The New 'Sandwich Generation': New York Hospital Exec Says Pandemic Will Force Rethink of Eldercare

The following interview has been edited for length and clarity.

S&P Global: How have you been handling the balance between work and family responsibilities during the pandemic in a hotspot like New York?

Pamela Sutton-Wallace: It's been a little surreal. I'm almost misty just talking about it. I began this new opportunity in January. And of course, COVID hit the New York area in early March. And literally, I was probably the newest executive to join the team at the time. And so to move to a new community, a much larger city, during the pandemic, was just both exhilarating and a bit overwhelming. I had the usual pressures of being a new leader, a new employee coming to an organization, and you want to hit the ground running and prove what you can do, what you know how to do, and you're getting oriented, you're spending a lot of time meeting people. And literally, that all came to a halt in March.

And quickly I had to pull on my 25-plus years of experience as a healthcare leader to help the organization prepare for circumstances we've never seen before. It was absolutely compelling to watch and to support our frontline caregivers as they heroically save lives every day. And my specific responsibility during the pandemic, I took on a leadership role of coordinating all of the logistics. And that meant I was responsible for coordinating with our teams to procure supplies, to ensure we have the equipment we needed, to ensure that we have materials and support systems and supply chain items.

So here I am, the brand-new executive, being held responsible for probably the most challenging parts of the pandemic of ensuring that our workforce had what they needed to do the job. And it was difficult, it was scary, it was day-to-day—harrowing. Some days, we were trying to figure out what the next step was going to be, because, as you know, this became a worldwide problem.

Personally, it was particularly challenging because unlike in Charlottesville, [Virginia, where Sutton-Wallace previously worked,] where my commute was literally 20 minutes door to door, I now have a 1.5 hour commute on public transportation. So for the first time, I was personally scared about how am I going to get to work every day? And what was that going to mean for my own health, for the health of my family?

Our daughters…they're both in college and university, and we had to think about what their needs were going to be during this time. And then my mother lives with us as well. So I had to be particularly thoughtful about my own health as it relates to her health. And while she doesn't have significant comorbidity, certainly it's clear that the elderly were at a huge disadvantage during this pandemic. And so all of those things were kind of running through my mind during this time, and really that lasted intensely from March to, I would say we started resuming fairly normal — new normal — operations in June. So that's a long time.

I can't even imagine both the professional struggle and also the personal. Can you tell me a little bit more about how you managed that? What were the steps you took to kind of balance that very harrowing work experience with the needs at home of your kids and your mother?

First, I am very, very fortunate to be part of an organization that allowed such a high degree of flexibility during this time, particularly for those of us who did not need to physically be in the hospital setting. And in fact, it made a lot more sense for us to steer clear of the hospital setting to not pose more risk to people. And so for the most significant period of that time, I was able to work remotely and I traveled into the corporate setting as infrequently as possible. And so to have that flexibility was just extraordinary. And it was not obviously just for senior executives — that held true for almost all of the administrative parts of the organization that didn't have to actually deliver care to patients.

Now that being said, many of those administrative roles, whether it's a frontline administrative role or a senior leader administrative role, got redeployed to provide services that they didn't ordinarily do. And it was wonderful to watch our teams come together and take on those roles and responsibilities to the extent that it was needed.

I think oftentimes before COVID hit, we always thought of working remotely or working from home as kind of this solution for work-life balance, or what I prefer to call professional-personal life balance. When in fact, I, by far, gave more hours working remotely than if I was physically present. Literally, 18-hour days were not uncommon.

It was stressful and it took a toll physically that I did not anticipate. And frankly, I was eager to get back to the office because it allowed me to walk, to be outside, to get fresh air, to see other people. We're now just learning the mental health toll that the pandemic is taking, continues to take, on our workforce.

You mentioned that your mother is living with you. Can you tell me more about that? Did that happen as a result of COVID?

My mother moved with us, she was living with us in Virginia. And when we took this new professional opportunity she moved with us here to New Jersey. Many of us are in that sandwich generation where we are still raising our children and now have to begin caring for our parents. I'm on the early part of that journey. And while my mother is physically able to move around and is relatively physically healthy, we are starting to see her have early memory decline and I think we're just hitting a point now where we're not comfortable with her being home alone.

And of course, a transition from Charlottesville, Virginia to New Jersey was hard on her. Now we're in a much smaller apartment. She is relegated to kind of one floor of our apartment and so her mobility is limited, and I often have to think about her ability to get out and stay healthy and get exercise and eat well. During the pandemic, when I could work remotely, I could keep an eye on that and I could make sure she had what she needed. When I returned to the office, it wasn't as easy to do that. And we're starting to now enter a stage where we can't go out of town for business travel anymore without having someone available to care for her.

It became a big pivot point professionally for me when I realized, oh, someone has to be home with her. And I do think it's just like when you had children, you couldn't just go on a business trip without making arrangements. I find the same now to be true as I care for my mother.

 [Healthcare executive Pamela Sutton-Wallace with her two daughters. Source: Pamela Sutton-Wallace]

In this project, one of the things we're looking at is how the responsibility of care for children and for aging relatives often falls to women. What impact has that had on your own career trajectory or that of colleagues?

As much as I wish it weren't the case, I still believe that women serve double duty. In my generation, it's still the case that women are doing a disproportionate share of the housework and disproportionate share of the childcare-giving and parental support. We find that we're responsible for cleaning, cooking, ensuring that the kids have what they need, the racing around town if they're involved in extracurriculars. We may not physically be doing the running, but we're often the ones responsible for ensuring the coordination. When I talk to my peers who are about the same age group or professionally at the same level, it's been their same experience as well.

