by Sally Treadwell

Time was, the only question you had about sandwiches was 'peanut butter or grilled cheese?'

Those were the days. Now many of us know all too well that being part of the so-called sandwich generation means trying to cope with not only the demands of toddlers, teenagers and unemployed grads moving home, but also with parents who are unable to live completely independently. And that means making some major adjustments, whether two (or even three) households need to merge together or you're trying to help elderly parents long-distance.

First, let's look at the upside. What do Grandma and Grandpa bring to the table? Often, a heck of a lot. Unlike most heavily-invested, time-crunched parents, they can be there to listen without being judgmental, and they've not only seen it all before, they've seen it several times. Think Captain Sully, who famously said that his ability to land a plane safely on the Hudson came from decades of many small decisions and experiences.

Sue Burgess of the Area Agency on Aging can tell you about the tricky part from personal experience. Her mother-in-law has Alzheimer's, and began to need full-time care just as Burgess' daughter was entering her last year of high school. "She went from adoring her grandmother to resenting her, and I was resentful too; it was my last year with my daughter. Sometimes it's just timing—which side of this am I going to protect?"

She finally called a family meeting and struck a deal with another family member; if he'd take on the majority of the caregiving for a year, she'd take over the next year.

But more, Burgess learned an important lesson. In her first year of college, her daughter wrote a paper on Alzheimer's, including both the facts of the disease and her personal experience of the difficulty of adjusting to a beloved grandparent's condition. "If I'd known all the things you sent me about Alzheimer's, I'd have been much more sensitive to Nana's needs," she told her mother.

"Now she'll tell other people, look, this is exactly what's going on in Nana's brain…" says Sue, who encourages people not to assume that a child understands what a disease feels like and how it limits activity. "Saying, 'Grandma has Alzheimer's, be patient,' isn't enough."

Look for books that will help younger kids—"What's Happening to Grandpa?" by Maria Shriver and "Singing with Momma Lou" by Linda Jacobs Altman focus on Alzheimer's, for instance, or "Sunshine Home" by Eve Bunting is a terrific book about nursing homes.

You can go further. Nissan has designed "aging body suits" that simulate lousy balance, poor eyesight, arthritic pain and even thickening waistlines so that their engineers can design better cars for seniors. Take a cue from them and have kids experience what it's like to climb steps with creaky knees by binding theirs tightly with duct tape; smear swimming goggles with Vaseline and ask them to navigate through the house or send a text message while visually impaired. Bonus: kids will become more sensitive to other people's difficulties for life.

Money and chores
Maybe your child is moving home after college, unable to find a job. Or maybe you've been downsized or divorced and need to move in with your parents, kids in tow. Regardless, one of the biggest causes of dissent is money. Picking up after grown people who should know better is another.

Even 'kids' of 50 will revert to letting Mom and Dad look after them, given the chance, and it will rarely occur to the average 22-year old that he or she should now pay rent. Ideally you should structure a financial plan beforehand. But if you're sick of Junior lying on the couch all day watching Oprah, it's not too late to put your foot down.

Everyone needs to contribute to the household in some way. Everyone. No exceptions. Social security benefits, unemployment benefits, savings—whatever income you have, at least a token amount towards rent and food is important. If you're uncomfortable taking rent from your kid, take it anyway and put it in a savings account towards their future down payment on a house. If a grad has literally no source of income—and is genuinely unable to find a casual job to sustain life while looking for a career job—then they should have plenty of time to take over almost all housekeeping duties, including tracking down bargains to make an expanded household more affordable. Have a family meeting to list all chores and assign them fairly.

Young child benefit: An early understanding of the need to contribute and be responsible for oneself, both financially and physically, is an amazing life lesson.

Elder benefit: A 2005 study found that people who felt that their life had purpose suffered less cancer and heart disease; several studies have found that people who retire early are twice as likely to die in the next few years as those who don't. If physically impaired, a grandparent's job might be simply being there to listen to and advise a younger child after school, create menus, or organize that backlog of family photos into a scrapbook.

The distance version: It's difficult, but you should have That Conversation about money with your parents. Plummeting investment portfolios and staggering cost increases might have left them in an unforeseen pinch that they're reluctant to tell you about. Use a news article or financial planning TV show as your 'in' to a casual chat, or ask them if they'll keep you company at a financial planning workshop.

There's a burgeoning movement of 'financial organizers.' They'll talk to you or your parents about goals, establish a system of recordkeeping that will be easy to use, set up online billpay, coordinate with an accountant, help file insurance claims—whatever it takes, on a one-time or continuing basis. Get several referrals and be sure to check up on things periodically. Never sign over check-writing powers. An outside Care Manager (more about that later) could also keep an eye on finances and act as a gatekeeper against scams.

