Journal of Family and Economic Issues

, Volume 30, Issue 3, pp 252–267 | Cite as

Informal Caregiving: Dilemmas of Sandwiched Caregivers

Original Paper


Increased demand will intensify pressures for informal caregiving, especially for sandwiched caregivers. Using 1999, National Long Term Care Survey data, we contrasted socio-demographic statistics, care environments, activities of daily living (ADL) and instrumental activities of daily living (IADL) assistance, life quality, and employment burden of sandwiched versus non-sandwiched parental caregivers. Regression analysis explored variables influencing caregiving hours, employment accommodation, stress, strain, time for self, social life limits, free time, and excess burden. We found no differences in caregiving hours, no greater labor force accommodation, but lower quality of life among sandwiched caregivers with more than they can handle, but they undertook parent care despite quality of life reduction. Uniquely, the research indicates sandwiched caregivers’ employment mitigates stress, strain, and burden and supports policy changes providing more supportive workplace environments.


Employment accommodation Informal caregiving Labor force accommodation Parental caregivers Sandwiched caregiver 


  1. American Association of Retired Persons. (2001). In the middle: A report of multicultural boomers coping with family and aging issues. Washington, DC: AARP Research Center, pp. 1–7. Retrieved November 16, 2006, from
  2. American Association of Retired Persons. (2002). Beyond 50: A report to the nation on trends in health security. Washington, DC: AARP. Retrieved November 16, 2006, from
  3. Boaz, R. F., Hu, J., & Ye, Y. (1999). The transfer of resources from middle-aged children to functionally limited parents. The Gerontologist, 39, 648–657.Google Scholar
  4. Boise, L., & Neal, M. B. (1996). Family responsibilities and absenteeism: Employees caring for parents versus employees caring for children. Journal of Managerial Issues, 8, 218–238.Google Scholar
  5. Callahan, J. J. (2007). Sandwich anyone? The Gerontologist, 47, 569–571.Google Scholar
  6. Caputo, R. K. (2002). Adult daughters as parental caregivers: Rational actors versus rational agents. Journal of Family and Economic Issues, 23, 27–50.CrossRefGoogle Scholar
  7. Caserta, M., Lund, D. A., & Wright, S. D. (1996). Exploring the caregiver burden inventory (CBI): Further evidence for a multidimensional view of burden. The International Journal of Aging and Human Development, 43, 21–35.Google Scholar
  8. Chappell, N. L., & Reid, R. C. (2002). Burden and well-being among caregivers: Examining the distinction. The Gerontologist, 42, 772–780.Google Scholar
  9. Chou, K. (2000). Caregiver burden: A concept analysis. Journal of Pediatric Nursing, 15, 398–407.CrossRefGoogle Scholar
  10. Colorado Gerontological Society and Senior Answers and Services. (2008). Medicare section medicare overview. Retrieved February 11, 2008, from
  11. Damiano-Teixeria, K. M. (2006). Managing conflicting roles: A qualitative study with female faculty members. Journal of Family and Economic Issues, 27, 310–334.CrossRefGoogle Scholar
  12. Dautzenberg, M. G., Diederiks, J. P., Philipsen, H., & Stevens, V. (1996). Women of the middle generation and informal care for the elderly. Tijdschrift voor Gerontologie en Geriatrie, 27, 141–149.Google Scholar
  13. Dilworth, J. E. L., & Kingsbury, N. (2005). Home-to-job spillover for generation X, boomers, and Matures: A comparison. Journal of Family and Economic Issues, 26, 267–281.CrossRefGoogle Scholar
  14. Dolliver, M. (2000). Sandwiched: Dealing with the worries that confront a caregiver. AdWeek, 41(43), 33.Google Scholar
  15. Durity, A. (1991). The sandwich generation feels the squeeze. Management Review, 80(12), 38–42.Google Scholar
