Sandwiched Support

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  • March 24, 2026

    Downtime

    Sometimes I hate to call her on it because I cannot imagine the pain of having bone on bone knees, but Mom tends to thoroughly complete the PT exercises that involve her moving her arms and legs in various ways while sitting or lying down, but struggles to motivate herself to choose weight bearing exercise for her knees. So far she has gotten one knee replaced about a month and a half ago now and her recovery was slow but steady at first as she transitioned from the smallest local inpatient hospital where the procedure took place to our favorite local rehab facility for intensive PT and OT. She was certainly making progress with daily therapy.

    Then she qualified for home health which we greatly appreciated because I am her primary driver, advocate, and support person and I work two part-time jobs (one from home where I primarily set my own hours and one in an office two days per week) and I have 4 children of varying ages and a husband and we all have a home to care for. It’s a lot and reducing the number of appointments we have to take Mom out to is very helpful because she does not drive due to her bad knees , not always being able to get in and out of vehicles and buildings without help, and many years of no longer driving. I also accompany Dad to many of his appointments so that I can be an advocate and a second set of ears. My dad is a back up driver for her but they do tend to stress one another out and he is a cardiac patient with a quadruple bypass surgery in his medical history so having him take Mom to appointments can be exhausting and some of the physical help she needs at times involves him exerting himself in ways that are questionable. But the options are limited when we have to get out to appointments for Mom. So we like it when the providers are able to come to the home.

    But as the weeks go by she no longer meets criteria for them to stay and they discharge her one by one. The nurse goes and will come back if signs of infection or another issue start, and really it’s a good thing to see Mom improve of course and we don’t want her to need providers, but sometimes it’s more that she does still need providers but not badly enough that they will drive to us. Next OT usually discharges Mom as she is very resourceful with her ADLs even when she has to make a lot of her own accommodations. She is brilliant that way and teaches the therapists tips and tricks that they have not thought of at times.

    The one who stays the longest given Mom’s condition is the Physical Therapist, but even when the Home Health PT first starts seeing Mom the most she ever has gotten approved for is 3 days a week with sometimes having a 4th or 5th day with another provider having eyes on her or working with her (nurse or OT) and I get it, staff is limited and funds for this kind of service paid for by insurance are limited as well. But coming from an inpatient rehab where Mom was doing exercises with a therapist typically 6 days a week or at least 5 to cutting that on half right away is a bit of a bummer of a drop off. She is supposed to do the exercises herself on the off days and she will tell you she does, but she is not doing any extra walking without a therapist standing right there pushing her because it hurts.

    And the biggest bummer, which quite frankly feels like a gap in the care plan and does not make sense, is when they say she can still qualify for home health PT but PT will only come to the home once weekly because that is all they will approve and she cannot (as far as I know- I have not yet asked a physician to order outpatient PT while Mom is still having home health PT but I doubt it is permitted) have two levels of care at one time in the same speciality.

    So then the therapist asks us to decide do I want her to discharge Mom and just go ahead and start her on outpatient PT (which she actually has never actually started before- she completed an intake before but then something happened such as a worsening condition or a hospitalization and she never started the outpatient PT). Well this home health PT has specialized training in lymphodema, which is another one of Mom’s complicating conditions, and does such a great job and we don’t want to lose her and I don’t want us to have to drive mom to and from PT 3 days a week selfishly as that adds to the schedule so we say “sure stay on for 4 more weeks.” But she’s only coming once weekly and she was just off for a week and they will usually send a fill-in therapist but it sounds like she got Mom to say it was fine to skip a week and Mom does not choose to do the weight bearing exercises when the therapist is not there. So Mom is only getting the full benefit of the PT one day per week because there are so many family-related factors that keep us dragging our feet when it comes to setting up outpatient PT and Mom certainly isn’t begging to go.

    Wondering if insurance companies and treatment teams have considered that if they just pay for a few times a week of home health PT for a patient who is not fully exercise-compliant on the off days the patient might have better outcomes and then discharging a patient like that (who is not going to do the hardest exercises on her own on off days- especially when the hardest ones are the ones she needs the most) directly to outpatient PT so that she is going from at least 3-4 days of working out with a PT coming to the home and motivating and guiding her though fears and roadblocks to 3-4 days a week of working out at outpatient PT so the number of days participating remains consistent in the transition to a lower level of care.

