Caught in the middle: trying to balance work, child care, and elder care can be a challenge.

The report is due tomorrow." "Mom, did you forget? The class play is Friday, and I need..." "Mrs. Adams, your mother needs..." "Honey, when are you going to sit down?"

"Sandwich generation" refers to middle-aged couples with their own children, some living at home and some needing financial support at college, and a parent or parents who also need their attention and care--sometimes more. Providing care for older loved ones represents a growing national concern that will touch nearly every American family. Today more than 8 million older Americans need assistance with personal care--washing, dressing, cooking, housecleaning, shopping, and driving. This care is still something families expect to do and want to do, but it requires sacrifices of time, money, energy, and peace of mind.

Betty spent her days juggling a part-time accounting job, trips to music lessons and the orthodontist for her children, and driving her widowed mother, who lives 45 minutes away, to the ophthalmologist and the doctor. Overstressed and exhausted Betty was forced to find a different solution. She now gives her mother one full day a week, every Tuesday. This is the day her mother schedules her medical appointments, grocery-shops, gets her hair done, and visits with her daughter. Betty calls it Mom's Day Out.

Privacy Important

Nancy tries to give her husband as much private time as possible. Whenever he travels out of town on business, she invites her mother to stay with her. This way she can spend less time with her mother when her husband is home without feeling guilty.

Sometimes the easiest way to care for seniors is to have them move in with you. But sharing living space results in tighter living quarters and less privacy and independence for every family member. If a house is a snug fit for two parents and two growing children, how can it accommodate another adult or even two? Do you add on, move, or make do?

Still, when Margaret's parents moved in, she found it was an opportunity for members of the three generations to spend time together in a way that will add dimension to their future memories. Although it was a big adjustment for her children, and her older daughter had to give up her spacious bedroom for her grandparents, Margaret feels their lives have been enriched.

All Affected

Isolation from familiar surroundings may be a challenge for the displaced elders. They will miss their friends and former neighbors, their church, the comfort of their old neighborhood. "But " Margaret's mother points out, "I have my kids here to play with. I'm happy living with them. It's wonderful!"

Every member of the family is affected by the new living arrangement. Because a woman is most often the caregiver for the children, parents, and in-laws, elder care can cause her to lose the freedom she expected to have as her kids grew older. She may have to turn down a job opportunity that would require travel. Children may resent not having Mommy readily available. But they will reap benefits as well, including the extra attention of their grandparents. Husbands may be dissatisfied with the impact on social activities or intimacy. This can place added pressure on a caregiver who is already overloaded.

Quality Time

Communication between husband and wife requires time together--quality time that is planned, not just opportunities. Couples need to know what is going on privately with each other. Just as you schedule your children's lives around school, music lessons, sports, and orthodontists, and your parents' time for doctors' appointments and shopping trips, schedule time for yourself as a couple.

Be alert for signs of stress--bickering, short tempers, sleepless nights--and ease the situation by finding some "special" time alone together. It might be something as simple as a daily walk around the block after dinner. Or set aside a night as a time apart. One night a week, no matter what, Margaret and her husband go out and do something together.

Too often couples curtail their socializing with other couples. Instead of going out, they invite other couples over. Their parents assume they are included and automatically join in. Or, afraid to leave the elders alone, the couple goes out only in shifts. If this is the case, get a sitter for your parents. It may be difficult to find someone, but respite care is sometimes available at no charge through nonprofit or voluntary agencies. Call your Area Agency on Aging.

The absence of sibling support can bring additional strain into the home. If a brother or sister does practically nothing and offers to do nothing, ask. David Knotts, a psychologist in suburban Philadelphia, confirms the importance to caregivers of coming out and asking for the help that is needed. "Too often we don't ask for help, thinking that because it has to do with family relationships, `you ought to know that I need help,' end then feel resentful when it doesn't happen. Don't just say `I need help.' Say `I need you to watch Mom on Saturday while I ... ' or `I need you to have Dad stay with you two weeks this summer so we can take a trip with the children.' Be specific," Knotts continues. "The sibling who lives in a distant city doesn't really know what kind of help you need."

Trying to balance work, child care, and elder care can be a challenge. But what if you are an only child and your parent or parents live miles away? Long-distance caregivers, as they are called, walk a fine line between doing too much for the elder out of guilt or poor communication, or not enough. Marianne's mother wanted her to move back home to care for her. When Marianne suggested her mother move to a retirement community near her instead, she was accused of abandoning her.

"If you are caring for your parent, you are not neglecting or abandoning her, even though she may tell you you are not doing enough," Knotts says. "A patient in a nursing home may feel abandoned, even though her children telephone and visit regularly. This parent's definition of not being neglected is that she live with one of her children."

Peace of Mind

If your elder is frail but living independently, a few simple safeguards can ease anxiety and avert crises. Debbie's children gave her a "personal emergency response system" that sends distress signals when an elder can't reach the phone. She thought it was a rediculous waste of money, until she fell in the bathroom. Now it provides a sense of security to both her and her children.

Carol is an elderly widow who lives alone. Her neighbors are her children's eyes and ears. If Carol's bedroom window curtains aren't opened by 8:30 in the morning, it is a sign that something is wrong.

Wile calls her parents every morning, and they call her in the late afternoon. This way she knows what is going on in their lives, if they are feeling well, or if they need anything. It is reassuring for them all.

Feeling overburdened and on edge? Talk to your pastor. He or she will listen and advise you about local support groups and other members of your congregation who have worked through similar problems. Talking and sharing concerns and solutions can reduce your stress level and provide some helpful advice as well.

Yes, it is the time of your life when you are in the middle, caught between your responsibilities to your parents, your children, and each other. Still, in life most of us do what we have to do. It is simply a matter of love. Gail Morrissey is a teacher and writer in Wayland, Massachusetts.

RELATED ARTICLE: Where Turn for Help With Elder Care

1. Your state's unit on aging (check local phone directory for number and location). 2. Children of Aging Parents (1-800-227-7294) is a national nonprofit referral service. It provides caregivers with free information on topics associated with aging and maintains a national directory of caregiver support groups. 3. Elder Care Help Line (1-800-25-ELDER) provides information about government programs, community resources, and also helps callers resolve insurance, legal, and financial issues. 4. The Administration of Aging (AoA) is a federal agency that provides information about social services, nutrition, education, senior centers, and other services for older Americans (202-619-0724, or write AoA, 330 Independence Avenue, SW., Washington, D C. 20201)