The ‘Sandwich Generation’: Caring for Both Parents and Children

Increasingly, many people in their 40s and 50s find themselves simultaneously supporting ageing parents and helping teenage or adult children, as part of the so-called ‘sandwich generation’. This can create emotional, practical, and financial pressures, and is increasingly recognised as one of the defining challenges of midlife.

This page explores some of the challenges associated with being part of the ‘sandwich generation’. It explains how to recognise potential problems and also when you may need to seek help from others, including healthcare and social care professionals, siblings or other family members, and others. It also explores the concept of setting boundaries with those for whom you care, other family members and healthcare professionals.

What is the Sandwich Generation?

The sandwich generation is a term coined in the late twentieth century for people who found themselves caring for both ageing parents and their own children at the same time.

Anecdotally at least, the problem has arisen largely because of demographic changes over the last 30 to 40 years. It is a combination of people having children later, and their parents living longer, especially following serious illness.

If our grandparents had children in their early 20s, their parents were probably only in their 40s or 50s at the time. However, the parents of many of the sandwich generation did not have their children until their late 20s or early 30s—and neither did their children. Grandparents in their 60s when their grandchildren were born will be in their 80s by the time those grandchildren become adults.

We are also surviving more serious illnesses. In the 1970s, only 24% of those receiving a cancer diagnosis lived 10 years or more after that. Now, that figure is closer to 50%. However, these illnesses have a toll on those who have experienced them—and this toll is also felt by their families, especially their children.

Estimates suggest that around 3% of the UK population are currently caring for both parents and children. This sounds relatively low—but in a population of 70 million, that is still more than 2 million individuals, and the figure is expected to rise.

What are the Challenges of Being Part of the Sandwich Generation?

There are several key challenges that people caring for both ageing parents and children may face. They include:

• Recognising when your parents need help

  The first challenge, oddly enough, is actually recognising when your parents need help.

  It is difficult because most of us do not want to see that our parents are ageing. We don’t want to face their mortality—and we certainly don’t want them to become ill and frail.

  Paradoxically, it can be hard for both adult children living locally to their parents and those living further away to recognise changes, but for different reasons.

  • Those living nearby may see their parents often enough that slow changes over time are not obvious (a bit like the analogy of the frog in the pan of water being brought slowly to the boil). They adapt what they do and how they do it without really thinking about it.

  • Those living further away may find that their parents make a special effort when they are around. This hides the changes that have occurred since the last visit, and these children may only recognise that a change has occurred when a sibling living closer does something unexpected to help a parent.

  Case Study: Long Slow Change

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  Rachel lived near her mother Mary, and walked with her regularly. Over time, she had noticed how much more help her mother needed to walk over rough ground.

  Rachel’s brother James invited his mother, sister and her family to visit him in the Lake District. On the first day, James’ wife Anne took Mary, Rachel, and Rachel’s husband out for a walk before the children were awake. When they reached some stepping stones, Rachel automatically offered a hand to her mother, and helped her to balance over the stream.

  As they walked on, Anne said to Rachel, “I hadn’t realised your mum needed that much support now.”

  “Oh yes,” Rachel said, surprised. “She finds it hard to balance now. It’s been a while. Maybe a year? I hadn’t really noticed how much she’d changed until you said that, though. I’ve got used to it.”

  Later, James suggested a hill walk.

  “I’m not sure Mum will manage that,” Rachel said. “She and I can go out separately though.”

  “Of course she’ll manage!” James responded, glancing at their mother. “She managed last time.”

  “Well, only just!” their mother said. “I was really tired after the last walk you took me on. It took me several days to recover. I’ll just go with Rachel.”

  The glances exchanged between James and Anne told Rachel that this holiday was proving quite eye-opening to all of them—and a conversation later confirmed that. None of them had fully appreciated how much Mary had aged in the last year or so.

  Adult children may also wish to respect their parents’ independence, or simply avoid having a difficult conversation. This may mean that nobody takes action until affairs reach a crisis point, which can then be far more difficult to resolve than putting in some support earlier.

  Issues that you may need or want to consider include:

  • Whether your parents should still be driving (and if not, what they will do instead);

  • If they need help with shopping or other activities like housework or gardening;

  • Whether they have put arrangements in place for powers of attorney in the event of not being able to manage (and for more, see our page on Planning for Death and Incapacity); and

  • Support with healthcare, including accompanying them to appointments, and making sure that they have the right medication and know how to take it.

  These are all difficult conversations to initiate—but very important to have.

• Getting access to the care that is needed

  The next issue is to ensure that you can get access to the care that your parents need—and whatever you need to continue to support them.

  This is not always easy because health and social care systems around the world are increasingly short of money. They therefore tend to avoid providing additional help until family carers are unable to cope any more.

  Clearly this is not very sustainable—but it is also increasingly a reality.

  It is therefore important that you are able to advocate for yourself and your parents. You need to ask for help before any situation becomes a crisis.

  That may be from siblings or family members, or it may be from healthcare or social care professionals. Being assertive with other people, and not allowing yourself to be ‘taken advantage of’ can go a long way to making sure that you don’t end up too stressed.

• Looking after yourself while still caring for others

  Providing care for anyone is hard.

  Parenting is challenging, whether your children are tiny or in their teens. In fact, most parents don’t stop worrying about their children even when they have left home.

  Looking after your parents is also stressful. You don’t want to see them growing older and more frail, and it may be difficult for them to recognise that they need help.

  Being in a state of constant worry—even low-level worry—is stressful.

