Survival for the Sandwich Generation: Navigating the hidden costs for working caregivers

You're not alone — more than 40 million family caregivers provide 80 percent of long-term care in this country

Published May 20, 2018 11:00AM (EDT)

 (Getty/Dean Mitchell)
(Getty/Dean Mitchell)

It began years ago: my father wandered off from a family gathering and became disoriented. Things started to add up: missed appointments, mistakes with the bills, getting lost driving to the post office. At age 72, my dad had dementia. So began our family’s long caregiving odyssey — a journey so many of us will take over a lifetime.

Along with my mother and siblings, I joined a large and growing club: the more than 40 million family caregivers who provide 80 percent of long-term care in this country. Most of us don’t even identify as caregivers. We’re just trying to do our best to help Mom or Dad, yet constantly feeling we’re not doing enough.

By 2050, the population of people over 65 is projected to nearly double. An estimated 70 percent of them will need some type of long-term care. The responsibility for providing that care will most likely fall on us: daughters, sons, nieces, nephews, grandchildren, spouses — even friends and neighbors will pitch in.

Well-heeled caregivers are fortunate enough to have financial resources to pay for care. Others will rely on state and federal funds to supplement their efforts. But almost all of us — rich or poor — are simply unprepared for the emotional and financial challenges of being a family caregiver.

Like many caregivers, I was in the workforce, sandwiched between the needs of my three kids and a dad with dementia. The number of adults getting squeezed from both ends will only grow. I became one of the nearly half of American adults in their 40s and 50s who are in the Sandwich Generation — caring for a child and an aging parent, not to mention having a full-time job.

In many ways, though, my family was fortunate. Once my mother could no longer safely care for my father at home, we made the tough decision to move Dad to a nursing home, with an annual price tag of $90,000, which we could afford, at least for a while. When the money started to run out, we relocated my father, a veteran, to the local soldier’s home at a fraction of the cost.

Most of us plan ahead for the costs of caring for our kids, but when it comes to caring for our parents, we are caught off guard. Parents often stock away funds for big-ticket college expenses right after their children are born. But many of us underestimate the cost of long-term senior care, and the same type of financial planning doesn’t typically take place when considering the needs of aging parents — or ourselves.

We think Medicare will step in when we need it. Think again.

A big shocker for many is that Medicare, the primary insurer for 55 million older adults and people with disabilities, does not typically pay for long-term care. People dig deep into their pockets to pay for all sorts of things not covered by insurance, such as medicine, medical supplies, food, transportation and household expenses. On average, family caregivers spend roughly $7,000 per year on out-of-pocket costs related to caregiving. For the average family caregiver, that’s a whopping 20 percent of annual income.

Many caregivers also cut back on other spending, which can jeopardize a family’s financial security and wellbeing. According to a recent AARP study, 30 percent of family caregivers dip into their personal savings to cover long-term care costs, 16 percent reduce contributions to their retirement accounts, and about half cut back on leisure spending. What about that college savings plan for little Jimmy? Paying for Dad’s home health aide, who he needs on Tuesday, may come first.

The tough reality is that many families aren’t rich enough to afford the staggering cost of long-term care. Yet at the same time, they don’t qualify for Medicaid, a health care program for eligible low-income and disabled adults. That was the case with my father, who spent six years in two different nursing homes. Most caregivers focus on the obvious costs of long-term care, such as hiring an in-home caregiver or paying for a nursing home. But there are many other unexpected costs.

And it’s not just baby boomers who need to be worried about this. One in four family caregivers is a millennial and about half are under the age of 50. There are a lot of us in this boat and most are in the workforce. Jobs and caregiving don’t always go together well.

Four months after my father died, my mother fell and broke her femur. After surgery, she was in rehab for weeks, then returned home alone in a wheelchair for seven long months. During that time, I frequently left work early and took time off to help out. I was not alone. Close to 70 percent of working caregivers experience work-related disruptions due to their dual roles, and it’s not something you can easily hide. The fear of getting “the call” is always in the back of your mind because you know you’re just one crisis away from it all falling down like a house of cards.

Sooner or later, you’ll come in late, rearrange your work schedule, or cut back your hours entirely. Maybe you’re showing up to work, but aren’t able to focus on the job because you’re distracted and stressed out. What happens when your body is perched at your desk and your head is weighed down with Dad’s dementia or your frail mom who has to care for him?  It may not be absenteeism, but it is a problem. Employers call it “presenteeism.”

