What is the Sandwich Generation? Unique Stress and Responsibilities for Caregivers Between Generations

“My life changed overnight,” she says. “I went from watching my son grow up and become independent to watching my mom rapidly decline. She was always healthy and fit, and we didn’t plan on anything like this happening for years.”

Bailey is one of millions of sandwich generation caregivers in the United States. The term “sandwich generation” was coined by social worker Dorothy A. Miller in 1981 to describe adult children of the elderly who are “sandwiched” between caring for their own children and their aging parents.

Sandwich Generation caregivers are an extraordinary group of people. It takes energy and devotion to care for an elderly parent while raising or supporting children at the same time. As the vast majority of the Sandwich Generation is aged 40 to 59 — 71%, according to Pew Research Center statistics — this means they also face the additional challenges of middle age.

Learn sandwich generation statistics, common stressors, and how you can find help.

Over the past decade, studies on sandwich generation caregivers have become more popular, with the Pew Research Center and National Caregiving Alliance (NCA) performing regular surveys on caregiving habits. Several striking statistics show what makes this hard-working group unique:

• More than one in 10 adults with a child under 18 also care for aging parents, according to a 2017 report on sandwich generation demographics by the Pew Research Center.
• These caregivers spend about three hours a day on unpaid care. Nearly three quarters of them are employed full-time. That’s 21 hours a week of caregiving on top of a 40-hour job.
• About 60% of sandwich generation caregivers are women. Male and female caregivers spend about the same amount of time a day caring for their aging parents, but mothers, on average, spend about 45 minutes more daily on child care, regardless of employment status.
• Sandwich generation caregivers spend an average of 86 minutes less a day on paid work, and nearly half an hour less sleeping.

Some adults spend years as a sandwich generation caregiver, while others experience only a brief overlap. Jennifer Graham of Charlotte, North Carolina, had her children in her late 30s, only a few years before her mother suffered a debilitating stroke. “I was juggling two toddlers and a woman who could no longer care for herself, but it didn’t ever feel like something I was forced into,” says Graham. “I loved them both, and it was a responsibility and an honor to care for them.”

Long-term sandwich caregiving is becoming increasingly common as the population ages. Increased life expectancy, coupled with financial insecurity, means many seniors require family care. At the same time, millennials are having children later than their baby boomer and Generation X parents, leading to more multi-generational households.

The sandwich generation has to learn to make hard choices, writes Carol Bradley Bursack in an AgingCare article about her personal experiences as a sandwich generation caregiver. A multi-generational caregiver may have to make the decision between their daughter’s first piano recital and an important medical appointment with a parent.

Bursack describes one particularly difficult scenario when her son was recovering from an asthma attack while her mother experienced a fall. Learning to carefully weigh loved ones’ needs is one of the toughest parts of caregiving, she writes.

Despite these difficulties, multi-generational caregiving often leads to close-knit families and strong support systems, according to the NCA. Children raised in sandwich generation households have the benefit of growing up with both parents and grandparents, while elderly relatives are able to enjoy time with their grandchildren.

In multi-generational households, grandparents can help with child care, and later those children can help care for their aging loved ones.

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Being a multi-generational caregiver is stressful both emotionally and financially. In fact, more than one in three sandwich generation caregivers report significant emotional stress, and one in five report financial stress, according to a report published by the National Alliance of Caregiving (NAC). 

Financial burden of caregiving

Adults caring for both children and older relatives estimate they’ve lost more than $10,000 over their time as caregivers, according to an informal sandwich generation survey by The New York Times and data research group YouGov. Reduced work hours, increased expenses, and loss of career opportunities all contribute to this statistic.

In addition to this increased economic burden, sandwich generation caregivers often sacrifice their own retirement and savings to help aging relatives, according to the survey. Aging parents’ lack of a retirement nest egg can seriously affect adult children’s own preparations, increasing the likelihood they’ll have to rely on their own children someday.

Emotional health effects of sandwich generation caregiving

Caring for people with different needs can lead to extreme stress — mothers in the sandwich generation, ages 35-54, exhibit the highest levels of stress of any population demographic, according to the American Psychological Association’s Stress in America survey. 

This anxiety is spurred by the constant balancing act of caring for both parents and children, and is complicated by the fact that multi-generational caregiving leaves members of the sandwich generation unable to take time for themselves. 

