Sandwich Generation: Pulling Double Duty

Stresses and lessons abound as the sandwich generation struggles to care for aging parents while raising their own families

By CAROLINE AOYAGI, Executive Editor, Pacific Citizen

When Lorinda Waltz’s parents both fell ill over five years ago she willingly agreed to take care of them, building a two-bedroom Ohana unit for them behind her family’s home in Honolulu.

Waltz, now 53, had just left her position at a company and was able to devote her energies full-time to taking care of her parents Lorraine and Fred Chang. But Waltz quickly learned that taking care of her parents was a 24-hour job of cooking meals, bathings, administering medications, and making sure they were safe from injury.

Soon, the daily stresses and drain on her energies started to take a toll. Waltz suffered a stress fracture in her foot from the constant climbing of stairs as she struggled to care for her parents. She also found she no longer had the time or energy left in her days to spend with her husband Dick and her two kids Allison, now 26, and Jon, 17.

“It’s a lot of hard work. I could feel myself reaching a point of exhaustion — emotionally I needed help,” said Waltz. “You do it because you need to do it but you have to think of the core family.” She added, “There was a loss of the warm and fuzzies from my family because I had no time. Just physically, I was exhausted.”

Waltz is part of a growing group known as the “sandwich generation” — those taking care of elderly parents and growing children at the same time. It is estimated that 44 percent of Americans between the ages of 45 and 55 have children under 21 and also have aging parents or in-laws. Today, about 14 million U.S. workers are caring for aging family members.

The sandwich generation phenomenon is overwhelmingly prevalent in the Asian Pacific American community where taking care of one’s elders is an imbedded part of the culture and a feeling of giri, or giving back, is an automatic response. Yet, this group often shies away from seeking help or speaking out about the issues. And frequently, senior care homes are an unpleasant option and families take on the care giving themselves.

“With most Japanese Americans there’s a feeling of doing something to take care of the parents. The level of feeling is automatic,” said Sandy Mori, development director for Kimochi, Inc., a nonprofit organization in San Francisco providing culturally sensitive care for senior citizens. “A lot of people of color are supportive of the elderly for a longer period of time.”

Mori believes there is still a stigma surrounding senior care homes and facilities and a reluctance to place parents in them. “They don’t feel they should do it, there’s a lot of guilt,” she said. “The family will do everything to avoid that at the sacrifice of more stress.”

After years of home care, Waltz’s mother Lorraine passed away in November 2003 at the age of 80 of diverticulitis (inflammation of the colon). Soon her father Fred, now 86, took a turn for the worse. Already suffering from diabetes, arthritis, and hearing loss, he started to suffer from Alzheimer’s.

Her father’s safety now became the overwhelming concern as Waltz tried to keep him from using dangerous household tools and leaving the stove on. In desperation, Waltz sought the help of nurses and home caregivers but her father’s growing belligerence spread even to them, in the end refusing to eat meals and take his medications.

After much heartache and soul searching Waltz and her family made the difficult decision to place her father in a state licensed private care facility, after consulting with their longtime family doctor.

“He was not happy there but he was adapting very well,” said Waltz, who noted that he was making friends and taking part in various activities.

But after two weeks, Waltz’s older sister, furious with the decision to place their father in a home, took him out of the facility this past January. Although her elder sister had not been a part of her father’s care until recently, she now cares for Fred full-time.

The struggles to take care of their ailing father have left permanent scars on the family and to this day Lorinda and her sister do not speak and Waltz is no longer involved with the daily care of her father.

“The family dynamics will never be the same. We cope but I try not to have anything to do with it,” said Waltz. “But I have absolutely not a single regret, no sadness. It gets to a point where you say it’s either me or him. I have a family and I still love my father.”

Beverly Ito, administrator of Keiro Intermediate Care Facility in Los Angeles, agrees that for many sandwich generation caregivers there is still a stigma attached to seeking help from a senior care facility. In turn, many elders are reluctant to consider a senior home as an option, believing they are doing okay on their own.

