Sandwiched!
Navigating Intergenerational Caregiving
by Ryan Farmer, Biology and Psychology
How do adults who care for both aging parents and their own children navigate the social, emotional, and financial challenges of intergenerational caregiving? This paper serves to understand the strategies sandwich generation caregivers employ in regard to family dynamics, economic planning, and cultural differences. I synthesize existing literature on intergenerational caregiving in the United States. I focus on sociological research that examines both individuals and larger stratifications within the sandwich generation. This review merges major findings regarding the sandwich generation to gain a more cohesive understanding of known sandwich generation issues. Existing research suggests that society expects women to provide more social care to both children and elders than men. For all members of the sandwich generation, caregiving depletes savings, pushing back retirement age and increasing financial stress. Furthermore, there is a difference in intergenerational caregiving strategies between biological races: white and Asian Americans approach caregiving through financial support while black and Hispanic Americans contribute time and hands-on care. As most current research is constructed from already existing literature there is a lack of novel experimental findings on intergenerational caregivers. The review concludes with new proposals on how intergenerational caregivers can cope with the pressure of aiding others based on information from past and current research.
intergenerational caregiving, sandwich generation, family dynamics, economic planning, cultural differences
Introduction
With life expectancy increasing across the nation, the United States has seen a significant increase in what is known as the “sandwich generation” —those who take care of both their children and elderly parents. It is estimated that 12% to 24.3% of adults in the United States are a part of the sandwich generation (Owisany et al. 2023: 1). Raising one’s own children is already a challenge, yet this struggle becomes more taxing as adults must step into an additional role of caring for their own parents. What social, emotional, or financial conflicts arise with this choice? And, as Americans navigate intergenerational caregiving, what differences exist across cultures?
In this synthetic literature review, I blend multiple sources to create a cohesive narrative on the effects of sandwich caregiving. I utilize existing sociological studies to understand the complexity of multigenerational caregiving. This review focuses on studies from the past 27 years (1997 and beyond) done on American citizens. Most researchers utilize cross-sectional surveys and National Study databases to examine sandwich adults. Most existing literature on the sandwich generation focuses on heterosexual married couples in the United States, defining the trajectory of this evaluation. However, further research on homosexual couples and divorced couples with children should be conducted to fully understand the impact on non-nuclear multigenerational families.
In this review, the term “grandparent” is used to describe the elderly parent of an adult in the sandwich generation. Additionally, a grandparent can be a biological parent to a sandwich adult or an in-law. The term “child” refers to anyone ranging from a newborn to twenty-five years old whose parents still provide for them in a variety of ways– insurance, housing, telephone or car bills, school loans, etc.
Family Dynamics
Women vs Men
Women and men tend to differ in caregiving responsibilities. This begs the age-old question–who takes care of whom? Although in a society where women attain the same education level and work the same number of hours as men, there is still a divide between care- taking responsibilities. The traditional view that women should be homemakers remains prevalent even in the modern world. In non-sandwiched households, where parents only serve their own children, women average 137 minutes of aid per day while men provide 110 minutes (Dukhovnov et al. 2015: 192). In multigenerational families, the mother assumes the role of the primary caregiver of both the children and grandparents. Women average 181 minutes per day aiding children and grandparents while men will typically spend 157 minutes (Dukhovnov et al. 2015: 194). 24 minutes between sandwich women and men– while insignificant on paper– is the difference between a hot or cold meal at dinner time, an undisturbed or interrupted shower, a moment of relaxation or constant pressure. 24 more minutes per day a mother will spend caring for her children, parents, and in-laws than her husband will. Though men will devote less time to their sandwich responsibilities, they primarily provide financial support (Friedman et al. 2015: 194). With this concept of women providing time and men providing money, traditional gender roles emerge within the sandwich generation. However, caregiving contributions are amplified, now aiding three generations simultaneously rather than two.
Grandparents
Though sandwich caregivers are the main providers to their multigenerational households, grandparents also contribute to the family. To fully understand the dynamics of the sandwich generation, it is also necessary to examine the role of the elderly grandparents. For most households with multiple generations, there is an assumption of earned reciprocity: the parents pay for the living arrangements (food and shelter), while the grandparents provide care for the children (babysitting, tutoring, or driving to school events). This dynamic benefits both the grandparents and the sandwich generation adults; so largely that as the number of grandchildren increases, the likelihood of grandparents living in the home also increases (Rapp et al. 2023: 5).
