An introduction to the sandwich generation caregiver

What I quickly learned is this: Even though my husband and I were technically part of Generation X, we were now finding ourselves included in a relatively new and exponentially growing generation — the “sandwiched” one. ”Sandwich generation” accurately described our undesirable situation of being squeezed between two other generations who simultaneously needed our care and assistance: our aging parents from the baby boomer and silent generations and our young and developing children from Generation Z.

Which type of sandwich (caregiver) are you?

Sometimes, finding a definition that describes your situation can feel like all the affirmation you need. While I felt like our family was going through this experience alone, I was mistaken. 

A 2019 report entitled Burning the Candle at Both Ends: Sandwich Generation Caregiving in the U.S identifies 11 million Americans caring for an adult family member due to health needs or disability while also caring for one or more children at home. 

Two social workers, Dorothy Miller and Elaine Brody, coined the term “sandwich generation” in 1981. Since then, subcategories of the sandwich generation now exist to incorporate more color into this daunting predicament. 

Sandwich caregiver types: who are you?

• Traditional: Squeezed between two care levels, typically aging parents and children
• Club: A traditional sandwich with an additional layer of care, typically grandparents or grandkids
• Open-faced: Used to describe anyone who is non-professionally involved in eldercare

What it feels like in the middle

As a sandwich generation caregiver, the weight on my shoulders primarily came from emotional stress. I never felt I was doing enough for anyone. I compare this season of my life to a mother robin working tirelessly to feed her nest of crying, hungry birds. In my analogy, the wailing birds represent my care recipients and my marital relationship, household responsibilities, career, and health. There is a constant tugging of different essential and competing priorities. Even though mama bird is on the cusp of burnout, no one is ever satisfied with the morsels they receive.

For some, their sandwich generation season has a short shelf life, like when an aging parent is recovering from surgery or rehabilitation. For others, like me, the sandwich generation season can last multiple years. 

Five reasons that demonstrate we are in a caregiving crisis

The emergence of the sandwich generation has added complexities to a caregiving culture that is already in crisis. Here are just a few reasons why this is a growing societal concern — i.e., crisis — for the caregiving community and all U.S. residents. 

1. People are living longer

Modern medicine, emerging technologies, and healthier behaviors are causing older adults to live longer. According to the U.S. Census Bureau, the total life expectancy in the U.S. in 1960 was around 70 years old. In 2060, the projected life expectancy will be approximately 85 years old. And according to this Forbes article, our population of those over the age of 85 will almost triple between 2015 and 2050!

With this increase in age comes an increase in common health issues, such as hearing loss, osteoarthritis, diabetes, and dementia. What’s more, many older adults will likely experience multiple ailments simultaneously.

As parents, we anticipate providing physical and financial assistance for our children. However, we often overlook what may be required of us to care for our parents, including the potential financial burden involved in their care. Family caregivers are also living longer; we will need our physical and financial resources to sustain our futures.

2. Youth are becoming outnumbered by older adults

As our older adult population grows in the U.S., the number of adults available to provide care diminishes. According to the Center for Disease Control, the population of adults 65+ expects to double between 2000 and 2030. Due to lower marital and birth rates across the country, the CDC also stated that the potential pool of family caregivers per adult is dwindling from seven to only four by 2030. 

3. Employee productivity is suffering

Caregivers need income to pay for today’s cost concerns, such as medical appointments and hiring additional care. Employment is also essential to set aside money for future expenses and retirement. Somehow the average family caregiver has to find the time in their already-maxed schedule for 24 hours of assistance per week. This is equivalent to a part-time job!

Many companies are beginning to recognize the impacts of caregiving on the workforce. According to an estimate from MetLife and the National Alliance for Caregiving, U.S. companies lose $31 billion a year to lost productivity. In addition, over half of the working caregivers surveyed reported going to work late, leaving early, or taking time off to accommodate care. Plus,10% have had to give up work entirely or retire early.

Unfortunately, COVID-19 exacerbated these circumstances. According to Roslynn Carter Institute for Caregiving’s report, Caregivers in Crisis: Caregiving in the Time of COVID-19, 83% of caregivers surveyed reported increased stress related to caregiving since the start of the pandemic. These caregivers also shared a statistically significant decline in support received from family and friends, adult respite/daycare, coaching or counseling, support groups, and transportation.

4. Long-term care is costly

Many family caregivers are surprised to learn that their private health insurance or government benefits do not cover the expenses that many will encounter as older adults. In the U.S., Medicare is available for people age 65+, younger people with disabilities, and people with permanent kidney failure. However, Medicare currently does not cover financial assistance for ongoing personal care at home, senior living facilities, or skilled nursing facilities. 

Long-term care insurance may be an option, but only for those who pay the premiums. The average annual premium for a 55-year-old couple is $3,050, with the cost varying based on age, health, and the selected policy. When older adults need help with daily living activities and don’t qualify for Medicaid or other government benefits, families either pay privately or surrender their time and personal resources. 

5. The professional care workforce is dwindling 

Yet another facet of this crisis is the lack of professional elder care worker supply to meet the growing demand –– a dilemma known as a “care chasm.” According to the Eldercare Workforce Alliance, the U.S. will need an additional 3.5 million health care professionals and direct-care workers by 2030. More recruitment, training, retention perks, and competitive compensation will be required to meet this demand.

This care chasm ultimately puts a strain on family caregivers. Caregivers try to fill this gap because they want their loved ones well cared for, often leading to increased stress, financial loss, and physical overwhelm. This heavy load eventually becomes an unstoppable cyclical concern –– at the end of the day, who will care for the caregiver when their finite physical and financial resources deplete?

What can help the sandwich caregiver?

Besides more helping hands and financial resources, fast-tracking family caregivers must look to resources and products that increase independence, improve communication, and reduce worry in the long-term. 

One such product is Hero’s medication management service. Hero will streamline your care recipient’s medication management by automatically sorting and dispensing their pills on schedule and tracking their adherence through their connected mobile app. Hero’s service also allows you to receive notifications if one of their pills was missed or taken late, even if any medications require a refill. To learn more about Hero, click here. 

Talking about your situation may also help. Try searching online for a local family caregiver support group. These individuals provide a direct source for your questions about trusted local service providers such as home health, elder law care attorneys, care facilities, and healthcare specialists. They’ll also help validate the emotional and physical overwhelm you are experiencing.

While circumstances outside your control may unwillingly place you in the sandwich generation, support and resources are out there. More options exist today than when I searched for them just seven years ago. If you are caring for multiple generations, I hope you will not only take advantage of the resources but also share this article with your friends and family to initiate more conversations about how to help the sandwich generation. 

About the author

Elizabeth B. Miller is a family caregiver, certified caregiving consultant, and founder of Happy Healthy Caregiver. Through her speaking, consulting, and online resources, Elizabeth helps family caregivers integrate caregiving and self-care with their busy lives. She is the host of the Happy Healthy Caregiver podcast on the Whole Care Network, author of “Just for You: a Daily Self-Care Journal,” administrator of the Self-Care Support for Family Caregivers FB Group, and facilitator of an Atlanta caregiver support group, the Atlanta Daughterhood Circle.