Caring for Our Parents : ‘Bridge Generation’ Faces the Stressful Legacy of Longevity

They saw you from Dick and Jane through Dickens and James, and now it is they who need the help.

For a variety of reasons, an increasing number of Americans are finding themselves in an unexpected and sometimes stressful situation--being a parent to a parent. They are the sandwich generation, squeezed between the needs of their children and the needs of their parents.

“The essential problem we face is that we aren’t prepared for this new role,” Dr. Gary W. Small said. “No one is prepared for it at any age.”

Small, assistant professor of psychiatry at the UCLA School of Medicine and an authority on aging, has teamed with Dr. Lissy F. Jarvik, professor of psychiatry at the UCLA School of Medicine and also the school’s chief of neuropsychogeriatrics, on a timely book called “Parentcare” (Crown Publishers: $19.95).

A Straightforward Cycle

“Until fairly recently, the parenting cycle was straightforward,” Small said in an interview. “We were born our parents’ children, they took care of us until we were old enough to take care of ourselves. Then we became old enough to take care of our children. Then the probability, in most cases, was that the older parents would have died.”

What now is happening, the doctor went on, is that advances in medical technology have causes survival rates to increase. At the turn of the century, only 4% of the population was 65 or older; today that figure is 12%.

“But although parents are living longer, we haven’t figured out how to eliminate chronic illnesses and disabilities,” Small said. “More than half of the people 75 or older today have some kind of disability.

“Not only are children having their own children later in life, they are finding that at the years when the needs of those children are greatest, that is when their parents also are needing their help.”

In many cases the care-giver to the elderly parent has herself or himself already finished with the child-rearing, and now finds a new challenge to be faced.

“And,” Small said, “we now are seeing the beginning of baby boomers becoming parents to parents. Also, because people are living longer, we are more and more seeing people elderly themselves become parents to parents.”

He said he knows a 93-year-old woman being cared for by her daughter, herself a senior citizen.

“What we are seeing in the latter part of the 20th Century is the emergence of the verticalized family,” said Dr. Vern L. Bengtson, director of the USC Gerontology Research Institute, and sociology professor at the university.

“There are more members of different generations alive than used to be--but fewer members of each generation.”

Bengtson used the term “beanpole family, long and skinny.” Until about 1940 to 1950, he went on, there had been a pyramid family structure--few members of the oldest generation, many of the younger generations. Now that pyramid base has compressed.

“This suggests that the generation in the middle has more burdens on it than ever before in American history,” the gerontologist said.

Jarvik, the co-author of “Parentcare,” said in an interview that young adults are having their children later in life.

“Therefore, they are going to be older while their children are still young, and this often is when their own parent or parents are beginning to make demands on them.”

In former times, she said, not only were these demands not made, but the parents were still young enough to help out with the children.

In a recent newsletter, Rep. Mel Levine (D-Santa Monica), said: “For the first time, the average household couple has more parents than children.”

Furthermore, Levine said, “estimates suggest the average woman is likely to devote more years helping an elderly relative than caring for a dependent child (17 years for child care versus 18 years for elder care).”

“We learn in school about child care,” Jarvik said, “but we don’t learn about parent care. Neither the parents nor the child expected it to happen.

Americans Less Prepared

“Most people fantasize that they will just drop dead or not wake up in the morning. In most cases, though, we will have a chronic disease before we die. And we hadn’t expected to be taken care of by anybody.”

Among many Asians, Small said, there has been a greater expectation of aging parents being taken care of. “Culturally, however, Americans are less prepared for it.”

Interestingly, Bengtson said, “research suggests that among wolves in northern Canada, younger members of the pack take care of the ones who get older.”

Small reflected on the growing situation among humans in the United States:

“There is a sense of sadness. There always is a part of us that feels like a child, and we look to our parents for support. Then when we see that they need us, that they have less mental and physical strength, the child in us is forced to grow up.”

The situation of the sandwich generation, he said, is going to become worse, one reason being that women are remaining in the work force longer. In the past, he said, it often was traditional for a daughter to provide the care for elders.

