Sample Sociology Paper on Labour of Love: The Effects of Caregiver Resilience on the Sandwich Generation

Abstract

The term “sandwich” generation defines individuals who are wedged between the competing demands of caring for at least one dependent child and one or more aging parent/in-law. Of the estimated 8.1 million caregivers in Canada, 28% of them were classified as “sandwiched.” Presently, little is known about the unique experiences of those providing care at both ends of the generational ladder and how they cope with their stressors. As a result of caregiver burden, sleep disturbance, depressive symptoms, turnover intention, and job satisfaction may also be negatively impacted by mindfulness-based stress reduction (MBSR). This research paper proposes conceptual framework consisting of three multigenerational caregiving practices (eldercare, spousal support, and childcare) offered by sandwich generation and the associated effects on caregiver resilience on job satisfaction, turnover retention, sleep disturbance, and depressive symptoms.

Keywords: Sandwich generation, resilience, caregiving, mindfulness-based stress reduction (MBSR), eldercare, spousal support, childcare, job satisfaction, turnover retention, sleep disturbance, and depressive symptoms

 

 

Labour of Love: The Effects of Caregiver Resilience on the Sandwich Generation

Introduction

Work-life balance research highlights the dissimilarity between work-to-family and family-to-work conflict. Work-to-family conflict occurs when work demands and stressors conflict with the responsibilities of family life, resulting in decreased attention to family life, and is allied with reduced marital satisfaction (Green, Bull Schaefer, MacDermid, & Weiss, 2011). Nevertheless, family-to-work conflict (family-related demands hindering performance in the work environment) has been understudied. A family demand individuals face is caring for both growing children and aging adults, referred to as the sandwich generation. An individual from the sandwich generation could be anywhere from 40-65 years of age (Ward & Spitze, 1998). Of the estimated 8.1 million caregivers in Canada, 28% of them were classified as “sandwiched” (Boyczuk & Fletcher, 2016). Current estimates suggest that 9% to 13% of households in the United States of America are sandwiched (Hammer & Neal, 2008; Ruppanner & Bostean, 2014).

The purpose of this study is to explore the lived experiences of the sandwich generation who have the responsibility of caring for their elderly parents and/or in-laws, their spouse as well as their children while juggling paid employment. Sandwich generation caregivers are individuals who concurrently care for their aging parents and dependent children (Miller, 1981). With an aging population, there is a pressing need to explore caregiver resilience for sandwich generation caregivers.

In the organizational behaviour literature, caregiving is rarely examined as a significant and multifaceted behaviour (Bear, 2019). Effective caregivers are accessible, sympathetic, and receptive whenever called upon (Bowlby, 1973). In addition, they ‘neither encroach nor abandon, that is, are neither too impassive (when others seek proximity or help) nor overactive and imposing (when others need to explore and operate on their own); instead they ensure to be present and to assist should the need arise’ (Kahn, 1998, p.43). While caregiving is an imperative part of             the “life” component of work-life research and is vital to human survival (Bowlby, 1982; Mikulincer & Shaver, 2007), it is normally evaluated in the family domain in terms of time devoted to childcare or eldercare (Bedeian, Bure, & Moffett, 1988; Payne, Cook & Diaz, 2011). However, for numerous individuals, caregiving is more than the sum of hours spent or an arrangement; instead, it is a bounding experience for which they have exclusive aims in multiple domains, such as work, family, and society. With an aging population, there is a pressing need for caregivers. Caregivers are discovering that their roles are lengthier as a result of older adult longevity (Abramson, 2015). Caregiver burden is the influence of the demands allied with caregiving such as physical, psychological, social, and financial demands (George & Gwyther, 1986). Caregiving has more adverse effects on women’s health in comparison to men (Caputo, Pavalko, & Hardy, 2016; Chesley & Moen, 2006; Marks, 1998; Marks, Lambert, & Choi, 2002; Pinquart & Sörenson, 2006, 2011). Despite the fact that multigenerational caregivers face a burden, coping mechanisms have been understudied and require special attention.

Caregivers experience stress related to role strain, role clarity, and role expectations. Role strain may develop as a result of role expectations from the caregivers. As caregivers seek role clarity, there is an amplified risk for caregivers to suffer from emotional exhaustion. Role clarity is apparent for the caregiver when the seeming equilibrium of the familial relationships is attained (Boss, Doherty, La Rossa, Schumm, & Steinmetz, 1993; Price, Price, & McKenry, 2010). As families face obstacles and challenges, stress escalates. Particularly, caregivers experience stress. For caregivers, a range of stressors could occur such as finances, time, and communication within the family system (Price et al., 2010). When faced with stressors, caregivers who employ effective coping strategies are better off.

