as physical, speech and occupational therapy, your parents’ temperament and your feelings about caring for a dependent person.  Your past relationship must be considered.  “Past conflicts will not disappear simply because someone became disabled,” explains Dr. Salamon.  It is foolish to imagine that you can bring your mother-in-law home, bathe her, dress her, take her to the doctor and forget that you haven’t said a kind word to each other in 30 years.

It is unrealistic to attempt in-home care without help.  Involve your siblings, spouse, and to an age-appropriate extent, your children.  Accept help from friends and relatives.  Explore community resources.  Many organizations provide transportation to and from senior day care centers that offer company, stimulating activity and a hot lunch.

Assisted living arrangements allow residents to maintain their own apartments while partaking of services such as shopping, meals, transportation and in some cases, limited medical assistance.  Many families find this to be a practical arrangement that provides a sense of security to parents and child alike, while allowing the parents to feel independent.

Nursing homes provide less independence, but more medical care. Noted rav and author, Rabbi Berel Wein, asserts, “Most poskim will say that halachah supports [placement in] permanent nursing care, when a parent is in need of it — particularly in cases of dementia.”  Once you opt for this, you should explore varied choices.  Visits to nursing homes and discussions with your rabbi, gerontologists and care-giver support group members will help you make the best choice.  Your role will take on a different, but equally important, function.  Visit often, and be your parents’ advocate.

Take Good Care of Yourself

Practical Aspects

The lion’s share of the work is generally performed by one child, usually the daughter or daughter-in-law.  Therefore, it is essential for the primary caretaker to make her own needs heard.  “The bottom line,” Dr. Salamon says, “is that you simply can’t take care of anyone else if you don’t take care of yourself.”  You must get sufficient sleep, nutrition and exercise.  “How do I find time for myself, my children, my spouse and my parents?”  You make time.  Not by yourself, but by involving others.

Family members must pitch in.  Younger children can set the table, prepare the salad and fold the laundry.  Teenagers can pick up Grandma’s prescriptions, drive her to the senior center or assume the responsibility (instead of Mom) of visiting Zeide in the nursing home once a week.  When friends or relatives offer, accept their help and ask for specific favors that will ease your schedule.  Perhaps you want someone to accompany you and your father to the doctor; or you may prefer that someone come in to share a bit of Torah-learning with him, read him the newspaper or play a game of cards — while you go to the gym.  The individual who made a sincere offer will feel good about providing concrete support.

Emotional Aspects

Jugglers have to drop the ball at times.  Accept that you cannot do it all.  “It’s crucial to be kind to yourself; forgive your own mistakes,” says author Leah Averick.  “Remember,” she adds, “every day is a new beginning.”

Establish boundaries.  “It is proper to help,” says Dr. Salamon.  “It is not appropriate to be manipulated.”  It is important to discuss reasonable guidelines with your parents about what you can and cannot do for them.  Since your obligations to your parents are bound to take you out of the house and away from your children, discuss reasonable, age-appropriate participation and limits with them.  Rabbi Wein explains that your primary obligation is to your young children.  In practical terms, this means that you can tell your 15-year-old to heat up dinner for himself and his younger sister while you are meeting with the social worker at Bubby’s nursing home.  It is not appropriate to make this demand of an eight-year-old.

Clearly, as children get older, they can become more involved in helping to care for their grandparents.  As long as your expectations are realistic, you should not consider this to be a burden you are placing upon your children.  Rather, it is a gift you are bestowing.  You are teaching the essence of chesed and kibud av v’em, honoring one’s parents.

It is natural to feel conflicted about opting for nursing home care.  Recognize your feelings for what they are:  regret that you could no longer care for the person who cared for you, sadness about your parent’s aging and feelings about your own mortality.  “If you have made the best decision based on options that you’ve investigated carefully,” says Dr. Salamon, “you need not feel guilty.”

Don’t Underestimate Support Groups

Support groups are an invaluable source of reassurance and practical help.  “Members of a support group speak the same language,” explains Rea Kahn, R.N., M.P.S., Support Group Coordinator, Alzheimer’s Association (New York City Chapter).  “Particularly in the case of dementia,” she explains, “a support system helps normalize a pathological situation.  Unlike friends, who may think you are impatient, group members understand how difficult it is for you to tell your father that his wallet is in his pocket — for the 27th time in one morning.  They can relate to how hard it is to help someone who has no insight into his or her own situation and refuses the help that he or she desperately needs.”

