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State of Caregiver Burnout in America

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.

By Marlena del Hierro Updated on Jul 14, 2023
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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. 

 The state of caregiver burnout study

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:

  • Strain on caregivers: We examined factors such as the percentage of multigenerational households, projected increase in Alzheimer’s Disease and demand for long-term care, and the age dependency ratio – the number of working-age people compared to the number of people ages 0-14 and 65+ – with a higher rate indicating a greater financial burden on working adults
  • Health status of caregivers: We looked at mental distress, chronic health issues and access to health insurance.  

The complete methodology with links to sources is at the bottom of the study. 

Key findings: 

  • Caregiving takes its toll: Dual caregivers spend more than 10% of national average  household income – an average of $7,242 per year – looking after loved ones; 23% say their own health has worsened; and 50% had suicidal ideation during the pandemic. 
  • Six southern states in the top 10: Florida (1), South Carolina (3), Georgia (4), Texas (6), Tennessee (7), and Louisiana (10) dominated the top 10. Southern seniors tend to have poorer health which places an increased burden on caregivers. 
  • Florida ranks no. 1: Caregivers in the Sunshine State have the greatest burden. 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. Caregivers are also less likely to have health insurance (86.6%) than their counterparts anywhere in the U.S.

 Caregiving takes its toll, especially on women 

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.

Why the crisis is worsening

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.

States where caregiver burnout will increase the most

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. 

Least burdened states

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.

Tips to prevent or manage caregiver burnout: 

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:

  1. Set your financial strategy: Consult a financial advisor to ensure you understand your plan for the future.  Together you’ll evaluate the potential costs of elder care, child education, and your own retirement to avoid financial stress down the line.
  2. Seek support: Don't hesitate to ask for help and seek support from others. Reach out to family members, friends, or support groups who can offer assistance, guidance, and understanding. If necessary, consider hiring professional caregivers or respite services to give yourself regular breaks and time for self-care.
  3. Prioritize self care:  Caring for yourself is crucial in preventing burnout. Make sure to prioritize your own physical and emotional well-being. Get enough sleep, eat nutritious meals, exercise regularly, and engage in activities that you enjoy and help you relax. Remember, taking care of yourself allows you to better care for others.
  4. Delegate tasks: Don't shoulder all responsibilities alone. Delegate tasks to family members or friends, or consider hiring professional help if finances allow. 
  5. Use resources: Research and utilize resources tailored for caregivers like respite care services, adult day programs, caregiver training programs, and assistive technologies.
  6. Keep organized: Organize medical documents, insurance details, and important paperwork for easy access during emergencies. Caregiving apps like Medisafe or Iancare are great for staying on top of all the details.
  7. Communicate openly: Encourage honest discussions within the family about the challenges faced, helping everyone understand your role and responsibilities, and how they might contribute to lighten the burden.

Reach out if you need help

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:

  • National Alliance for Caregiving (NAC): The NAC is a non-profit organization dedicated to supporting caregivers. You can visit their website at
  • Caregiver Action Network (CAN): CAN is an organization that provides education, support, and resources for family caregivers. They offer a helpline, support groups, and an online community. You can contact them at 1-855-227-3640 or visit their website at
  • Eldercare Locator: The Eldercare Locator is a public service of the U.S. Administration on Aging. They can help connect you with local resources and support services for caregivers. You can contact them at 1-800-677-1116 or visit their website at


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:

Strain on caregivers

  • Age dependency ratio, measured as the number of working-age people compared to the number of people ages 0-14 and 65+, with a higher rate indicating a greater financial burden on working adults (Census Bureau, 2021)
  • Share of non-caregivers (age 45+) who expect to begin providing care for someone in the next two years (Centers for Disease Prevention and Control, 2017)
  • Change in projected demand for long-term care workforce (Health Resources and Services Administration, 2020-2030)
  • Share of households that are multi-generational, with a higher rate suggesting a greater caregiving burden (Census Bureau, 2021)
  • Projected percentage increase in the number of people with Alzheimer's disease (Alzheimer's Association, 2020-2025)

Health status of caregivers

written by:
Marlena del Hierro

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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View other articles written by Marlena

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