The Sandwich Generation: Caught Between Children and Parents can be a Real Struggle

Meredith Price

Between visiting her mother in a nursing home, worrying about her son who is serving the Israeli army in the Gaza Strip and babysitting grandchildren, Judith Lerner has little time for herself. "I need to take care of so many people," she says. "I am caring for my mother, my son and my daughter's children. I work 30 hours a week, and I still need to find time for my own house." When I asked her how she accomplishes everything, she answered that she simply doesn't sleep at night. Over the last five years, the number of people living beyond the age of 80 in Israel has increased by over 20 percent, making the number of families in situations similar to Lerner's higher than ever before. Many adult children in the "sandwich" generation are struggling to care for elderly parents and, at the same time, ensure the welfare of their own children. "Sometimes choosing between children and elderly parents tears you apart," says Noga Gabrieli, the director of the WIZO Parents' Home in Tel Aviv.

According to Dr. Yaffa Lerman, the head of geriatrics at the Sourasky Medical Center, one of the biggest problems with the rapid rise in the elderly population in Israel is that it constitutes a huge burden for families, the economy and health services. At one time or another, almost every family finds itself in a situation where aging parents need more help, and most people are unprepared for the drastic change in lifestyle this requires. Thanks to the Israeli government and some non-profit organizations, many options and a wealth of information exist. Families in need of assistance can choose between homes for the aged, skilled nursing homes, day care centers, respite homes or hiring a worker to help out in the personal residence. For those who qualify, the Israeli Ministry of Health provides ten to fifteen hours a week of care by a qualified social worker at home and subsidies to those families most in need. The director of services for the Ministry of Welfare, Miriam Bar-Giora, says that one of the main problems with the recent rises in longevity is that they coincide with an increase in poverty among the elderly population. "The elderly always have more problems than others, and they have more expenses with all of the doctors they see and medicines they purchase," she explains.

While the government cannot afford to subsidize every deserving family, it is trying to supplement the incomes of the poorest seniors, and provide information for people about where to go for care and how to best handle overwhelming changes. One of the hardest decisions for adult children to make when it comes to an elderly parent is where they should go and what the family should do to help. Many seniors prefer to stay at home, even if they are no longer capable of caring for themselves. Families need to be given direction in these situations as it is not easy to convince the elderly to make changes, and sometimes the siblings are not all in agreement about what measures to take. The Reuth-Eshel information center, formed in 2002, is a non-profit organization aimed at giving information and consultations over the phone to adult children about geriatrics, rehabilitation and nursing homes. "We are the only service in Israel with professionals giving both medical and social information to families with parents who encounter a crisis situation," says Tali Kadmon-Stern, the coordinator of the information project at Reuth-Eshel. The questions about where to go, whether or not to hire a worker, how much it will cost and what the family is entitled to receive from the government can all be answered by trained social workers over the phone. "We help people who don't know how to approach this situation with many basic things, like how to get permission for a foreign worker, day center options, where to rent a wheelchair and many other unforeseen details," says Kadmon-Stern.

WHEN THE unexpected does happen, families tend to panic, but in 94% of the cases, the elderly are actually able to stay in their own homes. Thanks to the constant supervision and care given by a foreign worker, many seniors who have lost some independence can feel less dependent. This option provides a huge relief for many families, and it gives seniors who are not inclined to move a much higher quality of life. "One time my father-in-law fell and we didn't hear about it for two days," says one woman who hired a foreign worker to help with her parents-in-law. "It was a tremendous relief to know that someone is now with them all of the time. It allows me to let them stay at home." For the Tsinamon family, the Reuth-Eshel information program gave advice to hire a foreign worker when a difficult situation arose where elderly parents needed more care but did not want to be moved or have their privacy invaded. "We didn't know what to do. My husband's mother was against having a foreign worker, but she could no longer give her husband the care he needed," says Dana Tsinamon. Recently, Tsinamon's mother-in-law passed away, leaving another difficult choice about whether or not to leave her father-in-law alone or to move him closer to where they live. "We are debating now and trying to weigh the situation carefully," says Tsinamon. "On the surface, it seems better for my father-in-law to be closer, but if we move him or change his situation, it may cause a setback."

The Tsinamon family is struggling to find the time, between work and other obligations, to take care of an elderly parent and visit their son, who is enlisted in the army and is only allowed visitors on the weekends. Danny Unna was obligated to raise his five children at the same time that he cared for his elderly mother, but his problem was even more complicated. When his mother, Lea, began to deteriorate after the death of her husband, he decided to hire a foreign worker to help her at her kibbutz home. "My mother refused to let us move her to a nursing home. She stayed in her apartment on the kibbutz, but we had to hire a foreign worker to help her," explains Unna. On the kibbutz where Lea lived, one woman was responsible for the elderly. It was clear to her that Lea could not be moved without Unna's express permission. One day, when her foreign worker was on vacation, the kibbutz moved Lea to the hospital. "My wife was bringing supplies from the moshav to my mother and she called to say no one was home. We had no idea where she had gone or why," says Unna. Neither did Lea. She told her son that they took her from her home by force to the hospital. She died a few days later. According to Unna, the elderly who live on kibbutz, where it is more profitable to rent their apartments out than keep them around, are often treated poorly and abused. "They want the old people to die and get out. They consider them to be a burden," he says. The generation who built the kibbutzim is now being kicked out of them, which creates even more complicated problems for adult children who are trying to take care of their parents, and is even worse for those seniors without families. "In this whole process, I was alone against the kibbutz and the social workers there, and I was supporting my mother financially and raising five children," says Unna. "I tried to do my best, but I feel that I failed to protect my mother."

PROTECTING PARENTS does not usually require keeping other people from harming them. Rather, they occasionally need protection from themselves, which is why homes for the aged are a good option for some families. But not every home for parents is equal, and not every resident of every home for parents is the same. One extraordinary woman from Tel Aviv, in perfect mental and physical health, made the unusual decision to move from her apartment into a home on her own initiative. "My daughter lives in the Galilee and she was worried. I appeased her by no longer living alone," explains Dvora Vardy, a retired psychotherapist who moved into the WIZO Parents' Home after her daughter tried to convince her to move into a house next door to her in the Galilee. "I chose to leave my home and I moved in here in February of 2003. I chose to come here and I still choose what happens to me," she says emphatically. A small apartment with impeccable style is still big enough for her to entertain, and she often goes out with friends in the evening or attends one of the programs sponsored by the WIZO home. "I am a city person. I don't belong in the Galilee, even if it is closer to my daughter," says Vardy. Her daughter visits her often and she has a wonderful relationship with her grandchildren. For Vardy, making her own decisions about her future before someone else had to was of critical importance. "I was prepared for this change and I knew what to expect," says Vardy. "But I am not typical."