This symbiotic relationship, however, only lasts while the grandparents are still agile with the ability to perform necessary tasks. Grandparents inevitably get older, require additional care themselves, and thus cannot provide the necessary level of support for the children (Carney 2024: 20). This creates pressure for the sandwiched parents to care for both their children and elderly parents. When that grandparent has a cognitive impairment—as 1 in 3 Americans ultimately develop—that stress intensifies (Solberg et al. 2014: 174). Sandwiched caregivers with a grandparent that has a form of dementia, typically develop feelings of irritability and anxiety that were not previously seen before the intellectual disability (Solberg et al. 2014: 174). Grandparents can alleviate responsibilities from sandwich caregivers until they begin requiring assistance themselves.
Well-Being
Physical Health
The physical health of multigenerational caregivers, single-generational caregivers, and non-caregivers differ tremendously. Multigenerational caregivers are less likely to exercise, check nutritional factors on food labels, and care if children use seat belts. Also, they are more likely to smoke cigarettes (Chassin et al. 2010: 8). The strain of being the primary provider of multiple peoples’ lives may lead to other health issues being overlooked. Thus, the health of sandwich caregivers is diminished.
Because women are likely the primary caregiver in sandwiched families, physical effects are commonly researched on them. In her 2015 phenomenological study, Allison Steiner analyzed nine American sandwich generation women of similar stature– between the ages 46 and 52, a post-bachelor’s degree, and the primary provider for at least one child between 6 and 25 years old and a geriatric adult between 40 and 85 years old. Steiner examined the participants’ health practices before and after becoming a sandwich caregiver. She found that health was negatively affected by caregiving roles; prior to being a part of the sandwich generation, women were more physically active and ate more nutritious meals. After stepping into the sandwich caregiving role, women reported a decline in sleep quality (Steiner 2015: 8). The intense demands of caregiving created physical, nutritional, and sleep-related strain for women in the sandwich generation.
Mental Health
Not only are there physical effects, but also mental ramifications associated with sandwich caregiving. Though increased psychological distress is correlated with sandwich caregiving, data leans toward the transfer of time or money to dependents as the direct cause of stress– not caregiving itself (Cheng et al. 2024: 6). Mental health issues stem from the conflicts created by being a multigenerational provider. Those in the sandwich generation have higher rates of labor force participation, producing a significant increase in financial and emotional strain as compared to non-sandwich caregivers (Lei et al. 2023: 8). In a study issued by Nancy J. Chapman, it was found that sandwich generation employees experience more stress and absenteeism than employees with only one caregiving role (1994: 1). Additionally, adults in the
sandwich generation report a lack of supportive services, such as childcare or therapy, for them which creates pressure at work, descending to mental health issues (Lei et al., 2023: 4). Adults who contribute to multiple generations, mainly through finances, are 1.6 times more likely to report mental distress than single-generation or non-caregivers. Adverse effects are more pronounced for sandwich adults who largely devote their time to caring for children and grandparents; they are 2 times more likely to report significant psychological distress (Cheng et al., 2024: 5).
There is a general trend that as caregiving responsibilities increase, so do levels of burnout. Burnout is a psychological condition defined by experiences of cynicism, emotional exhaustion, and decreased personal accomplishment (Maslach et al. 1997: 14). In a study that distinguishes child-caregivers, elderly-adult caregivers, and multigenerational caregivers from non-caregivers, all three types reported elevated levels of personal burnout as compared to non-caregivers (Owisany et al. 2023: 7). Thus, this indicates that caregiving has a direct correlation to stress levels in adults, leading to a decline in mental health.
Economics
Job Discrimination
The sandwich generation faces discrimination in the workplace that can hinder economic success. In a 2020 investigation, researchers conducted 3 surveys in order to determine bias in the hiring department towards those who are primary caregivers. 118 HR professionals and general managers were used as their sample. The first survey found that primary caregiver parents were less likely to be hired, were offered lowered salaries, and overall rated as less competent, available, and committed by hiring managers. Although similar patterns emerged in the second survey, it further clarified that sandwich women were given even less money and were rated more negatively as compared to sandwich men. The third survey revealed that sandwich caregivers were less likely to be hired in male-dominated fields, and if they were hired, they would be given less money. In both female and male dominated fields, sandwich caregivers were evaluated more negatively than single generation caregivers (Henle et al., 2020: 12). The research highlights the origin of financial stress for those in the sandwich generation. Not only must they provide for children and aging parents, but also, they must fight to be respected and earn fair wages in the workplace.