While stressors and strains occur in caregiving situations, there are positive aspects of caregiving. Sandwich generation caregivers benefit from high levels of resiliency and coping mechanisms (Abramson, 2015). Resilience is the ability to endure and rebound from predicaments and adversities from a psychological perspective (Walsh, 1996; Fredrickson, 2001) whereas, organization and management studies defines it as the skill and the capacity to be vigorous under conditions of immense stress and change and to become stronger in the process (Coutu, 2002; Cooper, Flint-Taylor & Pearn, 2013). Research indicates that resilient individuals with elevated positive emotions and the ability to manage negative emotions can find meaning and deal with the stressful events or conditions at work (Avey, Luthans & Jensen 2009; Tugade & Fredrickson 2004; Cooper 2013). Research signifying the relationship between spirituality and resilience has been observed in the civilian caregiving research and has been conjectured to function as a determinant of resilience by aiding caregivers to come together, comprehend, find meaning or purpose in the stressful situation (i.e., caregiving), harvest strength from a higher power, and ultimately overcome stress (Black & Lobo, 2008; Bormann, Warren, Regalbuto, Glaser, Kelly, Schnack & Hinton, 2009; Wilks, Spurlock, Brown, Teegen & Geiger, 2018). Sharma, Marin, Koenig, Feder, Iacoviello, Southwick & Pietrzak, (2017) discovered the protective role of spirituality was also observed among service members and veterans.

Research Question

Primary research question

  • What are the Effects of Caregiver Resilience on the Sandwich Generation?”

 

Secondary Research Questions

  • How does caregiving resilience affect the job satisfaction and turnover intention?
  • Do Sandwich Generation caregiver’s health behaviours change once they enter the multigenerational caregiving role?

Research Objectives

  • To examine the lived experiences of sandwich generation caregivers
  • To determine the influence of multigenerational caregiving on sandwich generation caregiver’s health and the associated effect on employment status (job satisfaction and turnover intention)

Literature Review

The Sandwich Generation as Primary Caregivers

Miller (1981) first credited the definition of Sandwich Generation caregivers as individuals caring for their children, spouses, and parents concurrently. In the last decade, both the Canadian and United States government have been advocating for a shift from the formal caregiving in hospital setting to informal caregiving in the home settings due to the current healthcare system characterized with shortage of healthcare workers, increasing aging population, and withering government funds (Bear, 2019). Formal caregiving is provided at monetary costs by personal support workers, occupational therapists, and nurses contracted by the government or community care access centres to offer home care and community support services to the children, older persons, and any other group of individuals with continuing complex care needs. Informal caregiving is the unpaid help provided to family members and friends (Barrah et al., 2004; Black & Lobo, 2008; Avey, Luthans, & Jensen, 2009). The Sandwich Caregivers are responsible for the provision of informal caregiving ranging from instrumental to emotional support. The government prefer keeping individuals in the home care setting to health care setting to reduce the financial strain on health care systems and workers. The consequent results is that the Sandwich Generation caregivers continue to bear increased caregiving burden, strain, and stressors.

Gender Roles in Caregiving

Globally, women are often responsible for assuming the roles of being the caregivers, either by necessity or choice, to the children, their spouses, or aging family members. Historically, men have been socialized as the breadwinners of the family and raised to solely invest their time in their respective careers, which has placed ultimate limitations on their responsibilities in caregiving. Women are associated with the helping and nurturing roles, and caregiving aligns with these characteristics (Boss et al., 1993). Therefore, in the Sandwich Generation, women are the most responsible gender for the caregiving role. As a result, women are more suffer from effects of caregiving resiliency than men. They are more likely to move in and out employment, record high turnover intention, experience sleeplessness, and become victim of depressive symptoms due to the increased work-life balance burden (Brody, 2003).

Effects of Caregiver Resilience on Sandwich Generation

Igarashi et al. (2013) conducted a qualitative study to examine the non-financial costs experienced by sandwich generation caregivers. The participants did indicate that care provided to the aging parents was often unanticipated, unpredictable, and distressing. The sandwich generation lacked any preparation on how to take care of their parents or in-laws and struggled with their changing health status. Besides, the increased care tasks conflicted with such opportunities available to them as career, personal growth, and travelling. Similarly, Voydanoff & Donelly (1999) determined that the amount of time spent by sandwich generation caregivers caring for their parents and children had a positive correlation with their psychological distress. Hammer & Neal (2008) agree with the findings by reporting that the married sandwich generation caregivers were experiencing higher levels of depression than the general population, with about 24 – 38% scoring above the depression cutoff score. The researchers, Hammer and Neal, found out that the sandwich generation caregivers were victims of experiencing higher rates of work-family conflicts recording greater levels of absenteeism from work.

