Sandwiched Support

Tag: motherhood

  • 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 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.

  • It’s fine, I’m fine, Everything is fine

    Sandwich Generation life took over over the holidays between all 8 of us getting the flu over our Christmas break and New Year’s, one after another after another. Thankfully we had our vaccinations but it was still yucky and ugly. I told myself I was going to be able to do this blog daily. Then I told myself I was going to be able to catch up all of the daily posts I missed starting in October and add photos and then starting with making the Trick or Treat magic for the neighborhood with an amazing fellow neighborhood mom and then getting everything ready for the holiday season this fell off the list. But isn’t that just the epitome of Sandwich Generation life. I am hoping to shift to once weekly consistently now in 2026 starting with today.

    Thrilled that Mom’s first knee replacement surgery is February 2nd but we still had to not only go to a surgery scheduling appointment with the surgeon’s PA to choose which knee to start with and discuss the surgery, but also had to have a Clear for Surgery appointment with the PCP, and another one with the Cardiologist. And as if that weren’t enough an NP at the surgeon’s office had to see Mom a month prior to surgery to clear her when we were just at the PCP three days before that and at the cardiologist 3 days before the PCP. Simply cannot help but think that there are too many cooks in the clearance kitchen and everyone wants a piece of the billing pie. She’s high risk in certain ways, but that last checkup with the NP when she had just seen her PCP took the overkill cake for me. I am the Sandwiched accompanying uber driver and appointment advocate and when I can’t schedule my own clients I don’t get paid. But yeah, let’s have an NP take up our time checking on Mom when a physician plus a specialist’s office just checked her within the past week.

    One of my awesome bosses gifted me some dumpster fire socks and I am still looking forward to finding a time to put my feet up so the sock bottoms can be read by others “It’s Fine, I’m Fine, Everything is Fine.”

  • October 9, 2025

    Tis the Season

    When Mom entered the hospital a year ago for emergent surgery (which led to nearly a year of complications at the little hospital before a seemingly successful surgery in September has provided significant relief and hopefully has solved the problem) I lost what little control I was getting of our already cluttered new-to-us home. When my parents sold their home and we sold ours 4 years ago and moved into one house I almost single-handedly cleared years of clutter (things Mom hoped to use again) out of my parents’ home. But then as we combined what we kept we realized we did not quite purge enough stuff along the way and 4 years later after a year of almost constant advocating for better care for Mom, there is a serious clutter explosion lining the sides of one basement room, piled in a basement storage room, covering the one side of our bedroom, choking our dining room, and don’t ask about the attic and one section of the garage. I use A Lot of the stuff but rarely have a minute to put it away rather than putting it down.

    So now we’ve entered the season of celebrating it all! We are counting our blessings and almost ALL of this holiday themed cheer from Halloween to Thanksgiving to Christmas to New Year’s, but honestly I am already exhausted from the trunk or treat I organized and moving through crowds at the Halloween Parade and there’s work and youth sports and plenty of ongoing outpatient appointments for both of my parents. So far I have two little Halloween signs set out around the mess and a Falk wreath on the door. I tend to go ALL OUT and love to, but these days it’s like I just don’t have the bandwidth.

    We just got our pumpkins out by the front door next to the doormat that says “Sunshine Vibes”. Maybe I’ll get the “Trick or Treat“ mat out by Friday, maybe not. But I do know that I have to clean up the dining room before the end of November (trust me there is very little margin to get this done and it will happen at the sacrifice of plenty of my sleep) and the Christmas shopping already began after Christmas last year because I’ll nearly single handedly be bringing all of the magic like I do every year. And I wouldn’t mind if that was all there was to do but, that’s the furthest thing from the case.

  • October 8, 2025

    The Why

    I have been talking with clients, particularly my college student clients who are questioning their life choices when midterms hit, about their “Why”. For them I point to my degrees and licenses on the wall of my office and tell them that I have been where they are and that though they must lock in now and grind it out when it’s difficult, if I did it, so can they.

    I have been struggling with it all. The mental load of this sandwiched situation, the inadequate support, the significant need for advocacy on my part to fill significant gaps in systems that I seem to pay quite a bit into in taxes and the insurance payments are astounding. It still makes me weak in the knees when I think of all who are doing this with fewer resources than I have and I try not to verbally express frustration when some more privileged than we are mention paying out of pocket for resources that we will likely never be able to afford.