As to a sense of purpose, ensure that your parents have friends nearby for an active social life—which has been shown to keep all of us healthier and happier—and if not, encourage them to join an exercise class or chess club. Volunteering is also a great way to make friends and regain joy in life. Schools often seek tutors for school kids who are struggling to master reading or math; or seniors might put career skills to use by mentoring young entrepreneurs.

Wii-hab and exercise
Exercise is one of the most important things we can all do for our health and happiness. Falls kill about 16,000 seniors every year, and a 2009 study published in JAMA found that the risk of dying more than doubles for elderly women after a hip fracture, while the risk triples for elderly men. Poor balance and weak thigh muscles are huge contributing causes of falls.

Nintendo's Wii gaming system is an important weapon. Can't get out to the links anymore? Missed bowling night? No matter—Wii's virtual version has cardiovascular benefits. The balance board is a fantastic tool; even my 17-year-old corrected her tendency to stand off-balance. And your athlete-snob 12-year-old might be awed by Grandma's killer tennis backhand.

What's more, the Wii is increasingly being used as an engaging adjunct to physical therapy. It's particularly helpful for stroke patients and people with Parkinson's or Alzheimer's; it's also useful for autistic children and for injury recovery.

Kid benefit: Patiently coaching Grandpa is a real life skill, and your child's payoff is finding that even when Grandpa is too frail for roughhousing, he can still pack a mean punch in a Wii boxing match. Your beefy grad and your 'second-wind' grade-schooler can also duke it out virtually. And Wii can level the playing field between arthritic knees and a 10 year-old's healthy cartilage.

Distance version: A Stanford study found that small amounts of social support, such as exercising with friends, phone or email reminders, or occasional meetings with fitness counselors resulted in a huge jump in time spent exercising. Programs like WalkGeorgia or the YMCA's Coach Approach could help get your parents on the right track. If you worry about mom or dad falling while out on a walk, get them a pedometer with a panic alarm and set it up for them.

Justkeepmoving.com is packed with tips, videos and structured programs for exercise, strengthening, flexibility and diet for people with arthritis.

Connecting with family history
As a writer, I'm constantly blown away by people with great stories—that they'd never tell if you didn't ask. Are you asking? Are your kids asking?

Need inspiration? I can't think of a better model than NPR's fabulous Story Corps, which regularly moves me to tears, smiles and greater understanding. Go to storycorps.org and listen. You'll even find a question generator and prompts like, 'What was the happiest moment of your life? What are you most proud of? What are the most important lessons you've learned in life? What is your earliest memory?'

If you can set up your kids or yourself to interview with a video camera or notebook, or just a set of ears, great. Otherwise, asking a parent to write down those stories, even snippets, could be rejuvenating for him. Maybe your badly arthritic dad can't keyboard, but he can probably use voice recognition software. (Dragon NatuallySpeaking, $100, is 99 percent accurate to about 160 words per minute.)

Kid benefit: They learn that Grandma hasn't spent her entire life playing bridge; heck, she marched on Washington for civil rights; or she actually was Rosie the Riveter. Grandpa founded a highly–respected program for alcoholics, maybe, or studied with Mark Rothko. That gives a greater understanding and appreciation of living history and the 'circle of life'—and of the sparky 17 year-old still inside every withered body. It also sharpens listening skills and helps the generations connect.

Senior benefit: It's mentally invigorating to think about childhood. Watch your parents perk right up when they tell you about the rotten kid down the street who pulled a mean trick and then got his. Ha!

Chris Brown versus Glen Miller
"Your generation's music is just awful!" Sound familiar? It should do—you've probably even said it. Generational music clash has been the norm for many years, although Woodstock-survivor grandparents might be more likely to complain that Green Day is an anodyne, suburban version of Sid Vicious than tuneless rubbish. And ubiquitous iPods have thankfully made it easier to keep music down low and personal. But music also brings people together. And Pandora—the internet radio station—can bring Usher and Duke Ellington into perfect harmony.

Pandora, relying on the Music Genome project, analyzes the 400 musical attributes, including rhythm, form, composition, melody and harmony, that underlie the structure of any piece of music. It then finds music with similar attributes.

Create a family radio station by plugging in one of each family member's favorite bands—and see what Pandora comes up with. You never know, you might grow to an appreciation of each other's music while cooking dinner together.

Distance version: "Dear, that music could get me out of my grave," one drooping elderly woman told me as she leaped back into action at our aerobics class when "King Porter Stomp" surprised us. In fact, she wasn't exaggerating all that much. Studies have found that hearing the music of your youth actually makes your cells act younger. So make sure your parents have an accessible source for swing dancing, big band concerts, or the Rolling Stones.

What's for dinner?
You're not a short order cook. So don't act like one. The rule should be that a family member doesn't have to eat the meal you've prepared, but they do have to taste it and they do have to politely thank you for cooking—and there isn't anything else. Mr. College Graduate doesn't get to slam out and cook himself the steak you'd planned for tomorrow. Get together to discuss menus and prepare a cooking rota if appropriate. Ask for help (usually free) from a nutritional counselor at your community hospital if you have trouble integrating special diets into a general family menu.

