'Sandwich generation' caregivers feel emotional, financial strain

Martha Miranda, 52, a Deer Park mother of four, shoulders the responsibilities of caring for her 86-year-old mother, who requires help with day-to-day living, while also supporting her 18-year-old special-needs daughter.

The burden was recently lightened for Miranda, who also has three self-sufficient grown children, after her husband took a leave of absence from his job to help care for her mother. Still, she knows the day will soon come when he must return to work and she once again feels the full weight of those duties.

“My husband is helping now, so it’s a little easier,” said Miranda, a full-time office assistant. “But from March through July when I was on sick leave taking care of her, it was a tough time. I felt burned out ... I would just get in my truck, take a drive and cry.”

Miranda is part of the “sandwich generation,” mostly middle-aged adults (ages 40 to 59) who are simultaneously caring for aging parents and raising or supporting dependent children. Those interviewed say the demands of juggling caregiving for two generations often lead to emotional and physical strain and — due to rising care costs and because they can limit one’s ability to work — impact financial well-being.

A 2014 Pew Center survey found roughly one-quarter of American adults belong to the sandwich generation. And nearly 64% of those caring for both an aging parent and children are women, according to a 2020 study by New York Life, a life insurance company headquartered in Manhattan.

Long Island-specific statistics were not available, but a 2023 AARP analysis found that the average age of a caregiver for a Medicare recipient who also has a child at home is 44. The demographic is also more diverse than that of caregivers without a child in the home. About 20% of sandwich generation caregivers are Black and 15% Hispanic, compared with 11% and 10%, respectively, for non-sandwich generation caregivers, according to AARP.

And while the work is tiring and unpaid, more than 90% of sandwich generation members said it brought them closer to the care recipient and about 80% said it made them more confident in their abilities, the AARP analysis found.

Factors contributing to the growth of the sandwich generation, experts say, include an increase in life expectancy, delayed childbearing and family dynamics.

“People who may be caring for ill parents or grandparents and children or grandchildren at the same time while juggling job demands could be in a stressful and precarious situation,” said Allison Aiello, the James S. Jackson healthy longevity professor of epidemiology at Columbia University’s Mailman School of Public Health. “The wear and tear on the body from these stressors may cause elevations in inflammation and cortisol [a primary stress hormone] and ultimately lead to chronic health conditions, such as cardiovascular disease, diabetes and poorer health at an older age, along with a higher risk of depression.”

Constant juggling act

For several years, Tara Mooney, a mother of two teenage children, said she balanced her job as a school custodian while helping her father care for her mother, who was diagnosed with dementia. After her mother moved into a nursing home, the Shirley resident’s life settled into a quieter rhythm — until her father had a disabling stroke.

“My mother’s diagnosis was emotional and tough, but my dad’s diagnosis was a sucker punch because I was not prepared for it,” recalled Mooney, 50, whose father needs assistance to walk and is in a nursing home. “I would cry in the shower and had insomnia because I’d focus on to-do lists while trying to go to sleep.”

Even though her parents live in a nursing home, her caregiving duties continue. Mooney said she acts as a liaison between her parents and nursing home staff and often fields calls from health insurance representatives while managing the couple’s finances. Her 19-year-old son attends college, but her 16-year-old daughter is a high school junior and depends on her mother to drive her to activities and for rides home from school. “Sometimes, I feel like there aren’t enough hours in the day,” she said.

Earlier this year while juggling a full-time job and caregiving duties for two generations, Miranda said she always felt pressed for time.

Serving as her live-in mother’s primary caregiver, Miranda helped her navigate the stairs to her basement apartment, bathed her, drove her to and from doctors’ appointments (which involved carrying her mother’s heavy wheelchair up and down the stairs in her home) and provided emotional support.

After tucking her mother into bed, Miranda would help her special-needs daughter with her homework. On some nights, she would squeeze in grocery shopping before finally calling it a day.

“The most challenging parts of my day were carrying my mother’s wheelchair up and down the stairs, bathing her and trying to understand what the doctor was saying during her medical appointments,” said Miranda, whose mother refuses in-home help with caregiving.

Since her mother’s health insurance-approved wheelchair was too cumbersome to lift, Miranda said she purchased a lighter, more portable one out of pocket and has been spending more money on food and household utilities. With her husband on an unpaid leave of absence, money is tight, she said.

Emotional, financial toll

According to a 2022 University of Michigan study, sandwich generation caregivers were “twice as likely to report financial difficulty and more likely to report substantial emotional difficulty than their peers who only act as caregiver to a parent over 65.”

Experts say dual caregivers often feel “overwhelmed all the time and like they are falling short in all areas of their life,” said Sarah McMillan, a marriage and family counselor in Massapequa. “They are your parents and they raised you, so you want to take good care of them, but at the same time you feel you’re shortchanging your kids, your marriage, your job and yourself.”

Jiji George, 50, says her caregiving responsibilities pull her in many directions. The New Hyde Park mother of three is a full-time nurse practitioner and the primary caregiver for her live-in parents. George juggles a demanding job while also driving her parents to their frequent doctors’ or physical therapy appointments or her 13-year-old twins to music lessons or their math tutor. Every evening, she also prepares three Indian-style meals for her parents, natives of India.

“It is very challenging to balance both being a caregiver and caring for children and going to work,” said George. “I feel burned out trying to meet everyone’s needs.”

But self-care is often last on caregivers’ checklists. Adults in the sandwich generation express feeling perpetually on standby, McMillan said.

For Mooney, the need to be constantly “on call” has led to cutting back on the number of family vacations each year. “I feel bad being away,” Mooney said. “I’d feel guilty if something happened to them if I’m not here.”

Stacy Pellettieri, a clinical social worker and the owner and founder of Long Island Counseling in East Meadow and Melville, said stress is often heightened by a sense of guilt for believing you are not doing enough, shame for prioritizing self-care over caregiving responsibilities and resentment toward the person you are caring for due to feeling overwhelmed.

“When you find that you’re constantly thinking, ‘I can’t plan anything for myself because I have to make sure I’m available for my kids or my parents . . . because there are so many people needing my time,’ that’s a sure sign of burnout,” Pellettieri said. “Feelings of guilt start to overwhelm you and before you know it, resentment and anger.”

Thomas Buckman, 60, is the father of two teenage children and a caregiver for his ailing parents, both in their 80s. Although his parents receive some in-home caregiving help, the East Rockaway resident said his mother, who has dementia, calls him multiple times a day, complaining that the “temperature in her house is too hot, or the thermostat doesn’t work or her TV remote is dead,” he said.

“The hardest part are the phone calls all day,” said Buckman, who often puts in 14-hour shifts at his heating and air-conditioning business and sometimes has to help his wife shuttle their children to activities or pick them up from school. “I’ll tell her, ‘You already asked me this question, and I’m taking care of it.’ I have days where I’m overwhelmed.”

Experts say relaxation is crucial for caregivers to prevent burnout, reduce stress and maintain mental and physical health. “There is a high level of demand on you, and you’re only human,” McMillan said. “You need to decompress and recharge because you can’t keep giving from an empty well.”

Long Island Counseling’s Pellettieri agreed. “When self-care goes out the window, you burn out and feel like you can’t control what’s around the corner,” she said. “It’s OK to accept the limit of what you actually can do because you only have so much time, so much money and so much of you to go around.”