The Sandwich Generation Juggling Act

For anyone who has learned to juggle, you start with one ball and slowly add another. Eventually, most people can learn to juggle three balls as hand-eye coordination becomes accustomed to the rhythm. It is adding the fourth ball that separates the amateurs from the serious jugglers. The best juggler in the world could juggle four balls for only a couple of hours.

In America today, there is a societal juggling act occurring within the Sandwich Generation of caregivers — the group defined as 24 million Americans who are juggling children, careers and caring for an older parent — and it is a juggling act that lasts for much longer than two hours. While many Americans can handle three balls (me, children, career), once the caregiving ball is added, inevitably the ball getting dropped is "me."

According to a 2013 Pew Research study, more Americans — 47 percent of the nation's 40- and 50-year-olds — are joining the Sandwich Generation and attempting this challenging juggling act. How does this at-risk group avoid the common pitfall of ignoring self-care in order to care for everyone else around them? The answer may just lie in the mental focus and rhythm of…juggling.

Jennifer Slaw, a professional juggler, said in an interview last year with The Huffington Post that juggling offers a unique form of stress relief. The focus of having just one ball in the air at a time but keeping the synchronicity of movement flowing with the other balls takes intense concentration and may offer some clues for our Sandwich Generation caregivers.

If we take the premise that juggling only requires getting one ball into the air at a time, caregivers can take each ball of responsibility and focus on ways to keep that ball moving in a fluid motion. Here is how:

Whether children are younger, in their teens or early 20s, they can become an essential ingredient in the care of an older grandparent. Consider that most children, even as young as 4 or 6, are tech-savvy unlike any generation before them. Having a grandchild connect with a grandparent, whether via videochats, playing multiple-player online games or singing along with a therapeutic music app, both young and old benefit from the intergenerational connection — in person or across the miles.

This "play time" also gives caregivers a needed break even for a few minutes to attend to other tasks, sit down and read a few pages of a magazine or book, phone a friend, or simply rest the eyes and mind to rejuvenate with a quick 15 to 20-minute cat nap. A quick afternoon nap has been proven to aid recuperative sleep time, increase alertness and improve mood, according to Dr. Gregory Belenky, research professor and director of The Sleep and Performance Research Center at Washington State University. In fact, afternoon naps were secret energizers for illustrious individuals such as Winston Churchill, Albert Einstein, Leonardo da Vinci and President John F. Kennedy.

Many working caregivers do not realize their employer may have elder care or caregiving services that can help them juggle work and caring for an aging parent. Some employers offer elder care research and referral services, employee flex time, back-up care or telecommuting options, acknowledging the challenges of the Sandwich Generation. Checking with an employer's human resources department may even uncover a special benefit offered by thousands of employers — access to a professional geriatric care manager who can assess the older adult's needs and create a care plan for the family that can include help coordinating needed home and community-based services.

In addition, many working caregivers forget that the Family and Medical Leave Act (FMLA) was created for just the type of caregiving situations 15 percent of the workforce faces today: the dilemma of caring for older parents. According to the 2014 National Study of Employers released earlier this year from the Society of Human Resources Management (SHRM), 99 percent of all U.S. employers offer some unpaid leave to full-time employees. FMLA calls for eligible employees to receive 12 weeks of unpaid leave (26 weeks if caring for a covered service member or veteran). Some states, including California, Rhode Island, New Jersey and the District of Columbia, actually offer some level of paid leave.

While FMLA provides job-protected leave, legal same-sex spousal caregiving eligibility and continuation of group health insurance coverage, it also has limitations. Only 60 percent of all employers offer the full FMLA benefits (private employers with less than 50 employees are exempt) and the SHRM report found there has been a decline since 2012 of employers fulfilling the full 12-week leave provision under FMLA. In addition, FMLA does not require leave for the caregiving of a grandparent, in-law or sibling, leaving that to each state's definition of care recipient. Of the states offering paid leave, only Rhode Island and the District of Columbia include these additional loved ones in their eligibility definition.

Adding this third ball to the juggling act is challenging but achievable. Many valuable resources are available to assist caregivers. The most crucial caregiving decisions focus on senior living options or in-home care and the financial aspect of caregiving that can include long-term care plan benefits, legal documents, medical billing and insurance coverage.

For senior living, online sites such as Caring.com and A Place for Mom offer excellent, comprehensive listings of various communities such as assisted living, memory care and nursing home, all with ratings, photos and facility details. Both also offer telephonic support from an expert adviser who can answer questions and help guide families to the best choices, avoiding what I call the "Goldilocks Syndrome."

For in-home care, traditional agencies with national services such as Home Instead, Visiting Angels and Right At Home, or the nation's largest online caregiver marketplace CareLinx (full disclosure: I serve on the advisory board for CareLinx) provide various personal care, non-medical services for caregivers helping their older loved one age in place.

For the review and verification or dispute of insurance claims and medical billing, hiring a patient navigator can take this time-consuming task off a caregiver's plate. And, perhaps the best adviser who can help caregivers save both their piggy banks and maximize a parent's fixed income, long-term care insurance and retirement savings is an elder law attorney — typically estate attorneys who have special credentials in elder care and senior issues.

In baseball, "Ball Four" means the player gets a "walk" — an easy jog to first base. As caregivers focus on each ball and achieve a solution for each, the most important ball becomes the fourth ball that says "me."

According to a health risk study conducted by the National Alliance for Caregiving, stress is a caregiver's No. 1 enemy. Stress relief can be found in finding caregiver support groups in person or online.

There are also online communities where caregivers create private groups inviting family and friends to volunteer to help out. Whether it's delivering a meal to the family while the caregiver is at the hospital with a parent, offering to carpool children to school and events, or be a companion to the older person while the caregiver attends to other activities or gets a little respite, online sites such as Lotsa Helping Hands and CaringBridge are great resources for caregivers to ask for and accept help from those that care about the caregiver.

Caregivers also have to acknowledge that finding "me time" is essential to maintaining the stamina and energy required to juggle the other balls. Whether it's a weekly luxurious bath, finding time for a yoga class, or taking that "Ball Four walk" around the neighborhood, self-care is the most important ball caregivers need to get up in the air and never drop.

Sherri Snelling 
Sherri Snelling is a corporate gerontologist, speaker, and consultant in aging and caregiving. She is the author of “Me Time Monday – The Weekly Wellness Plan to Find Balance and Joy for a Busy Life” and host of the "Caregiving Club On Air" podcast. Read More