“I used almost all of my sick days and vacation days to cover my kids’ snow days, or my mom’s important medical appointments. Then weekends were mostly supporting my daughter’s activities and household chores,” says Graham. 

Without time to attend to their own emotional needs, caregivers can develop chronic stress — an exhausting, non-stop version of the body’s fight-or-flight response. Chronic stress isn’t just emotionally detrimental, it also heightens the risk for developing high blood pressure, diabetes, depression, and heart disease. 

After a doctor’s diagnosis of high blood pressure as a result of continued stress and anxiety, Graham realized she needed to take a step back to care for herself. When her children were in school full-time, she declared one “me day” a month to catch up on rest, have lunch with friends, and read.

To stay healthy and effectively support their loved ones, sandwich generation caregivers need to take time to care for themselves. If you’re suffering from stress, anxiety, or caregiver burnout, take a deep breath, remember that you’re not alone, and consider these tips for managing stress.

You don’t have to do everything

Often, adults become consumed by their role as caregiver and leave their own wants and needs by the wayside. “There was a point when I was cooking three dinners per night: one that my kids would enjoy, one that my mom would eat, and one for my then-husband. I would eat whatever was left — whether it was mac and cheese or steak,” says Graham.

If you feel overextended by everyone’s demands, discuss how your family can make small changes to improve your life. In Graham’s situation, for example, her children could try new foods, or her mother could pay for takeout once a week.

Self-care is vital

The effects of caregiving are huge sources of anxiety, and self-care won’t solve everything. Caregiver burnout can’t be fixed with bubble baths and scented candles, but taking time to do the things you love can offer a chance to reflect on your own feelings and interests — and to create a balance between caring for yourself and others.

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Some methods of self-care include:

• Reading a book by your favorite author
• Talking on the phone with a friend
• Taking a weekly art class or joining a book club
• Exercising in a way that makes you feel energized, whether it’s yoga or a hike
• Eating a piece of chocolate cake all by yourself

Ask for help

Remember that you aren’t a burden, and you deserve care just like everyone else.

• Focus on what family can give
  If you have a sibling in another state who can’t visit often, see if they’ll help manage finances or schedule doctor appointments for aging parents. If your aging parents are still in moderately good health, see if they can occasionally help watch the children.
• Join a caregiver support group
  Share stories, feel connected, and get tips from others who understand what you’re going through.
• See a therapist or counselor if possible
  If you can’t afford traditional therapy, there are online and over-the-phone options available. Talkspace and Betterhelp are both affordable, reputable counseling sites.

Set up a power of attorney early

Knowing your elderly loved one’s wishes and having legal authority in advance can prevent stress by saving money and time in the long run. Additionally, setting up a power of attorney will make medical emergencies and end-of-life care easier for you and your children.

There are several types of senior care, and there’s no one-size-fits-all option for families seeking help for aging loved ones. Many multi-generational caregivers want to keep their aging parents at home, but constant caregiving can bring significant mental and emotional strain. Home care, adult daycare, and respite care are all options for relief.

Home care

Home care agencies generally charge by the hour. Care aides don’t provide nursing care, but they provide a combination of household help and personal care such as:

• Companionship
• Help with activities of daily living (ADLs)
• Meal preparation
• Housekeeping
• Transportation

A care aid visits Bailey’s home once a week while she’s at work. “It took a year for my son to convince me to hire home care for my mom, but it’s been the biggest relief,” she says. “I don’t have to come home to check on mom during my lunch break, or worry about preparing her dinner that night.”

Home health

Home health isn’t the same as home care. While home care offers daily assistance, home health provides clinical medical supervision. Home health care workers are registered nurses and therapists who are licensed to administer medication, give shots, and help with wound care or rehabilitation.

Home health requires a physician’s prescription and is typically covered by Medicare or private insurance.

Adult day care

Adult day cares offer supervision, socialization, and structured activities for seniors. Some facilities provide meals, transportation, and personal care. Generally, adult day cares have limited hours that correspond with standard workdays. The national average cost for adult daycare is $75 a day, but even one day a week can reduce caregiver stress.

Respite care

Respite care is offered by many assisted living communities. With this temporary relief of caregiving duties, caregivers know loved ones will be cared for by people who understand the unique needs of aging adults, while seniors can enjoy meals and activities geared toward seniors. It can even be a “trial run” to help determine if long-term assisted living would benefit your family.