  16. Ettner, S. L. (1995). The impact of “Parent Care” on female labor force decisions. Demography, 32, 63–80.CrossRefGoogle Scholar
  17. Ettner, S. L. (1996). The opportunity costs of eldercare. The Journal of Human Resources, 31, 89–201.CrossRefGoogle Scholar
  18. Fossen Forrest, H. M. (2003). Loosening the wrapper on the sandwich generation: Private compensation for family caregivers. Louisiana Law Review, 63, 381–411.Google Scholar
  19. Garson, G. D. (2008). Reliability analysis. Retrieved March 9, 2008, from
  20. Grundy, E., & Henretta, J. C. (2006). Between elderly parents and adult children: A new look at the intergenerational care provided by the ‘sandwich generation’. Ageing and Society, 26, 707–723.CrossRefGoogle Scholar
  21. Gupta, R. (1999). The revised caregiver burden scale: A preliminary evaluation. Research on Social Work Practice, 9, 508–520.CrossRefGoogle Scholar
  22. Gupta, R. (2007). The perceived caregiver burden scale for caregivers of elderly people in India. Journal of Applied Gerontology, 26, 120–138.CrossRefGoogle Scholar
  23. Haug, M. R., Ford, A. B., Stange, K. C., Noelker, L. S., & Gaines, A. D. (1999). Effect of giving care on caregivers health. Research on Aging, 21, 515–538.CrossRefGoogle Scholar
  24. Hogan, S. (1990). Care for the caregiver: Social policies to ease their burden. Journal of Gerontological Nursing, 16(5), 12–17.Google Scholar
  25. Huang, Y.-H., Hammer, L. B., Neal, M. B., & Perrin, N. A. (2004). The relationship between work-to-family conflict and family-to-work conflict: A Longitudinal Study. Journal of Family and Economic Issues, 25, 79–100.CrossRefGoogle Scholar
  26. Koh, S.-K., & MacDonald, M. (2006). Financial reciprocity and elder care: Interdependent resource transfers. Journal of Family and Economic Issues, 27, 420–436.CrossRefGoogle Scholar
  27. Kolodinsky, J., & Shirey, L. (2000). The impact of living with an elder parent on adult daughter’s labor supply and hours of work. Journal of Family and Economic Issues, 21, 149–175.CrossRefGoogle Scholar
  28. Kromrey, J., & Hines, C. (1994). Nonrandomly missing data in multiple regression: An empirical comparison of common missing-data treatments. Educational and Psychological Measurement, 54, 573–593.CrossRefGoogle Scholar
  29. Lai, D. W. L., & Leonenko, W. (2007). Effects of family caregiving on employment and economic costs of Chinese family caregivers in Canada. Journal of Family and Economic Issues, 28, 411–428.CrossRefGoogle Scholar
  30. Levine, C. (2000). Family caregivers and the health care system. Published in dimensions of family caregiving: A look into the future. Monograph of Papers Presented at a National Conference, Sept. 12, 2000, Washington, DC, Elizabeth Joyce (Ed.). Westport, CT: MetLife Mature Market Institute.Google Scholar
  31. Loomis, L. S., & Booth, A. (1995). Multigenerational caregiving and well-being. Journal of Family Issues, 16, 131–148.CrossRefGoogle Scholar
  32. Lovley, E. (2006, December 23). Caregivers get some relief: New respite law shows political clout of health issues. Wall Street Journal, CCXLVIII(148), A4.Google Scholar
  33. Maaike, G. H., Dautzenberg, M. G. H., Diederiks, J. P. M., Philipsen, H., & Stevens, F. C. (1998). Women of a middle generation and parent care. International Journal of Aging & Human Development, 47, 241–243.Google Scholar
  34. Maaike, G. H., Dautzenberg, M. G., Diederiks, J. P. M., Philipsen, H., Stevens, F. C., Tan, F. E. S., et al. (2000). The competing demands of paid work and parent care. Research on Aging, 22, 165–187.CrossRefGoogle Scholar
  35. MacInnes, D. L. (1998). The differences between health professionals in assessing levels of caregiver burden. Journal of Psychiatric and Mental Health Nursing, 5, 265–271.CrossRefGoogle Scholar
