When Life Hands you a Sandwich…Take a Bite!

A Clinical Psychologist Reflects on Lessons Learned in the ‘Sandwich Generation’.

By Hillary Bush, Ph.D.
Licensed Clinical Psychologist

Last summer, I read an article that stopped me in my tracks and I am still thinking about it.

As a clinical psychologist, the article grabbed my attention because it reported that adults living in the sandwich generation have much poorer mental health compared to adults not living in the sandwich generation [1]. In fact, nearly half have experienced serious suicidal ideation in the past month!

Sounding deceptively delicious, the term “sandwich generation” describes people who are primary caregivers for a younger generation and an older generation, all at the same time.

The sandwich generation makes up 23% of Americans [2].

I shared this staggering information with my spouse. After a pause, he looked at me and asked, “Are you surprised, though?” It was a fair question.

I get it.

Following the devastating loss of my mother three years ago, I entered the sandwich generation myself. Caring for my young children and my grandmother has been an exercise in radical acceptance, patience, prioritizing, and boundary-setting.

Along with my uncle (my mother’s brother), I took on many of the responsibilities for my grandmother that my mother had been doing until she became ill. Fast forward to today, my children are 3-years-old and 1-year-old, my grandmother is 102 years old, and sandwich generation life continues to be a big part of my day-to-day experience.

Here are some of the lessons I’ve learned along the way

Take a Load Off…

The sandwich generation is a stressful place to be, and the path that leads you there can be traumatic.

People can enter the sandwich generation under stressful circumstances. It can happen slowly, in the case of a progressive illness or natural aging. For others, it can happen in an instant.

Caregiving is demanding in and of itself. To make matters more complicated, sandwich generation caregivers may be grieving too. This grief could be for a loved one lost, but it may also be grief over the loss of where you thought you would be.

Try to be gentle and patient with people in the sandwich generation – including and especially yourself.

Use your resources wisely – financial, social, personal, and beyond – to navigate sandwich generation life.

“...the COVID-19 pandemic has turned the sandwich generation into the ‘panini generation’”

I like to joke (perhaps darkly) that the COVID-19 pandemic has turned the sandwich generation into the “panini generation,” with tremendous heat and pressure compounding the existing challenges on both sides.

Like many others, you might find yourself in a tight financial situation thanks to COVID-19. This and other stressors might force someone in a double-caregiving role to “go against the grain” of what others expect from us.

Let go of ideas about what you “should” be doing. There is never one single path, decision, solution, or way of doing things. Someone else could find themselves in your exact shoes, and yet make different decisions about how to use their time and resources. This is okay!

In support of my grandmother’s wishes, my uncle and I helped my grandmother continue living in her own home for over a year following my mother’s death. While this was inexpensive from a purely financial standpoint, it was expensive in terms of time, social, and human resources.

Which leads me to my next point: attempting to do it all by yourself will result in burning out.

Accept help.

Health challenges arose and it became clear that my grandmother needed more support than her close family could provide. We helped her move into assisted living, and later, into memory care.

We are fortunate that this was an option for us – for many, family caregiving is the only option. If being in the sandwich generation involves caring for an elderly relative, then I would strongly consider hiring a geriatric care manager. If you and your family are able, “outsourcing” caregiving responsibilities to others – either hire a professional or ask for help from family and friends.

Don’t be afraid to ask for help - you deserve it, I promise!

People in the sandwich generation should strongly consider working with a therapist and, if helpful, a medication prescriber.

These professionals can:

• help you develop tools for navigating the sandwich generation in a way that feels authentic to you.
• connect you with resources and community support - these were helpful for my grandmother while still at living home.
• help you keep boundaries, which are extremely important and can be threatened by the demands of dual-caregiving.

Be Mindful, Get Grateful.

“Mindfulness and gratitude are powerful antidotes to the stressors of the sandwich generation.”

I realize that “self-care” is somewhat of a buzzword. To some, self-care feels like another thing to do on a never-ending to-do list. I want to remind you that caring for yourself while caring for others, is critically important. Mindfulness and gratitude are powerful antidotes to the stressors of the sandwich generation.

Here are some practical ways to get started today

• Practice Mindfulness
  Mindfulness is all about noticing – without judging – where we find ourselves right here, right now. It’s easier said than done, and it does take practice. If you’re new to mindfulness, use your five senses to notice the present moment can be a helpful way to start.
  It’s easy to get pulled into the past or the future as a sandwich generation caregiver.
  I find myself reminiscing about the fun things my mother, grandmother, and I used to do together. At the same time, parts of sandwich generation life pull me into the future, like when I think about my grandmother’s health and finances.
  Allow thoughts of the past or future to melt away for a moment. Focus on the present. One trick I use is by simply pausing and noticing how I am feeling, experiencing the current moment.
  

• Engage in Gratitude
  ‍I also encourage you to practice gratitude. The sandwich generation is a stressful place to be and finding things to be grateful for can feel like an impossible reach. And yet, there is always something to be grateful about.
  Using a notebook to jot down a few things – or even just one thing – that you are grateful for each day can be a helpful way to start a gratitude practice. Try it!
  I’ll go first:
  ‍Amidst the many complications and hardships, I am grateful for my experience within the sandwich generation. It has allowed me to understand and connect with my patients better – especially those navigating difficult family dynamics or balancing multiple responsibilities.
  Through caring for my grandmother, I have grown closer to my uncle - I am so grateful for that strengthened relationship. I am grateful for my spouse and mother-in-law, who take on extra childcare responsibilities when my grandmother needs me.

Simply by having the opportunity to write this article, being in the sandwich generation has allowed me to share my experiences with others. I find that I can sit better with discomfort, and I can handle it better when things do not turn out the way I had hoped.

It is helpful knowing where my limits and boundaries are, and how to say “yes” and “no” with intention.

“If they say, when life gives you lemons, make lemonade…then when life hands you a sandwich, take a bite!”
— Hillary Bush, Ph.D.

About Dr. Hillary Bush

Dr. Hillary Bush is a licensed psychologist with expertise in child and adolescent neuropsychological assessment and delivering evidence-based, short-term interventions across different therapeutic settings (CT #4167, MA #10704, RI #PS02043). In her therapeutic work, Dr. Bush uses behavioral, cognitive behavioral, and solution-focused techniques. Believing that good work can happen quickly, she is passionate about delivering short-term, evidence-based treatments to culturally and clinically diverse youth. Learn more about Dr. Bush here.

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References

[1] Baskin, K. (2021, July 2). Parents who are also caregivers struggle with suicidal ideation, new CDC study shows. The Boston Globe.‍

[2] “More than half of Americans in their 40s are ‘sandwiched’ between an aging parent and their own children.” Pew Research Center, Washington, D.C. (2022, April 8).

[3] Czeisler, M. É., Rohan, E. A., Melillo, S., Matjasko, J. L., DePadilla, L., Patel, C. G., Weaver, M. D., Drane, A., Winnay, S. S., Capodilupo, E. R., Robbins, R., Wiley, J. F., Facer-Childs, E. R., Barger, L. K., Czeisler, C. A., Howard, M. E., & Rajaratnam, S. M. W. (2021). Mental health among parents of children aged <18 years and unpaid caregivers of adults during the COVID-19 pandemic — United States, December 2020 and february–⁠march 2021. MMWR. Morbidity and Mortality Weekly Report, 70(24), 879–887.