    But as I sit in this idyllic setting where our children are privileged to play soccer on a beautifully manicured field surrounded by brilliant fall colors and scenic farmland. And as I watch my healthy daughter run freely with the ball it is the ideal moment to practice gratitude for the health most of our household is experiencing now and the strides we have made. I am grateful for the medical care we do have available, even as I want to challenge us to be provide better. I am grateful that my children have a wonderful school district in an amazing community and that we can raise them in a healthy place where a variety of activities are available for their enjoyment and enrichment. And when I remember that everything I do is for family and that my children are thriving it reminds me Why I work this hard burning the candle at both ends.

    I truly care about my parents and about my children and my family as a whole and doing everything I can to give them the best life possible as far as it depends on the choices I make. I received this text from a dear friend who I respect very much. The whole text made my day, this part in particular:

    “You are a warrior and take such good care of your family. Remember to take care of yourself too.”

    As I walk this long winding road in this season of life and step up as a warrior for the cause of my family each day, I haven’t yet found the best way to also take care of myself. Yet is one of my favorite words though, I know I can and will learn at some point. But for now I am focusing on the “Why” for getting up early and getting to bed late so that I can keep it all going in this season for those who count on me. They matter so much to me and they are my Why.

  • October 6, 2025

    Something’s Gotta Give

    When sandwiched Mom/Adult Daughter is not feeling well, work (as a contractor at one job and a part-time employee at the other there is NO paid sick time, NO paid vacation time, and there are NO benefits so if I don’t show up and work I don’t get paid AT ALL) doesn’t stop, the kids’ needs don’t stop, the parents’ needs don’t stop, and the mess waiting for me doesn’t stop a bit either. So we, the sandwiched primary parents who are also only children of the aging (or whatever the situation is for you) rarely find a break. And something has to give and it’s been this blog. Playing catch up right now, but it might turn into once weekly posting if I fall too far behind. There are “life hacks” that cost me money, but they’re worth it. I have someone cleaning a portion of my house each week for 4 hours a week, I pay for grocery delivery from a chain store and a big box retailer, and plenty of packages with everything from toiletries to household goods to pharmacy health-related items to the gift I need for the weekend land by my front door. Then I hit up consignment sales and stores for all things pre-owned in the toy, clothing, shoe, and home decor categories to save money while living as well as we can. We like the name brand things too, but we typically live with them used and then sell them to consignment when all kiddos have grown out of them or we donate at various places. I rarely get to schedule my own appointments with my “hairapist” and my own therapist and time to connect with friends is becoming more and more rare unless that friend happens to be at a community activity that involves one of my children or something with our church where we are participating or volunteering. If I will already be there showing up where we are already committed on the calendar, we might get to chat. My texting thumbs are incredibly speedy and I am blogging on my phone with them while at my son’s soccer practice after zipping over here from my daughter’s parent/teacher conference which I raced to after hurrying home from work and stopping quickly in my driveway to pick up two of my sons (one to go to soccer practice and the older one to be his chaperone while my husband and I were at our daughter’s conference). And I had to pick up my sons because I let something (heaven-forbid) drop from my mental load and forgot to ask my mom-in-law to cover soccer. So I had to cover it. I promise my husband wasn’t volunteering to ask his mom for help or to help get my son to soccer. He did however tell me I would be cutting it close, which I was, arrived 3 minutes before conference time and got upstairs in the school to the classroom just in time. Thankfully the teacher had stepped out for a bathroom break so us showing up in the nick of time was beautifully anticlimactic. I got it all done again, while recovering from what I still don’t know and finishing up my period and another day I will tell you about ALL the kin-keeping I was doing at the same time plus all of the regular Mom of 4 and busy Adult daughter of two live-in aging parent stuff. Is this really all meant to be one WOMAN’s job?

  • October 4, 2025

    Resting on the move

    On Saturday, the day the post is dated for, I kept plans with two close friends from practically forever who I don’t see often enough and live a couple of hours from. In some ways I didn’t feel well enough to go, but we each brought along our youngest (all daughters) to meet about halfway between us and spend the day at a place that is a well-oiled machine for kids to have a BLAST and parents to (mostly) relax and enjoy in an outdoor activity farm setting.