In support of the findings by Igarashi et al. (2013), Voydanoff and Donelly (1999), and Hammer & Neal (2008), Robinson et al. (2003) reported that sandwich generation caregiving influenced increased chronic stress and missed obligations leading to decreased productivity and job satisfaction in the workplaces. Equally, Stephens, Franks, and Townsend (1994) support these findings by positing that women in multiple roles such as being a caregiver, mother, and wife at the same time experienced accumulated stress in all these roles of eldercare, spousal support, and children and recorded decreased well-being, in comparison to the women who only experienced stress in a single caregiving role. Remennick (1999) agree with the deliberations of Stephens, Franks, and Townsend (1994) by investigating the sandwich generation caregivers who immigrated from Russian to Israel and exercised multiple care roles, and reported that they had diminished well-being owing to the depressive symptoms associated with caring for more than one care recipient. Rubin and White-Means (2009) further support these deliberations by hypothesizing that the sandwich generation caregivers may have a reduced life quality due to engaging in more care duties than they can handle as a result of the accumulation of multiple roles.

There are studies that have focused on explaining the costs experienced by the sandwich generation caregivers. For instance, Pines, Neal, & Hammer (2011) carried out a focus group with sandwich generation caregivers who are dual-earners and determined that changes in the health of the parents, spouses, and children were the factors influencing the stress they experienced in caregiving. The study found out that there was a positive correlation between stress associated with caregiving needs and job burnout triggering increased turnover intention to exit one’s career path. Similarly, Green (2012) conducted a qualitative study on the purpose of examining the families caring for aging parents and children with disabilities. The results of study corresponded with those of Pines, Neal, & Hammer (2011) and provided an indication that the onset parental aging needs cause loss of support previously provided for the children with special needs, this support is fundamental for increasing the coping abilities of caregivers to maintain well-being.

Majority of the studies on sandwich generation caregiving have focused on the negative effects associated with job burnout triggering reduced job satisfaction, increased turnover intention, and increased depressive impacts on health. However, there are also limited evidence in existence citing the benefits of informal caregiving. For example, Christensen, Stephens, and Townsend (1998) conceived that caregivers that occupy multiple roles developed mastery feelings. The mastery feelings infer that an individual can influence the life events and gains competency in their management. In the study, Christensen, Stephens, and Townsend deliberated that the management of multiple care roles by the sandwich generation caregivers had positive contributions to the psychological well-being of an individual, hence, high levels of mastery was considered to influence increased life satisfaction. The findings of Marks (1977) coincided with those of both Marks et al. (2008) and Christensen, Stephens, and Townsend (1998) by theorizing that though having multiple care roles may not present any negative effect on the psychological health, it has the potential of contributing to positive health outcomes such as increased physical health and psychological well-being. Similarly, Stephens & Townsend (1997) agreed with the arguments of both Marks (1977) and Christensen, Stephens, & Townsend (1998) that caregiving has positive health outcomes by reporting that the mastery derived in the labor of love was a driving force for helping buffer the stress linked with the burden of children, spousal, and parental caregiving. The proposition of Stephens & Townsend (1997) is further supported by Cooper, Flint-Taylor, & Pearn (2013) who argued that the occupation of caregiving roles by both men and women may be beneficial to those who were previously performing few care roles by helping create a sense of belonging and meaning in life. Caputo, Pavalko, & Hardy (2016) also shares the same argument by describing the positive effect of caregiving on sandwich generation caregiving by elucidating that it provides a sense of status security, status enhancement, and ego gratification.

Allen & Martin (2017) carried out an investigation on the positive effects of caregiver resilience on the sandwich generation women in multiple roles as a caregiving daughter to the parents (elderly population), wife, and mother. The researchers determined that the caregiving daughters-in-law and daughters developed the feeling of being rewarded by their engagement in multiple caregiving roles. The accumulation of these rewards in any two of the three roles as a wife, mother, or daughter had significant result in the elevation of well-being when compared to the women who did feel that their participation in the multiple roles were stressful. Further, the findings of Pines, Neal, & Hammer (2011) supported those of Allen & Martin (2017) by finding out that the couples in sandwich generation did report job burnout at significantly lower levels than the general population in different employment occupations. The results from the focus group provided an indication that strong marriages served to assist the sandwich generation caregivers decrease couple and job burnout, even though they may have multiple stressors such as work, caring for aging parents, and parenting. The findings of these two studies are an illustration that the engagement in multiple roles is of benefit to other areas of life among sandwich generation caregivers, which is correspondingly supported by Ingersoll-Dayton, Neal, and Hammer (2001).

