Cuba’s “Sandwich Generation”: Looking after the Sick and Elderly

Irina Echarry

HAVANA TIMES — For six years, I lived with two elderly women (my grandmother and her sister). It was the saddest time in my life that I can recall.

The Special Period crisis had hit us hard and we didn’t have the conditions needed to care for them at home. I remembered that time some days ago when I heard about Elvira, an accountant who quit her job as an accountant at a State company a year ago. Why did she quit her job? She lives with her elderly parents and a brother who’s ill. Her situation is all the more complex because Elvira has a teenage son, now in high school.

Elvira’s situation is far from unique. It is in fact quite common. Several months ago, her father fractured his right hip and had a dangerous accident. To be with him during the surgery and part of the recovery process, she asked to be given a 3-month, unpaid leave at work.

After that time, she returned to work. Her kid (as tends to happen) has been ill several times. Such “trivial” things have forced her to stay at home more than once. Elvira’s brother has been battling with lung cancer for a long time. When he started to experience severe pain, she, already working miracles to put in her time at work and care for her family, had no choice but to tender her resignation at work (there was no other option after having been away for three months).

When she found herself without a job, she thought she’d go mad. Luckily, she had some training in “roughing it.” What was once a way of making a little extra money every month has now become the family’s sole income. In the little free time she has, she does laundry work and tutors small kids in the neighborhood.

Elvira is a member of what some call the “sandwich generation”: she is responsible for the physical and emotional care of people of different ages and supports her family financially.

The phrase was coined in the 1980s. It refers to those caught in the middle, having to care for small children and elderly or sick relatives. Its range of meanings has broadened over time and it is now also used to refer to parents whose children have become adults but not moved away from home.

The term isn’t heard much today in Cuba, perhaps because, in our country, it is nearly impossible to live any other way, and this because of the unending housing problem, which forces several generations to live under the same roof. The country’s measly salaries make it next to impossible for people to rent out a place for themselves or to pay someone to look after the relatives in need.

Another important factor is the overprotectiveness that characterizes Cuban mothers. Even though some men are in this situation, the group of people who care for others is made up chiefly of women.

Who in Cuba does not know someone in Elvira’s situation? Most of the time, the male in these families only concerns himself with the household finances. Social pressure generally compels women to look after the ill, children and elderly people on both sides of the family. This is ingrained in women to such an extent that many have taken on this role as though it were their natural lot in life. They have been educated in this fashion and they take on the commitment without anyone asking them to do so.

Since teenagers don’t work, they have to be supported by their parents while at school – the State stipend some of them receive isn’t even enough for a snack. Things are slightly more flexible now and some can earn a bit of money helping out a self-employed worker or at privately-run establishments. If teenagers have kids of their own, parents also have to look after these new additions to the family.

The age of “sandwiches” oscillates between 30 and 55. They shoulder a double or triple burden which, consisting of familiar, daily chores, is ignored by the majority. Given Cuba’s characteristics, it matters little whether someone has to look out for one or more persons – the ups and downs one faces in any such situation, be it looking after two small children or an elderly woman, is already a lot to shoulder. In addition to meeting their responsibilities at work, those who care for others must work miracles to fulfill their roles as parents, children and partners. It is an immense daily challenge that causes great emotional stress and gradually takes its toll on them.

One of the important issues addressed by gender studies is the huge work load women have, the combination of the work they do in their jobs and the unpaid work they do around the house. The law guarantees a maternity leave during pregnancy and for a year after giving birth. Fathers can also request a paternity leave to look after a newborn, but the number of men who do this is infinitesimal.

When one’s child is ill, one can think only about their recovery. Mothers know they will not lose their jobs while looking after their sick child, but they will not be paid the days they are absent from work.

A child’s illness, save in special cases, is normally temporary. The care of elderly people, however, spreads out over much more time.

We have been hearing about population aging and its consequences in Cuba for decades. Life expectancy is now at 78, and the generation that has to care for the elderly sees its professional life hanging by a thread. How can we lighten these people’s burden, from the legal, social and family points of view?

As placing the elderly in homes is foreign to Cuban culture, whenever someone mentions that a parent is in home, the accusatory comments come immediately. Things could of course change – it is just a question of getting used to new things. But, how can we even suggest this, when most old people’s homes in Cuba are in a deplorable state? The food is bad, the rooms are dirty, the nurses are lousy, not to mention how difficult it is to actually find one of these places.

Cuba’s welfare program helps elderly men and women who live alone. The State pays someone a monthly salary for feeding, cleaning after and keeping the elderly company. However, those who live with at least one relative are not entitled to this.

At this point, when more than 18% of the population is over 60, and we find no legislation designed specifically to assist the “sandwich generation” or any caregiver. No one is entitled to request a leave from work to look after their elderly parents. The option now is a short, unpaid leave (the new Labor Law that recently came into effect envisages leaves as long as a year, depending on the employer), and then quitting one’s job.

People’s salaries aren’t enough to live on and, without enough time to secure a steady income, it is next to impossible to support a family. Is this or this not a serious problem? One has to work in order to support oneself, but one can’t turn one’s back on the elderly: there are not enough care centers to look after them, public transportation makes getting to work and arriving home on time to prepare meals and administer medications extremely difficult.

To say nothing of the high prices of disposable diapers for adults and food products in general, or the fact it is impossible to purchase wheelchairs, Fowler beds, bedpans, anti-bedsore mattresses and other necessary items, not only because the State does not sell these, but also because, when someone who’s selling these turns up, the prices are simply harrowing.

In Cuba, caught in a permanent economic crisis, there are more and more “sandwiches” and caregivers. Faced with this situation, many people ask: how are we to pay so many people who are unable to hold a job? The matter must be poured over, acknowledged, and studied from different perspectives, in order to look for alternatives. To date, however, not a single Round Table program on Cuban television has devoted any time to it.

One thought on “Cuba’s “Sandwich Generation”: Looking after the Sick and Elderly

  • As Dorothy says, at the end of “The Wizard of Oz,” “There is no place like home!” Most old folks I know prefer to live at home; hence, the solution is to hire more home care providers/home health aides, which is far cheaper and more humane, than sending dependent elders to nursing homes. Up here, once folks are placed in such homes they seldom last more than a year or two. Besides the abysmal care received in such institutions–both here and in Cuba–probably the greatest factor in the rapid mortality of its prisoners is isolation. I once had a friend confined to such an institution. I took him out into the community at least once a week, sometimes twice; after a while I noticed that perhaps 80% of the signatures in the “sign-out book,” were my own, indicating that the other 28 folks on his unit seldom–if ever–were able to travel beyond the ever-contracting walls of their closed-off world. During the years I visited him almost all others on his unit, including his two best friends, died. I tried to spring them from the nursing home, to accompany us on our drives, walks, attendance at concerts, etc., but the nursing home authorities forbade it due to “liability issues,” or “pending approval of their families,” which never came.
    Such is the state of U.S. politics that funds for home health/care aides are extremely limited. Despite the expense (to care for an elder in a nursing home costs the state well over $100,000/year), too many elders are shuttled off to nursing homes. Why? Because the “nursing home Industry” has the big bucks and the powerful lobbyists who insure that a lion’s share of federal tax monies go to their industry, rather than home care aides and visiting nurses.

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