The Sandwich Generation Solution: Day Care for Kids and Senior

It’s 6 am. The alarm goes off, and you’re busy getting yourself, your 2-year-old child and your 70-year-old mother ready for the day. After a hectic breakfast, a scramble to get all of you dressed and equipped, you manage to get everyone in the car and dropped off at day care before racing off to work, only to repeat the same routine at the end of the day.

You’re tired and stressed. You are one of the 10 to 16 million Americans in the Sandwich Generation.

As the baby boom generation ages and the next generation waits until their late 30s to start a family, more and more new parents find themselves sandwiched between the pressures of work and the care (and costs) of their young children and their aging parents.

But a growing trend in day care facilities may alleviate some of this stress even while improving the quality of day care for both children and older adults: intergenerational day care. These facilities house adult care programs as well as child-care programs in one center, often combining activities for both sets of clients throughout the day. The number of these innovative programs is on the rise. In December 2005, the “Los Angeles Times” reported that more than 500 intergenerational day care facilities had opened up around the country, more than double what was available just 10 years earlier.

 

As the baby boom generation ages and the next generation waits until their late 30s to start a family, more and more new parents find themselves sandwiched between the pressures of work and the care (and costs) of their young children and their aging parents.

Mutual Benefits

Intergenerational care is not only a convenient option for those caring for both parent and child, it actually provides unique benefits unavailable in traditional day care.
Benefits for Elders

Generations United, a Washington D. C.-based advocacy group for intergenerational care, reported in July 2007 that adults enrolled in such programs have enhanced socialization opportunities and a greater sense of engagement in their communities. They have better emotional and mental health as well as stronger physical health than their counterparts in more traditional day care facilities. Julianne Joerres, marketing associate at the St. Ann Center for Adult and Child Day Care in Milwaukee, Wisconsin, elaborated on this trend. She said that when her adult clients served as mentors and teachers to the children they gained “a sense of purpose and added dignity to their lives.”
Benefits for Children

Children, too, benefit greatly from increased positive interaction with older adults. In the same July 2007 study on intergenerational care, Generations United noted that children involved in intergenerational programming had improved academic performance, a more positive attitude to aging and were more socially and personally mature than their peers.

Judy Hamilton is the senior program director at One Generation an intergenerational day care facility in Van Nuys, California. She also speaks of the many benefits her children receive from interaction with “the neighbors,” or the older clients. Children receive more one-on-one attention. The toddlers enjoy sitting on the lap of one of the neighbors and having a book read to them before napping. The 2-year-olds also get neighbor lunch partners who offer help and conversation during the meal. The elder clients also help out in the infant room holding and rocking the babies individually — an unhurried time that is not often possible in traditional child care facilities. In fact, when her own son came to the center for a week over the winter school break, he told her: “I wish I had neighbors at my school!”

Hamilton also cites several studies out of Virginia Tech and Penn State that found children in intergenerational programming had a stronger ability to handle delayed gratification, a reduced bias against the elderly and a greater sensitivity to persons with disabilities.

Safety Concerns

As in any day care program, safety concerns about the health of both the children and elderly need to be addressed. Hamilton also spoke of several myths that many people hold about intergenerational programs that speak to some worries people may have. First, people often ask her if the sick children endanger the older clients’ health. “Like in all day care, the health policy applies,” she counters. When a child or elderly client is sick, they are not allowed to attend and would not be in contact with each other. Further, each morning they have “wellness checks” where each child is examined to ensure that they are indeed healthy. If they seem hot or glassy-eyed, their temperature is taken and they are sent to the sick waiting room until their parents arrive to take them home.

Further, parents often worry about how their children will react if one of the older clients dies. However, in more than 10 years of working in intergenerational care, Hamilton has never had an older client die — although parents or even children have suddenly passed away. Intergenerational care is not hospice and typically the older clients are not near death. Rather, they simply cannot be left alone for a variety of reasons, including Alzheimer?s or physical disabilities, or they prefer not to spend the day alone for social reasons. For instance, the neighbors that work in the infant room are the most highly functioning of the elderly clientele. Many often attend the day care program not for medical or therapeutic reasons, but social ones as they prefer to spend the day with other people in the community. Additionally, only two to three neighbors go into the infant room at a time accompanied by an aide. With the two teachers always present in the infant room, this provides a one-on-one ratio of worker to neighbor/infant pair.

