Dilemmas and Solutions for Americans Raising Children While Caring for Elderly Family Members

Approximately half of middle-aged people in American provide financial, health, or emotional support for adult parents and minor or adult children. The term “sandwich generation caregiver” emerged in the 1980’s to describe middle-aged people who support minor children while providing physical, emotional, financial, or legal assistance to adults. Of course, doing so much exacts personal costs. Sandwich generation caregivers often experience stress-related illnesses, lost income, and decreased work productivity. They also find it harder to provide prolonged assistance to adult children. 

Historically, caregiving could be shared by extended family members who lived in close proximity. Now more people relocate for career opportunities. Younger people may do senior care at a long-distance, or aging parents may move closer to one of their adult children and increase the burden on that family. Caregivers who are employed full-time and taking care of multiple family members must adjust their work schedule and often take unpaid leave to fulfill obligations. They may lose Social Security and pension benefits or experience stressful financial strains that can cause them to become ill. Very often, sandwich generation caregivers choose to attend to the health of a child or parent and neglect their own health. Poor caregiver health is becoming a public health issue.

Sandwich generation caregivers also face barriers in the workplace and increase the cost of health care for employers. Health care costs for caregivers are approximately $13.4 billion greater than for employees that do not have caregiving responsibilities. Working caregivers may have a hard time juggling the crushing time demands of work and caregiving; and they may pass up promotions, decrease work hours, and take unpaid leave because they have depleted paid vacation and sick days. Caregiver absences cost the U.S. economy $25.2 billion annually in productivity; and workers often quit jobs, lose lifetime wages, retirement savings, and pension benefits. Less than half of U.S. employers offer flexible schedules or the opportunity to telecommute to accommodate caregiving tasks.

Guilt and Exhaustion

Sandwich generation caregivers at the same time express guilt that they are not doing enough – and say they feel exhausted from doing too much. Guilt and exhaustion about how caregiving affects their children is a perpetual undercurrent of stress that affects their own health. In one of my research interviews, Sophie said “I was a single mom at the time…[my kids] really needed me here and then it would be my night to go shower mom and put her to bed… I'd cry sometimes all the way there and then I'd get there and Mom would be sitting there, facing the wall …and then on the way home you'd cry because…how could I think that I didn't need to be there.”  And in another interview, Ellie explained that she felt  “…sometimes it's almost like a ball and chain and then I think, "What am I teaching my kids... I want them to have the freedom to live their life without feeling obligated to take care of me someday. And sometimes I wonder how strong a message I'm sending in that regard.”

Self-Care Helps Caregivers Cope – and Jobs Can Too

Parenting and caregiving are both consuming roles – yet many caregivers understand that they still need to take care of themselves, because otherwise the pressure or anxiety can be overwhelming. Self-care takes many different forms for sandwich generation caregivers: leisure, exercise, and socializing. Abby, for instance, told me that even during the hardest part of her caregiving experience she still did Friday night dinner and cards with her husband and friends, took her Tuesday golf outing, and walked her dog daily. Abby realized that carving out time for herself helped her stay healthy and not resent taking care of her dad. Similarly, at the beginning of our interview, Zach, said he “was not the type of person to feel guilty” about taking time for himself. He incorporated his kids into his coping strategies by going for long walks with them. 

Not only do most sandwich generation caregivers need the wages and benefits that work provides, they also need a break from caregiving. Work sometimes offers a “guilt-free” break, allowing them to feel productive and serving as either a social outlet or a place for solitude, as two interviewees explained:

• Chloe stated that caregiving was mentally and physically exhausting.  She admitted that it was hard to not feel guilty about taking time for herself but she had a “wake up call” during a physical when her cholesterol and blood sugar were elevated. She allowed herself to relax and socialize during her quarterly conference for work. 

• Leah believed the hardest part of being a parent, caregiver, and professor was that she was “always surrounded.” Leah said that she didn’t take any time for herself. She felt she had to work to make up for the “hole” she put her family in to earn her degree but then she revealed that being in her office at work was like a “retreat”.  She could play music and work at the computer and just be by herself while she graded papers and worked on her research.

What Employers Can Do

Employee assistance programs, flexible schedules, and telecommuting options can reduce some of the stress sandwich generation caregivers experience. Such employees often miss work due to caregiving tasks and their own poor health as a result of stress. They may not have the time to practice preventative health habits and coping strategies, and some develop cardiac, psychological, and chronic illnesses. Employee assistance programs can reduce such problems, to the benefit of all concerned. Employers can, for starters, create a supportive environment for caregivers and help them to seek and utilize institutional and community resources. In some cases, flexible schedules and telecommuting may allow caregiver workers to maintain their job productivity and prevent valued employees from having to reduce work hours or quit altogether. Employers and fellow employees should also realize that for some caregiver workers time at the office can also act as a coping strategy because it offers a physical and emotional break. This should not be seen as a problem. When caregivers practice self-care, they are healthier – and can be more productive even as they balance the complex demands of their work and family responsibilities.