Ingersoll-Dayton, Neal, & Hammer (2001) explained that the sandwich generation caregivers experienced benefits in multiple caregiving role in the sense that the care provided is considered as a reciprocation of the same help offered to them while young. The older adults may have offered different help ranging from emotional and financial support, household tasks, to childcare to the sandwich generation as their sons or daughters, and the care provided to them in form of eldercare is in return an appreciation. Ingersoll-Dayton et al. (2001) contend that the potential benefits affiliated to caregiving are dependent on either the current or past familial relationship with the recipient of the care. In relation to the same focus by Ingersoll-Dayton, Neal, & Hammer (2001), Pope (2013) examined the possible influence that caregiving has on the perspective of adult daughters regarding their future in the later life. The results were of revelation that the experience of caregiving present the potential of providing benefits such as gaining awareness on the practice of aging successfully. Likewise, Igarashi, Hooker, Coehlo, & Manoogian (2013) found that sandwich generation caregivers learned the caregiving experience from their parents. The practice of caregiving is, therefore, made a generation habit past from one group of individuals to another. The researchers argue that the situation creates the opportunity for the elderly who were once caregivers to receive the same care once they are old from the young population who might have emulated a similar path.

 

 

Propositions

Proposition 1: Multiple caregiving roles as perceived by sandwich generation caregivers negatively affect job satisfaction in career positions

Proposition 2: Multiple caregiving roles as perceived by sandwich generation caregivers positively affects turnover intention in the employment field

Proposition 3: Caregiver resilience in the continued participation of multiple roles by sandwich generation caregivers negatively affects health outcomes

 

Conceptual Framework

Caregiving Model Mediator

When caring for the loved ones ranging from the elderly, spouses, to children, age serves as the mediator for the resilience between multigenerational caregiving roles and consequential effects on sandwich generation. The three variables of eldercare, spousal support, and childcare are associated with job satisfaction, turnover intention, sleep disturbance, and depressive symptoms. The older the sandwich generation caregiver becomes, the more severe the effects of caregiving resilience on job satisfaction, turnover intention, sleeplessness, and depressive symptoms the caregiver is likely to experience, and the vice is true. Increased provision of eldercare, spousal support, and childcare by the Sandwich Generation caregivers reduces their job satisfaction, which in turn increases turnover intention by the sandwich generation women compelling them to leave their employment engagements to offer care to the respective family members. Conversely, increased provision of eldercare, spousal support, and childcare by the Sandwich Generation caregivers increases their risk of suffering from depressive symptoms and sleep disturbance.

Underlying Theories

Symbolic Interaction Theory

Symbolic interaction theory holds that when analysing the family dynamics and caregivers, there different components of interaction ranging from roles, rituals, gestures, social norms, identities, salience to social acts that must be taken into consideration (Smith & Hamon, 2012). The interactions among the family members, friends, and entire community are responsible for shaping the ways in which families interact. Each caregiver has varieties of roles. With every role, there are associated diverse perceptions and identities aligned with it. As more responsibilities are developed by the caregivers, there is a consequent growth in the need for analysing the caregiving resources. The caregiving resources play essential roles in the overall caregiving perceptions by the caregivers and the factors linked with caregiving strain.

 

 

Family Stress Theory

The caregivers often experience stress related to role clarity, role expectations, and role strain. Role strain undergoes evolution as the caregivers’ role expectations increase. The increase in role expectations compel the caregivers to seek for role clarity, which increases the risk to experience emotional exhaustion or overload. However, role clarity to reduce the associated burden becomes much evident for the caregivers in the situation where there is the achievement of the perceived familial relationship equilibrium. Family stress theory supports the necessity of positive communication interactions among the care recipients and caregivers. The theory suggests that the availability of such resources as communication, time, and money influence the quality of caregiving relationship (Boss, 1992; Boss et al., 1993).

Role Theory

Role theory states that individuals must meet the demands inferred in their roles if they wish to be successful (Greenhaus & Beutell, 1985; Kahn, Wolfe, Quinn, Snoek, & Rosenthal, 1964). When employed individuals become caregivers, they must learn how to manage the new demands although incompatible family and work role demands often compete for time and can result in behavioural pressures (Allen & Martin, 2017; Greenhaus & Beutell, 1985), creating family-to-work conflict. Employed caregivers must harmonize their roles by prioritizing demands across both life domains (Barrah, Shultz, Baltes, & Stolz, 2004; Kossek et al., 2017).

 

Social Role Theory

Social role theory proposes that social groups form attitudes and beliefs about the social roles of men and women, particularly in work settings (Eagly, 1987, 1997; Eagly & Steffen, 1984; Eagly, Wood, & Diekman, 2000). Throughout history, females have assumed the majority of caregiving roles and have provided care to aging family members and children (Ford, Good, Barrett, Harrell, & Haley, 1997; Gerstel & Gallagher, 2001; Pinquart & Sörenson, 2006; Kahn, McGill & Bianchi, 2011; Pavalko & Wolfe, 2016).  Men have been socialized to be breadwinners, whereas, women are expected to be caregivers. Men were raised to invest large amounts of time in their careers, which have ultimately placed limitations on their caregiving responsibilities (Moen et al., 1994). Wives and daughters are responsible for “home and kinship” (Moen, Robison, & Fields, 1994) and are three times more likely than sons to be primary caregivers to older parents and to become “women in the middle” undertaking multiple roles as spouse, mother, daughter, and employee (Brody, 2004).

