Sandwich Generation Caregivers:
After The Stroke

Have you heard the term “Sandwich Generation Caregivers?” It refers to adults, mostly middle-aged women, who are juggling two generations of caregiving. Caring for older and younger family members simultaneously can feel very much like being in the middle of a sandwich. It is a stressful place to be.

When adults take on the responsibility of caring for an aging parent, they face obstacles that can overwhelm the most organized person.

“Sandwich” caregivers struggle with finances, emotional and physical exhaustion, lack of self-care, and sometimes even depression. Personal time is no longer theirs and disorder follows them throughout their day. Caring for younger children has its challenges, but adding an aging parent only compounds the daily to-do list. Caregivers already have a full schedule, but “sandwich” caregivers have even less time to spend to their personal needs.

How do you manage care for multiple family members who are directly dependent on you and what do you do with the ever-changing emotions?

It requires patience, organization, emotional strength, and flexibility for the constant changes.

I’m comforted knowing I’m not alone in my care journey. I am reminded of just how many families are affected when the topic of caregiving comes up. Everyone has a story to share. Whether they are directly or indirectly affected, it seems caregivers are everywhere! It is an honor to have experienced Betty’s care journey firsthand while on my mom’s journey.

Betty is part of the “Sandwich Generation” and her mom, Catherine, was the most resilient woman I had met since my mom. Hers is a story about love, honor, resilience, and a journey of courage.

Catherine had divorced early in life, raising two children on her own. Betty, her oldest daughter, and husband Karl moved Catherine into their home while three of their four children still lived there. Karl worked outside the home while Betty homeschooled their children through primary and part of their secondary education. Catherine was vibrant, independent, strong-willed, and befriended everyone she encountered.

Betty’s purpose in moving Catherine into their home was to watch over her aging mom. But for Catherine, moving in was about so much more. Caring for her daughter’s family gave Catherine a sense of belonging and a purpose, which had been missing since retirement.

Betty’s mom loved being independent, but what she loved even more was feeling needed by her family. As Catherine saw a need, she would eagerly offer her help. To outsiders, it appeared as if Betty was taking advantage of her aging mom, allowing Catherine to prepare some meals, do housework, and shuffle grandchildren off to activities. But they couldn’t see her pride in giving to those she loved most. And for 17 years, the family experienced Catherine’s gifts of love.

Catherine continued to help, until she began to show progressive signs of impairment.

Impairment began as mild forgetfulness in misplacing items, then moved to confusion driving to and from stores, finally as repetitive behaviors uncharacteristic of her. But these changes needed to be more significant for Betty to notice. One day, while following her mom from the store, Betty noticed Catherine hesitated at the stop sign and turned a different way toward home. This was a trip she had made numerous times, but something was different this time. It took much longer to get home and when Catherine arrived rattled, she told Betty she had gotten turned around. She assured her everything was fine.

While Betty was concerned, she was not alarmed because elderly people have moments of confusion and Catherine was in her late 80’s. She thought about how she would approach the subject with her mom of giving up driving. Just thinking about that conversation filled Betty with deep sadness, so she put it out of her mind.

Worrying about her mom’s health, proved overwhelming. So, she threw herself into her already hectic life of homeschooling and tending to her family’s needs. Allowing Catherine to help with household chores was Betty’s way of distracting from reality. Her daughter was used to receiving her mom’s care, not giving it. Catherine’s health continued to spiral downward, and Betty slid into the black hole of depression. She worried about how to care for her mom because of her lack of confidence. As self-doubt increased, Betty did what many people do, she emotionally disengaged. Allowing others to step in and handle things gave Betty the excuse she needed to detach. Then she would not have to make life-altering medical decisions for her mom.

Self-preservation was a way to distract from the reality of her mom’s decline.

Things changed when Catherine fell and broke her foot. It was a game changer for the entire family. Catherine never drove her car again! Physically and emotionally fragile for the very first time in her life, Catherine was completely dependent on others for care. She didn’t like being dependent on others. Her resilience worked for her much of her life but worked against her when family tried to help. Everyone settled into a new routine.

But no one was prepared for what happened next.

One morning, in an early birthday call with Catherine, her niece Debbie, noticed something wasn’t right. Catherine was having difficulty speaking and stuttered when trying to talk. Debbie asked her aunt to put someone else on the phone. That is the day that changed everyone’s life.

