In a candid conversation with Steve Gurney of the Positive Aging Community, nurse practitioner, Doctor of Nursing Practice from Johns Hopkins, and longtime caregiver Irina Koyfman shared the story behind her new book, The Sandwich Generation. Drawing from her own life—immigrating from Ukraine at 17 with aging grandparents, parents, a brother, and a disabled uncle, while raising her own children and building a healthcare career—Koyfman created the guide she wished she had during her most overwhelming years.
“I had to put my grandmother in Hospice, my uncle was very sick, my father developed dementia, my kids needed me… and somebody said, ‘Oh, you’re a perfect sandwich generation,’” she recalled. “English is my second language. I had to ask, ‘What is the sanguage generation?’” That moment stuck with her. Years later, after losing several Family members and watching her mother turn 77, Koyfman decided to write the book as a short, practical handbook filled with personal stories, humor, clinical insight, and immediately usable strategies.
The book is deliberately slim—just 136 pages—organized into 18 short chapters (each only two to three pages). Why 18? Koyfman explains that in many spiritual traditions, the number symbolizes life, infinity, or the divine (in Hebrew, “chai” means both 18 and “life”). Each chapter opens with a relatable quote, outlines the problem (sometimes with statistics), offers multiple solutions, shares a brief personal anecdote, and ends with three actionable strategies readers can implement the same day.
Self-Care Isn’t Optional—It’s Survival
One of Koyfman’s strongest messages: caregivers routinely neglect themselves. A favorite chapter focuses on relaxation techniques, especially breathing exercises. “Breathing is like Exercise,” she said. “There are techniques that work like an espresso shot—fast breathing before a test or when you’re drowsy while driving—and slower ones for calm.”
She also stresses delegation and letting go of perfection. During her full-time doctorate program while working and Caregiving, professors warned the class they would not survive without delegating. Koyfman resisted at first, then sat her family down and admitted she needed help. She created a simple “battery assessment”: list what charges your energy (for her, cooking) and what drains it (laundry). Her husband took over laundry—ten years later, he still does it because it’s now his relaxing time watching soccer.
Even small acts matter. In a dementia support group story Gurney shared, a husband with dementia gave his wife a foot massage after she asked. Both felt the oxytocin release—the “hormone of Love and connection.” Koyfman agrees: “Don’t assume they can’t do it.” She once pushed her mother (whose English is decent but not perfect) to schedule her own doctor appointments. It briefly strained their relationship, but her mother succeeded, felt empowered, and has handled it ever since.
Dementia Care: Knowledge, White Lies, and Planning Ahead
Chapter 10, “Navigating Dementia,” offers two standout tips most families miss.
Medicare’s Cognitive Assessment and Care Plan — a free, hour-long preventive visit (no deductible or copay) covered twice a year. The doctor performs cognitive tests, scores the decline, and creates a full care plan with Diet, medication, and resource recommendations. It’s an easy way to track progression objectively.
Strategic “therapeutic fibbing” and advance planning. When her father with dementia wanted to drive, Koyfman and her brother hid the keys and repeatedly told him the car battery had died and was at the dealership. Eventually they sold the car but kept the story alive. He forgot about driving. When placement in a nursing home became necessary, Koyfman started the paperwork months early—knowing it takes time—so that when her mother was finally ready, a bed was immediately available.
AI as a Caregiving Tool (With Important Caveats)
Koyfman devotes an entire chapter to Artificial Intelligence because “it’s here, it’s getting bigger, and it’s moving so fast.” She compares AI platforms (ChatGPT, Copilot, Gemini) to different phone brands—same basic function, different strengths.
Practical uses for caregivers:
Generate organized medication tables with dosages, times, and side effects.
Summarize downloaded medical records (after blacking out all personal identifiers—name, date of birth, etc.).
Draft questions to ask doctors: “I’m a 50-year-old male with high cholesterol and hypertension—what should I ask about my recent pre-Diabetes test?”
Critical rules: Never upload identifiable Health information. AI can “hallucinate”—sounding confident while being wrong—so always verify. The best results come from specific, iterative prompting: add age, sex, medical history, and keep asking follow-up questions until the answer is tailored and deep.
