The Sandwich Generation: Hoagies and Healthcare

Sandwiches: They’re not just what reps bring physicians for lunch. They’re also a generation of Americans that have responsibility for making healthcare decisions for 3 generations. Often referred to as the Sandwich Generation, they’re people in their 30s, 40s, and 50s who care for their aging parents while still supporting their own children. And they are fast becoming the meat of the matter.

According to the Pew Research Center, nearly 50% of adults ages 40 to 59 have a parent 65 or older and are raising a minor child or supporting a grown child. And almost 60% of people between the ages of 40 and 60 already manage or are very likely to manage the care needed by their parents. Baby Boomers are getting older and living longer, and people are having children later in life, so the Sandwich Generation won’t be going stale anytime soon and should be kept fresh in the mind of healthcare professionals. Why? Because they play a vital role in the delivery of care.

The doctor-patient relationship is no longer straightforward; more parties are involved and each requires a different style and depth of communication. Doctors can’t deliver test results to a 5-year-old or assume that an 87-year-old understands a treatment plan, and yet the doctor must still interact with them both. The real conversation occurs, though, between the doctor and the Sandwich Generation, with the latter being responsible for following through. And that’s a big responsibility.

Managing the interpersonal relationship between a caregiver and patient is challenging enough, especially when one is experiencing the pain, emotion, and confusion that often accompany health issues. But for the caregiver, the challenge extends beyond that relationship to those with the provider, insurance company, and pharmacy. While a parent is considered the legal guardian of a child and has access to all of the child’s health information, that’s not always the case when the patient is an aging parent. Privacy regulations can restrict access to records. And that’s just information; the caregiver must also manage appointments, prescriptions, and treatment plans. It’s easy to see how the Sandwich Generation is being squeezed.

But they’re not just the point people, the project managers, and patient representatives for their children and parents, they’re patients themselves. And the stress is getting to them—financially, physically, and emotionally—and if they go down, others are bound to go with them. So it’s imperative that the healthcare industry recognize the need to also provide care for the caregivers.

What does providing that care entail? There’s a lot to consider. The health needs of their children and parents, their family status, their own health, and even their ethnicity. Hispanics and blacks, for example, are more likely to provide support to their extended family, according to Pew. But it really begins by recognizing the Sandwich Generation and the importance of their role. It means factoring them into the patient communication, patient care, and patient experience process.

I’ve avoided dozens of telephone calls and countless hours on hold by using patient portals like MyChart and FollowMyHealth to access my sons’ medical records, schedule their appointments, and even request their prescriptions. And although these portals have made it more efficient to communicate, different providers use different portals, so some of the benefit is lost. If I was also responsible for my parents’ care, that would mean even more portals, passwords, and profiles to manage. The industry has long had an appetite for integrating technologies and centralizing databases, hoping to streamline their own information systems, but the Sandwich Generation is starving for those advancements as well.

But are there simpler ways to make the caregiver’s role less frustrating? Are there seemingly minor issues that, over time, could have a meaningful effect? For example, how can a healthcare professional tell the difference between an actual caregiver and someone who’s simply accompanying the patient for moral support? Does it require a conversation or is intuition enough? Do caregivers tire of having to re-identify themselves? Perhaps there’s a way to incorporate that information into the EHR, so all staff members who interact with patients already know who’s who. And would providing staff with skills and strategies to communicate with caregivers, especially when a child or elderly patient is in the room, be worthwhile? I’ve witnessed physicians saying things in front of their child patients that should have been communicated to the parent without the child being present. My son, nearly 7 years later, still recalls that frightening disclosure. And as his caregiver, I still wish I had done a better job of establishing expectations with the physicians.

Instances like those abound, and we can all agree that the burden being carried by the Sandwich Generation is real, which means we can also agree that the burden isn’t just theirs to bear, but the entire industry’s. The more cognizant we are of the caregiver’s role through every step of the patient journey, the better job we can do providing support and improving outcomes. There’s really no dilemma. It’s simply a question of making an effort—and an effort that’s as big as the one being expected of the Sandwich Generation. If you’re interested in learning how they impact your business or practice, let’s do lunch.


Jonathan Richardson, who works out of our Scottsdale office, is an experienced copywriter with a deep appreciation for rich context. He complements Fingerpaint’s medical expertise with the strong patient and family perspective he’s gained through raising twin sons with special needs. Jonathan has a keen interest in healthcare trends and writes with the goal of creating emotional connections with readers.

At Fingerpaint, we use a consumer-driven approach for health products and services. We build from consumer insights and use behavioral methods to empower people to take action for better health outcomes, combining inspiration with education to activate change.