Rethinking Caregiving Support for the Sandwich Generation

The "sandwich generation" refers to adults who are simultaneously caring for their children as well as older parents or relatives. This places unique strains on caregivers, who must balance their family responsibilities with work and their own self-care. As Guy Weissinger, PhD, MPhil, RN, the Diane Foley Parrett Endowed Assistant Professor at Villanova University’s M. Louise Fitzpatrick College of Nursing notes, many feel like they are being "shortchanged" on both sides—unable to fully support their children or their aging relatives. The result is stress, guilt and difficult decisions about how to allocate limited time and resources.

“Hard decisions are also a psychological tax,” Dr. Weissinger says. “You have to use the resource of time and brain energy to weigh the options, so it compounds on itself every time they intersect. And that's complicated and hard."

These challenges have only increased due to larger societal shifts, according to Melissa O'Connor, PhD, MBA, RN, FGSA, FAAN, the M. Louise Fitzpatrick Endowed Professor in Community and Home Health Nursing in the College of Nursing.

"For the first time in the history of the world, older adults will outnumber children in the United States by 2035,” said Dr. O’Connor.

This rise in numbers of older adults foreshadows a looming caregiving crisis, as more seniors will require care without enough nurses and family caregivers to meet the need.

The sandwich generation can also feel overwhelmed due to lack of training in managing complex care needs. As Dr. O'Connor states, there is "no caregiver school" - instead it's "baptism by fire." Learning wound care, managing feeding tubes, giving medications and handling dementia behaviors on the fly can take an emotional toll. Caregiver stress and burnout have also been linked to declines in physical and mental health, and financial strain, as well as increased elder abuse (though unintentional), she says.

Dr. O’Connor believes that home health services can serve as a critical resource for supporting overwhelmed sandwich generation caregivers. Home health nurses, aides, therapists and social workers can provide skilled care, educate family members, assess safety and coordinate services.

"Home health can make or break someone's success at staying home,” Dr. O’Connor says. “It can also make or break the stress levels of patients and caregivers. If caregivers have support, they can do a really good job."

However, misconceptions about home health care persist. Many do not understand what home health services entail or worry about strangers entering their home. Although refusing home health may seem like the safer option to some, the consequences of caregivers trying to provide care without assistance can be dire. Isolated and overwhelmed caregivers who don’t have support oftentimes end up seeing their older adult parents experience health declines that necessitate nursing home placement, which takes a financial toll on families as well.

From Dr. Weissinger’s perspective, the caregiving crisis is a “family and a systems issue.”

“This is a systematic problem, so we need policy changes at the state, national, and organizational levels to address it. We can’t solve society-level problems through individual responses," he says.

Supporting caregivers and easing this crisis will require policy changes at the highest levels along with a societal shift in how we view and assist caregivers. Though individual families feel the squeeze, truly addressing the caregiving crisis demands broad, systemic solutions. With an aging population, the need for action in the form of policy change is more urgent than ever.