Caregivers Feeling the Squeeze of “Sandwich Caregiving”
May 10, 2023
When Kate’s* mother was diagnosed with Alzheimer’s Disease, her three children were still in elementary school. With her father already deceased and no family living nearby. Kate took on the responsibility of driving her mother to appointments, cooking her meals, and making sure she took her medications. She continued to be the primary caregiver for her children, too. Juggling demands from the older and younger generations, Kate was feeling the overwhelm of sandwich caregiving.
“I remember thinking this would all be a lot easier if my kids were a little older and more self-sufficient,” said Kate. “But I think it would have been hard no matter what.” As her mother’s illness progressed, Kate quit her job to care for her mother full-time. “There was always some crisis, whether with my kids or my mom. And someone was always getting the short end of the stick.”
An estimated 11 million Americans provide unpaid care to older adults while also caring for their children. (For comparison, that’s slightly more people than the entire population of the state of Georgia.) Known as “sandwich caregiving,” this type of intergenerational care is emotionally, physically, and often financially taxing. Elder care is expensive and increasingly complex. Navigating the bureaucracies of health care and insurance can feel like a full-time job. Moreover, due to a variety of societal trends, the “sandwich” years are lasting longer than ever, increasing caregivers’ risk of burnout.
What is sandwich caregiving?
Sandwich caregiving most commonly refers to caring for both older adults and children under the age of 18. However, sandwich caregiving can also be caring for elders and adult children and/or grandchildren. Young adults are increasingly likely to remain in or return to their childhood homes. Partially fueled by the pandemic, half of Americans between the ages of 18 and 29 were living with their parents in July 2022. And 38 percent of grandparents provide care to their grandchildren, from occasional babysitting to full-time care. These trends are changing both the prevalence and complexity of sandwich caregiving.
Who is most affected by sandwich caregiving?
Traditionally, sandwich caregivers have been middle-aged women, though this, too, is shifting. Recent research indicates that 39 percent of sandwich caregivers are male and the average age is 41. Sandwich caregivers come from all different ethnic backgrounds, but cultural norms vary when it comes to caring for elders.
BIPOC individuals may be more likely to see elder care as an expectation, not something they can opt out of if provided the opportunity. Families of lower socioeconomic status feel the disproportionate pinch of supporting additional family members with fewer resources. Adding to the financial burden is the fact that many sandwich caregivers have to make some sort of job change to accommodate their caregiving responsibilities, from a reduction in hours to leaving their jobs completely.
What are the challenges of sandwich caregiving?
While there are some similarities between caring for elders and caring for children, there are also unique challenges. “At least with your kids, you can look forward to the day when they are more independent,” said Kate about her own sandwich caregiving experience. “There is a reward. But with an elder, there is just progressively more debility and anticipatory grief.”
The Emotional Burden
Sandwich caregiving can elicit a maelstrom of emotions, including sadness, anger, resentment, guilt, and even defeat. “When my mom died, I felt like I had failed,” said Kate. “Even though I obviously couldn’t cure her Alzheimer’s, so much of my day-to-day activity was oriented toward keeping her alive. It felt like I had failed to do my job somehow.”
The Mental and Physical Load of Sandwich Caregiving
Sandwich caregivers also carry the mental load of managing multiple schedules, keeping track of appointments, and communicating with healthcare providers and insurance companies. Caring for elders can be physically taxing, as they may require assistance bathing, toileting, or getting in and out of bed.
Shifting Family Dynamics
Caring for an elder can shift family dynamics, as more activities are oriented around the elder’s needs. Children and spouses may end up feeling neglected as they get less of the caregiver’s time. In addition, family members might have different opinions about what the elder needs and who should be responsible for their care, creating conflict.
Loss of Identity
Sandwich caregivers can also experience a loss of identity, as the demands of intergenerational care leave little time and energy for hobbies or social relationships. This can be particularly true if the caregiver makes changes at work, such as assuming a less intensive role or quitting their job altogether.
Finally, sandwich caregiving can have a financial toll on a family, beyond reduction of income related to changes in work status. Medicare rules limit payment for care, requiring that elders meet specific criteria to qualify for home health care and not paying for help with eating, bathing, dressing, and other activities of daily living. This leaves sandwich caregivers to fill in the gaps, often with their own savings.
Advice for sandwich caregiving
Because sandwich caregivers are at high risk for burnout, it is imperative that they find ways to take care of themselves, too. Although it can be challenging to find the time and energy, these tips can help to restore some of the balance between self-care and sandwich care.
Set boundaries around sandwich caregiving
There is a reason hospitals and nursing homes set limits on shift length and frequency. They know that if they stretch professional caregivers too thin, they will burn out and ultimately affect the quality of care. This is even more true when the “patient” is a family member. Unless you set boundaries around your caregiving, you can end up feeling like you are on-call 24/7, a fast track to burnout. Try to carve out at least a couple of hours a day when someone else can assume caregiving responsibilities. Take time away from the home and engage in activities that replenish, as opposed to deplete, you. Let your family members know that there will be times that you will not be available except in the case of an emergency.
Ask for and accept help
Try to delegate as many tasks as possible to family members, friends, and neighbors. Reach out to your local high school to see if there are students interested in being an “elder companion” in exchange for community service hours. Younger children can help with tasks like preparing and delivering food or providing mental stimulation in the form of games or puzzles.
Utilize adult day care programs
Adult day care programs allow elders to socialize with their peers while giving caregivers a much-needed break. Contact your local senior center or council on aging to see what services they offer to elders in your community. You can also access the National Adult Day Services Association’s online directory here.
Make a plan for self-care while sandwich cargiving
Sandwich caregivers often find their own needs languishing at the bottom of the priority list. Unless you are intentional about when and how you are going to fit in self-care, it often gets overlooked. Put that yoga class on the schedule along with grandma’s appointments and the kids’ soccer practices. Try to resist the urge to “bump” your self-care activities except in cases of true crisis. Consider joining a support group for sandwich caregivers so you can share strategies and encouragement.
Keep the lines of communication open
Be honest with your family members about the challenges of sandwich caregiving, and allow them to express their feelings about the situation, too. Some families find it helpful to schedule a weekly or monthly meeting where they can discuss any developments and reassign responsibilities.
Give yourself LOTS of grace
Being caught in the middle of a caregiving sandwich is not easy. If you feel like there is not enough of you to go around, you’re right! Remember that you’re doing your best with the resources you have. Sometimes that means that a family member gets less of your time or attention one week. Try to look at the big picture instead of getting caught up on perceived failures.
Sandwich caregiving isn’t all doom and gloom. Despite the multiple challenges that Kate faced when caring for her mom, she now looks back on her time as a sandwich caregiver with some nostalgia. “As hard as it was, I’m glad we had that time together,” says Kate. “Caring for an elder, you have to slow down and meet them at their own pace. And that gave me the space to appreciate little moments that I otherwise might have ignored.”
*Note: name has been changed to protect privacy
Lindsay Schwartz is a psychotherapist in private practice in Acton, MA, where she specializes in the treatment of depressive and anxiety disorders. She has a background in school counseling and a special interest in mindfulness-based treatments. Lindsay earned her Bachelor’s degree in Psychology and English from Williams College, and her Master’s degree in Social Work from Simmons College. In her free time, Lindsay enjoys writing, reading, running, and spending time with her husband and 2 children.