Asset Distribution
The planned allocation of finances by sandwich parents directly influences their children’s college funds. In the United States, where 37.9% of adults have bachelor’s degrees, it is common for parents to prioritize saving money for their children’s post-high school education (Schaeffer 2022: 2). Sandwich parents are twice as likely to have reduced college savings due to paying for their elderly parents’ healthcare rather than taking care of their own expenses. If elderly dependents limit what a parent can pay for their children’s education, the offsprings’ future earnings are potentially decreased (Bogan 2015: 614). The decreased investment into younger generations restricts human capital accumulation. The lack of intergenerational wealth transfers can set families back financially for many generations.
Retirement
With limited direct financial transfers from sandwich parents, children tend to rely on other forms of support from their parents, potentially delaying parental retirement. There has been a recent burst in what is known as the “boomerang generation”—young adults who return home to live with their parents, typically due to a limited job opportunities, lack of marriage, or inability to afford a house (Murphy 2019:3). Boomerang children have typically collected debt from student loans or other young-adult living expenses. To combat this predicament, parents will add the boomerang child to bank accounts and sign on to the child’s student loans, creating financial pressure and debt for themselves as they must run their own household and pay adult- expenses for their children (Murphy 2019: 4). For the sandwich generation adults, the financial burden of supporting children is compounded by the growing debt of aging grandparents.
According to the Federal Reserve Bank of New York and the Consumer Financial Protection Bureau (CFPB), the number of adults over 60 with outstanding loans has quadrupled from 2005 to 2015; 2.8 million Americans over 60 have unpaid loans (Murphy 2019: 4). Consequently, the debts of the elderly and young fall into the hands of the sandwich generation. The data highlights that members of the sandwich generation must work longer, pushing back the enjoyment of their own retirement, in order to support their family financially.
Cultural Differences
White Americans
There are different strategies utilized by sandwich caregivers based on biological race within the United States. As the race with the second highest national median income, white Americans can provide formal support without financial stress (Cravey et al. 2011: 307).
Though white Americans can financially support their children and aging parents, they tend to perceive an emotional burden due to sandwich caregiving. A study utilizing the Behavioral Risk Factor Surveillance System dataset revealed a direct upwards trend between intergenerational caregiving and poor mental health among white Americans: this correlation suggests that white Americans find sandwich caregiving to be more emotionally taxing than other races do (Do et al.
2014: 6). Furthermore, as the amount of economic resources for sandwich adults decreased, white Americans experienced an increasingly burdensome feeling of caregiving (Do et al. 2014: 6). This mental strain bleeds into a physical one too. White intergenerational caregivers typically have higher basal metabolic rates than white non-caregivers and are less likely to report good physical health (Do et al. 2014: 4). Though white Americans can support their “sandwich responsibilities” through money, there is a trade-off with mental and physical health issues.
Black Americans
Black Americans tend to welcome multigenerational caregiving, but the prolonged responsibilities combined with a lack of financial resources creates strain on their mental and physical health. Though black Americans have one of the lowest national median household incomes amongst races in the United States, researchers have found a trend that as black socioeconomic status increases, the likelihood of grandparents in the home also increases (Lee 2023:1). When money is not a barrier, black Americans are prone to accept sandwich caregiving. Further, a significant trend in the study of all sandwich caregivers is that as the number of children increases, the report of poor health also increases (Do et al. 2014: 6). However, this trend is amplified for black Americans: 26% of black Americans have at least four children, making them the race with the highest average number of children (Cravey et al. 2011: 308).
Black Americans are likely to care for elderly parents and have more children, which can lead to a build up of stress over many years (Cravey et al. 2011: 309). As the length of poor grandparental health increases, the personal physical and mental health of black sandwich adults decreases (Sohn 2024: 338). Being a sandwich caregiver does not initially create more stress for black Americans, but the prolonged effect of caring for a sick, elderly parent becomes a source of strain.
