Not Ready For Prime Time: The Needs of Sandwich Generation Women,
A National Survey of Social Workers
A Window into the Lives of Sandwich Generation Women, An Online Journaling
The full survey and journaling results are available online at www.HelpStartsHere.org.
Some 42 million American women make up the "sandwich generation"—meaning they are "sandwiched" by the needs of their own children and their aging relatives. At a time when women are having children later and their parents are living longer, an increasing number of women find themselves caring for both kids and parents at the same time.
In 2006, the National Association of Social Workers and the New York Academy of Medicine â€˜s Social Work Leadership Institute commissioned a survey to better understand the challenges faced by sandwich generation women. While the survey pointed to some of the strains these women experience in caring for their families, deeper insight was needed about how sandwich generation women manage their caregiving responsibilities, the kinds of assistance they would most benefit from, and their efforts to seek outside help.
To answer these lingering questions, additional research was conducted in 2007, forming the substance of this two-part report. The first part, a first-ever survey with social workers who provide services to caregivers of older adults, offers a unique perspective from the "front line" of professionals who help sandwich generation women and their families navigate their day-to-day caregiving responsibilities. The second part, a qualitative, online journaling project, explored the thoughts and feelings of sandwich generation women themselves.
Research Scope and Methodology
The National Association of Social Workers (NASW) and the New York Academy of Medicine (NYAM) commissioned Pursuant, Inc. to conduct a survey with social workers who work with sandwich generation women—defined as women between the ages of 35 and 64 who are a parent to at least one child and have at least one living parent. The survey was fielded online with a random selection of members of the National Association of Social Workers and the National Association of Professional Geriatric Care Managers. Completed surveys were collected from 1,489 social workers who reported working with sandwich generation women. Pursuant, Inc. fielded the poll (margin of error +/- 3.0%) online November 19, 2007 – December 17, 2007.
In addition, NASW and NYAM commissioned Pursuant to recruit sandwich generation women from three metropolitan areas in the United States (Westchester, NY; Chicago, IL; Irvine, CA) to participate in a qualitative journaling project. Forty-one (41) women completed ten journal entries during a two-week period to document their personal experiences and feelings during that time. Each woman was between the ages of 35 and 64, and was in some capacity taking care of their children and elderly parents. Journal participants responded to questions online for a two-week period beginning November 5, 2007 and ending on November 16, 2007.
Sandwich generation women are emotionally overwhelmed by responsibilities.
- Question: Last year when we surveyed sandwich generation women, only 20% reported being very happy, as compared to 34.0% in the general population. In your professional opinion, what are the top reasons that may explain sandwich generation women's lack of happiness?
Response: 47% of social workers believe this lack of happiness can be attributed to these women being overwhelmed with too many responsibilities. Nearly 1 in 5 attributed the unhappiness to the stress of caring for both parents and children.
- Journal research conducted with sandwich generation women supported this sentiment. Women reported that they could use the most help with housework and fundamental parenting responsibilities.
Sandwich generation women underestimate the emotional and physical toll of providing care to aging loved ones.
- Question: In caring for their parent(s) or other aging relative, in your experience do most sandwich generation women overestimate, underestimate, or correctly estimate the following?
Response: 91% of social workers report that sandwich generation women underestimate the toll caring for an aging relative will take on their own health. In addition, 86% believe that these women also underestimate the emotional toll of providing care and the stress on their marriage or partnership (80%).
- Journaling revealed that sandwich generation women feel their own emotional and physical well-being frequently suffers because of the time and stress associated with taking care of their families. Sandwich generation women also report providing emotional, physical and financial support to in-laws, which adds to the stress they already experience helping their own parents.
Sandwich generation women are not prepared for shouldering the burdens of an aging parent's care.
- Question: As their parents age, how prepared do you believe most sandwich generation women to be regarding the following?
Response: 74% of social workers believe that sandwich generation women are not prepared for the cost of paying for care for an aging relative. In addition, social workers believe these women are also not prepared for care planning (63%) and end-of-life planning (53%).
– The survey we conducted in 2006 also revealed that financial issues (including rising health care costs) were among the top concerns for sandwich generation women.
- Journaling among sandwich generation women showed that many of these women continue to support their adult children financially at the same time they begin to assume caretaking responsibilities for their aging parents.
Although sandwich generation women report not feeling "very happy," they often do not seek help for a variety of reasons.
- Question: There are a number of reasons sandwich generation women may have for not getting the help they may need from a social worker. How frequently do you hear the following from sandwich generation women as reasons for not getting help sooner?
Response: 52% of social workers said that getting help for themselves is often not a priority for sandwich generation women. Also, 47% of social workers say that sandwich generation women believe they can handle their concerns on their own. And about 57% said that lack of awareness that social workers can help is "very" or "somewhat frequently" a reason for not seeking help.