I think we have learned really good mechanisms for mitigating some of that, which includes asking for help. We were very fortunate to have a caregiver who helped us when the children were young. She was a family friend, and she stepped in disproportionately. We would have never have been able to both pursue our professional aspirations without her. She was part of our family from the day they were born to the day they went to college. I think it's incredibly hard for women—and men, quite frankly—to rise up the professional ranks without that level of support somewhere, whether it's their parents, whether it's friends, whether it's church, whether it's paid services. You need help to balance it all.

I mentor many, many women, and this question always is top of mind: Can we have it all? I won't even try to answer that, but I try to get women, young women, in particular, to ask themselves: What do you want? And let's figure out a game plan to achieve that which you want.

And let's also untether the expectation of our own perfectionism, which is my big issue. I wanted to be super mom, I wanted to be super healthcare executive, I wanted to be super wife. And I often was my worst enemy, feeling guilty when I couldn't deliver the best or the perfect circumstances in all three of those realms. And I try really hard to coach women to understand you can't have perfection in all of those realms. And nor should you strive for it.

When you had your kids, did you take time off?

My oldest child is 21. She was born prematurely and even more challenging, I went on hospitalized bed rest at 23 weeks of pregnancy. And at the time, the only benefit that I had to rely on was FMLA, Family Medical Leave Act, which only guarantees 12 weeks of leave. I actually delivered her at 30 weeks — I was on hospitalized bid rest for seven weeks. So I had already exhausted seven of my 12 weeks. So as a result, I only had five weeks home with her. And it was crushing because I really wanted the full three months of family medical leave to bond with her, especially as a premature child.

Now, the wonderfulness of it is I had a boss who was just incredibly understanding and he let me work from home as much as I could. He was flexible by allowing me to go to the hospital to visit her as often and as much as I needed to. He allowed me to make up time on weekends and off hours. And then he was just incredibly supportive. And I think, in general, most managers would be supportive—but not always, right? Especially for someone who has work that isn't flexible or conducive to a flexible schedule. If you have to work a shift, that kind of flexibility just isn't possible. 

Over time, I'm really glad to say that my observation working in a number of organizations is that that has changed. So not only do we have FMLA, but I find that more organizations, especially healthcare organizations, are now offering paid parental leave. And by the way, FMLA doesn't guarantee your pay unless you have sick time that covers that pay.

So I think that's a really important change. And I think organizations have done that because they want to retain and recruit talent as more and more women make up the majority of the professional workforce. And I think more men are now insisting that they also be allowed to be involved early on in their children's lives and share in that responsibility. So I am hopeful that we see policy changes taking place in both private and public industries. But it's a slow move.

I do see more organizations allowing time off for caring for one's parents. And having resources available, like contracted services or vendors available. So I can go look at my employer's website and pick three home health services that have parent care that when I do have to have business travel, they can come, help take care of my mom. 

But that being said, these are expensive services. So while I have the means to afford that, not all employees do, especially those who are doing some of our essential work. I think about the housekeeper or the environmental services or food services team—they don't necessarily have the resources to support someone taking care of their family members when necessary. So there's still real challenges.

You mentioned a role for the public and the private sector to step in. Do you think federal government policy has a role to play in employee leave?

I do. It shouldn't obviate the need for private employers to do the right thing, though. What we do find though is oftentimes a governmental approach or policy kind of pulls everybody else along. But I think it gets challenging when you start thinking about the expense of it. So I would love to see as happens, I believe, in some of the Scandinavian countries that women are given a year off after birth. What a wonderful opportunity. Countries that invest in Pre-K and offer high-quality Pre-K services and childcare have clearly been able to demonstrate better educational and health outcomes for those children later in their lives.

And I think we're so far from that in the U.S., that it is such a political hotbed because of the tax implications and the financial strains on the national budget—although I would argue that redeploy some of that money to do child care, Pre-K and those kind of things, and you avoid some money spent in other realms later. But it gets so caught up in the politics that I think it's really imperative that the private sector take the lead to demonstrate the wonderful outcomes that happen and the support you get from the workforce. When the workforce feels supported, they are fiercely loyal and generally more productive.

What new family care leave policies do you see emerging during COVID as a result of the pandemic?

I think it's going to get complicated. I'm not sure how this is going to work. But let me say what I think some of the complications are going to be. I think working remotely is going to be a new norm. It makes a lot of sense. Parents who are working remotely have to also now ensure that their kids are getting educated in the home. That's a challenge I can't even fathom. And I've been incredibly impressed with some of my colleagues when I look to see how they set their children up in their own little kind of school offices at home and seem to be making it happen and plus try to work themselves, but I think we're going to have to think about the reality of that. And how is that going to last? And if we have a new normal, what does education look like for kids?

And also, what does it mean now when our loved ones do get sick or when we get sick? I think we're going to see new policies around sick leave, and shoring up people's income when they are sick. I think that was one of the interesting things that happened during COVID that there were, in some states, executive orders that said you had to keep paying your employees if they got sick or if they had a loved one who needed to be cared for. So I think it's going to force us to reconcile having some basic coverage for sick leave and away time.

I do think it's going to force us to have hard conversations about how we care for our parents and elderly. Of course, nursing homes were some of the hardest hit by COVID, and losses of life took place disproportionately in nursing homes and in communities of color. So how can families keep their loved ones home longer before placing them in nursing homes is going to be a really important conversation. And what's the availability of home health? Will we see greater coverage of home health care, even when it's not necessarily for an acute illness, but when an elderly [relative] or a family member just needs custodial care or assisted living—which today is not covered by Medicare or Medicaid—when someone just needs a little help, so to speak. 

So I think: To be determined. And I think it's going to be a hotbed issue because what has been clear is that there hasn't been a national dialogue on these topics.