Attachment Theory

The family relationships among sandwich generation caregivers are multifaceted. An important factor in relationship quality is perceived degree of closeness between the caregiver and care recipient. An assured attachment is essential for older adults in a stage of increased dependence on their caregivers. Attachment theory describes how individuals develop relational attachment orientations through repeated ‘caregiving’ interactions with significant others (Ainsworth, Blehar, Waters & Wall, 1978; Bowlby, 1980). Attachment theory posits a useful lens to better understand caregiver and care recipient relationships (Santona, Tagini, Sarracino,  De Carli, Pace, Parolin & Terrone, 2015). Within family caregiving situations, communication patterns change to varying degrees for family systems (Mancini & Blieszner, 1989; Nussbaum, Pecchioni, Robinson, & Thompson, 2013). Recurrent contact with family members inherently leads to an increased need for communication.

 

 

Methodology

For this conceptual research paper, the design method employed was descriptive. The descriptive method was based on locating, evaluating, and assembling diverse body of literature on the topic of “Effects of Caregiver Resilience on the Sandwich Generation” In regards to the two objectives of this paper seeking to answer the research questions, there were four major themes revealed through the descriptive method of analysing the diverse body of literature on the specified topic, which described the lived experiences of caregivers, their perceived health, and participation in economic activities (employment). These themes included (1) The roles of the caregivers, (2) The balancing act of caregiving, (3) There are usually stormy seas in caregiving and it is always not rainbows and sunshine, and (4) The caregiving roles amidst the turmoil experienced have some silver linings. A summary of the themes and subthemes are provided in the Table 1 below, and their explanation provided in the discussion section.

Table 1: Themes and Subthemes of sandwich generation caregivers’ lived experiences

Discussion

The purpose of this conceptual research paper was to explore the lived experiences of sandwich generation women and the influence multigenerational caregiving roles had on their health behaviours and economic engagements such as employment to determine the feelings of caregivers on job satisfaction and turnover intentions. The paper provides in-depth analysis of the literatures focused on the tasks involved in the sandwich generation caregiving and their effects on caregivers’ health and other life commitments such as work.

According to Allen & Martin (2017), the care for spouses and children requirements are significantly less challenging compared to the care demanded by the in-laws/parents (older population). The care provided to the older care recipients was perceived to be requiring more time as it was more demanding. Conversely, the care provided to the spouses and children was expected and, therefore, was perceived by the caregivers as being more manageable.

In a study conducted by Caputo, Pavalko & Hardy (2016), using a sample participants of 24 sandwich generation caregivers, the caregivers provided an explanation on how their children’s and spouses’ care was different from the older care recipients’ care. All of the participants agreed that increased caregiving demands resulted in a decrease in the time spent with the immediate family members or to participate in full-time employment, which caused reduced job satisfaction and increased turnover intentions. In the study, the children, spouses, and in-laws/parents were included in the tug-of-war and juggling act that caused exhaustion and strain, which negatively impacted the caregivers’ health. As a result, sandwich generation caregivers experiencing great challenges when providing help to their care recipients and the difficulty in balancing other areas of life such as work and being a parent (father or mother of the children), spouse (wife or husband), and a daughter or son (to the older adults).

Physical caregiving is an important aspect of care involving cooking, moving houses, cleaning, bathing, toileting, managing finances, purchasing foods, dressing, and feeding the care recipients. Chesley & Moen (2006) highlighted that these physical caregiving roles were good indicators of the time and amount of assistance needed by the care recipients, and are specific to the multigenerational caregivers. The study noted that the caregiving tasks did differ between the genders with the women typically responsible for the provision of nurturing role while the men are involved in the provision of transportation and managing finances for the care recipients. In some cases, the women complete all these caregiving tasks for the older adults with the men being left with the duties of childcare when elderly care recipients demand more of the caregivers’ time. The situation suggests that men assist in the caregiving phenomenon mostly by looking after the children. However, the women are the ones involved in performing the majority of the care tasks that are more demanding such as caring for the parents and in-laws.

The sandwich generation caregivers provide emotional support to the care recipients (children, spouse, and elderly). Emotional caregiving serves to provide comfort and empathy to the care recipients, especially those with severe health conditions. The caregivers play huge emotional role as the care recipients with health conditions requires significant support to help the older adults cope with stressors and losses of life. Emotional caregiving is extended to the care recipients with higher care needs, making it just as important as the physical care.