It is difficult to feel sandwiched between two generations without feeling that the filling — your own self — is getting squeezed beyond recognition.  Yet setting priorities, knowing when and how to get help and seeking the wise guidance of the Torah, can transform these challenging years into rewarding ones.

Candace Plotsker-Herman is a communications consultant and writer in New York.  As a wife and mother, and as a daughter, daughter-in-law and granddaughter, she is a card-carrying member of the sandwich generation.

Recommended Reading

Leah Averick, M.S.W..  How In-Laws Relate:  It’s All Relative and Don’t Call Me Mom:  How to Improve Your Relationships (Lifetime Books, Inc.)

Rabbi Moshe Lieber.  The Fifth Commandment (ArtScroll Press)

Michael J. Salamon, Ph.D. and Gloria Rosenthal.  Home or Nursing Home:  Making the Right Choice (Springer Publishing Company, Inc.)

Alan P. Siegal, M.D., Robert S. Siegal.  Forget Me Not:  Caring for and Coping with Your Aging Parents (Celestial Arts)

Important Resources

If there is a Bikur Cholim organization in your area, find out what services it provides.  Many Bikur Cholim groups go beyond volunteer visits to hospitals and offer family respite service, meal delivery, shopping or transportation to health-related facilities.  To find out if there is a Bikur Cholim near you, ask your rabbi or a Jewish chaplain at the local hospital.

Your local chapter of the Alzheimer’s Association provides workshops, information about Alzheimer’s Disease and related dementias, medical information that will help you cope with present challenges and plan for the future, and legal and financial information.  Visit http://www.alz.org or call 1-800-272-3900.

The American Parkinson’s Disease Association provides literature, information and a medical referral service.  They can be contacted at: American Parkinson’s Disease Association, 1250 Hyland Boulevard, Staten Island, NY 10305.  Call 1-800-223-2732.

Products

Take advantage of the many products geared for people with infirmities.  Many devices can not only enhance your parents’ independence and dignity, but can also make daily life easier.  Shower seats, hand-held showers, properly fitted canes, sloped door-way saddles and a host of other products or modifications can simplify daily life.

Medic Alert bracelets can be engraved with emergency contacts and essential emergency medical information.  Vital medical facts will be stored on the Medic Alert computerized data base and released to emergency health care workers or authorized medical personnel.  The first year’s cost is only the cost of the bracelet ($35 for metal; $50 for sterling; $75 for 10K gold-filled; $300-$700 for designer bracelets and chains); subsequent years have a $15 annual fee.  Call 1-800-432-5378.

Safe Return is a nationwide identification, support and registration program designed to help when a person suffering from dementia wanders away from home.  When a disoriented person wearing a Safe Return bracelet, necklace or clothing label is found, citizens or law officials can call the Safe Return number.  Safe Return will notify the listed contacts.  Similarly, when a person becomes lost, Safe Return will fax their information to local law enforcement agencies.  Call 1-800-272-3900.

Torah tidbit:  On family obligations

Both men and women are obligated to give parents kavod, which is halachically translated into attending to their physical needs, and morah, which halachically translates into gestures of respect, i.e.: not sitting in their seats, not contradicting them, etc. (Yoreh Deah 240:17).

The Talmud modifies the obligation of a married woman on the basis that her first obligation is to her husband.  There is some debate as to whether that refers only to kavod, personal service, or also to the gestures of respect, when they are disagreeable to her spouse.  General consensus seems to be that the “dispensation” only applies to personal service.  The Shach rules that if her husband does not mind, her obligation to her parents is fully operative.

It goes without saying that the ethics and morals of the Torah (“Its ways are ways of sweetness.”) dictates that all three parties; parents, daughter and husband, should be reasonable and compassionate in their demands on each other.  Without such consideration, family life would become dysfunctional.

—Rabbi Joseph Grunblatt

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This article was featured in the Spring 1999 issue of Jewish Action.
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