    And I realize that different patients have different needs and (seemingly even more importantly unfortunately) different funding sources approve different numbers of days and types of care, but patient outcomes are important too. And speaking about a patient like my mom who has had so many readmits and is not fully compliant with the hardest exercises that are the ones that will really build back her strength and have the potential to improve the outcome of the next knee surgery and recovery, wouldn’t it make sense to keep that at home PT coming four days a week for maybe a couple fewer overall weeks and then transition to 3 or 4 days of outpatient PT a week so someone is getting her to do the exercises instead of so much sedentary time?

  • March 17, 2026

    Home Health Highs and Lows

    Your loved one has a surgery or gets out of the hospital after being treated for a condition that is ongoing or has weakened them and sometimes they meet criteria for a stay in an Acute Rehab Facility where they receive nursing care, PT, OT, and sometimes Speech Therapy often with a private room reserved just for them and therapy for several hours a day in their room and in a state of the art gym down the hall. These places (at least the ones that Mom has recuperated in, 3 different facilities so far) are wonderful for ongoing care after they are stable for discharge from the main hospital. We couldn’t be more thankful that these places exist to help rehabilitate our loved ones before they head home.

    Side notes: be aware that these Acute Rehabs count as days in an inpatient hospital for the Medicare day count limits, there are Skilled Nursing Facilities (regular nursing homes, some of which are better than others, do sometimes provide rehab but are billed differently and do not always provide the same number of hours of rehab especially on weekends), and PT and OT while inpatient in a main hospital typically only happens for evaluation purposes to choose the level of care for discharge (if you’re hoping for rehab for your loved ones when they start recovering- it’s a great hope- but it’s really not likely to happen regularly. They come to assess when they have to and that’s about all they have the staff for).

    Then if you are fortunate and your family member needs home health because they cannot get out on their own to appointments, you get help coming to your home. Don’t get too excited. The help at home can be and frequently is great, but it is very limited and they won’t be there for long. Very rarely is a nursing assistant included in this (someone to help bathe and dress your loved one and do light chores like laundry or bringing a meal to them). What the nurse’s assistants do is a very short list and they do not stay long if you even get them at all. Dad had one to stand nearby while he showered after his quadruple bypass surgery several years ago. We were offered one this time after Mom’s knee surgery but not following her previous procedures and hospitalizations. You almost always (if not always) get a nurse assigned especially one to come check that all of the meds are in order and to do the intake into home health, but they typically examine the patient very little and, in our experience, provide education and talk with you but do very little hands-on care. Once Mom needed something badly that can be done on an outpatient basis and the nurse was still there at the time and I was coming home from work. The magnet from the agency says “Call us First” regarding help with issues and the nurse declined to provide the needed care and I as an untrained family member came home from working all day to handling a delicate and awkward situation with my own Mom myself because that home health RN doesn’t do that. Hmmm, ok. You did not even examine my mom that day but I suppose you collected all of your pay for showing up and being on the Olympic Standing There team. But this is what insurance pays for in home healthcare.

    We have had mostly great OT and PT home health staff members and Mom has needed PT the most so she qualifies for PT to stay longer while the nurse and the OT sign off earlier in treatment. Home healthcare stays for about a month, maybe two, but they do not come every day. Maybe the first week you could possibly get one person coming each day if the nurse is once weekly and PT and OT are cleared by insurance to come twice a week each. But they are there for about an hour to an hour and a half per day. This is not what it sounds like, care if your loved one needs someone to be with them at home, that’s not provided. It’s a check in here and there briefly and some therapy that you did not have to drive your family member to.