The provision of physical and emotional caregiving takes up inordinate amounts of time for the sandwich generation caregivers. The caregivers experience time constraints that they have been subjected to due to demands of the caregiving roles. The caregivers must consistently either be physically available or on-calls with their care recipients. Although the caregivers rarely put records of the amount of time they often spend on their caregiving roles on weekly basis, previous literature has determined that caregivers balancing the caregiving roles with employment usually spend approximately 34 hours per week completing the tasks of caregiving (Duxbury et al., 2009). The amount of time spent completing the caregiving roles further confirms the time commitment associated with the care for multigenerational care recipients. Most of the care tasks are often completed both with and without the presence of the care recipients, specifically the financially and administrative related tasks. Therefore, caregiving continues even after the caregivers have physically left their respective care recipients.

Rubin and White-Means (2009) reported that the sandwich generation caregivers spend more time caring for their children, spouses, and parents/in-laws when compared to other caregiving members of the family. Therefore, the study relates to proposition 2: “Multiple caregiving roles as perceived by sandwich generation caregivers positively affects turnover intention in the employment field” and proposition 3: “Caregiver resilience in the continued participation of multiple roles by sandwich generation caregivers negatively affects health outcomes due to increased sleep disturbance and depressive symptoms” as time is a major limitation when it comes to the sandwich generation caregivers attempting to complete their roles, especially the employed caregivers. The caregivers either juggle their care and work responsibilities successfully or at sometimes experience tugs-of-war between their care demands and work obligations, which compels them to sacrifice their involvement in other activities of life. The increased care recipients’ demands means more caregiving burden causing heightened feelings of depression due to the inability to complete all the care needs within the required time and less time to sleep. The increased care duties and lack of adequate time to get enough sleep trigger increased turnover intentions influenced by the inability to balance care and work demands, which results in caregivers quitting their part-time or full-time employment responsibilities to focus their attention on attending to the care recipients. Similar findings were determined by Dhar (2012), who issued the revelation that the participants (sandwich generation caregivers) felt that their roles were clashing with each other making it difficult to complete their tasks in caregiving and other competing priorities. The caregivers are largely under the control of the demands of their care recipients, which makes participating in employment engagement more of an option.

Roles transitions, as one of the characteristics of multigenerational caregiving roles explained by Evandrou & Glaser K (2004), relate to proposition 3: “Caregiver resilience in the continued participation of multiple roles by sandwich generation caregivers negatively affects health outcomes.” Role transition often occurs when there is expansion in the caregivers’ roles as a result of the increasing number of care recipients or care needs. It trigger the changes in relationships between the caregivers and care recipients. For example, the health demands of a caregiver cause relationship to transition from being either a daughter or son to a caregiver for the older adults. explained that the daughters and sons as caregivers to the in-laws and parents often develop the feelings that their relationships change from being a mother-daughter to caregiver-care recipient, when their fathers and mothers needed more eldercare. As health status changes, the caregivers are required to constantly negotiate their relationship with the care recipients. All the role transitions on multigenerational caregiving indicate complexities in the caregivers’ roles, which make the sandwich generational caregivers’ roles become more challenging and end up placing increased demands on their lives. The increased demands on the sandwich generation caregivers make them convey the frustration and resentment feelings because of the considerable amount of their time demanded by the care recipients and the overwhelming care responsibilities. The care tasks required for the caregivers to perform coupled with the issue of limited time make the caregivers feel stifled and obligated to perform the care roles. These findings were similar to those of Green et al. (2011) whose participants felt resentment towards their respective caregiving roles because of not choosing to be informal caregivers. Further, McGill, & Bianchi (2011) reported that the adult daughters and sons pointed out that the involvement in caregiving roles prompted the feelings of frustration and anger. These results depict that caregivers have negative feelings arising from the increased caregiving burden, which affect their mental health due to increased depressive symptoms.

The sandwich generation caregivers revealed that their health was compromised by their active involvement in the multiple caregiving roles. The effects on health was largely contributed by sandwich generation caregivers placing the needs and demands of their care recipients a priority at the expense of their health. Kossek et al. (2017) believe that the caregivers put their health needs last since they care for their recipients when both at work and home having little time address their personal health condition. The study relates to proposition 3: “Caregiver resilience in the continued participation of multiple roles by sandwich generation caregivers negatively affects health outcomes.” The responsibilities of work, family, and caregiving consumed majority of the caregivers’ time, leaving barely enough time for attending to their health. The amount of time available to address personal health needs as a caregiver is important to recognise as it poses major limitations to the caregivers’ health and potential ramification on their abilities to complete their work obligations and caregiving tasks. An unhealthy population of caregivers presents the risk of their care recipient needs going unmet, which has the likelihood of causing further complications such as the inability to assist the elderly with activities of daily living and medical care. Therefore, the caregivers’ health not only influences themselves alone abut also the lives of their care recipients. The sandwich generation caregivers report that their multiple caregiving roles affect their levels of physical activities. The caregivers feel that the increased care needs of their care recipients, which always come first, limit them from getting as much exercise as they may intend. The caregivers also have feeling that even if they may have the spare time to participate in physical exercises, after completing the care tasks, they are often too exhausted to indulge in the physical activities. Marks (1997) and Pope (2013) confirm that the multiple role caregivers are less likely to participate in exercising activities in comparison to the non-caregivers or those caring only for their parents due to increased exhaustion, which results to health deterioration.

