Millions of Americans are now caught in a crushing 'triple-decker sandwich' of caregiving responsibilities, squeezed between raising children, supporting ageing parents, and navigating a political climate hostile to compassion and public support.
The Personal Cost of a National Crisis
Alissa Quart's experience is emblematic of this growing demographic strain. On an autumn day spent at New York's Memorial Sloan Kettering cancer centre with her 90-year-old mother, she was forced to miss her daughter's school volleyball game. Trapped in the slow-moving time of hospital visits, she checked her phone to see grim headlines: the National Guard deployed and federal plans to gut Medicaid and Medicare by $1tn over the coming decade via the so-called One Big Beautiful Bill Act.
"I sighed and resigned myself to only worry about what I could control for the next few hours," Quart writes, describing a reality familiar to a rapidly expanding cohort. The term 'sandwich generation' was coined in the 1980s, but for Gen Xers and millennials today, it has evolved into a more complex, burdensome triple-decker.
A Statistical Surge in Caregiving
The scale of this silent crisis is vast. In the past decade, the number of family caregivers in the United States has surged to 63 million – a staggering 45% increase, representing nearly 20 million more people. Crucially, among caregivers under 50, 47% are now caring for both a parent and a child simultaneously.
For Quart, an only child, her mother's cancer diagnosis created a 'time-space continuum' where the most crucial stages of life collided. After full days at the clinic, she rushed home to make dinner for her daughter, perpetually stretched thin. She began to recognise the same frayed, furrowed look on the faces of friends and strangers in waiting rooms across the city – most of them women.
Political Pressure Cooker: Cuts and Anxiety
In 2025, this personal strain is compounded by a political 'anti-care ethos'. Julie Gayer Kris, a social worker specialising in elders, is herself sandwiched between her 81-year-old mother, a stepfather with Alzheimer's, and a 14-year-old son. She leads therapy groups for family carers and describes the added pressure of the current political era as creating "another layer of hopelessness and stress."
Kris does not mince words about the systemic failures: "The systems are terrible. It's so hard to get the right care – and to get approved for it." She summarises the experience bluntly: "It's a multi-layered sandwich of shit."
The threats are multifaceted: potential stock market crashes, AI disrupting jobs, endangered pensions, and defunded medical research. Celina Su, a political science professor, cared for her dying father and six-year-old daughter while facing Trump-era cuts to academic funding. After her father's death, she learned two of her research grants had been revoked under a federal crackdown on diversity-based studies.
Economic Squeeze and Precarious Support
The economic realities are stark. Eldercare is prohibitively expensive, while in New York City, childcare costs rose 79% between 2019 and 2024. The supply of professional caregivers is also dwindling, with many being immigrants facing precarious legal status.
Dessy Acevedo, 55, became a full-time caregiver for both parents with Alzheimer's and dementia. She voices a common fear: "With so much uncertainty in the political climate, I worry about whether my father will be able to maintain the Medicaid support he is rightfully eligible for."
Anthropologist Danilyn Rutherford, parent to a disabled young adult, warns of a future with restrictions on caregiver overtime pay, referencing proposed labour rule shifts. Julie Croghan, a caregiver in Santa Cruz, is "absolutely disgusted" by policies "hurting disabled children," including her own son. She fears the proposed $1tn cut to Medicaid will make things "really ugly," while also worrying about her ageing mother and her own lack of retirement savings.
A Collective Problem Demanding a Collective Solution
Brigid Schulte of New America's Better Life Lab notes that care workers often earn so little they qualify for public benefits. Removing supports like SNAP and Medicaid, she argues, will devastate the already fragile care infrastructure.
Quart acknowledges her own relative privilege: access to paid family leave in New York, a supportive spouse, and a mother with long-term care insurance – a benefit she compares to a "dodo bird" today. For most, the social safety net is vanishing.
The solution, advocates argue, lies in robust policy: universal paid sick leave and family leave laws. The experience of the triple-decker sandwich generation is not an individual failing but a collective crisis. As Quart concludes, we must remember these burdens are shared, and one day, it will be our turn to need compassion. The current political trajectory, however, suggests that compassion is in dangerously short supply.