    I had had my symptoms for like 2 1/2 weeks by then and it didn’t appear that I had gotten anyone else sick and also I had been on antibiotics since that Wednesday morning and steroids for a lot longer and things seemed somewhat better.

    I decided to go while not super well because I was on the high dose steroid and getting into the thick of the antibiotics then and during the days I was on my feet or sitting in a chair or car doing everything I normally do (because no one is filling in for me as a woman in the thick of the sandwich generation season of life). I mean I was avoiding lifting bins or anything heavier housework- wise and then later in the evening I was getting to bed earlier.

    But having my two youngest kids home on a Saturday together without any help to entertain them is not at all restful so I think the best idea was to go to a super fun place with just my daughter to meet friends and play and to have chatting therapy with my friends.

    It turned out to be the best plan! One of my friends is battling an ongoing challenging health issue and we all enjoyed moseying, sitting, rocking, and finding shade while the kids enjoyed unlimited admission bracelet fun for 6 straight hours. They were happy and in sight and we got to just breathe and catch up.

    In this stage of life for all of us there are many (different but similar) very real reasons why we might not have been able to reschedule anytime soon. Talking with your people about similar life challenges is truly a light in what can feel like a very dark and heavy time.

    If you’re on your feet at home it can help to take at least one kiddo and go where there’s fun, where there’s amazing people you miss often, and where you can mostly sit where you are not feeling the piles of laundry staring at you.

  • September 28, 2025

    Looking at the Week Ahead

    It’s a season where I am already overwhelmed on a Sunday night just looking at my week ahead with some manner of dread. A lot of weeks are like this but not all. Last week I was able to get coffee with two dear friends and we are aiming for once monthly and are so far two for two.

    But tomorrow I work and then I get Mom on an online appointment and then I head to two back to back appointment that I am fitting in to attend them in person for me. Then two additional online clients and then running kiddos to their evening activities. 2 kiddos out of 4 have something tomorrow evening so it’s not a super heavy load where we need to ask my Mom-in-law to be the third driver. Phew! She’s out of state visiting my sister-in-law and her family.

    Then it’s work outside the home the next two days with quick dinners and the evening rush and then Thursday I have client from home and doctors’ appointments for Dad and Mom to and Friday has more appointments for Mom.

    I am planning to watch a show online and spend a little time on social media and also try to get a decent night’s sleep while I’m not feeling my best.

    It’s A LOT right now while sandwiched. A whole lot.

  • September 24, 2025

    Pushing Through Anyway

    I haven’t been feeling well this week, but I’m sandwiched daughter and mom. There is really no one to fill in for me without rearranging or canceling plenty and without a TON of favors being asked likely of other moms who either don’t work outside of the home or work from home. Quite frankly unless I am completely incapacitated with a stomach virus that won’t quit I don’t want to take the time and energy to ask multiple people for help with ALL that I do for my family each week. Text after text to try to find the right person who happens to be free and willing to do each thing honestly ends up being a lot and quite frankly it wouldn’t be right if I didn’t return the favor later. And it’s not that I don’t want to help them out, it’s only fair and these individuals are friends and relatives and fellow sandwiched moms in solidarity, it’s just that I already feel like I don’t have the bandwidth to keep up with my own family’s needs and wants. And I know they feel the same way. So just like people show up to work sick, Moms do that too except we don’t get a real restful break unless someone chooses to step up to take something off of our plates and between the meal prep, the appointments, the running kids to activities, the housework, the laundry, and the childcare, homework support, and support of aging loved ones, no one is willing to take it all on. Lightening the load of a member of the sandwiched generation is absolutely a thing and it is greatly appreciated, but truly there is no one who is really taking it all on for even one day. Sometimes a husband takes on putting out the “fires” of what’s needed to get his children through the day or a mom-in-law runs the kids to everything, makes lunch and dinner, and puts in a load of laundry, but it is a rarity that coverage does not leave plenty for the primary sandwiched adult to catch up on once well.

    A comparison can be made here to any job, but truly there is no comparison to the number of items on the primary caregiver/sandwiched adult’s list. And so very many categories leaving “tabs” open in the brain.

    A visit to urgent care or a nap or a trip to pick up a medication is carefully considered and life juggled to fit it in with everything else. And boy do we ever try not to loop in someone else. Instead sleep is lost, meals are skipped, and we do the next thing while the laundry and dust bunnies collect and multiply.