The Sandwich Generation: Support for caregivers

Demographic change means more people, young and old, require care. As demands on caregivers rise, what public and private support can they get?
Allianz Knowledge on Demography: As burdens on caregivers of the young and old increase, .../ Credits: Reuters
Faced with the dual responsibilities of raising children and caring for elderly relatives, members of the Sandwich Generation must confront numerous challenges. Perhaps the most pressing: how to balance employment and caregiving, and how to finance medical and home care. As the demands on caregivers have grown, countries around the world have begun offering support for caregivers struggling to manage bills, hired help, and lost wages.

As researcher John Jankowski discussed in a 2011 report for the U.S. Social Security Administration, in Europe many countries offer caregiver credits as a part of their public pension systems. First introduced in France in 1945 as a childcare pension bonus, similar programs were widely adopted during the 1980s; today, caregiver credits for childcare are nearly universal across the European Union. However, programs that provide credits to those caring for sick or elderly relatives are less common.

In addition to Norway and the UK, Germany is one of the EU countries that offer both: in 1995, Germany introduced a program that gives caregivers pension credits for time spent providing unpaid care. It also provides services such as respite care (temporary “breaks” for caregivers) and training. In addition, Germany has established a separate employment category for informal caregivers which provides additional rights and benefits.

While Germany’s generous family policies are not without problems and controversy, proposals to introduce similar programs in the United States have been entirely unsuccessful. In his analysis, Jankowski explains that the U.S. has resisted such caregiver credit programs due to three main concerns: how to design a program that targets the credits to the correct population, how to address the administrative challenges of such a program, and how to pay for the new benefit.

America’s caregiver challenges continue

In the U.S., there are currently two primary public programs that help pay for care services: Medicare and Medicaid. Medicare only covers medically necessary care and focuses on acute, short-term medical care such as doctor’s visits, drugs, and hospital stays. Medicaid is a joint federal and state government insurance that covers both short-term medical care and long-term care services at home, but it is only available to low-income individuals, and eligibility requirements are strict.

Other federal public programs, such as the Older Americans Act, and state-funded programs, do pay for long-term care services; however, like Medicaid, these programs only cover services for people that meet stringent low-income criteria.

Legislative efforts to provide affordable long-term care insurance have so far not been successful. In 2010, the Obama administration proposed the Community Living Assistance Services and Supports (CLASS) Act, which would have created a voluntary public long-term care insurance option, which currently does not exist in the U.S. The proposal, which was heavily criticized by some lawmakers, was dropped after nearly two years of trying to find a way to fund the program.

While the “Obamacare” federal health care reforms have introduced new incentives for states to expand home- and community-based care services in Medicaid, and extended Medicaid and Medicare support, it remains to be seen how these measures will be implemented on a state-by-state basis. It’s also unclear what impact the upcoming U.S. presidential election may have on healthcare reform.

As a result of this uncertainty, caregiver support discussions in the U.S. still generally involve encouraging people to seek private financing options to help pay for long-term care. This usually means purchasing private long-term care insurance, but can also include trusts, annuities, and reverse mortgages.

One option available for those who pay for day care expenses for their children or disabled adult dependents while working or looking for work is the Child and Dependent Care Credit. This is available to taxpayers who incur expenses related to taking care of children under 13 or adults who are mentally or physically unable to care for themselves.

For eldercare, there are other resources U.S. caregivers can turn to for information, advice and support. The National Clearinghouse for Long Term Care Information, an extension of the U.S. Department of Health & Human Services, offers a variety of helpful tools including a financial planning quiz, a long-term care saving calculator, and an interactive map that allows users to locate state aid agencies.

As federal aid can be limited and state-based options vary, identifying local support services is of utmost importance. Local agencies can connect caregivers with a variety of services; caregivers can visit the Eldercare Locator at to find out what organizations are located in their area.

The future of caregiver support

One of the most powerful tools available to caregivers, as well as to the ongoing public policy discussions around the world, is information and knowledge sharing. In Asia, an increasing amount of resources and research are being devoted to studying how to best care for its growing elderly populations. For example, in 2011, the first Asian Conference on Integrated Care was held in Singapore, and was attended by over 1,000 delegates.

Speaking of the conference’s focus on integrated long-term care, Dr. Dennis Kodner, Director and Professor of Medicine and Gerontology at the New York Institute of Technology’s Centre for Gerontology & Geriatrics, said: “Integrated care is a global challenge. It is also a major driver of healthcare reform worldwide."

The international focus on care integration reflects growing concern about how fragmented and disjointed healthcare policies, financing, providers and services adversely affect overall access, efficiency, quality and costs.”

The conference also launched the Singapore Silver Pages, Asia’s first online resource for the elderly and disabled and their caregivers. It offers comprehensive information to help assess needs, determine support options and identify suitable care providers.

While the challenges modern caregivers face are difficult, they can take some measure of comfort in knowing that around the world, discussions over the best way to support and manage the demands of caregiving will continue in earnest. Governments, healthcare organizations and financial services providers will have to respond to the demographic and economic changes that have swelled the ranks of the Sandwich Generation.

In the final installment of the Sandwich Generation article series, we’ll examine the segment of the world’s population most heavily affected by caregiving responsibilities: women.

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