Parents often wonder what kind of background checks are done on the elderly clients. Hamilton allays these fears by noting that at no time are any of the children left alone with another client. All clients, elderly or otherwise, are always supervised by trained, professional staff members who have undergone early-childhood and geriatric training, as well as background checks. The highly-trained staff ensure that both the neighbor and the children interact in safe, healthy and mutually beneficially ways.

Best Practices

However, not all intergenerational programming is equal. Sonia Miner Salari, sociology professor at the University of Utah, notes that there is a danger in infantilizing older adults when intergenerational programs are not appropriately structured. As she concluded in a 2002 paper, “[Adult] clients should be provided with mentoring roles, adult status, and autonomy, and the two generations should not be treated as status equals.”

In evaluating any intergenerational programming, she advises, make sure that there is a choice of participation for the adults, that children and adults have separate spaces in which to retreat during the day, and that the adults are respected and tapped for their experience and wisdom.

One Generation’s programming exemplifies these best practices. The facility houses separate but adjoined buildings for the child care and adult day care services. For adults who choose to participate, there are several opportunities throughout the week to interact with the children. In each activity, the adult is paired with a child to serve as a mentor and teacher. Some of the more popular programs include cooking classes, nature walks, and music and movement classes.

St Ann’s Center also demonstrates some innovative ways to program developmentally appropriate intergenerational activities. The center?s most popular activities include musical therapy and water sports. They also have a rock-a-bye baby program, as well as cooking, gardening and woodworking classes where older clients share their experience and wisdom to help guide and care for the children. The center?s intergenerational programs have seen such great success that they have created a best practice manual for other facilities interested in developing a similar program.

The benefits for people in the “Sandwich Generation” are enormous. The ease of having one facility that provides quality day care to both a parent and child can reduce stress and time management issues. It also reduces financial stress, as many intergenerational care facilities offer discounts to family members. Perhaps more important, intergenerational care provides an opportunity for the grandparent and grandchild to interact more often and mutually benefit from a closer personal relationship.

To find out more about intergenerational day care facilities, or to find one in your area, check out Generations United.
Megan Clarke juggles a husband, four children and a freelance journalism career in Oak Park, IL. Her work can be seen on Care.com, BabyZone.com and USCatholic.org.

Excerpts from a study by Generations United and Leading Edge 2017

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Although most older adults prefer to age in place (Stone and Reinhard, 2007), many move into independent senior communities for a variety of reasons, ranging from health to nancial and social concerns (Sergeant and Ekerdt, 2008). Research suggests that when individuals transition into senior housing, many find it difficult to establish new social connections and/or become integrated into the broader community (Mitchell and Kemp, 2000; Carroll and Qualls, 2014). These barriers can result in a sense of being “left behind,” and can a ect an older adult’s quality of life (Blaschke, Freddolino and Mullen, 2009).

Independent living environments vary widely, and are rarely regulated or standardized (Stone and Reinhard, 2007). In some locations, independent living may be little more than senior apartment living with common meals and group transportation (Stone and Reinhard, 2007). When older adults move into independent living communities, the desire to age in place can be threatened, and quality of life may be reduced as familiar worlds are signi cantly changed (Chapin and Dobbs-Kepper, 2001; Park, 2009). This may be particularly detrimental

in the affordable housing setting, where residents are more likely to live alone, and often have higher rates of chronic conditions, lower incomes, and fewer social supports (US Department of Health and Human Services, 2014).

Loss of social connections, physical separation from familiar places and routines, and resulting emotional distress can combine to affect the mental and physical health of residents (Ball et al., 2000). Many residents of affordable senior housing may find themselves isolated, due to distance from or lack of transportation to community or group activities in which they previously participated. This isolation can lead to decreases in life satisfaction and mastery as well as increases in loneliness (Ball et al., 2000; Hawes and Phillips, 2000). Decreased contact with social network members outside the housing community, combined with the social constraints of institutional settings, can affect the quality and quantity of residents’ social interactions (Cannuscio et al., 2003).

Due to these factors, it is increasingly important for senior housing providers to offer residents a range of support services and to develop opportunities for residents to engage with and contribute to their communities. In addition to promoting general volunteerism and connecting residents with lifelong learning programs, there is a growing interest among housing providers in intergenerational programming.

Intergenerational practice involves bringing people together in purposeful, mutually benefcial activities that promote greater understanding and respect between generations and contribute to building more cohesive communities. Intergenerational practice is inclusive, and builds on the positive resources that both young and old can offer each other and those around them (Hatton-Yeo and Ohsako, 2000).

