Understanding the “Sandwich Generation” of Family Caregivers

A new study published in the Journal of the American Geriatrics Society provides some insight into the “sandwich generation,” the middle-aged adults who care both for their children and their aging parents. The profile shows the considerable strain on time, finances, and mental health for these family caregivers.

“Our analysis highlights the extraordinary level of demand faced by sandwich generation caregivers, who by many measures provide as much support to their aging parents as the non-sandwich caregivers, while also taking care of children under 18,” University of Michigan Department of Psychiatry postdoctoral fellow Lianlian Lei, PhD, said in a statement. “More research is needed on this specific population’s challenges and needs.”

Family caregivers have been pushed into the spotlight in recent years as the nation contends with a growing senior population. Baby Boomers are aging, and with that, they have more chronic illnesses and, therefore, more supportive needs.

But with the high cost of specialized assisted living and senior care, those supportive needs are largely falling on their family members.

The sandwich generation is defined as a subset of family caregivers who are taking care of both an adult loved one and a child. About 2.5 million people comprise this sandwich generation of family caregivers, said the researchers, who hailed from the University of Michigan. That represents about a quarter of all family caregivers.

Using data from the 2015 National Study of Caregiving (NSOC) and National Health and Aging Trends Study (NHATS), the researchers found that sandwich-generation caregivers are having a more difficult time than their non-sandwich counterparts.

To be clear, being a family caregiver of any generation is not easy. Not every family caregiver receives pay, and the healthcare education and emotional load can be a lot to handle when one is also balancing the needs of their everyday life.

But the researchers said there were some challenges unique to sandwich generation family caregivers that do not affect non-sandwich caregivers quite as much.

Around a quarter of sandwich-generation family caregivers reported substantial financial strain, compared to only 12 percent of non-sandwich caregivers. Additionally, 44 percent of sandwich-generation family caregivers said they experience substantial emotional strain, compared to 32 percent of non-sandwich caregivers who said the same.

Both sandwich-generation family caregivers and those they care for are also more likely to use social services, with around one in five caregivers and 30 percent of care recipients being enrolled in Medicaid. That compares to just 11 percent of non-sandwich caregivers and 21 percent of non-sandwich care recipients who are also on Medicaid.

The defining factor here may be the dual or even triple focus demanded on sandwich generation family caregivers. Sandwich-generation caregivers provided about the same amount of care as their non-sandwich counterparts (about 77 versus 72 hours monthly), and they were about equally as unlikely to use supportive services as their non-sandwich caregiver peers.

But even still, sandwich generation family caregivers were more likely to have a job outside of their caregiving duties, meaning their focus is often split three ways.

“Policymakers and employers should pay special attention to the individuals caught in this ‘trilemma’ of being caregivers to two generations and members of the workforce at the same time,” Donovan Maust, MD, MS, a member of the Center for Clinical Management Research at the VA Ann Arbor Healthcare System and of the U-M Institute for Healthcare Policy and Innovation, said in a statement.

“Making support services and paid time off available to all caregivers of older adults, whether they are taking care of aging parents, other relatives or friends or neighbors, could make a difference in workforce participation and even nursing home use,” said Maust, who is also a geriatric psychiatry associate professor.

This is not the first survey to indicate that family caregivers need more support. Previous studies have indicated that family caregivers need more social support as well as family engagement and education.

Earlier in 2022, the Department of Health and Human Services unveiled a plan to improve support for family caregivers, beginning with some changes at the federal level and recommendations for local officials to take, as well.

“Supporting family caregivers is an urgent public health issue, exacerbated by the long-term effects of the COVID-19 pandemic,” HHS Secretary Xavier Becerra stated publicly. “This national strategy recognizes the critical role family caregivers play in a loved one’s life. I know the importance of this first-hand, as someone who cared for my late father and navigated the challenges associated with caregiving.”