Hispanic Americans
Sandwich caregiving does not tend to place additional stress on Hispanic Americans due to cultural expectations. Hispanic families typically believe that taking care of aging parents is more responsible than placing the parents into nursing homes (Li 2024: 3296). This cultural stigma normalizes sandwich caregiving, placing less perceived stress on Hispanic providers.
Multigenerational households are more common in Hispanic Americans when Spanish is the primary language spoken at home, compared to when English is the main language (Lee 2023: 8). In families that prioritize traditional language and values, sandwich caregiving is a cultural convention. Hispanic Americans caregivers are less likely to utilize short-term care facilities, choosing to rehabilitate elderly family members within their own homes (Patterson et al. 2019: 8). However, Hispanic American women tend to be the primary caregiver, so responsibilities and potential pressure fall on them rather than men (Li 2024: 3296). In Hispanic cultures, taking care of family is an expectation, so Hispanic caregivers are less likely to see providing for both children and grandparents as an additional struggle as compared to other races in the United States.
Asian Americans
Sandwich Asian Americans tend to provide financial assistance to their wards yet have higher familial stress. Due to cultural values that emphasize filial piety—respecting and caring for elders—Asian American caregivers are likely to tend to multiple generations (Lee 2023: 8). However, because Asian Americans have the smallest average family size, they tend not to have siblings to help provide for aging parents, so they feel pressure to contribute entirely to caregiving (Cravey et al., 2011: 307). The median income for Asian American households is $112,800 which is the highest income for all races in the United States (Guzman 2024: 2). Because Asian Americans are likely to have more financial security and economic resources, they are able to support their aging parents and children monetarily (Cravey et al. 2011: 309). Though Asian Americans feel pressure to be the sole provider for their elderly parents, their financial freedom decreases the strain of sandwich caregiving.
Conclusion
There are many factors contributing to how the sandwich generation approaches caregiving. Cultural expectations and structural inequalities often place caregiving responsibilities on women, leading them to dedicate their time to dependents, while men are more likely to provide financial support (Dukhovnov et al. 2015; Friedman et al. 2015).
Grandparents, though traditionally seen as a nuisance, can aid with caring for younger children until they begin requiring additional assistance themselves (Carney 2024). However, the demands of caring for both younger and older generations places considerable strain on caregivers: sandwich adults have worse physical and mental health, marked by not prioritizing physical well-being and increased stress due to caregiving (Cheng et al. 2024; Steiner 2015).
Additionally, providing for multiple generations depletes financial savings, prolonging one’s working years until retirement (Murphy 2019). When examining caregiving strategies by race, white and Asian Americans approach sandwich caregiving from a financial standpoint and tend to feel more stress (Cravey et al. 2011; Do et al. 2014). Conversely, black and Hispanic Americans provide through time, but prolonged responsibility creates tension for primary caregivers (Do et al. 2024; Li 2024).
Based on the examination of existing literature, I have identified two ways for sandwich providers to cope with the stress of caregiving. Sandwich caregivers should focus on emotional and cognitive resources. Emotional resources are ones that help sandwich adults manage any depressive or anxious feelings about caregiving and plan for the later stages of their lives. These are resources such as support groups, family therapy, intergenerational group therapy, individual sessions, peer mentoring, and psychoeducational groups (Abramson 2015). Cognitive resources revolve around setting priorities based on an individual’s values. Examples of cognitive resources include goal-setting frameworks, time-management strategies, and structured reflection tools (such as journaling and decision-making charts). These can help stabilize one’s work-life balance (Neal et al. 2009). Psychologists highly suggest that sandwich adults do not self-isolate but instead lean into their family and friends when they need help (Neal et al. 2009).
Further research should be conducted on ways children or grandparents can assist the sandwich generation. How can aging adults best manage their finances to relieve future stress on sandwich adults? How can children care for both themselves and grandparents while still living at home? There is a lack of research in this area, yet knowledge on ways to assist adults can benefit multigenerational caregivers tremendously.
It is fortunate to be in a country where it is common for people to live with both their aging parents and their own children. The beauty of multiple generations living as one family should not be tarnished by the negative effects on the sandwich generation. The education of sandwich adults on the potential outcomes of intergenerational caregiving can mitigate these adverse results by preparing them for the future. It is crucial to recognize and support the sandwich generation; after all, they support us first and last.
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