Sandwich Caregivers: Holding it All Together

Bathing and grooming, managing medications, toileting assistance and wound care may pop to mind when you hear the term “caregiver.” These activities are very much under the umbrella of caregiving, and so are dropping off groceries once a month, mowing someone’s lawn, or giving a ride to a doctor’s appointment.

12 of Ohio’s 88 counties have more adults over 65 than they do children under 18.

Ohioans are growing ever more familiar with the tasks associated with caregiving, and how they can vary widely in the time, financial and emotional investment required of the caregiver. Our communities are aging is a demographic fact – one that Community Solutions has written about on numerous occasions. In fact, the latest Census estimates show that twelve of Ohio’s counties have more adults over 65 than they do children under 18. With more aging adults comes an increased reliance on family caregivers.
In March 2023, AARP released an update to their Valuing the Invaluable report, which highlights the importance of family caregivers. The report estimates the economic value of family caregivers nationwide is $600 billion. This figure represents more than the total out-of-pocket spending on all health care and an increase of $130 billion from the estimate four years prior. In Ohio, the estimated economic value of family caregivers is $21 billion. This figure is based on an estimated 1,460,000 caregivers in Ohio; another way to say 1 in 6 adults in Ohio are family caregivers.

1 in 6 adults in Ohio are family caregivers.

National surveys suggest that caregivers spend an average of 18 hours a week on caregiving, with many spending even more time. The estimate of the economic value of caregivers does not take into account the out-of-pocket costs caregivers incur. A 2021 survey of caregivers found that, on average, family caregivers spend over $7,000 on out-of-pocket costs for caregiving activities annually.

What are Sandwich Caregivers, and why are the demands on them different?

The report pays special attention to sandwich caregivers – those caring for an older adult while also raising a child or a grandchild. In 2019, 30% of all caregivers were sandwich caregivers. This is an increase from 13% in 1999. Sandwich caregivers are younger than other caregivers, including both Gen Z and millennial generations.

While overall 60% of caregivers work a full- or part-time job in addition to caretaking, sandwich caregivers are even more likely to be employed. As a result of being younger, sandwich caregivers have fewer financial resources or supportive work benefits, which results in higher levels of financial and emotional stress. The demographic forces of having children later in life and increased longevity means that the number of sandwich caregivers is set to continue to grow.

More women than men are caregivers and minority caregivers are overrepresented.

Disparate impact across demographic populations

Not surprisingly, the burden of family caregiving is more often felt by vulnerable populations. More women than men are caregivers and minority caregivers are overrepresented. Where family caregivers spend, on average, 26% of their income on caregiving activities, this percentage rises to 34% of their income for Black caregivers and 47% of their income for Hispanic/Latino caregivers.

Age is a factor as well as economics. Hispanic/Latino caregivers are more likely to be younger and in the sandwich caregiver role than other groups. The financial costs that come with caring for an older relative exacerbate the existing financial stresses on families, such as inflation, childcare costs, and cuts in supportive programs.

Policymakers and employers should take note

Policymakers and employers can do more to support caregivers. The National Strategy to Support Family Caregivers lays out almost 500 actions that would support family caregivers. Some of the more concrete suggestions include providing financial assistance and employment support to family caregivers.

  • Federal or state tax credit
  • Direct payments through Home- and Community-Based Services
  • Improving Social Security benefits for family caregivers who have had to reduce work or quit entirely to assume a caregiver role
  • Expanding FMLA to apply to employers with fewer than 50 employees
  • Requiring paid FMLA
  • Requiring employers to provide a reasonable number of sick days

Any employers who care about supporting their employees can voluntarily adopt these policies, as well as provide flexible work arrangements, caregiving resources, or peer resource sharing and support groups.

A personal note

Rosalynn Carter has said, “There are only four kinds of people in the world—those who have been caregivers, those who are currently caregivers, those who will be caregivers and those who will need caregivers.” This topic is personal for me and given the scope of family caregiving in our country I imagine it is personal for many others as well. I witnessed my mother as the primary caregiver for her parents, as well as losing both her parents when she was a young mother; younger than I am now.

While I am not yet a caregiver, I am an only child and have always known that when my parents need assistance in the future, I will be there for them. I feel immense gratitude that I can rely on “Grandma Uber” as my mom refers to her role in shuttling my kids to and from activities this summer and have not had to step into the stress of the sandwich caregiver role. I hope that when that day comes, our society will have made strides in the support available for that invaluable responsibility.