Women ‘Torn to Bits’

“But women now are having to take care of their own households, hold down a full- or part-time job, and deal with aging parents or their husband’s parents. Because women are becoming less available for this latter responsibility, adult sons are more and more getting into the picture.”

Still, Bengtson said, mostly it is the daughter or daughter-in-law who is called on.

“I think women are being torn to bits,” Jarvik said. “They feel they should be with their kids, with their husband, working at a career, helping their parents.”

Bengtson’s term for those in the middle is the “bridge generation.”

“My focus,” he said, “is on problems and opportunities that middle-aged individuals have in relating to two adult generations. They not only have children, but have grandchildren as well.”

The health factor figures into the problem. “In terms of health, most disabilities of old age aren’t evident now until age 70 or 75,” Bengtson said. “In the earlier part of the century it was 60 to 65.” The reasons for the change? Advances in medical technology, and more consciousness of health.

At what point in life does the parent become, in effect, child to the child?

“It varies, but usually health determines when it happens--chronic debilitating illness,” Jarvik said. “Sometimes it happens with widowhood--the surviving spouse gets depressed.”

Said Bengtson: “This is a new cultural issue, namely parents surviving into a prolonged period of health dependency.”

The Money Factor

Then there is money. Some parents, if they have it, use money to try to control their grown children, Small said: “Nowadays, for instance, many adult children don’t have enough money for the down payment on their first house without parental help. They accept that help, but then they may also have to cope with the parent’s or parents’ advice on how to decorate it.”

Or sometimes, according to Jarvik, the conversation will go something like this: “I’ll give you the money for a down payment, if you’ll move to Connecticut, where I live--but not if you stay in California.”

In return for the money, Jarvik said, “care is implied. Very few parents ask explicitly.”

Very often, Small said, “it is a humiliation for parents to accept care from their children. On the other hand, some feel it is their due. But others feel, I took care of my child, I can take care of myself. I think most of us dread the day when we will have to be taken care of by someone else.

“A baby sitter for the kids is considered OK in our society. But the idea of hiring help for parents is often unacceptable both to the parents and to the children,” Small said.

Perhaps a key factor is the difference between child care and parent care.

“When we have children, we are elated, we anticipate, there is joy. A child is coming into our world knowing no other,” Small said. “With parent care, it is a foreign concept, dreaded by both sides. The parents may come into our world with ideas of their own, such as how care for them should be provided.”

Heart-Wrenching D-day

Increasingly, for many families, there comes the inevitable and heart-wrenching D-day, decision day, what is to be done with the parent or parents suddenly themselves in need of a parent. Quite often the children assemble for an emotional conference on it.

The possibilities, as mentioned by Small and Jarvik in the interviews:

--Allowing the parent to remain in his or her own home by setting up, in effect, a nursing home on the premises. This can become expensive.

--Having the parent move into the home of one of the children. “This can be disruptive,” Small said. “The needs of both the parent and your family must be considered. Think of how elated you were when you grew up and moved out of the house, what a sense of independence it was. Now the reverse is happening. Your parent is coming back. The struggles and conflicts you experienced as a child while everyone was under the same roof may resurface.”

--Putting the parent into a nursing home. “Sometimes there is tremendous guilt in committing a parent,” Jarvik said. “It may be the feeling of, my mother never sent me away, I was never too much for her, but she was too much for me.” The loss of privacy, the psychiatry professor said, can be a major blow for the parent.

Still, she said, nursing homes do fulfill an important function. “Some people don’t have kids, or they are in their 80s or 90s and their children have died. Or they are too frail for anything else. The average age nationally in nursing homes is 85.”

Whatever the decision, the bottom line is that, as Small put it: “Our parents aren’t going to be around forever. . . . We should do the best we can, so that we can all enjoy the new relationship, even when we are forced into it.”

Bengtson concluded: “Living in close interaction with an older generation can provide an important sense of identity for all generations. For the middle and younger members especially, they can look ahead and see how their parents are coping with a life change.”