Research suggests that engagement in high-quality intergenerational programs and meaningful cross-age relationships may decrease social isolation and increase older adults’ sense of belonging, self-esteem and well- being (Barnes et.al.2004, Seeman et.al.2001). In addition to bene ting individuals, intergenerational programs and practices can address the pervasive ageism that threatens to undermine the social compact of obligations we have made to each other over time (Pastor and Carter, 2012; Robbins, 2015).

Senior housing can offer an ideal platform for high-quality intergenerational work, given the nature of housing to provide economies of scale that help to ensure sustainability. Developing long-term partnerships with local educational institutions and youth-serving agencies can help expand the social networks of older adults, create meaningful civic engagement opportunities, and build social capital within the broader community.

Although some intergenerational programs have been developed within senior housing, little is known about the characteristics of these programs and the implementation challenges they face.

The only national survey of intergenerational sites was conducted by AARP in 1997. A need exists to consolidate what is currently a body of small- scale and largely anecdotal research evidence on the benefits of intergenerational practice into a more systematic and critical review of the properties, principles and parameters of effective intergenerational practice (Bernard, 2006). A better understanding of the barriers and benefits faced by senior housing providers, particularly those serving low- resource communities, will provide valuable information about promising practices that can be replicated nationally.

‘It’s like being reborn’: inside the care home opening its doors to toddler

With benefits for older people’s physical and mental health, a new care home-based nursery in London is the first intergenerational care facility in the UK

Sasha on Fay Garcia’s lap

Acrescendo of nursery rhymes is not what you’d expect to hear in an care home for older people, but arriving at Nightingale House in south London, you can hear the children before you can see them.

“Isn’t it fantastic? It’s the highlight of my week,” says 89-year-old Fay Garcia, while bouncing baby Sasha on her knee. “It’s like being reborn.”

Garcia never had children but is one of the regulars at the baby and toddler group. It’s been running since January in preparation for the new nursery, which opened this week.

The Apples and Honey Nightingale nursery, run by founder Judith Ish-Horowicz, is the first of its kind in the UK. The concept of intergenerational care began in 1976 when a nursery school and a care home were combined in Tokyo. Since then, there have been successful schemes across Europe, Australia and the US. In Singapore, the government has committed £1.7bn to initiatives to improve ageing in the country, including 10 new intergenerational housing developments.

Combining care for older and young people has economic benefits for care homes, and health benefits for their residents.
Combining care for older and young people has economic benefits for care homes, and health benefits for their residents. Photograph: Barbara Evripidou/Channel 4

The UK is still catching up with the idea, says Stephen Burke, director of United for All Ages. For seven years, the development agency has worked with a range of organisations – including local authorities, housing providers, care homes and community centres – to encourage them to think more broadly about opportunities for combining care.

Interest is growing. Burke expects the UK’s first housing development for students and older residents (as seen in the Netherlands) to launch soon, and representatives from Torbay council in Devon will travel to the US this autumn to see examples of best practice. Nurseries are run near to care homes in cities such as Chichester and Edinburgh, but Apples and Honey is the first to run a nursery within a care home itself, with daily joint activities for the children and residents including exercising, reading, cooking and eating meals.

“[It’s] about bringing people together,” says Burke. “By getting people talking to each other, you break down some of the barriers and challenge some of the stereotypes [particularly around ageism, dementia and other conditions affecting older people]. We see this having benefits for all generations.”

Ish-Horowicz came up with the idea many years ago after bringing children from her first nursery in Wimbledon to visit Nightingale House each term. The new nursery, housed in the care home’s refurbished maintenance block, has 30 places for two- to four-year-olds and a number of spots reserved for the children of care home staff.

“Everyone I’ve spoken to loves the idea,” says Ish-Horowicz. The Ofsted registration process went smoothly, although there were issues finding insurance: “We had to explain to them that we weren’t going to leave the children in the care of the residents (or the other way around), and they didn’t all need to be DBS checked,” she says.

Ish-Horowicz’s proposal came when the home was reassessing its own approach to care, says Simon Pedzisi, director of care services at Nightingale House, who had consulted students of medicine, occupational therapy and nursing for new ideas.

“Our average age on admission is 90, so we have to think in an innovative way about activities,” says Pedzisi. “[Care] has to be more meaningful, deeper and measurable. It’s about social interaction because that’s what older people really [need].”