Distance version: Adult children worry that a depressed, frail or lonely parent isn't eating right. Regular freezer-stocking trips might be an option, or meal assembly kitchens like the Let's Eat chain (easymealprep.com for similar kitchens) can be helpful. Suggest sharing cooking duties with a friend in a similar situation. When income is limited, try Angelfoodministries.com—ten convenience meals nutritionally designed for seniors cost just $28.

Meals on Wheels provides meals for people at risk, and not necessarily financial risk—for instance, I was interviewing a middle-income diabetic whose wife was suffering from Alzheimer's when some really great-looking plates of barbecue arrived, courtesy of a cheerful volunteer. An added advantage is that someone is checking on parents daily.

Keep them driving safely
Until Nissan comes up with the perfect car for seniors, consider modifying their current car. Add a back-up camera for as little as $100; install a panoramic rear-view mirror; find swivel seat cushions and grip bars or strap hangers that will help both drivers and passengers with getting in and out of the car.

Seniordrivers.org offers a cornucopia of ways to help your parents drive safely. You'll find online driving and field of vision tests, info about safety courses, hints for you to help them and understand their difficulties, and resources for alternative transportation should they need to give up driving.

Bonus: Your budding Dale Earnhardt might get off your back about your instinctively slower driving if he learns that 55-year old eyes take eight times longer to recover from glare than 16-
year-old eyes, and that the amount of light needed to drive doubles every 13 years.

Managing meds
If a parent seems confused or has problems concentrating, a consultation about their medications should be your first step. Anticholinergics—including Detrol, some Parkinson's drugs, and to a lesser extent drugs like Lasix, Zantac and warfarin—and statins can be associated with cognitive decline. You also need to immediately query any drugs that appear to cause dizziness. Be sure that a senior gets all his drugs from one pharmacy; a good pharmacist will always look at potential interactions.

Ensure that important drugs are getting taken—but not too often!—by investing in a MedReady Automatic Medications lockable dispenser. Different versions use alarms and/or flashing lights to alert the senior when a compartment has popped open for them; one is capable of sending alerts to up to three emergency phone numbers if drugs aren't removed on time. Blister packs that head off did-I-take-it confusion are also available for some pharmaceuticals; ask at your pharmacy.

Sharing the Load
Sometimes you just need a friend or a professional to help you think things through and maybe change your approach, says Burgess. "You're really taking on a lot. You might need to call a family meeting and discuss pooling money to pay for help, and you might need to re-assess what a parent needs and wants. There's the 'dignity of risk'—where a parent says, I'm not going to live with you, and if I fall down the stairs, so be it—and sometimes a family member is just over-protective or has unreasonable expectations."

Also, look for neighbors in similar situations. Maybe only one of you needs to make the drive to the podiatrist or library. Look for disease-specific websites, too—they'll provide a world of resources and support groups. Try also:

Sharethecare.org
This organization supports ordinary people in pooling their efforts to help people without nearby family and to ease the burden on family caregivers. The idea is to avoid caregiver burnout and keep those without support in their own homes.

Caringbridge.org
This site enables you to create a free, private website to update friends and family during a serious illness such as cancer, and thus avoid fielding endless phone calls. Well-wishers can upload messages of support.

WhatFriendsDo.com
People love to help, but eight casseroles on Tuesday and nothing on Friday helps no-one. Again, here you can create a free, private website to coordinate schedules for childcare and meals etc., list needs, and update everyone on the patient's condition.

Caremanager.org
Geriatric Care Managers are specialists who can helps families who are caring for older relatives. They're trained and experienced in nursing, gerontology, social work, and/or psychology. Caveat: hiring one privately isn't cheap, but for those who qualify the service can be free through social services.

AgingAtlanta.com or 404-463-3333
A comprehensive source of services and referrals for area senior citizens. Sometimes, says Sue Burgess, your employee insurance will have surprising benefits for caregivers.

Eldercare.gov or 800-677-1116.
Parents in another state? Find local resources right here.

Technology is your ally
Telemedicine means that your parents can "virtually" visit a far-distant specialist without grueling flights. Skype video conferencing means that they can see their granddaughter in her prom dress in real time, plus 'meet' her new boyfriend (and don't believe that "I'm too old" thing. I had a centenarian friend who joyfully got online every day). And, surprisingly, texting can bring the generations together—one older friend 'talks' to her grandson more than ever before via texts, and feels much more part of his life.

Running a sandwich generation household is definitely not for the faint-hearted. But thinking clearly about options and learning to ask for help when you need it can make it much easier. And remember that our new multi-generational households aren't new; they all used to be like this.

"Nobody has ever before asked the nuclear family to live all by itself in a box the way we do.  With no relatives, no support, we've put it in an impossible situation," Margaret Mead once said.

Well, our generation is fixing that.