    I am grateful that they come to the home, but it is daunting as my parents continue to age and as I am committed to keeping them in their home with their family, that insurance does not pay for help to come into the home and provide supportive care. All of that is out of pocket. It sounds like Medicaid can provide a limited amount while the state takes all resources to pay for it if the person qualifies. It also sounds like there are some community resources one can sign up for if qualified, but agency care in the home is expensive and not covered by insurance unless your loved ones thought far enough ahead to pay into long-term care insurance (before they developed any pre-existing conditions) and even that really doesn’t cover much. Even going to an assisted living facility will cost quite a bit long-term (though I admit I have not looked into that because it is not an option we are considering at this time).

    So the family, usually the daughters, are left to figure it out when there isn’t really a long term plan. And for so many there is not enough income to plan well in advance. And to be honest even when there is it is a difficult choice to prepare for the unknown (who knows how much care a person will need?) versus using one’s income to enjoy a quality life while one is able to enjoy it.

    Home health is usually great when they are there. They are very knowledgeable and, especially the therapists, seem to put in a lot of energy and effort to providing great care. Today the PT found an infection in part of Mom’s incision while I was at work and alerted the surgeon’s office before my day ended. SO helpful that I did not have to do that today. But now the office hasn’t done anything and will call back in the morning while I am working again.

    OT and nursing have signed off and PT is the only one approved to stay for now but she only got approval to come once weekly for the last month. Mom struggles to push herself through the pain to do the exercises. When we get her approved for outpatient they will work with her more often in a week’s time but we will have to drop everything during the day and drive her because she no longer qualifies to get more than once a week to the house.

    I need to look into whether we could have started outpatient while home health was still coming once weekly. I doubt the service can overlap in any way….no matter how much it would make sense for the patient.

  • March 10, 2026

    We are experiencing an extremely high call volume

    I call the small hospital’s health system often. My children’s pediatrician is within this system as are most of my parents’ specialists and our primary care providers.

    At many of the offices now AI is answering and taking me through an annoying menu of options and asking me questions that I assume lessen their liability more than they are useful. Almost every time I call any of the offices I wait on hold for several minutes and hear a recorded statement “we are experiencing an unusually high call volume.” When a human being answers it is typically someone working from home and after I talk with them I typically am transferred to the front desk of the office I am calling (and stating the name and date of birth of the patient for the second time or more).

    Last evening as soon as I finished my final online session of the day for work I called the pediatrician’s office at 4:59 PM hoping I would get someone before they closed. After going through AI and getting the first person who took down my information I was disconnected while waiting on hold to be connected with the front desk of the pediatrician’s office. I was very honest in sharing that my daughter had not been feeling well for the second time in a month and explained why I thought the same issue had returned based on her symptoms. I repeated myself multiple times to multiple different people and they had no sick visits available for over a week. We have decent insurance benefits but I still asked them to squeeze my daughter in if not today the next day and one of the nurse’s that called said that they sometimes open appointments same day and that I should call in the morning while in the meantime my daughter is very uncomfortable.

    I told them, which maybe I shouldn’t have that I would probably end up going to their urgent care if she could not get an appointment to be seen but expressed frustration about this because it is more expensive to do that and it would be much nicer if our pediatrician was not just for well visits.

    My husband came home from work and decided just to spend his entire evening at Urgent Care with our daughter and she did in fact have something they found that needed to be treated. Someone from the office called me hours later once he had already left to take my daughter to Urgent Care Care and she was calling to let me know that the doctor looked at my daughter’s chart and wanted this staff member to tell us to just go to urgent care. Great.

    I can’t help but feel that they are funneling us to the urgent care facilities and don’t mind that we waste a lot of personal time waiting (and having our sick daughter sit and wait) instead of having an appointment scheduled because as an organization they then get to charge us more to be seen.

    Specialists are scheduling months out just for the intake appointment and treatment is further out. But you can receive waiting list texts for which you’d better stop everything you are doing immediately and check your calendar and respond as fast as you can or it will be gone.

