The Caregiver Crisis: When Demographics, Immigration, and Economics Collide
Learning Journal - Article 003Earlier this year I moved back to Northern California to help care for elderly relatives. It’s a blessing that I can be close and help out more directly, and unlike my siblings, I don’t have my own kids who also need my time and attention. But 54% of Americans in their 40s are part of the “sandwich generation” and find themselves having to juggle both - caring for a parent over 65 and a child under 18 (or an adult child they provide for financially).1
This isn’t just a caregiving story - it’s a collision of three simultaneous crises that together threaten to fundamentally reshape American families, workplaces, and the entire care industry.
Today we’re seeing how demographic pressures on families, immigration enforcement, and policy changes that threaten care funding are simultaneously reshaping our world. Understanding how these forces interact isn’t just academic - it’s essential for anyone trying to navigate the future of elder care, whether as a family member, employer, or business operator.
The Sandwich Generation Squeeze Intensifies
The “sandwich generation” isn’t a new phenomenon. But what has changed dramatically is its scope and intensity. As millennials delay childbearing and family sizes shrink, the age range of those feeling squeezed has widened while the support burden falls on fewer people to meet growing needs.
The numbers tell a compelling story of economic and emotional strain. More than 23% of the workforce now cares for aging parents and young children simultaneously,2 representing a massive segment of American workers managing dual caregiving responsibilities.
To meet these increasing demands, many caregivers are making difficult choices that reshape their career trajectories. A striking 51% of moms in the sandwich generation have left a job due to caregiving responsibilities,3 which will inevitably affect their ability to return to the workforce, their long term career progression, and their retirement - in addition to their current income.
Whether they leave their jobs or not, the path isn’t easy. Research shows that nearly 25% of caregivers report “substantial financial difficulties” and 44% experience “substantial emotional difficulties,”4 both markedly higher than noncaregivers. Perhaps most concerning for employers, 75% of moms in the sandwich generation report having to take time off work several times a year for unexpected elder care needs, while 40% feel ostracized at work due to their caregiving duties3.
What makes this trend particularly significant: 61% of sandwich moms have been in their caregiving role for five years or less, while 56% of all moms surveyed anticipate entering a dual-caregiving role in the future.3 This points to a deepening workforce shift where the barriers faced by this group are rapidly expanding beyond a niche issue.
Immigration Enforcement Disrupts Care Operations
While families struggle with unpaid caregiving burdens, the professional care workforce faces its own crisis through immigration enforcement. The impact on elder care operations has been immediate and measurable.
ICE enforcement is specifically causing “staff shortages in nursing homes and elder care, making it harder to maintain adequate staffing levels and increasing burnout among remaining aides.”5 The ripple effects extend beyond individual facilities. Recent surveys show 75% of executives said immigration policies are among their top concerns, with 70% expecting a significant workplace impact over the next 12 months.6
The scope of this workforce disruption becomes clear when examining dependency on immigrant workers across the care sector. Nationally, 1 out of every 5 child care workers is an immigrant.12 Undocumented workers, specifically, are “essential to the very functioning of our health care systems” including as “home health aides”7. California faces particular exposure to workforce disruptions caused by immigration enforcement, with approximately 2 million residents without legal status—the highest of any state.8
The business implications extend beyond immediate staffing challenges. Even the fear of immigration enforcement reduces workforce availability as undocumented workers avoid employment situations where they might face scrutiny, further straining already short-staffed facilities.
This creates a cascading effect that ultimately falls back on families. When nursing homes, home health agencies, and daycare programs cannot maintain adequate staffing due to immigration enforcement, facilities reduce capacity or close entirely. This forces more families to provide direct care themselves—adding to the already overwhelming burden on sandwich generation caregivers who were counting on professional support to manage their dual responsibilities.
Policy Changes Threaten Care Funding
As if demographic pressures and workforce disruptions weren’t challenging enough, fundamental changes to care funding are reshaping the financial landscape for both families and care providers.
Recent Trump administration legislation cuts $1.1 trillion in health-care spending over the next decade, with over 90% of those cuts coming from Medicaid.9 This is particularly concerning since Medicaid serves as “the payer of 44% of long-term supports and services [assistance with daily living tasks for people with chronic illnesses, disabilities, or aging conditions] and is the primary payor for 63% of all nursing home residents.”10
The human impact of these cuts is projected to be substantial. An estimated 1.3 million people over 65 will lose their Medicaid coverage by 2034.11 For facilities like the board and care home my grandmother operated—which historically served clients almost exclusively through Medicaid—these cuts could fundamentally reshape the industry. Independent operators may struggle to maintain operations without reliable Medicaid reimbursements, potentially forcing consolidation or closure of smaller, community-based facilities that have traditionally provided more personalized care.
These funding pressures face immediate exacerbation from the October 2025 government shutdown. While Medicaid payments can continue for approximately 30 days during a shutdown through reserve funding, extended shutdowns create delayed payments to care facilities—forcing operators to cover costs out of pocket or reduce services. For small, independent facilities already operating on thin margins, even temporary payment delays can create cash flow crises that threaten operations.