In Channel 4’s Old People’s Homes for 4 Year Olds, residents of Bristol-based St Monica Trust were found to have improved mood, mobility and memory after spending six weeks with children.
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In Channel 4’s Old People’s Homes for 4 Year Olds, residents of Bristol-based St Monica Trustwere found to have improved mood, mobility and memory after spending six weeks with children. Photograph: Barbara Evripidou/Channel 4

When care for older people faces staff shortages, funding cuts and estimates that another 71,000 care home places will be needed by 2025, it’s understandable that innovation is in short supply. But Pedzisi insists that any extra money needed to support the nursery will be well spent.

There can be economic benefits for care homes considering sharing their sites, says Burke, including gaining additional rent and sharing administrative, ground maintenance and catering costs. Co-location can also improve recruitment and retention of staff, who take advantage of flexible on-site childcare or find satisfaction in the increased variety in their roles.

The health benefits of alleviating residents’ social isolation may also lead to savings elsewhere. “If people are well stimulated and live meaningful lives, they’re going to eat well. They’re then at less risk of dehydration and falling, therefore you’ll lower the risk of hospital admission,” says Pedzisi.

Increased social interaction is linked to a reduced risk of disease in elderly people, which was recently highlighted in Channel 4’s Old People’s Homes for 4 Year Olds documentary. Eleven residents of Bristol-based St Monica Trust were found to have improved moods, mobility and memory after spending six weeks with children. The trust has since committed to adding a full-time nursery to one of its residential care homes, playgrounds at a number of other sites, and is developing a new retirement village.

“We’ve always done intergenerational activities, but we wanted evidence so we could roll out wider programmes,” says David Williams, the trust’s chief executive. “It has created a buzz and a feeling that we can do things differently. It’s also had an impact on our staff. If you’re working in an organisation you feel is [making a difference], you want to be part of that innovation.”

As Apples and Honey Nightingale welcomes its first class of nursery children, Ish-Horowicz is optimistic for the future of intergenerational care. “There’s such a positive feel around this; you know it’s going to work,” she says. “It’s about learning through generations and caring about each other. This kind of thing can change society and the community.

Here’s the problem: so many older adults need assistance

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When Lucy Garrison and her sisters suggested to their mother, Katherine Garrison, that she start going to JABA’s Adult Care Center, she — like so many older adults who need assistance — was at first reluctant to leave her home. But they already had been dealing with their mother’s physical problems from a stroke for more than a decade, had their own families and work lives to consider, and had begun to worry about her spending so much time alone in her condition.

“Mom had always been the caretaker and problem-solver in the family,” Lucy Garrison said, “and so it was understandable she didn’t want to go.”

Indeed, for many people like Katherine Garrison, the idea of going to an adult care center seems akin to entering an assisted living facility — something they may not want yet or be emotionally prepared to consider, even though the care they are now requiring at home may be a growing burden on their caregivers. It’s an unfortunate misconception, said Danielle Flippin, manager of JABA’s Adult Care Center in Charlottesville, because time spent at a center like JABA’s actually can help keep people like Katherine Garrison in their homes.

“People often think this is an assisted living facility, and that they are going to have to stay overnight,” Flippin said, “and we always have to reassure them that it’s not. In fact, many people can avoid having to move to an assisted living facility because of us.”

As Flippin points out, specialized care and an array of activities are available for older adults every weekday — even for those with Alzheimer’s or other forms of dementia — which can take a considerable burden off caregivers who are working or raising children, and drastically reduce the time spent alone at home.

“And it’s much more affordable than assisted living, or even in-home care,” Flippin said. “And coming here reduces the risk of social isolation.”

What’s more, Flippin says that caring for people during weekday hours only — 6:30 a.m. to 5:30 p.m. Monday through Friday — instead of having to house, feed and care for people 24/7, as assisted living facilities must do, allows the center to focus more on activity programming and personalized care.

It’s also worth noting that JABA’s Adult Care Center accepts Medicaid and veterans benefits and has scholarships and grants available to help people with specialized needs or who those who need financial assistance. In addition, many people might not know that the center is not just for older adults, and that anyone 18 or older with a disability is eligible to become a member.

Still, Flippin acknowledges that it isn’t primarily the misconceptions that prevent people from visiting the center, but rather the reluctance that older adults like Lucy Garrison’s mother have for leaving their homes and their routines, and relying on strangers for assistance.

