The Sandwich Generation

Welcome to the Sandwich Generation

We are getting older.

In 1950, the average United States citizen was about 24 years old. Today, the average age is 38. Currently in the United States, more than 52 million people are over the age of 65 and 72,000 people are over the age of 100. By 2035 there will be more people over the age of 65 than children. And by 2060 there will be over 604,000 people over the age of 100. These are startling numbers that all point to the need for a plan to care for our aging population. Most of the time that plan falls to the adult children of the elderly, the same adults who are caring for their own children under the age of 18.

Welcome to the sandwich generation, a term first coined by Dorothy Miller in 1981. Fifteen percent of adult children are providing financial support to both an aging parent and a child. Thirty-eight percent are providing emotional support for grown children and aging parents. In reality, we’re all a part of the sandwich. Care for aging Americans is going to touch each of us in one way or another.

Family is the first line of care when it comes to aging parents and grandparents. According to the Pew Research Center, 47% of adults in their 40s and 50s have a parent 65 or older and are also either raising young children or financially supporting a child 18 or older. Many of these families consist of single parents with few siblings trying to juggle obligations at both ends of the spectrum.

Meals, doctors appointments and running errands are just a few of the tasks that a child may take on. They may even bring the aging parent to live in their household, so care can be given when needed while still being available to their own children. Regardless, the pressure of the situation, especially if the parent has serious medical problems such as stroke or cancer, can be extreme. Relationships become strained or nonexistent due to the time spent caring for others in the household, both young and old.

And then there is the issue of money. When taking in an elderly parent, you soon find that not everything is covered by Medicare and social security doesn’t provide much of an income. The cost of medications, co-pays and more all fall to the family. Members of the sandwich generation are typically in their prime working years. They face sacrificing upward mobility due to the obligations of caring for an aging parent. They may be forced to reduce working hours or quit altogether if working from home isn’t an option.

When caring for an aging parent becomes too difficult, a home health aide may be considered. Just the ability to have a break and allow someone else to do the “heavy lifting” is a benefit. But that, too, is not without its problems. There is a growing shortage of frontline care workers including home health aides. Often paid minimum wage or slightly over, these workers have few opportunities for advancement. The turnover in this field averages 74% annually. Just when an aide really learns to relate to a new client, they leave for better pay at the local big box retailer, and the whole process of training a new aide starts again.

The number of people in the medical field as a whole is declining. There are approximately 76 million baby boomers, including qualified medical professionals who are now approaching retirement. Of the aging medical population, 44% of doctors are over the age of 55, and 51% of nurses are over the age of 50. Turning to the other end of the spectrum, students who want to go into medical professions face limited opportunities to study, and are often waitlisted at universities because there is a shortage of teaching staff. So, there are fewer graduates available to care for all of us including the elderly.

When caring for mom or dad at home is no longer feasible, adult children will, as a last resort, turn to the nursing home. When investigating options for nursing home care, many are surprised to find that Medicare will not cover the long-term costs of a skilled nursing facility. Most people do not have long-term care insurance, which can be very expensive for relatively little coverage. While Medicaid will cover the cost of a nursing home, it is only available to those who are in poverty. There are many elderly who fall in the gap. They don’t have enough money to pay the high cost of a nursing home yet they have too many assets to qualify for Medicaid.

In addition to the cost of coverage, there are only about 1.7 million skilled nursing beds available for about 15 million people in need of skilled nursing care. Nursing homes are often not profitable, so the construction projects don’t get funded.

The adult children of aging parents really want to do what is best for the people who cared for them. Unfortunately the options are limited at best.

Planning for the inevitable

The time to have a well-developed plan in place was many years ago. The healthcare worker shortage combined with the aging population affects us all and will continue to worsen until a viable solution is found.

Medicaid, funded by everyone in the working population, falls woefully short when it comes to providing the quality of care that the elderly deserve. Because the workforce is dwindling, there will not be enough of us helping to fund Medicaid. Past efforts to have a structure in place that would cover the cost of care were not adopted. It’s clear that there is a need for a long-term care solution that would provide a system of payment for structured, quality care, yet no one wants to think about paying additional taxes to cover such a plan.

There have been many advances in medicine and behavioral health. The advances are both a blessing and a curse when it comes to seniors. All of us are expected to live longer, but that also means we’ll need medical professionals who can see to our increased needs as we age. Setting up a program that would help the elderly to remain healthy and active for as long as possible would help take the burden off providing skilled nursing. Providing community services that help seniors to keep moving, eat well and catch potential health problems early is a start. But implementation and cost continues to stymie the powers that be.

Employers can also do their part by understanding the dilemma that faces employees with aging parents to care for. Allowing more flexibility to work from home or adjusting work schedules to accommodate the obligations that come with caring for an elderly parent would also help. Two out of five employees currently have concerns that their future could be negatively impacted if they took advantage of any flexibility options available to them. The fear of losing a job or potential promotion is very real.

Looking to other countries for ideas might yield a solution. Japan, for example, has the oldest population. They have implemented a long-term care insurance program that relies heavily on community support to care for citizens over the age of 65. They have even experimented with using robots to assist the elderly in their homes.

At GraceMed, our providers are the first to identify potential problems and needs with our aging patients. Patients who need assistance are referred to our Community Cares program. Home and community based programs in the state are contacted and services appointments are coordinated with the patient. Community Cares provides ongoing communication and support acting as a liaison with the services provided by the state.

The crisis we are facing is not restricted to a single special interest group. This will affect everyone, young and old. No matter the age, people deserve to live life to its fullest. While we are living longer, healthier lives over all, the current system is woefully behind reality. Our focus as a national community should be to provide the support and care people need as they age.