The Sandwich Generation: A Review of the Literature

Many Americans balance dual caregiving responsibilities for both children and aging family, dubbed the “sandwich generation.” Between 1 out of 8 and 1 out of 11 households with an adult aged 30 or older is comprised of dual-earner, sandwiched generation couples. There are psychological, physical, employment, and financial outcomes of balancing multiple caregiving duties. The literature shows positive benefits for caregivers too. A review of literature in the past 30 years, citing only U.S.based studies is summarized in this paper. Policy, clinical, and research implications are included. It is possible that multigenerational caregiving responsibilities will continue to rise for the children of baby boomers as life expectancies continue to go up, people continue to have children later in life, and continue to support those children to older ages. Policy and clinical supports must be put into place to facilitate the highly necessary and valuable caregiving responsibilities of this population. Florida Public Health Review, 2012; 9, 95-104. Background Many Americans are balancing dual caregiving responsibilities for both children and aging family members. Researchers have named this population the “sandwich generation” because they have both child rearing and aging family member caregiving responsibilities (Miller, 1981). The baby boom generation, between the ages of 45-55 years old, is often the focus of research on this population but it can impact any person of any generation as they balance multiple caregiving roles across generations. Sometimes the caregivers are referred to as the squeezed generation or stretched generation. The real sandwich occurs when people manage the demands of many different responsibilities and roles in their lives including those of parent, caregiver to an elder, and an employee (Keene & Prokos, 2007). Several demographic trends are putting caregiving pressure on middle-aged adults. Americans are experiencing longer life expectancies reaching just over 78 years old on average (CIA World Fact Book, 2011). Due to advancements in medical science, technology, and healthcare we have the oldest aging society in the history of the world. Fertility is on a steady decline in industrialized societies, and women are delaying parenthood into their 30s and 40s (Kent, 2011; Dye, 2010). This means that families are smaller, and the age span between grandchildren and grandparents is larger than it had been before. Sixty percent of all women are in the paid workforce, which means they must balance traditional caregiving roles with paid employment (U.S. Department of Labor, 2010). The mobile nature of today’s societies means that family members are dispersed across the country, which adds to caregiving complications and stressors especially given the “age in place” desires by today’s seniors. Several characteristics of the U.S. healthcare systems have created undue pressure on family members including a lack of coverage for long-term care and shortages in employees in the health care workforce. Medicare pays for the first 100 days following a hospital stay. If someone needs long term care beyond that, they either must have the financial resources to pay for it out of pocket or qualify for Medicaid (must have low income and little assets). Finally, the shortage in healthcare workers leads to family members providing care to loved ones rather than hiring professionals, which is also often cost prohibitive. This paper summarizes the literature on the sandwich generation in order to explore what is known about this population in the scholarly arena. Methods Academic Search Premier was used as the search engine. Four combinations of terms were used: (1) sandwich + generation, (2) multigenerational + caregiving, (3) care + aging parent + children and (4) caregiving + burden + generation. The search strategy included finding articles for which the terms came up in the abstract, title, or key words. Letters, editorials, book reviews, and metaanalyses were excluded. Only peer-reviewed articles that utilized U.S. studies (to avoid comparing the U.S. to countries with more developed long term health care programs) were included. No date range was given because the coinage of the term only dates back to 1981. A total of 833 articles were identified using this search method. Every article was scanned to determine its relevance to this review. Those that didn’t pertain to the topic were eliminated. Abstracts were read for the remaining 61 articles followed by full article readings to reach final inclusion decision. A set of criteria was established to determine whether an article was going to be included or not. Articles