The nutritional habits of sandwich generation caregivers is influenced by their multiple caregiving roles. O’Sullivan (2015), Boyczuk & Fletcher (2016), and Christensen, Stephens, & Townsend (1998) deliberate the interesting situation revealed by the caregivers that they would sometimes rather not eat or skip meals due to buy schedules leaving them with not time for eating. These studies relate to proposition 3: “Caregiver resilience in the continued participation of multiple roles by sandwich generation caregivers negatively affects health outcomes.” The lack of eating or under eating leads to the failure to provide enough sustenance that eventually become detrimental to the caregivers’ health. For instance, consuming less optimal calories amounts can result in a decrease in the energy expenditures, which may make it increasingly difficult for the caregivers to complete caregiving responsibilities and other activities. It is an imperative requirement that the caregivers look after themselves and their nutrition to enable them complete the care roles successfully and concurrently remain healthy.

The study by Spielman, Yang and Glovinsky (2011) deliberated that the sandwich generation caregivers perceive that their energy and sleep levels are influenced by their multiple caregiving roles. The study relates to proposition 3: “Caregiver resilience in the continued participation of multiple roles by sandwich generation caregivers negatively affects health outcomes due to increased sleep disturbance.” The care recipients usually need the multiple care roles around the clock both during the day and at night. The caregivers are unable to have enough sleep since they must be constantly awake and alert to respond to the recipients’ care needs whenever necessary. The caregivers become both mentally and physically exhausted by the problem of sleep disturbance. Sleep deprivation make the caregivers feel fatigued making it difficult to complete the care tasks or be productive in the workplaces. Multiple caregiving roles influence the caregivers’ sleep patterns and contribute to exhaustion compromising the ability to participate actively in the caregiving roles or other life engagements such as work, consequently increasing the turnover intentions due to the inability to balance the work and care demands considering the deterioration in health status.

Bormann et al. (2009) and Pinquart & Sörensen (2006) report that the caregivers involved in multiple care giving roles experience mental health problems. The studies relate to proposition 3: “Caregiver resilience in the continued participation of multiple roles by sandwich generation caregivers negatively affects health outcomes due to increased depressive symptoms” and proposition 1: “Multiple caregiving roles as perceived by sandwich generation caregivers negatively affect job satisfaction in career positions.” The mental health was influenced by the intense caregiving demands requiring them to spend a lot of their time on caregiving tasks at the expense of any other life engagement such a work. Sandwich generation, being the primary caregivers for the care recipients with dementia results in increased feelings of irritability, stress, and anxiety associated with negative health. The increased stress, anxiety, and irritability feelings causes apparent strain that reduces job satisfaction due to mental health problems affecting commitment and concentration at work as a result of the inability to balance the care ad employment demands. The apparent strain on mental health creates the need to emphasize on the significance of adopting coping strategies for buffering the stressors linked with multigenerational caregiving roles owing to the effects caused to caregiving and other work engagements.

The studies by Kossek et al. (2017). Moen, Robison & Fields (1994), and O’Sullivan (2015) all have a consensus finding that the caregivers’ employment engagement is compromised due to putting the needs of the care recipients ahead of their own leading to increased depressive symptoms and sleep disturbance. The studies relate to proposition 1: “Multiple caregiving roles as perceived by sandwich generation caregivers negatively affect job satisfaction in career positions” and proposition 2: “Multiple caregiving roles as perceived by sandwich generation caregivers positively affects turnover intention in the employment field.” The increased care burden posses challenges to the caregivers creating perceived tug-of-war between caregiving and working. The caregivers must constantly negotiate the important caregiving tasks, which compels them to neglect other obligations at the detriment of their well-being such as social activities, physical activities, and nutrition) leading to the compromising of their health. Therefore, it is due to the increased caregiving roles demands and deterioration of health that the sandwich generation caregivers’ job satisfaction and turnover in the workplaces are negatively affected. Owing to the involvement in multiple caregiving roles to meet the care needs of their care recipients (the children, spouses, and older adults), the participation of sandwich generation caregivers in other life activities such as work become affected. Increased physical, mental, psychological, and emotional health problems influence the caregivers to record reduced levels of job satisfaction, which consequently serve to propel the increased turnover intentions. In other words, a caregiver who is heavily involved in the caregiving roles finds it challenging to balance the work demands, should he or she be employed, with the responsibilities of caring for their children, spouses, and parents/in-laws who might be in need of their help. Since the care needs to the children, spouses, and parents/in-laws is often indispensable, the caregivers are prompted to forego their jobs and focus their attention to the caregiving roles.