In fact, it’s estimated that presenteeism costs employers even more than absenteeism. Speaking of which, the average working caregiver misses about six and a half days per year. When the going gets really tough, some people quit their jobs altogether. But there’s often a heavy cost for those who do. Over a lifetime, employees who leave the workforce to care for a parent or family member lose close to $300,000 in wages and benefits, and the amount is ever higher for women.

Working caregivers who live paycheck-to-paycheck are often hit hardest by the financial strain of out-of-pocket long-term care costs. Many are lower-income women of color caring for a parent or family member who needs daily help requiring hands-on assistance like bathing or dressing. Employed in restaurants, retail, factories and healthcare, these workers struggle to keep their heads above water and eke out livable wages. When they become caregivers and have to pay for a host of unanticipated expenses, their shallow financial well may run dry. It’s much harder to come forward and ask an employer for support if the risks feel too high.

So how can you juggle it all and avoid the common pitfalls of being a working caregiver? Fortunately, there is some good news. Employers have some skin in the game and, increasingly, they’re providing benefits that serve both ends of the caregiving spectrum, from children to seniors. Lost productivity, absenteeism and workday interruptions due to caregiving costs U.S. businesses up to $33 billion annually. And that doesn’t include an extra $13 billion per year in healthcare costs, because caregiving employees get sick more often than their non-caregiving counterparts. Whether they recognize it or not, there’s a financial incentive for employers to step up to the plate.

During the years that I was helping care for my father, I found myself spending a lot of time in my car. It was a two-hour drive each way along the Massachusetts Turnpike, from my home outside of Boston to the western part of the state where my parents lived. I looked forward to these visits, especially my father’s sweet smile of appreciation when I arrived.  Eventually the frequent trips, along with a full-time job, three teenage kids, and a husband who traveled on business, took a toll. I felt stressed and overwhelmed. What made it even remotely possible was that I worked for a boss who gave me the flexibility and support I needed.

Keeping your job and caring for your parent at the same time should not depend on being lucky enough to have an understanding manager, but it often does. Many caregiving employees are afraid to speak up and advocate for themselves. They push themselves harder, heap more onto their overflowing plates, and eventually don’t do a very good job of caring for anyone, including themselves. No one should have to choose between work and caregiving. Even if you have to cut back or take a leave, there are steps you can take to keep your job and salary afloat — and care for Mom too.

1. Don’t suffer in silence

If you don’t advocate for yourself, chances are no one else will. Ask your manager or human resources department about employer-supported benefits such as backup care and resource and referral programs. Check to see if there are there workplace policies, such as flex-time, so you can adjust your schedule and spend more time caring for Mom if needed. If you need extended time off, ask about the company’s family medical leave policy. Companies with 50 or more employees are obligated by law to allow employees a protected leave of absence to care for children or aging parents. This is typically without pay, but it can save your job.

2. Remember the Scouts' motto: Be prepared

Learn about payer options: Medicare, Medicaid, long-term care insurance and veterans’ benefits. What you don’t know can hurt you. Some employers offer seminars and webinars on eldercare topics, which can teach you some of the basics. Or you can go to for information about long-term care and how to pay for it. Elder law attorneys can provide you with much-needed information about estate planning and Medicaid eligibility that can steer you in the right direction. Learning the financial landscape ahead of time often results in less confusion and better outcomes if you’re faced with an eldercare crisis.

3. Have the talk about money

Discussing money is one of those thorny, uncomfortable subjects that adult children and their parents often avoid, to their own detriment. Viewing money as a private matter is ingrained in our American culture, particularly for the generation that came of age during World War ll. But it’s precisely these candid conversations about money that enable caregivers to chart a pragmatic course based on realistic options.

Sadly, your parents won’t need your help forever. During the months or years they do require support, it’s important to stay grounded in the present while anticipating and planning for their care down the road. If you leave the workforce altogether to focus on caregiving, you may end up hurting your own financial future. Finding a caregiver-friendly employer can make a big difference. And while you can’t cram for a crisis, getting support and information early on can help you navigate the twists and turns of this unpredictable life journey and keep you focused on what really matters — being there for your loved ones.

Children’s health care in crisis

Is Trump failing kids?

By Jody Gastfriend

Jody Gastfriend is the author of "My Parent’s Keeper, The Guilt, Grief, Guesswork and Unexpected Gifts of Caregiving" and is Vice President of Senior Care at

MORE FROM Jody Gastfriend