  36. Manton, K. G., & Gu, X. L. (2001). Changes in the prevalence of chronic disability in the United States Black and nonBlack population above age 65 from 1982 to 1999. Proceedings of the National Academy of Sciences, 98, 6354–6359. Retrieved November 18, 2006, from
  37. Marks, N. F. (1998). Does it hurt to care? Caregiving, work-family conflict, and midlife well-being. Journal of Marriage and the Family, 60, 951–966.CrossRefGoogle Scholar
  38. MetLife. (1999). The MetLife juggling act study: Balancing caregiving with work and the costs involved. Westport, CT: Metropolitan Life Insurance.Google Scholar
  39. Montgomery, R. (2002). Using and interpreting the Montgomery Borgatta caregiver burden scale. Retrieved February 11, 2008, from
  40. Musil, C. M., Morris, D. L., Warner, C. B., & Saeid, H. (2003). Issues in caregivers’ stress and providers’ support. Research on Aging, 25, 505–526.CrossRefGoogle Scholar
  41. National Alliance for Caregiving, the American Association of Retired Persons. (1997). Family caregiving in the U.S.: Findings from a national survey. Washington, DC: NAC and AARP.Google Scholar
  42. Navaie-Waliser, M., Feldman, P. H., Gould, D. A., Levine, C., Kuerbis, A. N., & Doneian, K. (2002a). When the caregiver needs care: The plight of vulnerable caregivers. American Journal of Public Health, 92, 409–413.CrossRefGoogle Scholar
  43. Navaie-Waliser, M., Spriggs, A., & Feldman, P. H. (2002b). Informal caregiving: Differential experiences by gender. Medical Care, 40, 1249–1259.CrossRefGoogle Scholar
  44. Neal, M. B., & Hammer, L. B. (2007). Working couples caring for children and aging parents: Effects on work and well-being. Mahwah, NJ: Erlbaum.Google Scholar
  45. Nichols, L. S., & Junk, V. W. (1997). The sandwich generation: Dependency, proximity, and task assistance needs of parents. Journal of Family and Economic Issues, 18, 299–326.CrossRefGoogle Scholar
  46. Noh, S., & Avison, W. R. (1996). Asian immigrants and the stress process: A study of Koreans in Canada. Journal of Health and Social Behavior, 37, 192–206.CrossRefGoogle Scholar
  47. Pagani, L., & Marenzi, A. (2008). The labor market participation of sandwich generation Italian women. Journal of Family and Economic Issues, 29. “Online First” retrieved from, JFEI website:
  48. Pavalko, E., & Artis, J. (1997). Women’s caregiving and paid work: Causal relationships in late midlife. Journal of Gerontology: Social Sciences, 50B, S170–S179.Google Scholar
  49. Pavalko, E. K., & Henderson, K. A. (2006). Combining care work and paid work: Do workplace policies make a difference? Research on Aging, 28, 359–374.CrossRefGoogle Scholar
  50. Pearlin, L. I., Pioli, M. F., & McLaughlin, A. E. (2001). Caregiving by adult children: Involvement, role disruption, and health. In R. H. Binstock & L. K. George (Eds.), Handbook of aging and the social sciences (5th ed., pp. 238–254). New York: Academic Press.Google Scholar
  51. Pierret, C. R. (2006). The ‘sandwich generation’: Women caring for parents and children. Monthly Labor Review, 129(9), 3–10.Google Scholar
  52. Rubin, R. M., White-Means, S. I., & Feagin, T. (2003). Impacts of the 1997 balanced budget act on venipuncture beneficiaries. Journal of Applied Gerontology, 22, 252–268.CrossRefGoogle Scholar
  53. Schwiebert, V. L., Giordano, F., Zhang, G., & Sealander, K. (1998). Multidimensional measures of caregiver burden: A replication and extension of the Caregiver Burden Inventory. Journal of Mental Health and Aging, 4, 47–58.Google Scholar
  54. Spector, W., Fleishman, J., Pezzin, L., & Spillman, B. (2000). The charactersistics of long-term care users. Agency for Healthcare Research and Quality Research report (00-0049). Rockville, MD: U.S. Department of Health and Human Services.Google Scholar