“We encourage people to start slow, maybe a day or two, then build up,” Flippin said. “To me, it beats sitting at home all day with a caregiver, or on the couch watching TV.”

For Lucy Garrison and her sisters, it involved knowing their mom.

“Mom had always been the caretaker and problem-solver in the family,” Garrison said, “so we got her to go by telling her to think about it as a job, like going to work, and there would be things to do and accomplish. We knew we had to give a her a purpose.”

That was five years ago. Today, at 83, Katherine Garrison sits happily in the main room of JABA’s Adult Care Center in a comfy chair with her feet propped up and a fuzzy blanket across her legs, wearing a pair of bright red Converse high-tops. Her daughter said the family first bought her a pair when she started falling at home, as a younger athlete in the family suggested they would give her better ankle support, but the high-tops obviously became her thing.

“I have blue ones, black ones, green ones and gray ones, too,” Katherine Garrison said, turning slowly toward me with a slightly wry smile, looking at me intently, if not a bit skeptically, with her dark, intelligent eyes.

“I feel safe here,” she said. “It’s important to feel safe, and I like the people, and the music, and the food. I also have a great-niece who goes to the preschool next door.”

There are only two adult care centers in the greater Charlottesville area, both of which are operated by JABA — one located on Hillsdale Drive behind Toys R Us and the other at the Betty Queen Intergenerational Center in Louisa. JABA’s centers have something truly unique — adjoining preschools and programming that allows the children and center members to interact on a regular basis.

For individuals who need a higher level of care typically provided by nursing homes or long-term care institutions, Blue Ridge PACE — of which JABA is a partner — operates a specialized day program on Carlton Avenue that includes extensive medical and therapeutic services.

“The children can get members to do things we can’t get them to do,” Flippin said. “They see those smiling faces and they want to help, want to teach them, so we see them playing games, eating meals together, creating crafts and telling stories.”

 

While kids are often shy with the older adults at first, it doesn’t take long for them to break out of their shells, Flippin said. And she added that parents report that the kids treat older people differently in public after their experience at the center, smiling and saying hello more often. Of course, for members who’d rather not spend time with children, the center provides other activities when the preschool is visiting.

A look at the Adult Care Center’s daily activity calendar shows how much is going on. Ice cream socials with the preschool, special meals, holiday celebrations, field trips to museums and places like Carter Mountain Orchard, exercise classes, live music and other performances, outside visitors from schools and organizations, gardening, puzzles, games, movies, theme days and even the occasional Elvis impersonator.

“We are pretty entertaining here,” Flippin said with a smile.

“I was skeptical at first,” said Elinor Witcher, 82, a member for two years now who takes a JAUNT bus from her home on Prospect Avenue every weekday, “but then I started participating in all the activities.”

Witcher is fond of balloon ball, a game played with kids from the preschool; she loves all the live music, and playing bingo. “It makes my two daughters feel good that I’m here, and that I’m safe,” she said.

While an adult day care situation may not be right for everyone, and it’s up to families and individuals to make those difficult decisions, there’s a lot to be said for the way these programs help support the whole family.

“We see a lot more three-generation households now,” Flippin said, “and many caregivers who are still working and raising children. We’re here to let them know that you are not alone, and that we can help relieve the burden of caregiving.”

“Once we got her there, the socialization was very important, and it revived her, brought new life to her,” Lucy Garrison said of her mother. “The center has helped us in so many ways, giving her the personal interaction she needed, allowing us to keep her at home. … We can go to work … and we’re comfortable knowing she’s in a safe, loving environment. It’s a truly amazing program.”

 

David McNair handles publicity, marketing, media relations and social media efforts for the Jefferson Area Board for Aging.

It’s a lot of us

screen-shot-2016-11-07-at-9-39-48-pmThe Pew Research Center and California HealthCare Foundation found that 39% of adults in the U.S. are family caregivers. Almost two-thirds of these are grown children caring for their parents or in-laws. While there is often a financial strain on families caring for aging parents, there are emotional challenges as well.

Both the aging parent and grown child often feel a deep sense of loss or guilt at their changed relationship. While the child previously looked to the parent for support and guidance, this role is now reversed. Aging parents may find it difficult to adjust to being the one who needs support and may find it threatening to their independence.Often families face the most emotional stress when a parent has to be moved from their home to live with a grown child or move to an assisted living or long-term care facility.