  • March 7, 2026

    You have to Bring Us the Med

    I’m new to this additional drain on my time as a member of the sandwich generation. Maybe it’s just injectable medications that this is happening with? Friends of mine who have lived abroad tell me that they have to go get antibiotics and bring them to their hospitals when prescribed (instead of the hospital having them there) whereas others have told me that in some countries there are antibiotics in vending machines that people can purchase without a prescription. Well Dad was prescribed a vitamin to be injected. Mom was recently prescribed another medication that needs to be injected. Dad is now taking that vitamin orally, but when he was getting weekly injections not only was he going into the doctor’s office to get them, but he had to go to the pharmacy to pick up the medication and bring it into the office. If something is being done at a doctor’s office, why is the patient running to get it? Something else for the patient and family to do. Mom’s medication is extremely expensive so we had the doctor send it to an online pharmacy. Then we found out that the deal it looked like we were going to get was not going to work out and picking it up at the local pharmacy was the same price. Due to Mom having surgery and recovering in a rehabilitation facility we didn’t know when she was going back to the office to have this medication injected so we waited to order it and now it is too late to order it from the by mail pharmacy anyway. But now the prescription has been sent to the online pharmacy so we had to call the specialist’s office to ask them to call it into the local pharmacy again. Anytime you place a call there it takes them at least 48 hours to get anything done and every time I am wrapping up with work the doctor has left for the day and anything we are looking for is a tomorrow problem (if that). So she has an appointment for next week for the nurse to inject her, but we must get the meds first and we have to refrigerate them and remember to bring them along. The first time I hurried Mom over there for a nurse appointment for an injection I forgot the medicine in my fridge. Thankfully they did have a sample they were able to use but I had to put in a reminder not to do that again. Mom has home health coming to the house for PT and OT post surgery and in preparation for her next knee to be replaced. The nurse saw her for less than a week and signed off saying we only needed PT and OT. I asked could she please stay on until next week to give Mom the injection at home so we don’t have to take Mom to the specialist’s office just to have a nurse give her the injection. The nurse declined to stay on for one visit next week and said that even though her home health agency is owned by the small hospital system just like the specialist’s office is there would have to be a whole separate order for her (the agency nurse working for the same company) to give the injection that we are paying for and picking up instead of the nurse who works at the specialist’s office. No problem, I’ll just lose a whole client session in the middle of my work day to bring Mom to the office after losing work time while on the phone with the office to get the prescription transferred. And you don’t even want to know how long it took with both Mom and I calling and using the portal to get the specialist’s office to let my dad come pick up Mom’s injection that they were storing in their fridge (because it comes in a 2-pack so once we get it to the office one of them can remain there until the next appointment but getting them to store it was a whole thing that they almost didn’t do also) and take it to the rehab hospital (which by the way is also part of their own hospital system) so Mom could get the injection while she was in there because they didn’t want to transport her to that nurse’s appointment at the specialist’s office.

    I as the sandwiched daughter and advocate was told that I could give the injections at home to avoid all of this if I am comfortable doing that. I am currently quite hopeful that I will not have to become comfortable with that. There are many reasons I chose to work in mental health.

  • February 28, 2026

    Checking Their Boxes

    The rehab my mom went to was top notch. She has been there before, I believe 3 times, and we love the proximity to home, how beautiful the facility is, and how fantastic the staff is. We rarely have a complaint about the place. But I will say that’s it’s interesting to see what they try to do to check boxes and maybe meet third party payor requirements (I’m not sure if these things are required). It is an interesting experience to be the sandwiched advocate of my aging mom and to be called by someone who I think was a nursing student (props to them for using students to connect with the patient’s support system! Students have time!) and asked a whole list of questions with multiple choice number ratings regarding what I am and am not comfortable with in terms of aftercare at home for Mom who would be returning to live with us. I answered her questions and then she asked me to set up 5 hours of caregiver training during the day during the work week.

    I have two flexible part time jobs and I did schedule the training even though I had had it at this facility and other facilities multiple times before. I ended up rescheduling the training when Mom’s discharge date was pushed back due to her not being ready for discharge and when I rescheduled it I advocated for myself as a busy working mother of 4 and the social worker reduced the training to 2 1/2 hours. He stated that it really does seem to be a challenge for family members who work to come in for 5 hours of training during the day during the week. Um, ya think?

