Among women caring for their parents, none face the rock-and-a-hard-place choices of those in the so-called sandwich generation. Now, a new analysis estimates that there are 20 million Americans — the vast majority of them mothers — who are juggling responsibilities for their own children and their aging parents at the same time. 

The analysis, commissioned by two companies, Christian Companion Senior Care and Presto Services Inc., both selling services to this group, found that 53 percent of those in the sandwich generation feel forced to choose — at least once a week — between being there for their children or being there for their ailing parents. One in five say they make that painful choice every single day. 

So what’s a double-duty caregiver to do? We asked that question of Jeannie Keenan, a registered nurse and vice president at My Health Care Manager in Indianapolis. The company is one of a growing number of for-profit companies that provide case managers to families caught in this thicket. It does not employ home care aides or other care providers but, rather, hooks clients up to available services through a national network of affiliates. 

Ms. Keenan said that the biggest mistake adult children make in this situation is trying to segregate their dual responsibilities. 

Their well-meaning goal is “they don’t want their children’s lives affected by what’s going on with their elderly parent,’’ she said. The result is a constant series of no-win choices like: “Do I go to my kid’s ballgame, or do I go and make sure Dad eats his dinner?” That is a formula for feeling you are failing everyone, Ms. Keenan said, and is also avoidable, by accepting that this is a family experience that must be shared, sometimes with the help of others in the community. 

In the case of the ballgame, Ms. Keenan said, one solution might be to enlist a friend to visit Dad at dinnertime, on the pretense of a social call, and report back whether he is eating. Then after the ballgame, as a family, “go see grandpa and bring him some ice cream.’’ The Little Leaguer, still in uniform and bubbling with details of the game, will surely be a tonic to his grandfather, and the ice cream will ensure a high calorie treat. 

If your elderly parent is living in an assisted-living center or a nursing home, Ms. Keenan suggests, strike up relationships with other adult children who have family members there. These facilities sometimes have formal family associations, but they are often dominated by disaffected relatives who meet to grouse about the food or the staffing ratios. Far more effective, Ms. Keenan said, is an informal circle who will look in on each other’s parents, during vacations or simply when they happen to be around. 

For sandwich generation caregivers without friends to help them out or enough money to pay for professional help, Ms. Keenan has a grab bag of suggestions. Volunteers are available through churches, senior centers, 4H clubs and high school community service organizations, as well as colleges that train nurses, social workers and others interested in experience with the elderly. Let these volunteers sort the mail, go grocery shopping, do laundry, pay social visits, drive an elderly person to doctors’ appointments or help them at mealtime. 

“Get help for as many task-oriented things as you can,’’ Ms. Keenan said, “so you can concentrate on being a daughter, a mother and a spouse. Understand that for however long it takes, this is your life, not something you can hurry up and get through. Come to grips with the reality that it affects the entire family, whether you want it to or not. And be mindful. Make a plan that accounts for the dignity of the senior, the sanctity of the marriage, the demands of being a parent and the sanity of the caregiver. And when that plan stops working, make another plan.’’