Strategic Implications: Navigating the Perfect Storm
These converging pressures create both immediate challenges and strategic opportunities across multiple stakeholders. The organizations and individuals who recognize the interconnected nature of these forces will be better positioned to adapt and thrive.
For Care Businesses
The most resilient operators will likely be those who can innovate around workforce constraints while maintaining quality. This might include technology-enabled care delivery that reduces labor intensity, partnership models that share workforce costs across multiple facilities, or premium positioning that justifies higher wages to attract and retain stable staff. Given that labor shortages affect care sectors disproportionately, businesses that solve workforce challenges will have sustainable competitive advantages.
The Medicaid cuts also create potential consolidation opportunities for well-capitalized operators who can weather the funding transition while acquiring distressed competitors. However, this consolidation could reduce the diversity of care options that many families have historically relied upon.
For Employers
With over half of sandwich generation mothers leaving jobs due to caregiving responsibilities, companies that offer comprehensive caregiver support—flexible schedules, emergency backup care, eldercare benefits—may gain significant competitive advantage in talent retention.
Forward-thinking employers are beginning to recognize that organizations lose more than $44 billion annually in productivity due to caregiving responsibilities,2 making investment in caregiver support both an employee retention strategy and a bottom-line business decision.
For Families
The convergence of these pressures makes proactive planning essential. This includes researching care options before they’re needed, understanding insurance coverage gaps, and building support networks early.
Families should particularly focus on understanding how potential Medicaid changes might affect their long-term care options and consider whether private insurance or alternative funding strategies might be necessary.
Looking Forward: A Fundamental Shift
What I’m observing through this research isn’t just a temporary crisis—it’s a fundamental shift in how care gets delivered and funded in America. The convergence of demographic certainty, workforce disruption, and policy changes is creating new realities that require different approaches than what worked in previous generations.
For families like mine navigating these decisions right now, understanding these interconnected forces isn't academic—it's essential for making informed choices about the care options that will shape our family's future.
The organizations that thrive will be those that recognize this isn’t just a workforce issue or a policy issue or a demographic issue—it’s all three simultaneously. They’ll need to develop strategies that account for the interconnected nature of these challenges while identifying opportunities that emerge when traditional models break down.
The next 18 months will be critical as these demographic, policy, and enforcement pressures intensify. The question isn’t whether the care industry will transform—it’s which business models will emerge stronger, which communities will be left behind, and how families can best position themselves to navigate a rapidly changing landscape.
This exploration of converging caregiving pressures builds on my ongoing research into elder care business models. As I continue documenting my learning journey, I’m particularly interested in how innovative care businesses are adapting to these workforce and funding challenges while maintaining their mission of dignified care delivery.Sources
Pew Research Center. (2022). More than half of Americans in their 40s are ‘sandwiched’ between an aging parent and their own children. https://www.pewresearch.org/short-reads/2022/04/08/more-than-half-of-americans-in-their-40s-are-sandwiched-between-an-aging-parent-and-their-own-children/
Grayce. (2025). How Sandwich Generation Caregivers Impact Your Business. https://withgrayce.com/resources/blog/sandwich-generation-caregivers/
HR Dive. (2025). Half of moms in the ‘sandwich generation’ say they’ve left jobs due to caregiving roles. https://www.hrdive.com/news/caregiver-employee-benefits/749650/
PMC. A National Profile of Sandwich Generation Caregivers Providing Care to Both Older Adults and Children. https://pmc.ncbi.nlm.nih.gov/articles/PMC10023280/
Law Firm for Immigrants. (2025). The Economic Impact of ICE Enforcement in June 2025. https://www.lawfirm4immigrants.com/what-is-the-economic-impact-of-ice-enforcement-in-june-2025/
Axios. (2025). Employers worry over immigration crackdown as labor shortage fears loom. https://www.axios.com/2025/05/07/trump-immigration-policies-workforce-survey
STAT News. (2025). Allowing ICE in hospitals is a public health catastrophe in the making. https://www.statnews.com/2025/01/23/ice-hospitals-citizenship-status-undocumented-workers-health-care/
NPR. (2025). Health care workers are rushing to learn about immigration law in case of ICE raids. https://www.npr.org/sections/shots-health-news/2025/02/25/nx-s1-5307229/health-care-workers-are-rushing-to-learn-about-immigration-law-in-case-of-ice-raids
CNBC. (2025). How Trump bill Medicaid cuts will impact U.S. health care. https://www.cnbc.com/2025/07/01/how-trump-bill-medicaid-cuts-will-impact-us-health-care.html
National Partnership for Women & Families. (2025). Trump’s plan to slash Medicaid will harm older women – and the economy. https://nationalpartnership.org/report/trumps-plan-slash-medicaid-will-harm-older-women-and-economy/
Association of Health Care Journalists. (2025). How Trump’s budget impacts older adults. https://healthjournalism.org/blog/2025/07/how-trumps-budget-impacts-older-adults
National Immigration Forum. (2025). Explainer: Immigrants’ Critical Role in the U.S. Childcare Workforce and in Increasing Labor Force Participation Rates. https://forumtogether.org/article/explainer-immigrants-critical-role-in-the-u-s-childcare-workforce-and-in-increasing-labor-force-participation-rates/