Debbie immediately recognized her aunt was having a stroke and shared this with her cousin. Realizing every second counted, Edward quickly scooped up his grandmother and drove her to the hospital without waiting for help. Because everyone acted quickly, Catherine’s stroke caused minimal damage. It could have been so much worse! But she was not the same afterward. Betty agonized over necessary medical decisions for weeks. When it was apparent she needed more care than her daughter could offer, Betty made the toughest decision of her life. This was not made lightly and not without hours of conversation with her support system.

Catherine had always been the protector and now it was Betty’s turn. But she realized she knew nothing about being a caregiver. Adding to her responsibilities as mom to younger children, her new role as “sandwich” caregiver was completely overwhelming. She was shocked at the energy it took to care for her mom. Knowing what to do was distressing. Anxiety quickly turned into paralyzing fear that she would have to make life-changing decisions for her mom.

Catherine was released from the hospital, and placed in skilled nursing where she could get more hands-on care. But Betty’s role as caregiver did not end after her mom was moved. With each stroke, more care was needed, new decisions had to be made, and a new facility was required.

The stroke slowly began to take Catherine away from her family.

She challenged everyone who tried to help. Perhaps it was life’s lessons in resilience for what she had endured as a single mother, or her independence that kept her going. Regardless, it was emotionally challenging for the family. The sister, aunt, mother, and grandmother that everyone knew was slowly slipping away and the emotions were like a never-ending rollercoaster.

Caregiving became Betty’s full-time job. And her cousin tried to help by preparing Betty for the many difficult decisions that lie ahead. Debbie offered proactive support and guidance on getting Catherine’s affairs in order, but Betty resisted. As Catherine’s needs increased, so too did the need for decisions. But Betty would say: “I cannot do it today. It is too much for me to handle right now. I will deal with it later.” This went on for months.

The most difficult part of the care journey is letting go of the guilt.

Debbie’s experience with her own mom proved crucial in helping her cousin. Betty agonized over her decision to move Catherine into a care facility. Unbearable guilt took over her life, but sitting in the quiet at night was the worst. Now, the promise she made to her mom to live at home was a lie. Her heart was heavy with regret because she had broken that promise.

Family meant everything to them. Betty’s childhood was centered around family, and guilt was wreaking havoc on her conscience. Catherine had taken care of her brothers from an early age and continued nurturing them after their parents passed. She became their matriarch, giving advice and continuing to instill family values in her brothers. They loved her and valued her opinion. After Catherine’s stroke, her brothers continued calling and sending gifts. She looked forward to receiving those calls and the gifts made her feel loved and needed. Her love of family kept her going.

It’s ironic how powerful words like determination and pride can work against someone at the end of life. Determination can push someone through a difficult time, while pride can be detrimental to one’s care. At the end, Catherine was no exception as she proudly dug in her heels and made her care difficult when family tried to intercede on her behalf.

When a loved one passes away, the family is left blindsided!

Betty managed to finalize some of Catherine’s legal documents before the impairments took over. And just like that, Catherine was gone! The end came way too soon. No one was prepared, especially Betty. She sank into a deep depression that took more than two years to reclaim control from the guilt. But reclaim she has! Now when she remembers her mom, they are loving memories in the forefront of her mind, not the punishment of guilt.

Several obstacles hindered Betty’s recovery: Unrealistic Caregiver Expectations, Promises Unkept, Fear of Loss, and Forgiveness.

So, make the most of your time together without worrying about the future! The memories you make will carry you through tough times on your own journey. Forgive yourself often for all promises unkept, as promises are meant for the moment and can change during your journey. Learn to face your fears. Caring for a loved one is not one size fits all. Each journey is unique. And forgive those who don’t understand your emotions; forgive yourself for your emotions. Above all, forgive your loved one for what they put you through whether intentional or not. You will live a more peaceful life if you can master forgiveness!

*** NOTE: If you believe someone is having a stroke, it is crucial to get medical treatment for them quickly as their chances for a full recovery diminish with each minute that goes by. It is possible to have a stroke without being aware. Strokes can be asymptomatic or even silent and can be discovered as scar tissue on the brain.

If you or your loved one are experiencing any sudden symptoms out of the ordinary, please call 911 immediately. In many instances, time can be the difference between recovery and death.


  1. Daniel

    Thank you so much for sharing this, Debra! This is very true and encouraging!

    • Debra

      Daniel, thank you for your encouragement. While caregiving can be a difficult journey, this has been a true labor of love for me. I am grateful for your support.


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