Worker/caregivers face stress from all sides

Health of sandwich generation’ at risk

They have come to be known as the "sandwich generation"’ Caught between the demands of college-age children and aging parents, members of this subgroup of baby boomers are buffeted by continual pressures as parent and caregiver. When these caregivers are also workers, it can be a recipe for disaster.

And the problem will only get worse. "Just look at the basic demographics; we’ve got the boomers on the edge of the aging cycle and their kids are having children later in life than the boomers did, and of course there are fewer X-ers’ than boomers, so there are fewer family members available to provide care," notes Suzanne Mintz, president and co-founder of the Kensington, MD-based National Family Caregivers Association, a grass-roots organization created "to educate, support, empower, and speak up for America’s family caregivers."

"Some projections done back in 1996 show a declining ratio of available caregivers ages 50-64 to those who need care (aged 85 and older), from 11 to 1 in 1990, to 4 to 1 by 2050," Mintz adds. 1

The stress for those individuals who must also work is considerable, she notes, "Because on top of the stresses of just being a two-income family, or trying to balance the needs of the workplace and the needs of family, you have a whole other person being cared for — and that person is not well, and may or may not even live with you."

Although nobody teaches us to be parents, we all know where to go for help, Mintz notes, and we have parents and neighbors to whom we can turn. "But to know what to do with family care giving is very much trial and error," she explains. "Although the resources are out there they are very hard to find, since you’re dealing with a situation so outside the norm."

Impact on employee health

Situations such as those faced by family caregivers are bound to have workplace ramifications, says Myrl Weinberg, president of the Washington, DC-based National Health Council, a nonprofit umbrella group that has 114 national health related organizations as its members. The group’s core constituency consists of 50 leading patient-based organizations such as the American Cancer Society and the American Diabetes Association.

"Clearly there are physical and psychological impacts for workers who take care of kids at home as well as spouses and parents," says Weinberg. "What we have found is that they are incredibly stressed. What their employers provide or do not provide [in terms of benefits] has made a big difference. If there are no benefits, these employees are not as productive as they could be. Some have had to turn down promotions, or have actually quit their jobs because they couldn’t do both."

"We all hear about the repercussions of stress, and in some of these cases it can be extreme stress," adds Mintz. "Depression levels tend to be high, there is sleeplessness, back problems, and other stress-related ailments. There have also been studies that show that caregivers with high stress levels will heal more slowly. The stress of care giving can have an impact on literally every part of your life, and can impact not only your ability to be a good caregiver, but your ability to be a good worker."

In addition, says Mintz, there are financial stresses. "The Family Medical Leave Act [FMLA] is great, but not everyone can afford to use it [the FMLA provides only for nonpaid leave]," Mintz points out. "Yet, caregiving families spend more than twice as much on out-of-pocket medical expenses than noncare giving families." (See facts on the impact of care giving, below.)

Family Caregiving Facts:
There is $11.4 billion in lost productivity due to care giving each year. — Metropolitan Life
There are currently (1997) more than 23 million, or one in four workers, providing some level of care to family members. — The National Alliance for Caregiving and the American Association of Retired Persons
Approximately 30% of all workers have some responsibility to care for a family member. That will rise to 54% by 2008. — U.S. Department of Labor

Toolkit offers solutions

The good news, says Weinberg, is that there are strategies available to employers that can significantly reduce the stresses of care giving on working adults — and many of them require little or no financial outlay. "I have served as chair of a Workplace Task Force which has examined the issues of family care giving for the Last Acts organization," she notes. "We developed a toolkit, which can be found on their web site (" The toolkit is divided into no-cost, low-cost, moderate, and high-cost initiates, and includes illustrations of model activities. "It even includes sample memos for informing employees about an upcoming seminar," says Weinstein.

One of the no-cost solutions is to make absolutely sure the employer’s benefits are examined as to how they may apply to caregivers — and then inform the employees. "There’s often a clear gap of knowledge about what’s in those benefits that could be used in a flexible manner," Weinstein asserts.

A second no-cost solution: Have known, publicized flexible time schedules. "During the core hours you can have your people there, but give them the flexibility to take a family member to the doctor, as long as their total hours are still the same," Weinstein explains.

One low-cost solution would be employee leave pools. "You can create a pool of vacation or sick time that will be available for caregivers to use," says Weinstein. "Individual employees may be allowed to donate to that pool."

It’s also critically important to be able to offer workers some counseling assistance, either through an employee assistance program) or by hiring a full-time care coordinator, Weinstein advises. (This would be classified as a moderate-cost initiative.) "The care coordinators provide one-stop shopping for employees looking to find the right services," she offers.

In the high-cost category are strategies such as providing paid leave for the family care giver. "A smaller employer might consider implementing the FMLA and then extending it," Weinstein suggests. "Or, you could provide long-term health care insurance."

[For more information, contact:

Suzanne Mintz, National Family Caregivers Association, 10400 Connecticut Ave., #500, Kensington, MD 20895-3944. Telephone: (800) 896-3650. E-mail:

Myrl Weinberg, National Health Council, 1730 M St., NW, Suite 500, Washington, DC 20036. Telephone: (202) 785-3910. E-mail:

[Editor’s note: The Workplace Task Force toolkit is available in print form, and will also be available on CD-ROM. Call: Shawn Zelman or Anna Bauer at Barksdale Ballard, (703) 827-8771.]


1. Chronic Care in America: A 21st Century Challenge. The Institute For Health and Aging, University of California at San Francisco for The Robert Wood Johnson Foundation. San Francisco;1996.