    The training was very helpful with PT and OT. Always has been. But for Mom who is not currently in need of a lot of nursing care the nurse did not show up to provide my training and 15 minutes into it we called and a nurse’s assistant went to get her which took several more minutes. She asked a few questions about my knowledge of wound care and signs of infection as Mom has a healing incision and apparently I passed, but she admitted she does not really do trainings, had just met my mom, and did not have a plan for what to share with me despite me being told that meeting with the nurse for a half hour was required. Well…two out of three “ain”t bad” I suppose.

    The other thing that is a little wild in terms of them checking their boxes is that upon admission and upon discharge a nurse on a LIVE video call just pops onto the TV screen in your room. The first time my mom was admitted to this rehab (second time overall) she was not told that the person doing part of the admission was going to not only just appear on the screen but that she could see right into Mom’s room through a camera right above the bed. It gave a “Better always get dressed in the bathroom” vibe and was pretty startling. That person was upbeat and gained our confidence within a few minutes. But during this discharge a nurse who needs a public speaking class came on the screen (thankfully we were told to expect her) and the camera on us was at a super weird angle so that Mom was barely on her screen while sitting on her wheelchair by the bed and I had to stand behind the wheelchair and squat down a bit to be seen and to speak up to be heard. This nurse had her face buried in the paperwork and just read it to us as though we understood everything, barely asked for questions a couple of times without making much eye contact, mumbling very quietly throughout, and answered almost all of the questions I dared to ask with mumbled dismissive repossess about how it’s a good question for another person (PCP, PT or OT therapist, anyone but her) and gave the impression that she really did not know much about Mom’s condition or the meds she is on or her aftercare plan that she was presenting to us. But she read the sentences about crisis phone numbers, patient rights, and the substance abuse support line in hushed mumbles. I guess check those boxes we did.

  • February 17, 2026

    Brick by Brick

    Brick by brick we are carrying our dependents along while building our family’s future and what we hope is a legacy of support and love. Brick by brick we are building and diversifying our careers. Brick by brick we are scaffolding our children’s education and adding to their exposure to a variety of extracurriculars while learning what we can about future options as they discover who they are and what they are called to. Brick by brick we are advocating for the best in healthcare for my parents (for now) and ourselves and our children and finding ourselves pouring hours into appointments, calls, portal messages, reading and seeking resources, and delivering care. Brick by brick we are shuttling everyone to everything most of the time when we are not working and we are bearing witness to rehabilitated steps and skill building with each passing year. It is exhausting. It is meaningful. It is the life of the Sandwiched.

  • February 14, 2026

    Invisible

    For a few years now I have felt invisible to myself for long stretches of time. I come up for air during brief, but special times of reprieve, but in the day to day there is SO much that falls on me and for which I am responsible that I rarely have time to feel like myself. I am often drained and my marriage has been too. I don’t want to regret oversharing at this time, but I will say that if you feel like you are being treated like you are invisible to your husband and it seems like he is on another planet you are not alone. If your Valentine’s Day was what you set up for your family and you were completely overlooked, you’re not alone. If it felt like just another day of being dead last on your and everyone else’s list, you’re in no way the only one. Please know that it’s not just you. There have been darker times and there certainly can be far more difficult circumstances. But sometimes it feels like I am unrecognizable both inside and out to me. There’s just so much that I am carrying in this season. While Sandwiched I just have not been myself quite often and I find that it is very rare for anyone to pour into me other than my Incredible tribe of women who get it. Some of them get some of it, some get other parts, and some just care A Lot and by God’s grace their support can always be found and is enough to spur me on. Sometimes the little times of reprieve are SO magical where I get to take a break that finds me or I get to engage in an experience where I feel more myself than ever. These come with careful planning and literally several people providing favors to stand in for me (some of which I will end up returning because they were provided by another overextended Mom who can surely use one owed to her from someone who will deliver because she didn’t have much to give in the first place but get it). Sometimes the little times of reprieve are quiet whispers that were unexpected. They come when I experience song lyrics that remind me of youth and freedom. They come when I see some cardinals or robins and think of the irreplaceable love I enjoyed while I still had my maternal grandparents on this earth and I remember how worthy I am of love. They come when I have an excellent session with a client and they commend me for my help and I remember my competence. They come in the best moments with my children where I feel God’s presence and am reminded of my inherent value. But this is a season of depletion, of giving beyond what I have to give and far beyond when it hurts, and it tends to take a whole lot of rearranging to steal time to truly recharge.

