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Sandwich Generation

What are our Ethical Obligations to Care for our Aged-Parents and Children?

The other day I found out for the first time in a conversation with my brother that I was part of the “sandwich generation.” You can find the term in both the Oxford English and Merriam Webster Dictionaries.

In the early 1990's very few had even heard of the term "sandwich generation." Most thought it was connected to a sandwich eaten by children who were "latch key" kids. Instead, sandwich generation refers to those people who are sandwiched between aging parents who need care and/or help and their own children. It could be the parents have “boomerang” adult kids who come back home after school and/or unsuccessful attempts to get a job. At the same time, one’s parents need in-home care, 24/7 adult supervision or independent/assisted living.

The task is not easy to become elderly or a parent to your parent(s). After all, our society "says" adults should be able to take care of themselves. But, as more live well into their 80s and 90s and families are dispersed across the country, everyone is going to be involved somehow, some way, in elder care. If not today, then tomorrow.

Being a Sandwich Generationer - an elder/parent caregiver - is a new role on the stage of life for which no one can ever rehearse. Becoming a parent to an aging parent presents extraordinary challenges. The challenges to elders are just as daunting. To lose control of one's life - even the little things - can be shocking and frustrating.

Members of the sandwich generation face difficulties in allocating time and money and often describe themselves as being pulled in two directions. Emotional difficulties, especially depression, and marriage conflicts are common problems for those in this situation.

The challenges currently present in the field of aging lend themselves strongly to issues that require ethical consideration. Ethics, defined as a set of principles of right conduct, or a theory or a system of moral values, are critical to reevaluating our treatment and beliefs toward aging individuals. 

Should families be required to care for their aging family members? One ethical principle is “Universality” that asks: Would I want others in my situation to do the same thing I am about to do for the same reason? For me the answer is simple. I would want my daughter and her family to care for me if I were in the position of my aged mom.

We must create a world that provides to older adults independence (including access to safe environments, health resources and opportunities for personal growth), participation (including the ability to remain integrated in society and have a voice), care (care and protection, ability to maximize well-being, and enjoy basic human rights and freedoms), self-fulfillment (access to educational, cultural, spiritual and recreational resources) and dignity (freedom from exploitation and being valued independently of their economic contribution).

While the need for care by older adults is increasing, availability is decreasing; people over 65 are expected to increase at a 2.3% rate, but the number of family members available to care for them will only increase at a 0.8% rate. Unfortunately, availability of care is a major factor in predicting whether or not an older person can remain at home (aging in place) versus being moved to institutionalized care. Furthermore, the services provided by family caregivers represent 80% of all home care services and are conservatively valued at $306 billion a year, more than twice the amount spent on paid home care and nursing home services combined.  

Family caregiving has become the norm. According to the National Family Caregivers Association, more than 50 million people provide care for a chronically ill, disabled or aged family member or friend during any given year. Currently, there are over four million family caregivers in California alone. Caregivers care for spouses (5%), and parents (40%) as well as grandparents, parents-in-law, other relatives, and friends (55%).

Here are five simple rules for caring for the aged: (1) listen; (2) always be there; (3) make them smile; (4) don’t lie; and (5) protect them.

Blog posted by Steven Mintz, aka Ethics Sage, on January 25, 2013