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Sandwich Generation: When Insurance And Caregiving Collide

Sandwich generation. I remember the first time I heard this phrase. I had just started my career in financial services and I was confused. I thought, “Are they saying my generation likes sandwiches?”

Then the instructor explained what it meant: a person who is sandwiched between caring for aging parents while also caring for children at home.

Clever term — but even as I watched my parents care for my grandparents (three of whom died of Alzheimer’s disease), I couldn’t relate. After all, I was a recent college graduate, living on my own and just starting my career.

Now, everything is different.

When I look back on the past 18 months, I realize how naive I was. When my parents moved from Oregon to Minnesota to be closer to my family, we looked forward to kids’ sports and choir concerts, holiday meals and planning my parents’ 50th wedding anniversary celebration. Little did we know just how fast things would change.

Although my mom struggled with memory loss for a few years, it was swept under the rug. “It’s just part of aging.” “She’s under stress.” “It’s not a big deal.” Only after my parents moved, and after my siblings and I insisted, did we finally have her evaluated by a neurologist. The doctor confirmed our worst fears - Mom had Alzheimer’s disease. In fact, she was entering the disease’s advanced stage.

What? How did we go from “casual memory loss” to advanced stage Alzheimer’s disease? But her body is healthy, so we have time — right?


At the time of their move, my mom occasionally used a cane, actively participated in conversations and enthusiastically joined activities in their retirement community. By spring, shortly after her diagnosis, she started falling and could no longer walk notable distances. By summer, she stopped walking altogether. By August, she stopped talking, reduced to one word at a time. By September, we moved my parents into an assisted living apartment. By December, we made their final move — my mother to a memory care center, and my father into my home.

How Did We Get Here?

It quickly became evident that, despite working in the long-term care insurance industry for 20-plus years, I knew nothing about finding and managing quality care. And I didn’t know how I could balance it all, juggling my parents’ care with my kids’ school events, homework and sports.

Sandwich generation. Now I get it. And I’m not alone.

Securian Financial recently conducted a survey of more than 800 people who are currently providing, or who have provided, unpaid care to a parent, in-law or spouse who is aging, or has a disability or chronic disease.

Here’s what we found:

The majority of caregivers (60 percent) spend more than 10 hours per week caring for a family member, and about one in four (29 percent) spend more than 20 hours weekly. Women (32 percent) are more likely than men (26 percent) to spend more than 20 hours each week on caregiver duties.

As the oldest female child, I can certainly relate. Between calls, doctor appointments, memory care center visits, balancing checkbooks, ordering services, communicating with siblings, and organizing medical equipment and prescriptions, I spend about 15-20 hours a week, after work, providing care.

And although more than half (55 percent) of us characterize our role as “supportive,” one-third of us feel “concerned” (33 percent) or “overwhelmed” (32 percent) by our caregiving responsibilities.

Juggling And Struggling

We say the most difficult aspects of being a caregiver are maintaining emotional stability (60 percent) and maintaining a healthy balance between the time we spend caregiving and being with immediate family members (56 percent). There are days when I start with well-intentioned plans, only to have them completely blow up. And although I feel blessed in many ways, the lives of my family members have changed dramatically. My children and spouse have made tremendous sacrifices, and they have done so with love and patience.

Other areas caregivers struggle with are keeping up with day-to-day tasks (54 percent) and maintaining our own financial well-being (52 percent), with one in six people (17 percent) finding the latter very difficult.

One of the hardest aspects of my parents’ journey is watching their retirement plans disappear. Not only did they lose vacations and dreams, they’ve lost their home and they’re now living apart. My father was forced to move into my home in order to manage the financial burden of my mother’s care, as her needs are now beyond my ability to manage.

Our survey found that 48 percent of caregivers say the person they are caring for does not have long-term care insurance. Those who care for a family member for more than 20 hours per week are the least likely (34 percent) to say their care recipient has long-term care insurance. Cost is the No. 1 reason why people do not purchase LTCi. Half of caregivers (50 percent) whose care recipients do not have LTCi believe it is too expensive, while another 10 percent do not think it is a worthwhile investment.

Some of this is true of my family, as neither of my parents medically qualified for a long-term care insurance policy. However, even if they could, they likely would not have been able to maintain the premiums into retirement. 

Caregiving can affect more than just the balance at home. Half (50 percent) of us who hold jobs while providing care say it affects our job performance, with the most common impact being the need to take days off from work (41 percent). In addition, more than one-fifth of us (22 percent) say our work hours or responsibilities were reduced. Moreover, 15 percent of employed caregivers had to take a leave of absence, and 12 percent said they quit work altogether because of their caregiving responsibilities.

I’m thankful my company allowed me some flexibility. However, it meant sometimes working late or on weekends. And although I could do some work from home, my family certainly noticed my lack of presence.

Individual LTCi wasn’t an option for my family, but there are other insurance options designed to help pay for long-term care. These include life insurance and annuity policies with long-term care funding riders, and hybrid policies combining life insurance with long-term care benefits. Self-funding (i.e., paying out-of-pocket) is the most common way Americans pay for long-term care, and Medicaid is an option for care recipients with depleted assets — a bridge my family may cross in the near future.

In saying all this, my family is doing what we do best — we continue marching forward, one step in front of the other, one breath at a time. And we’re doing it with hope. Hope for a cure, and a better future — for us and for generations to come.

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