A Closer Look at Sandwich Generation Caregivers of Medicare Beneficiaries

Family caregivers have a critical role in our fractured system of long-term care, and sandwich generation caregivers are pulling double duty caring for people at both ends of the age spectrum. Early research has shown the negative impact the compounded responsibility of caring for an older adult while still caring for young children can have on caregivers’ physical health, well-being, and financial welfare.

Read the full report.

This report uses qualitative and quantitative data to depict sandwich generation caregivers to Medicare beneficiaries and the care they provide. Today, the combined dynamics of Americans delaying having children and younger generations taking on caregiving for older adults are leading to a new picture of what it means to be sandwiched between two generations who need daily care.

This is the first in a three-part series of reports on Medicare beneficiaries and sandwich generation caregivers of Medicare beneficiaries. Future papers will explore the specific experiences of working caregivers of Medicare beneficiaries and sandwich generation caregivers and the health and well-being of these groups of caregivers.

Data used

The data used in this study is 2021 data from the nationally representative National Health and Aging Trends Study (NHATS) and its supplement, the National Study of Caregiving (NSOC), led by the Johns Hopkins University Bloomberg School of Public Health and the University of Michigan’s Institute for Social Research, with data collection by Westat and support from the National Institute on Aging.

The NSOC data on caregivers are limited to Medicare beneficiaries ages 65 and older and do not include any information on sandwich generation caregivers providing care to someone 50 to 64 years old. This constraint is important to note because, according to the Caregiving in the US survey, almost 30 percent of caregivers of someone age 50 or older were also caring for a child or grandchild in their household in 2019 (AARP and National Alliance for Caregiving 2020).

Demographic highlights of sandwich generation caregivers

• The average sandwich generation caregiver to a Medicare beneficiary is 44 years old.
• Nearly 80 percent are Generation X, millennials, or Generation Z.
• Thirty-five percent of them identify as African American/Black or Hispanic/Latino.
• Nearly three-quarters (74 percent) are employed in full-time or part-time work on top of their dual caregiving duties.

Policy recommendations

The analysis shows that most sandwich generation caregivers are younger, working, and just building their economic futures. Effective policies must support the economic future of these caregivers and help them provide the best care possible. The report offers a detailed discussion of state and federal policy solutions, including:

• Paid sick and family leave laws to support care for both generations
• Protection for working caregivers from employment discrimination
• Financial support for caregiving-related expenses
• Help in navigating social support and health care systems

While sandwich generation caregivers report increased confidence in their abilities and closer connections to their care recipient, they also say that it is exhausting and stressful, unpaid work. It is critical that we understand their experiences and needs and advocate for policies and practices that support them and the valuable care they provide.