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Too many bites: Managing the sandwich era of life

Running a household, working full time and maintaining some type of healthy balance can be hard enough without the added strain of managing the sandwich era of life.

The average life expectancy in the United States is nearing 80 years old, and according to the most recent U.S. Census research, life expectancy is projected to increase to nearly 86 years over approximately the next 40 years.

At the same time, according to Pew Research Center, due to the rising cost of living as well as the lasting effects of COVID-19, young American adults are living with or financially dependent on their parents at rates that have not been recorded since the Great Depression.

What does this mean for adults who are roughly in their late-30s to their mid-50s?

As people are living longer and many young adults are struggling to gain financial independence, those stuck in the middle – commonly called Generation X plus an older Millennial sub-generation called Xennials – are now part of what is dubbed the “sandwich generation.” In other words, these individuals are “sandwiched” between their own aging parents and their adult or soon-to-be adult children, often caring for both simultaneously. Pew estimates that right now more than half of Americans in that bracket are "sandwiched" to varying degrees.

Running a household, working full time and maintaining some type of healthy balance can be hard enough without the added strain of managing the sandwich era of life.

Parenting both sides

While setting clear boundaries, charging for household expenses and communicating a realistic timeframe for young adults in the home to establish financial independence are critical, things get a little bit trickier when it comes to caring for aging parents, especially as it becomes more difficult for them to care for themselves on their own.

The burdens of health care and other costs, helping with daily activities, overseeing supervision, legal considerations and other concerns can take a physical and emotional toll when dealing with an aging adult. Among the many challenges facing those with caregiving responsibilities are:

  • Caregiver burnout and feelings of depression, guilt and isolation.
  • Finding the time to be a good spouse, parent and child simultaneously.
  • Trouble managing work, hobbies, relationships and time for themselves.

While the to-do list when caring for an aging adult may seem endless, it is important to remember to take things one at a time. First, make sure that advance care planning, including advance directives, has been completed so you can advocate and make health care decisions for your loved ones, if necessary. Next, discuss, well in advance, how to deal with caregiving tasks that may exceed what the family can physically and financially provide. How will you know when you can’t safely provide care? What will you do if/when that day comes? Also, it is important to meet with your financial advisor to go over all of the possible ramifications of this decision. Make sure your long-range financial plan can absorb the costs of care, or that you have taken advantage of ways to increase access to care.

Access to care

One critical way to improve one’s own well-being as well as the proper care of an aging adult is by ensuring access to long-term care. Long-term care involves a variety of services designed to meet a person's physical and mental health needs, helping people live as independently and safely as possible when they can no longer perform everyday activities on their own.

Long-term care can be provided in a variety of ways, depending on a person's needs.

The Arizona Long Term Care System (ALTCS) is Arizona’s Medicaid program that provides long-term care services, at little or no cost, to financially and medically eligible Arizona residents who are aged, blind, disabled, or have a developmental and/or physical disability. Those who qualify do not have to reside in a nursing home. Many ALTCS members live in their own homes, with family members or in an assisted living community and receive needed in-home services.

The Arizona Health Care Cost Containment System (AHCCCS) contracts with three program contractors to provide long-term care services. An ALTCS program contractor is a health plan. Your choice of ALTCS health plans varies, depending on where you live in Arizona. The ALTCS health plan works with providers, nursing homes, assisted living facilities, hospitals, pharmacies, specialists, etc. to provide access to care. People who qualify for long-term care can receive services such as:

  • Nursing facility.
  • Hospice.
  • Attendant care.
  • Assisted living facility.
  • Adult day care health services.
  • Home health services, such as nursing services, home health aide and therapy.
  • Home delivered meals.
  • Case management.
  • Dental services (up to $1000 per contract year).
  • 600 hours of respite care services annually, as a temporary break for caregivers to take time for themselves.

Fighting labor shortages

Another stressor on the sandwich generation: labor shortages. Are there enough trained providers out there to help with long-term care?

Mercy Care, through its community giving initiative, Mercy C.A.R.E.S. (Community Action Resources Education and Service), partners with organizations that further the organization’s vision that everyone deserves to live a healthier life. As part of that initiative and recognizing the importance of education and training for family members who take on the caregiving role, as well as others who choose this as a profession, in 2019, Mercy Care began collaborating with community partners and contracted providers, committing $2 million to recruit, train, hire and retain direct-care workers.

By developing a workforce of trained in-home caregivers to assist with basic needs, older individuals will have the option to remain living safely in their homes, with independence and dignity.

Cindy Leach is vice president of long-term care of Mercy Care. Mercy Care is a not-for-profit Medicaid health plan, serving AHCCCS members in Arizona since 1985. Mercy Care is a local company sponsored by Dignity Health and Ascension Health. Mercy Care provides access to physical and behavioral health care services for Medicaid-eligible families, children, seniors and individuals with developmental/cognitive disabilities. Learn more at