The Sandwich Generation: Taking Care of Children and Parents

I recently read a great blog post by a nurse and patient advocate Anne Llewellyn in which she described her experience as a patient trying to mitigate potential surprise billing. Even those of us within the healthcare field can struggle to determine how much something will cost and how to shop for providers within the system. If healthcare professionals find navigating the system difficult, how much more so must it be for patients who do not work within healthcare? What about their families and adult children who are the current sandwich generation?

After my dad had a basil cell carcinoma removed from his temple, he received a surprise bill in the mail for over $1,500. He had no idea that the procedure wouldn’t be covered by his insurance and no one in the dermatology office had discussed his potential financial obligations with him. This was terribly stressful for our family as paying that bill was not possible at the time. I was also personally embarrassed by all this because it happened within my own healthcare system. There were other complications from the procedure that led to him swearing, rightly so, that he would never visit that dermatologist again.

This is not a unique story, unfortunately.

Healthcare is overly complicated in this country. Even those of us within the industry who are educated regarding payers, insurance authorizations, and regulations are sometimes stymied by the impenetrable walls of misinformation or lack of information available in provider offices or billing departments.

I learned during this experience that I now need to become a bit more involved with my parents’ healthcare. I work within the industry, have a specialization in utilization review, and hold a case management certification; all that combined should make me an ideal patient advocate for my parents. Yet, this is not a position I relish or desire.

As a mother to three young children, I have responsibilities for their care; they cannot call their pediatrician when they have an ear infection or pink eye. That’s solely my responsibility and, like most moms, I fully embrace and accept the vital role I play in keeping them healthy and happy while they develop into independent people. As a daughter, however, I am uncomfortable being forced into a patient advocacy role for my parents.

My parents are grown, intelligent, and fully functioning adults. They are, hopefully, decades away from needing direct care or requiring someone to make their decisions for them. They should be able to navigate the waters of healthcare without a professional daughter being involved. Yet the industry has made that impossible. The overly complicated schemes within healthcare payment force my hand and I resent it.

The term for the generation caring for both growing children and aging parents is called ‘the sandwich generation.’ That is, apparently, what I am now. I am the filling to a sandwich, which is one of the most unflattering analogies I have ever used to describe myself.

As an advocate for healthcare change, I would be remiss if I didn’t use my platform to share this experience and urge all leaders within the industry to band together for much-needed reform. I should not be forced into an advocacy role for my parents who are in their early 60s; the system should be easy enough to navigate that my involvement is unnecessary.

Perhaps within my lifetime, we will see healthcare change and reform, simplification of the billing process, and more standardization within healthcare and insurance relationships. For the sake of my children, I hope so. I sincerely do not want them to be the filling of a sandwich when they are in their 30s.

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