Sisters Judy Johnson and Joann Niemi, along with their two brothers and their two other sisters, tried to persuade their parents last year to move to a small townhouse, but their parents just couldn't imagine it.
In response, the kids put together a rotating meal-making schedule for the parents. They also share yard care, housecleaning and errands for their mom and dad.
"They just do too much," said their father, Bill Niemi. "We appreciate it, but we also think of what they have to do -- what their lives are like, and what they have to do as a family and so forth."
Bill Niemi gets teary thinking about how much his kids do for them.
"We have grandchildren. We have one who calls us almost every day, and she asks, 'How are you doing?'"
Bill Niemi is 87 years old, and his wife Henriette is 86. But Bill is not ready to stop driving or hosting the holiday meals.
The daughter who tends to her parents the most is Joanne Niemi. Her siblings worry that she spends too much time keeping everything going.
"Being here a lot keeps me in tune with what's going on, what's happening, how they're feeling," Joanne Niemi said. "In a way, I'd rather just be here, and be in the know and be participating."
Lots of people are finding themselves in the Niemi kids' position -- sandwiched between caring for their own children and caring for their parents. That's partly because of the aging of America.
Within the next 20 years, one in five Americans will be 65 or older. And they will need care. Eighty percent of care to elders is provided by family and friends, according to The National Alliance for Caregiving.
Another reason more people are feeling the crunch is that these days, women tend to wait longer to have children. So by the time they do, their parents are elderly.
It's usually women who do the caregiving for both, says Kathryn Ringham, a caregiver coach at the Wilder Foundation in St. Paul, a health and human services organization that has an elderly care program.
"I just don't feel like I know what my role in life is anymore, except that I take care of people all the time."
"Even when men are involved, it's the women who tend to do the most challenging tasks related to caregiving," said Ringham. "The men typically get involved with the finances, become the power of attorney. They may be in the position to do some of the care coordination, kind of a managerial approach, whereas women are doing the dressing, the feeding, and the more challenging personal care tasks."
According to a recent survey by the National Association of Social Workers, most sandwich generation women don't seek help caring for their parents. Some of them don't realize help is available, Ringham says.
Social workers can help make long-term care arrangements. They can find the money for assistance. They can find home health care that's affordable. They can provide counseling and support. Some women are ashamed that they can't do all of this themselves.
Many women underestimate how long they'll be stuck in the middle of the sandwich. They figure it'll be a year or two, Ringham says. But it ends up being four years, or eight or more.
"One of the strongest issues that's emerging is just the physical and emotional long-term consequences of being a caregiver," Ringham said. "Caregivers have a higher percentage of alcoholism, of use of psychotropic drugs and medications. They experience higher anxiety, higher stress."
Caregivers have always faced stress, Ringham says. But now, more women are working full time, so there's just more to do in any given day.
"There are days when I just don't feel like I know what my role in life is anymore, except that I take care of people all the time," said Mary Louise Clary as she whizzes through Bread and Chocolate Bakery in St. Paul.
Clary is on her way to visit her mom at a nursing home. She's been caring for her elderly parents for 10 years.
Clary has two sons. She's recovering from breast cancer. She had a successful career as an educational psychologist. But she quit her job when she realized that she couldn't keep up with everything.
"We have no income coming in for me, and yet I worry about what we're going to do long term if I can't be bringing in my own salary, which I'm perfectly capable of doing," Clary said.
Clary was so overwhelmed that she finally went to Wilder's caregiver services. They put her in touch with a support group from the University Of Minnesota's Family Caregiving Center, where she attends weekly meetings.
"We all help each other, and we talk about medications and doctors. And we'll cry and say, 'I just can't do this one more day. I can't do it,' and then we get back up and get going again."
Clary has come to rely on the group. And she's glad she finally gave in. Through her contacts, she located a home health nurse who convinced her dad to get Meals on Wheels.
"I think I would have been hospitalized if I didn't ask for help," Clary said. "This is an impossible task for one person to do. It's too multilevel. It's financial. It's emotional. It's physical. There are so many layers to it that you can't even begin to unfurl. It just felt as though it was overwhelming."
Clary has learned she has to take care of at least some of her own needs if she's going to take care of other people, too.
The number of households providing care to an elder will double in the next 25 years. Professionals recommend that each family devise a caregiving plan. They say the conversation can begin casually, at the next family gathering, or by e-mail.
Caregivers need to recognize that they need help. They can get it by tapping into the nonprofit organizations that provide services in their area, as well as online and by phone.
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