- The journals of sandwich generation women supported this finding, with a significant number reporting that they do not ask for help when they need it, or do so reluctantly.
Social workers help sandwich generation women by providing personal counseling, helping with family crises, and coordinating care for aging relatives.
- Question: Which of the following describes the primary or initial reason you hear most frequently from sandwich generation women for seeking your assistance as a social worker?
Response: 37% of social workers say sandwich generation women most frequently seek counseling services for themselves, followed by nearly 24% who say women come for a family/child crisis and 18% who say care management or coordination for an aging relative is the primary reason.
- Question: How frequently have you helped sandwich generation women with the following?
Response: Social workers most frequently help the women "manage the stress of daily life" (58%), followed closely by "managing feelings of depression/anxiety" (56%). About 30 percent very frequently help women ease caregiving responsibilities for aging relatives.
- Question: How frequently, if at all, do you provide sandwich generation women the following care management or coordination for their parents or other aging relative?
Response: Nearly half of social workers surveyed said they provide care management or care coordination for aging relatives (48%), specifically making referrals to health and social services (32%), arranging transportation and food delivery (31%), advising on insurance coverage and benefits (21%), and acting as a liaison for long-distance care (18%).
Facts about Aging in America
The Social Work Leadership Institute (SWLI) at the New York Academy of Medicine is working to expand the workforce of social workers trained in caring for older adults. Among the services these gerontological social workers provide is "care coordination" or "care management." By coordinating the variety of services and resources available to older adults, care coordination provides many benefits, including: helping the older adult remain independent longer; conserving money otherwise spent on nursing homes; and alleviating the stress on informal caregivers, who are most often sandwich generation women.
SWLI and NASW have assembled these key facts to help reporters, educators, and policymakers discuss America's changing demographics and the preparedness of families and professionals alike to meet the challenges of an aging population.
- The population is getting older: The Census Bureau projects that 54 million Americans, or 1 in 5, will be 65 or older in 2020.
- Families provide informal care: Studies estimate that an average of one in five Americans provide informal care for an elderly or ill family member.
- Informal caregiving has economic value: The value of informal caregiving is estimated at between $257-$350 billion annually, compared with $32 billion spent on home health care and $92 spent on nursing homes.
- Caregiving costs employers in lost productivity: The missed days, early departures, and on-the-job distractions of caregivers have been estimated to cost employers as much as $33.6 billion a year in lost productivity.
- Distance creates additional strain: Of the more than 34 million Americans who provide support to an aging family member, about 5 million do so from a distance—at an average cost of nearly $400/month in travel and other out-of-pocket expenses.
- Older adults in rural areas are more vulnerable: Nearly 1 in 4 older adults live in non-metropolitan areas. The more rural an area is, the poorer and less healthy the older residents are.
- More social workers are needed to care for older adults: Only 9% of social workers today specialized in aging care. The National Institute of Aging estimates that the U.S. will need a 40 percent increase–20,000 additional–social workers specializing in aging care by 2020.
The New York Academy of Medicine (NYAM) is an independent, non-profit institution whose mission is to enhance the health of the public. NYAM's Social Work Leadership Institute is working to ensure that there are enough social workers to meet the growing demand for professionals trained in the needs and services available to older adults. To address this need, SWLI has developed a program, underwritten by the John A. Hartford Foundation, that is being offered at Masters of Social Work programs at two-thirds of American universities. For more information, visit www.socialworkleadership.org.
The National Association of Social Workers (NASW), in Washington, D.C., is the largest membership organization of professional social workers with 150,000 members. It promotes, develops, and protects the practice of social work and social workers. NASW also seeks to enhance the well-being of individuals, families, and communities through its advocacy. NASW has developed a resource for sandwich generation women and others who are looking information, advice and or a connection to a social worker for themselves or their aging parent. For more information, visit www.helpstartshere.org.
1 Christine, L. Himes. "Elderly Americans." Population Bulletin, Population Reference Bureau, June 2002.
2 Melissa Healy. "The unsung—and unseen—caregivers." LA Times. 11 June 2007. Home ed., F 1.
3 Family Caregiver Alliance.
4 Melissa Healy. "The unsung—and unseen—caregivers." LA Times. 11 June 2007. Home ed., F 1., quoting The MetLife Caregiving Costs Study: Productivity Losses to U.S. Business, produced in conjunction with the National Alliance for Caregiving (NAC).
5 MetLife and the National Alliance for Caregiving, 2004.
6 "Assuring the Sufficiency of a Frontline Workforce: A National Study of Licensed Social Workers." National Association of Social Workers, March 2006. Page 20.
7 "Assuring the Sufficiency of a Frontline Workforce: A National Study of Licensed Social Workers." National Association of Social Workers, March 2006. Page 16; National Institute of Aging.