  It is tough on your body and mind, with physiological and psychological effects that can last a long time.

  It is therefore important that you look after yourself even when you feel that you don’t have time between responsibilities.

  Take—or make—that time. You need to eat properly, get enough sleep, and take some exercise on a regular basis. Ideally, you also need to be able to spend time doing the things that you enjoy, whether that is seeing friends, doing sport, or just chilling out with a book or your phone.

  There is more about all these things in our pages on Caring for Your Body. Our page on Personal Skills for the Mind explains that what is good for your body is also good for your mind—another reason to look after yourself.

• Recognising and managing caregiver stress and burnout

  Burnout is the feeling of being overwhelmed and unable to cope with the demands placed upon you.

  It is usually associated with work—and the World Health Organization specifically states that it is an “occupational phenomenon”, stating that the term should not be used in other areas of life. However, there is no question that similar symptoms can be experienced in those facing overwhelming demands in other areas. For example, our page on avoiding ‘grandparent burnout’ explains that burnout can happen when grandparents place the needs of their children and grandchildren above their own, and accept or take on more caring responsibilities than they can manage.

  The same thing can happen to those in the sandwich generation, because of the demands placed upon them by work, caring for parents and supporting children.

  Burnout is characterised by feelings of exhaustion or lack of energy, reduced ability to ‘get things done’, and feelings of distance or cynicism about the demands placed on you. People with burnout tend to describe themselves as having ‘nothing left’.

  Caregiver stress, by contrast, tends to be described using metaphors associated with ‘too much’, such as ‘drowning’ or ‘sinking’ under the demands. The two are therefore not exactly the same, but are closely associated, and neither are good.

  The way to manage both stress and burnout—at work or because of family responsibilities—is similar.

  Managing Caregiver Stress and Burnout

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  To manage or reduce caregiver stress and burnout requires ‘three Rs’:

  • Recognise when you are becoming stressed, and might start finding it hard to cope;

  • Reverse the effects by asking for help—from a sibling, social care or healthcare professionals, or your partner; and

  • Build your resilience by looking after yourself mentally and physically.

  For more about how to recognise and reduce stress, you may find it helpful to read our pages on Stress and Stress Management.

• Balancing work and family commitments

  It is unfortunate that the sandwich generation is also likely to be those reaching positions of responsibility at work, as well as taking on more responsibilities at home.

  However, you don’t have to try to do it all.

  Something will almost certainly have to ‘give’, and you don’t want that something to be your health, either mental or physical.

  Instead, it is important to find the right balance between work and family commitments for you.

  ‘For you’ is the operative phrase here. There is no single ‘right’ answer to this balance: it is just what suits you and your family. It is, however, absolutely essential to find it—and once found, stick to it.

  For more about achieving a sensible balance between work and home, see our page on Achieving Work–Life Balance.

• Setting boundaries

  One important aspect of being able to preserve a balance between work and family commitments is being able to set appropriate boundaries.

  Boundaries, in the words of eminent researcher Brené Brown, define “what’s OK with you and what’s not OK with you”. They therefore give you space to look after yourself within any interpersonal relationship—with family, friends, or coworkers.

  Boundaries vs Rules

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  Boundaries are not the same as rules.

  • Rules set out what other people are allowed to do.

  • Boundaries set out what you are prepared to tolerate, and what you will walk away from.

  You may, for example, set a clear boundary that you do not respond to work emails during certain hours, because you are spending that time with your children. That doesn’t mean that people can’t send you emails, but you won’t reply. You might also tell your parents that you cannot respond to them during your children’s school run time, or perhaps at bathtime if you have younger children. Again, they can contact you, and you will eventually respond—but later. Using time-based boundaries like this will help you to manage your time and avoid having to deal with two responsibilities at the same time.

  You can also set emotional boundaries about how much you are prepared to give. For example, you might tell your siblings that you are going on holiday, and they will need to support your parents while you are away.

  For more about how to set and maintain appropriate boundaries, read our page on Setting Boundaries.

• Sharing responsibilities with siblings

  One final area that many people find tricky is working out how to share responsibilities with their siblings.

  The challenge here is that there is often one sibling who is seen as the ‘obvious’ caregiver for ageing parents. This might be a matter of physical proximity, or simply that they have always been the one who responded first. It is—inevitably—easier for the other siblings to allow that to happen.

  The key with this situation is clear and open communication.

  That will almost certainly have to start with the sibling in primary position. They need to be clear about their boundaries and what they are able to do, and then ask others to step in.

  For example, to cover particular ‘holes’ in the schedule, the sibling in primary position may need to be clear about when they are not going to be available, and what others will need to do to fill the gap. It is also going to be up to them to say that they need additional support or help—and what help is needed. This does not mean that other siblings will have to step up, because there may be alternatives such as bringing in hired help. Sometimes just shared decision-making is enough. The key is to involve others in such a way that it reduces some of the load on the main caregiver, and makes sure that they can continue to cope.

  For more about this, you may find it helpful to read some of our pages on Communication Skills. Some of the pages on Personal and Romantic Relationships may also be helpful, especially Learning to Make Joint Decisions and Assertiveness in Personal Relationships.

A Final Thought

The myth of ‘having it all’ has long been debunked.

You can have a family and a career if you want, but you should never feel under pressure to excel at both all the time. You should certainly never feel that you are required to take on all the responsibilities of caring for both children and ageing parents. You definitely don’t have to ‘do it all’, and hopefully you now know how to avoid being put into that situation.