Feb. 28, 2008

Several years ago, I was zigzagging through traffic in a frantic attempt to get nowhere fast during rush hour. I pulled beside a van with a driver who appeared to be a thirty-something young woman. Her van and mine inched along together.

I noticed a gray-haired passenger beside the driver. A woman clearly in the 80+ age range. A grandmother, I speculated. As I looked further, there were two kids in child safety seats in the back. I’m guessing ages 5 and 3. The Mom was refereeing a dispute between them through the rear view mirror. Grandmother sat silently facing straight ahead. I remember thinking to myself, “My day may be hectic, but I bet it ain’t as bad as this young woman’s. Better her than me.”

As traffic moved along, I needed to be in the lane that the woman’s vehicle occupied so I signaled. The driver behind her let me in. The perspective from the rear only validated my imagined story line for this three generation troop. The back of the van had silhouettes of the top of a folded wheel chair along with what appeared to be swimming pool toys.

The punch line of the story, though, appeared as a bumper sticker on this young woman’s van. “HEAVEN DOESN’T WANT ME AND HELL’S AFRAID I’LL TAKE IT OVER.”

I was witnessing the contemporary sandwich generation woman with generations above and below her that she had been drafted to manage. You can see the heaven part: she’s an angel of mercy to her kids who fight her at every turn, as kids will do. And, Grandma needs help, which generates its own brand of tension and complication because of all the emotional and practical issues involved.

How did SHE become the person to carry out these multigenerational responsibilities? She probably wonders herself at times. Yet, she fulfills them with little complaint, I’d guess. Somebody needs to do it. Husband works. Mother has high blood pressure. Or, if Grandma is on hubby’s side of the family, she picks up pieces of in-law work – often thankless and fraught with emotional baggage. And maybe she works, as well. Teaches, perhaps. And had to take time from work to get Granny to the podiatrist, I speculated.

Whatever the specifics of my new imaginary friend's life, she had responsibilities delegated to her with little authority and minimal appreciation. In fact, you can bet some family members resented her angelic work. Yet, she is the woman in charge – and she has to be if someone is to keep the family stasis in healthy balance.

So, what are the implications of this story for us? Here’s my take –

1. All of our members must become woman friendly in all that we do. Everything from work place benefits and flexibility to services to our resident families that bend toward conveniences of women family members. We need to see frustrated daughters as people in need of support – not “potential problem families” or lawsuits. We need to recognize that many of these women-in-charge now must manage from long distances, so we need to ask how we can accommodate them.



2. We need to advocate for family-friendly law and regulations. Respite care, home oriented services need to be easily accessible and affordable to use. We need to make quality information available and easy to understand. Too often these services are rationed, difficult and bureaucratic.



3. Transitions of care continuity from hospital to post-acute, to home care, to doctor’s office follow ups need to be as smooth as the best hotel concierge services available. Today, the system is a fragmented, yellow pages approach that actually creates crisise and costs of care problems. Too often, it seems like the system is designed more not to help people than to help them. Redesign your system and extend it beyond your walls to help residents, clients and those in the community and their loved ones navigate it with minimal frustration.



4. Finally, work with AAHSA on our Long-term Care Solution Campaign. Financing long-term care must be transformed to a national insurance product available to everyone without prejudice where the dollars follow the need to make it easier – and more affordable – for the disabled and elderly and their families to care for them. Today’s financing through numerous programs, eligibility, government bureaucracies is a mess to manage and a nightmare to navigate.

Because, you see, any of us could wind up like that woman in the van. A 75 percent chance, in fact. Eighty percent of long-term care happens in family homes. Caregiving is a 35-hour per week job, on average for families. Out of pocket expenses for families are over $5500 annually – more than families pay for their own health care. American business is paying indirectly over $2000 annually to cover caregiving costs per employee. I’ll bet most businesses don’t know that fact. And Medicaid is going broke.

Yet, people like this young woman don’t complain. They just CARE. And we must make it affordable to care. Heaven can’t function without them. Let’s make it easier for her – and all caregivers- to do their great work.

And let’s help them take over hell. Somebody needs to clean that place up, I’d imagine.


William L. Minnix, Jr.
AAHSA President & CEO


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