Although the multiple caregiving roles place extensive demands on their lives, the sandwich generation caregivers still look past the challenges and recognize the positive moments in their roles. The caregivers perceive a sense of gratitude in their caregiving roles and are usually thankful for the experiences. The spouses are appreciative of their partners’ role in supporting each other’s caregiving roles. The caregivers reveal that they become much closer with their children and parents/in-laws due to their involvement in the caregiving roles. Evandrou & Glaser (2004) report improved familial relationships between the caregivers and care recipients due to the participation in multiple caregiving roles. However, the increased involvement in caregiving roles requires that the caregivers have flexible jobs, which is not always the universal case for all the caregivers. Therefore, some caregivers are obliged to forego their work engagements and focus their attention on the caregiving roles, especially the women since they have been historically perceived as the gender bestowed with the mandate of looking after the children and parents/in-laws.

However, the joy that the sandwich generation caregivers report to be finding in their caregiving roles to the care recipients keeps them motivated even if their efforts do not attract economic rewards. The caregivers have a genuine feeling that their caregiving roles bestow them with immeasurable but unquantifiable rewards providing sense of fulfilment in their lives, and this why they can afford to lose their jobs and all the associated economic gains and focus their efforts in caring for their recipients provided they have enough financial resources to sustain them. Hammer & Neal (2008), Black & Lobo (2008), and Bear (2019) report that the sandwich generation caregivers derive joy from their roles and this helps them to buffer the stressors linked with their care tasks. The caregivers have feelings of reward when occupying multiple caregiving roles as they are convinced that they are repaying for the care that their parents provided to them at young age and the care that their children would provide to them too once they are old.

The multigenerational caregiving roles is more of an intergenerational succession practice for reciprocation of care. Igarashi et al. (2013) suggested that the involvement of sandwich generation caregivers in the multiple caregiving roles was guided the hope that the children get the necessary preparation for their potential roles of caregiving in the future. The caregivers felt they are responsible to take care of the older adults (their in-laws and parents) so that their children can learn how to take care of them in the future. The understanding of the complexities of multigenerational caregiving roles by the children would better equip them as the future caregivers. The children would make the caregiving roles less burdensome and develop the ability on how to balance their care tasks with the health needs and work engagements to ensure that they have improved health outcomes, increased job satisfaction, and reduced turnover intentions, since these are areas most affected by the multiple caregiving roles.

Recommendation and Conclusion

Future Directions

Through the continued understanding of the factors, perceptions, and lived experiences of the caregiving strain and burden affecting job satisfaction, turnover intentions, and caregivers’ sleeping pattern, and depressive symptoms, future research is needed to determine the caregivers’ needs. The sandwich generation caregivers care for their respective care recipients including children, spouses, and older adults, however, the question that remains unanswered is, “who care for the caregivers?” Therefore, future study is needed to focus on the caregiving resources to provide greater understanding of the effective strategies that can help reduce the caregivers’ strain associated with feelings of emotional distress, physical burden, and stressor factors affecting their health and other economic engagement such as work. The future research should qualitatively explore how the stress-related feelings affecting the caregiver’s health can be reduced to eliminate the risks of burden and promote self-help techniques and self-care that will allow the caregivers balance their care recipients’ need with their work engagements whether in part-time or full-time employment.

Conclusion

The participation in caregiving by the sandwich generation caregivers is unquestionably both a rewarding and challenging role. The multigenerational caregiving roles enable the caregivers to share their lived experiences. The reflection on the current and past experiences allows the caregivers to provide in-depth examination of their caregiving roles for their children, spouses, and the aging in-laws/parents. There were the challenges of reduced job satisfaction, increased turnover intentions, and compromised health outcomes, specifically in reference to increased depressive symptoms and sleeplessness, which were influenced by the demands of multiple caregiving roles on the caregivers.

In spite of the challenges, the participation in multiple caregiving roles by the sandwich generation caregivers also presents some silver linings realized through the balancing acts of completing care responsibilities and other life’s engagement duties that presents the inevitability of change in the future. Therefore, this paper provides a holistic perspective on both the positive and negative effects of multigenerational caregiving roles on the sandwich generation caregivers’ health and employment. The understanding of the associated impacts of caregiving roles on the caregivers’ health and other life engagement such as work provides better anticipation of the care and work demands. The caregivers develop an insight to be more cognizant of their health and balance the demands of their care recipients with their economic responsibility roles, especially when employed.

 

 

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