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Caregiving and the Sandwich Generation

Sandwiched by Jobs and Roles

Caregiving is a job, even when it is an uncompensated act of love for a family member. The role of caregiving for a parent or children can be real work.   When an adult child is simultaneously caring for a parent and a child, it can seem as if he or she is “sandwiched” between the needs of others.

Now that kids are back in school, caregivers who have been overwhelmed by juggling the needs of multiple generations have an opportunity to regroup and consider options. Experience learned personally, as well as from caregiving experts, can help to set priorities and balance expectations.   As part of our ongoing commitment to community education, after Labor Day we are offering free seminars to suggest life hacks for sandwiched caregivers.

Carol Abaya copyrighted the term “The Sandwich Generation” as a label for the predicament of middle-aged adult children whose present identity is defined in substantial part by their responsibilities as a caregiver for aging parents, children and grandchildren. An article published previously here in 2012, which is still available by searching the resources on Keystone Elder Law’s website, explores The Sandwich Generation in more detail.  The internet has many insightful articles and testimonials from caregivers who relate to Abaya’s metaphor.

Sometimes a therapist will advise a stressed or depressed client to imagine that they are carrying a knapsack of rocks. The instruction is to examine each “rock” individually and determine if it represents a condition that can be changed.  If not, the advice is to take the rocks of unsolvable issues out of the knapsack and leave them alongside the path to lessen the burden before continuing the metaphorical journey.

As an elder care guide, I agree that it is good advice to leave some rocks on the side of the path before continuing the elder care journey. For example, it can be important to redefine one’s focus for hope as being for a loved one’s smoother and more peaceful landing at the end of life rather than by recovery from a chronic and debilitating condition.  Sometimes a promise to always care for a loved one at home needs to be redefined as to be an attentive advocate for a loved one’s care when home care is no longer a safe or affordable option.

The concept of being a sandwiched caregiver appeals to me more than the metaphor of being burdened by rocks. A caregiver’s outlook can be improved by recognizing a self-identity as the primary subject of the long-term care sandwich experience.   As with a sandwich, there is not a single right or wrong.  Individual preferences and needs matter, but nearly every sandwich is improved with a condiment of some kind.

Instead of cheese for the ham, or jelly for the peanut butter, maybe a caregiver needs a strategy for occasional respite, or a plan to enable modest compensation from a parent’s assets without facing a future penalty if nursing care is eventually needed outside the home. Specifically, Medicaid rules administered by the Department of Human Services (DHS) generally penalize the transfer of money if it totals more than $500 in any month without documentation of the services received. Since transfer of funds within families is viewed skeptically by DHS, a written caregiver agreement that is based on a care plan by a credible third party can be the relish that transforms a stale sandwich into a delicious option.

Even though Keystone Elder Law’s services are always geared towards serving the parent or older generation of the family, it is important for us to be concerned about the well-being of our clients’ caregivers, who are often confused or overwhelmed. Having felt sandwiched personally, it is easy for me to relate to the stress of the caregivers of our frail clients. As they are caught in the sandwich, it is important to help caregivers to understand that there are probably many more options than those they might be aware of to address the circumstances which surround them.

In being an elder care guide, it can be tricky to counsel a client to realize the importance of sacrificing a bit of independence to preserve their dignity and the balance of their independence. We have never had a client claim it to be a goal to spend the last days of their life in a nursing home.   But it takes a wise older person, often with the support of a proactive caregiving child, to take the precautions to make that less likely.

It is only natural for even the most loving family caregiver to eventually wonder “what’s in it for me?”   Caregiving is paramount to preserve a loved one’s dignity and independence.  But it is not inconsistent with a desire to preserve the family home and wealth.

Regularly, I ask our clients this question: “Given a choice, do you want what is left of your life savings to go the government, a nursing home, or your children?”  If an aging parent wants to leave a legacy for their children and grandchildren, we can help them to make sure that the right documents are in place.

While a parent still has the capacity to recognize the family and express trust and affection, it is important to make sure that the Power of Attorney document enables wealth protection, and that the Last Will and Testament does not unnecessarily expose the inheritance of a surviving spouse to the expense of nursing care.   When a family shares housing or assumes caregiving duties, wealth can be saved by the correct use of life estate deeds and family caregiving agreements.

Long-term care regulations are not logical and often conflict with advice given in good faith by other professionals. Unfortunately, many accountants still wrongly advise middle-class taxpayers that it is OK to give up to $14,000 per year without consequences.  That’s a wrong-headed understanding of a tax loophole related to federal estate taxes, which is intended primarily for  couples whose net worth exceeds $10,000,000.

Others advise clients that the primary goal should be to avoid probate with revocable living trusts or by adding a child to the deed of the family home. There are techniques that work to plan for long-term care and minimize probate, but these examples are not among them.

If any of this resonates with what is going on in your life, you aren’t alone. Welcome to The Sandwich Generation. You owe it to yourself to pause long enough to learn how some guidance can help you to better manage the experience, if not relish it, while you also set-aside time for you own spouse, children or grandchildren. Call 717-697-3223 to sign up for a free seminar; or if you are especially hungry to learn more you can skip that step and set up an initial consultation!  Learn more about available seminars at

by Dave Nesbit, Attorney