A new Seniorly study shows a record 53 million Americans are fatigued after providing $600 billion in unpaid family caregiving. Find out which states carry the highest - and lowest - burden for sandwich generation caregivers.
A record 53 million Americans are serving as unpaid family caregivers, up from 43.5 million in 2015. Collectively, these dedicated folks are providing an estimated $600 billion in care, according to a conservative estimate by the AARP Public Policy Institute.
The burden of family caregiving largely falls on America’s ‘Sandwich Generation’ – a group largely composed of middle-aged Generation Xers between the ages of 40-59. The majority of caregivers are women.
Historically, when parents reached this age, their kids went off to college, they became empty nesters and finally had time to pursue their own interests and needs.
Today, the Sandwich Generation is bound by a unique set of social and demographic forces that include a record number of seniors aging and financial challenges that have stunted the economic stability of their adult children.
As a result, the Pew Research Center reports that 54% of those in their 40’s are caring for their aging baby boomer parents and financially supporting their millennial or Gen-Z children.
Seniorly analyzed the most recent data from the CDC, Census Bureau, Health Resources and Services Administration, and the Alzheimer’s Association to determine where the Sandwich Generation’s financial, emotional and caregiving burden is expected to grow the most.
A multitude of metrics were analyzed nationally across all 50 states and D.C. in two main categories:
The complete methodology with links to sources is at the bottom of the study.
The financial, physical and mental health toll placed on family caregivers cannot be understated. The average caregiver spends $7,242 out of pocket annually, according to an AARP study, and spends nearly five hours per day providing elder care.
Women have long disproportionately carried the burden associated with family caregiving for both children and seniors. An estimated 61% of family caregivers are women and 35% have children under six years old. And at a time when the economy is struggling and two incomes are needed, 75% of women aged 45-54 are also working outside the home.
Ultimately something has to give. The amount of energy needed for caregiving forces many women to cut back on hours which hurts their career trajectory and earnings. In fact, the Department of Labor says unpaid family caregiving reduces a mother’s lifetime earnings by 15%.
Moreover, 23% of all caregivers also say their health has worsened; and the Centers for Disease Control and Prevention found that during the COVID-19 pandemic, 85% of caregivers experienced at least one symptom of poor mental health, while 50% reported serious suicidal ideation.
As the prevalence of Alzheimer’s disease and other conditions linked to old age continue to rise, the demand for long-term care workers is projected to increase by 25.8% by 2030. Unfortunately, long-term care facilities are facing a historic staffing shortage, losing nearly 229,000 caregivers – or more than 14 percent of its workforce – since February 2020. This marks the worst job loss among all health care sectors according to the U.S. Bureau of Labor Statistics and signals that much of the burden placed on the Sandwich Generation is only going to increase in years to come.
Florida ranks No. 1 in current burden score, and is likely to see the greatest toll on the Sandwich Generation in the coming years, which may come as no surprise given its older population (21.1% of residents are 65+). One in five adults ages 45+ expect to begin providing care for someone within the next two years – a higher rate than any state but Texas. At the same time, caregivers in the Sunshine State are less likely to have health insurance (86.6%) than their counterparts anywhere in the U.S.
Arizona, South Carolina, Georgia, Delaware and Texas also score highly on the looming burden for dual caregivers. In Texas, for example, demand for long-term care is projected to surge by 43.6% between 2020 and 2030, while in South Carolina,18% of caregivers age 45+ report frequent mental distress, one of the highest rates in the country.
Meanwhile, Arizona is expected to see a 33.3% increase in Alzheimer’s disease cases between 2020 and 2025, the highest rate in the U.S. In Georgia, 88.2% of caregivers have health insurance – and while that rate may seem high, it’s one of the lowest levels across the country. Delaware scores relatively poorly across the board, with an especially high age dependency ratio of 69.1.
While every state will experience a strain on caregivers due to the aging population, the burden will be lower in some parts of the country. Overall, Washington, D.C., Connecticut, North Dakota, Illinois and Colorado ranked last, driven by a relatively lower increase in demand for long-term care, a slower growth in Alzheimer’s disease prevalence and the fact that their existing caregivers are generally healthy and insured.
In North Dakota, for example, just 12.2% of adults age 45+ expect to become caregivers in the next two years, the lowest rate in the U.S. Meanwhile, Washington, D.C., has the lowest age dependency ratio in the country, at 46.1. Notably, South Dakota, which has a relatively low caregiving burden overall, has the country’s highest age dependency ratio, at 73.2.
In Connecticut, 99.1% of caregivers have insurance – the highest rate in the U.S. – while just 13.2% of people ages 45+ expect to begin providing care in the next two years. About 1 in 3 caregivers in Illinois has multiple chronic health conditions, making them healthier than their counterparts in most other states. And in Colorado, the age dependency ratio is just 57.5 – lower than anywhere else except Washington, D.C.
Striking a balance between caregiving responsibilities and other demands of life often proves overwhelming. Here are a few tips to help you manage the challenge:
If you're experiencing caregiver burnout and need immediate assistance or professional guidance, it's important to reach out to the appropriate authorities or organizations for support. Here are some key contacts you can consider:
The Sandwich Generation of caregivers represents a unique and multifaceted group, caught between the obligations of caring for their aging parents and their dependent children. Remember, it's important to recognize the signs of burnout and take action before it becomes overwhelming. If you find yourself experiencing persistent feelings of exhaustion, irritability, or a loss of interest in activities, consider seeking professional help from a healthcare provider or counselor who can provide guidance and support. By understanding state-by-state differences, individuals and policymakers can develop tailored support systems, provide appropriate resources and form strategic partnerships to help alleviate the challenges faced by caregivers across the country.
We used the most recent data from federal sources and the Alzheimer’s Association to determine where the Sandwich Generation’s burden is expected to grow the most. We used a Z-score distribution to scale each metric relative to the mean across all 50 states and Washington, D.C., and capped outliers at 3.
For nearly all of the metrics, a higher rate was a negative indicator, such as the increase in Alzheimer’s prevalence. Therefore, we multiplied Z-scores for the metric on caregivers with insurance by -1, given a higher score was positively associated with being above the national average. A state’s overall ranking was then calculated using its average Z-score across all metrics, with a higher ranking corresponding with a greater burden on the Sandwich Generation. Some states were missing data for a few metrics, so their averages were calculated by using the remaining Z-scores. Here’s a closer look at the metrics we used:
Marlena del Hierro is Vice President of Partnerships and Seniorly’s Lead Gerontologist. Marlena earned her Master of Arts degree in Gerontology from San Francisco State University and her Bachelor of Arts degree in Human Development from California State University. She also serves in an advisory capacity for Jukebox Health. As Seniorly’s first employee, Marlena is a vocal advocate for evolving the aging paradigm, and is a frequent contributor to public discussions about aging. She has served as a resource for media outlets like WGBH, FOX News, CNBC and the Today Show.
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