When I was pregnant with my now 8-year-old, my mom’s mental health declined. My dad had passed away years prior, my sister lived hours away and my brother worked double shifts, so I took on the burden. I rented out my house and moved in with her. The pandemic intensified my struggles as I worked remotely while I tried to manage her care and my toddler’s needs. Although things have stabilized with help from my brother and a home health aide, years of juggling these responsibilities left my health and well-being neglected. There’s a name for what I was going through—and it turns out I’m far from alone: I’m a part of what is called the “sandwich generation.” We’re sandwiched between caring for elderly parents while still having our children’s mouths to feed.
What does the sandwich generation mean?
The term “sandwich generation” describes those caring for elderly parents while still caring for their children. In the United States, middle-aged adults 45+ are the largest demographic to be considered members of the sandwich generation. Dr. Tina Sadarangani, an assistant professor at New York University specializing in geriatrics, says, “What happens in every family, even if there are eight siblings, is that somebody ends up taking on the lion’s share of responsibility.” Dr. Sadarangani, a family caregiver herself, adds that the strain can be hard to shoulder.
If you find yourself in this position, know you’re not alone. Drawing from my experiences and Dr. Sadarangani’s expertise, keep reading for guidance in navigating these dual caregiving demands.
Emotional implications faced by the sandwich generation
Being in the sandwich generation can take a toll on your mental health. “Caregivers are more likely to experience greater rates of depression and anxiety, as well as higher rates of chronic health conditions,” says Dr. Sadarangani. She also notes that older kids and teens are absorbing some of that load because they’re old enough to take in what’s happening and to help care for grandparents. “However,” she warns, “caregivers must learn to prioritize their well-being and teach their kids to do the same.”
Mindfulness became a vital tool for me. Meditating with my daughter using the Calm app since she was three created a relaxing ritual. Now at eight she reminds me to breathe during stress and asks for hugs when overwhelmed.
Dr. Sadarangani also recommends self-compassion and forgiveness for you and your kids. “Don’t hold anyone, including yourself, to unreasonable standards,” she advises. She recommends seeking therapy for you and your child if you find yourself both being pulled between duties, as it can help navigate the emotional toll of caregiving and provide much-needed insight.
Time management tips for sandwich generation caregivers
Managing caregiving demands while meeting family needs requires strategic time management. Through funding from the National Institutes of Health (NIH), Dr. Sadarangani helped create CareMobi, a free app for caregivers. “They can invite anyone to be on their care team, keep track of their loved one’s day-to-day health progress, eating, sleeping, and medications,” she explains. Another helpful tool is the Cozi Family Organizer, which allows caregivers to coordinate tasks and keep everything organized in one place.
For me, the “Rocks, Pebbles, Sand” method, introduced by Stephen Covey in The 7 Habits of Highly Effective People, was very helpful. Using my iPhone’s Notes app, I categorized tasks: Rocks—priorities with the greatest impact; Pebbles—less urgent but necessary tasks; and Sand—small tasks that often distract from what matters most. This approach helped me focus on priorities and avoid feeling completely burnt out.
Financial burdens, planning and resources
Being a caregiver can cause tremendous financial stress, too, because often personal savings are used when financially supporting your parents and young children. AARP estimates that caregivers spend an average of $7,000 a year on out-of-pocket costs.
If your money burdens become too much, you don’t have to shoulder them alone. If you can, Dr. Sadarangani suggests considering hiring a certified financial planner to help you manage your household bills, money for your kids (like extracurricular activities and college tuition) and protect your retirement savings as you are handling caregiving expenses. Some charge on a sliding scale and often show a return on their investment.
If that’s out of your budget, she recommends contacting your Area Agency on Aging (AAA) a network of local organizations across the United States that provide services and support to older adults and caregivers. AAA can assist with understanding and enrolling in programs like Medicare, Medicaid, or Supplemental Nutrition Assistance Program (SNAP). To find your local office, contact AAA by calling 1-800-677-1116 or visiting their website.
Legal considerations: HIPAA vs. medical power of attorney
Dr. Sadarangani emphasizes the importance of having the right legal documents in place. She says that consulting with an elder care lawyer is essential for estate planning, power of attorney, wills, and any potential guardianship arrangements.
She also says to recognize the difference between two important medical forms: HIPAA and medical power of attorney. “The HIPAA form can be signed in your doctor’s office and it authorizes them to speak to approved family members,” she says. She notes that there’s also a HIPAA authorization form, called a medical power of attorney in some states. “This one allows you to make health care decisions if a person is unable to do so themselves. So, the first one allows you to get the information, the second allows you to make decisions on their behalf,” she says. Your loved one’s signature is needed but if they are unable to sign for themselves, an elder care lawyer can allow a family member to sign for them, with the consent of other family members.
Building a support network
Often, caregivers get frustrated that nobody’s helping. Dr. Sadarangani emphasizes the importance of finding your “village”. “You need to think of your village as a broader extended kinship network,” says Dr. Sadarangani. “Perhaps a neighbor, a friend or someone from your congregation can come over so you can run to the grocery store or take your child to practice while you nap. Find out their availability so you know who can help if there’s an emergency.” I had interior and exterior security cameras installed inside my mom’s home, and one friend took her to weekly art classes while the other occasionally babysat my daughter.
There are several resources you can tap for building that support network: National Alliance for Caregiving focuses on improving the quality of life for caregivers; the Caregiver Action Network (CAN) provides resources and support for caregivers of individuals with chronic conditions or disabilities; and the Elizabeth Dole Foundation that supports military and veteran caregivers. These organizations can help you find local respite care, which is a short-term service in your home or at their facility so you can travel, get rest, or attend an event at your kid’s school.
If you can, she adds, consider part-time or full-time caregiving, and adult day services, which are centers that provide supervised care for 4–8 hours a day, offering meals and social activities.
Once you have a support network in place, don’t be afraid to ask for help and be clear in how you ask for things. “Say, ‘Can you take over for an hour because I need to recharge,’ instead of assuming your family can read your mind,” she explains. When I learned how to communicate clearly with my brother, he began taking care of my mother’s nighttime routine so I could focus on my daughter and get rest.
Why it’s never too soon to start talking conversations
With your parents, Dr. Sadarangani says it’s never too soon to start conversations about their care before they need it. Say, “Who would you like to make your legal decisions and your medical decisions? Where would you prefer to live? They may make choices you don’t agree with, but it alleviates confusion later on,” she says.
For older kids and teenagers not telling them the truth can cause more harm than good. Dr. Sadarangani notes, “Shielding them can create uncertainty and anxiety on their part. A balance of honesty and reassurance is crucial.” She continues, “Saying, “Grandpa fell. He’s in the hospital. He’s being well taken care of,” can help alleviate fears without overwhelming them with unnecessary details or running to the hospital with no explanation. Communicating your feelings and learning to ask for help teaches your kids to do the same.
She also recommends considering someone who is an objective party—like a doctor, an aging life care specialist or a social worker— to mediate family discussions and help set clear boundaries and expectations when things get complicated or heated.
By acknowledging the challenges of caregiving in the sandwich generation and implementing the strategies and resources recommended by experts like Dr. Sadarangani, it is possible to navigate these complexities with more confidence and less stress. The key is balance, open communication, and taking advantage of the tools and support systems available.