  55. Spiess, K., & Schneider, U. (2002). Midlife caregiving and employment: An analysis of adjustments in work hours and informal care for female employees in Europe (Economics Working Papers [009]). European Network of Economic Policy Research Institutes. Retrieved November 20, 2006, from
  56. Spillman, B. C., & Black, K. J. (2005). Staying the course: Trends in family caregiving (#2005–17). Washington, DC: AARP Public Policy Institute.Google Scholar
  57. Spillman, B. C., & Pezzin, L. E. (2000). Potential and active family caregivers: Changing networks and the sandwich generation. The Milbank Quarterly, 78, 347–374.CrossRefGoogle Scholar
  58. Stephens, M. A. P., Townsend, A. L., Martire, L. M., & Druley, J. A. (2001). Balancing parent care with other roles: Interrole conflict of adult daughter caregivers. Journal of Gerontology: Psychological Sciences, 56B, P24–P34.Google Scholar
  59. Stone, R. I., & Short, J. A. (1990). The competing demands of employment and informal caregiving to disabled elders. Medical Care, 28, 513–526.CrossRefGoogle Scholar
  60. Switzer, F. S., I. I. I., Roth, P. L., & Switzer, D. M. (1998). Systematic data loss in hrm settings: A Monte Carlo analysis. Journal of Management, 24, 763–774.CrossRefGoogle Scholar
  61. U.S. Bureau of the Census. (2004). Table 2a. Projected population of the United States, by age and sex: 2000 to 2050 and Table 2b. Projected population change in the United States, by age and sex: 2000 to 2050. U.S. Interim projections by age, sex, race, and Hispanic origin. Retrieved January 11, 2008, from
  62. U.S. Department of Commerce. (1999). U.S. Department of Commerce News. U.S. Census Bureau, Economics and Statistics Administration Census CB99-34. Retrieved February 12, 2007, from
  63. U.S. Senate Republican Party Committee. (1997). Balanced Budget Act of 1997. Legislative Notice 22, Calendar No. 91 June 23, 1997. Reported from the Senate Budget Committee June 20, 1997, by a 19-3 vote. No written report. Retrieved January 20, 2008, from
  64. Wells, S. J. (2000). The elder care gap. Human Resources Magazine, 45(5), 38–46.Google Scholar
  65. White-Means, S. (1997). The demands of persons with disabilities for home health care and the economic consequences for informal caregivers. Social Science Quarterly, 78, 955–972.Google Scholar
  66. White-Means, S. (2000). Racial patterns in disabled elderly persons’ use of medical services. Journal of Gerontology: Psychological Sciences and Social Sciences, 55B, S1–S14.Google Scholar
  67. White-Means, S., & Chang, C. F. (1994). Informal caregivers’ leisure time and stress. Journal of Family and Economic Issues, 15, 117–136.CrossRefGoogle Scholar
  68. White-Means, S., & Hong, G.-S. (2001). Giving incentives of adult children who care for disabled parents. Journal of Consumer Affairs, 35, 364–389.CrossRefGoogle Scholar
  69. White-Means, S. I., & Rubin, R. M. (2003). Racial differences in dilemmas of the sandwich generation. Consumer Interests Annual, 49, 1–4. Available at
  70. Wilson, M. R., Van Houtven, C. H., Stearns, S. C., & Clipp, E. C. (2007). Depression and missed work among informal caregivers of older individuals with dementia. Journal of Family and Economic Issues, 28, 684–699.CrossRefGoogle Scholar
  71. Wolf, D., Freedman, V., & Soldo, B. (1997). The division of family labor: Care for elderly parents. The Journals of Gerontology, 52B, 102–109.Google Scholar
  72. Yue, P. (2006). Reliability and validity of the caregiver burden inventory. Chinese Mental Health Journal (Zhongguo xin li wei sheng za zhi), 20, 561–563.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of Economics, Fogelman College of Business & EconomicsThe University of MemphisMemphisUSA
  2. 2.College of Pharmacy, University of Tennessee Health Science CenterMemphisUSA

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