  • February 5, 2026

    Clear for Surgery

    Mom had what we believe was a successful surgery at the smallest hospital yet (but beautiful and newly renovated). A well-respected surgeon from an orthopedic practice in the area performed a knee replacement Monday on Mom and a fantastic rehab associated with the small hospital accepted Mom Wednesday so we are hoping for a full recovery and the second replacement coming up soon. But in order to be cleared for the surgery she, understandably had an appointment with her PCP (sadly the one she had, who we loved, was leaving for a specialty practice, but we did get to choose another doctor in the practice who is fantastic as well). She also had to be cleared by cardiology, (also something we understood) so even though we were enjoying a stretch of time where we were told to return in 2 years to cardiology for the next check up, we headed in for an in-person appointment. This led to a test at the hospital being necessary and then on the day of that test at the small hospital it took 4 nurses to get an IV in Mom and then the images were not clear enough so we had to go back to undergo that test a second time. They were very apologetic and accommodating, but the hours at pre-surgery appointments really added up. Then after being required by the surgeon’s practice to have an pre-surgery clearance check-up appointment with her PCP we had to then come to one of the surgeon’s offices to meet with one of their nurse practitioners to also take vitals and check Mom to clear her for surgery (though we did have a previous appointment with a surgeon’s PA at that practice to check mom and answer questions and to schedule surgery). Then we received a lengthy call from a nurse a few days before surgery asking the questions that had already been answered countless times. Very thorough of course. Nothing wrong with being thorough. But yet was each appointment really necessary? Especially the PCP plus the nurse practitioner at the surgeon’s practice. What qualifies as overkill? Is there really added value at a certain point?

  • January 30, 2026

    Really?

    When we use the portal for the smaller hospital system there’s a note in the portal denoting contact with the provider and it is written as though we spoke directly. Many providers have nurses and even medical assistant’s respond. I sent a question to a nurse practitioner from Mom on a Sunday and the provider did not respond, understandably that day, but instead someone from her office responded during the upcoming week and she then responded herself to some follow-up questions I had and the way they wrote about it in the chart sounds as though I had a thorough call with the provider directly on a Sunday when all that happened was that I sent our message to the provider through typing it into the portal on a Sunday. But the notes says “You spoke with (name of provider is here in the record), CRNP on Sunday (date is here).” Did we really speak with her? Sounds misleading. I really didn’t look into the billing but am wondering if this is billed as though we spoke with or had some kind of session with the provider on a Sunday. Something to look into more. Interesting.

  • January 24, 2026

    I Might

    I frequently tell those who know me that I “might” be able to do this or that. I might be able to drop by with some clothes my daughter has outgrown for another mom to go through. I might be able to meet for coffee and conversations desperately needed with my similarly sandwiched sisterhood. I might be able to get my work notes done by a certain day. I might be able to make and keep an appointment with my own therapist every few months. I’m might write what used to be my annual Christmas Letter which started arriving just before Valentine’s Day and then not at all for the last 3 or is it 4 years? I might be able to show up at the monthly PTO meeting and it’s a bigger might for me to be able to find time to volunteer a little like I used to. I might get a corner of a room organized, but don’t count on the whole dining room being usable anytime soon. I might unblock the attic stairs and carry all that is on one of my many plunking piles to its place. If you need me I’ll just be here doing the next thing because my list is endless and so many tabs are open in my mind that I might never manage them all. But I might just put those to-do’s on a list and I heard research shows that I might get better sleep if I make that list before bed. So u might, or I might tell myself again that I don’t want to pause to make the list, that it will swallow too many precious minutes in all of the busyness. My favorite people tell me what an amazing job i am doing with everything on my plate. Others criticize mainly. I can’t promise I will manage today. I can’t be sure that I will manage tomorrow. But I might.