“Caregivers need to realize that it’s okay  — that there is a better quality of life that these facilities can offer,” said Ito, who noted that at Keiro, seniors receive much more social interaction and stimulation than they would living at home where caregivers often work full-time.

Bill Watanabe, 61, and his two older brothers took turns caring for their mother, 91-year-old Katsuye, after she suffered a stroke and became growingly absent-minded. Each week the brothers would coordinate their schedules to help their mother but four years ago the decision was made to place Katsuye, who is wheelchair bound, in Keiro.

“All of us of course willingly give … but it’s a huge toll on your time and your family … you still have an obligation to your wife and kids,” said Watanabe, who has a 27-year-old daughter. “It is stressful.”

Watanabe, who is also the executive director of Little Tokyo Service Center in Los Angeles, is happy with the decision to place their mom in a senior care facility.

“Keiro is an excellent facility and I’m glad there is a Keiro,” said Watanabe who encouraged other sandwich generation folks to educate themselves about the available options out there. “People need to know their options … make informed decisions.”

For former sandwich generation members Mitzi, 70, and Richard Toshima, 72, taking care of their mother — 90-year-old Fumi Yamanaka — has always been a family affair. For years, Yamanaka lived next door to her only daughter Mitzi and three grandchildren, but after she had several mini-strokes and falls, the decision was made to place her in the Keiro Intermediate Care Facility.

For three years now, the Toshimas visit their mother daily and have become regular volunteers and supporters of Keiro. In addition to helping the seniors with various activities like walking and shopping, Mitzi, a former salon owner, volunteers in Keiro’s beauty shop and Richard serves as a driver.

“At the beginning, there was a bit of stigma — she didn’t want to be in a facility,” said Richard. “But later she fit in.”

“It’s so much nicer being here … at home it was hard to take care of my mother for 24-hours,” said Mitzi. “Just do what I’m doing,” she advised sandwich generation folks. “Come and visit everyday. It’s the best way of caring for elders.”

For many APA families, placing a parent in a senior care facility is the only option, where busy work schedules and a need to raise their own core families make 24-hour care giving an impossibility.

Margaret Harada, a Sansei, made the decision to place her mother, 86-year-old Suzuye Hirakawa, in San Francisco’s Kimochi Home in October of 2001. After years of living independently, mild dementia and a heart condition left Hirakawa needing 24-hour-care.

Although Hirakawa did not want to enter Kimochi Home at first, Harada’s full-time work schedule and the need to take care of her two teenage daughters — Heather, now 19, and 15-year-old Lisa — left her with little choice.

“My mother still to this day says you put me here, that she’ll never forgive me for it,” said Harada, an only child whose father passed away 30 years ago.

But Harada, who regularly visits her mother along with her family, has noticed an exponential improvement in her mother who now has social interaction with the other residents and 24-hour supervision with Japanese speaking staff and Japanese meals.

“She doesn’t have to worry about things,” said Harada. “She has social interaction.” She added, “My mom does realize that we’re there every week.”

Health professionals and those experiencing the sandwich generation phenomenon agree that seeking help and talking about the issues is a necessity and may help alleviate some of the stresses. For Waltz, being able to join a support group like Project Dana, a volunteer caregivers program in Honolulu, helped her find some salvation as she struggled to care for her parents.

“You have no idea how relieved I was to see there are other people, they understand,” said Waltz, who has now gone back to work full-time helping her husband with their construction business. “You need to tap into the resources. Caregivers get so bogged down, you wonder if there’s any help out there.”

“I’m amazed at the amount of experience people have,” agreed Harada.  “It’s important to talk to peers who are going through it. It’s communication; the more people you talk to, the better network you have.”

“This is one of the biggest issues in America,” said Mori, who warns that the number of sandwich generation folks is going to surge in the coming years with the baby boomer generation. “People are experiencing it so now they’re being forced to talk about it.”

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