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Where Caregiving Hits Hardest—And Why
The global toll of multigenerational caregiving, by the numbers.
Philip Saparov
September 19, 2025
In partnership with
Caring for your kids. Supporting your aging parents. Trying not to burn out in between.
Welcome to the reality of the Sandwich Generation—millions squeezed by rising demands from both ends of the family tree.
In this edition, we map where the caregiving pressure is most intense, how countries are coping (or not), and what it all means for your decisions, your finances, and your future.
Let’s pull back the curtain on the data—and the strain behind it.
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In Japan, where nearly 30% of the population is over 65, caregiving has become a national conversation—and a growing personal burden.
Japanese adults frequently care for elderly parents while raising children, often with limited external support. Yet Japan has pioneered some solutions: its Long-Term Care Insurance (LTCI) system, launched in 2000, provides universal access to elder care services and helps mitigate out-of-pocket costs. The country also incentivizes multi-generational housing and robotic care technology—both of which are gaining traction.
Still, many caregivers reduce their work hours or leave the workforce entirely. In fact, over 100,000 people quit their jobs annually in Japan to care for aging relatives.
🔍 Curious insight: Japan now offers paid leave not just for childcare—but eldercare, too. A model others may soon adopt.
In the U.S., roughly 1 in 7 adults aged 40–60 supports both a child and an aging parent. And the costs—both emotional and financial—are steep.
Despite a relatively high per-capita income, the U.S. lacks universal eldercare programs, leaving families to navigate a patchwork of private insurance, Medicaid, and out-of-pocket expenses. The average caregiver spends $7,242 annually on caregiving expenses, according to AARP—often without reimbursement.
Time is another cost. On average, caregivers devote 24 hours per week to care duties. That’s three full workdays—on top of everything else.
💡 Trend to note: With rising life expectancy and delayed childbearing, more Americans are entering the “club sandwich” stage—supporting three generations at once.
Italy, with one of the oldest populations in the world, has long relied on family as the bedrock of elder care. But this cultural norm is under stress.
Roughly 70% of elder care in Italy is provided informally—by daughters, mostly—without compensation or state support. As women enter the workforce in higher numbers, the strain is showing. There’s growing demand for reform, especially in a country where 23% of the population is over 65.
To ease the burden, some regions are experimenting with family caregiver allowances, while others are subsidizing live-in foreign care workers, a trend also visible in Spain and Greece.
🎯 Fascinating fact: In southern Italy, multi-generational households still make up 42% of homes—more than double the EU average.
South Korea’s Confucian roots emphasize filial piety—but modern economics are eroding that foundation.
With the world's lowest fertility rate (0.72) and rapid aging, South Korea is confronting a caregiving crisis. Family-based elder support is no longer sustainable as more adults live apart from their parents and prioritize dual-income households.
In response, the government introduced a Basic Pension and expanded public home care services. But take-up remains low, and many caregivers—especially women—face job insecurity.
🧠 Unexpected insight: South Korea recently launched a “Caregiving Credit” pilot that lets caregivers accumulate pension benefits, even if they leave the workforce temporarily.
Germany provides a more structured solution through its statutory long-term care insurance, which covers both home and institutional care. Caregivers can also receive a “care allowance” if they provide informal care at home.
Yet even with this infrastructure, over 4 million Germans act as unpaid caregivers—most of them family members. Many juggle work and care responsibilities without flexible schedules, and burnout is a rising issue.
What’s evolving? Corporate Germany is slowly adapting: some companies now offer “family leave” for caregiving, similar to parental leave.
🔎 Surprising trend: The government is considering mandatory eldercare insurance for all workers, similar to health insurance—an idea gaining momentum elsewhere in the EU.
In Brazil, caregiving happens mostly under the radar. With limited public eldercare services and 70% of older adults living with family, care falls to daughters and granddaughters—typically unpaid and unsupported.
Cultural expectations around familial responsibility run deep, but economic pressures are changing things. As more women enter the workforce, fewer can afford to be full-time caregivers, leading to gaps in care—and rising stress.
In response, Brazil is piloting programs in São Paulo and Minas Gerais to train and certify family caregivers, offering stipends in exchange for formal training.
💬 Little-known fact: Brazilian caregivers report higher emotional stress than financial strain—reflecting a culture where “letting go” of a loved one’s care is often seen as a moral failure.
Globally, the strain of caregiving is intensifying—and most countries aren’t ready.
By 2050, the number of people aged 65+ will double to 1.6 billion, while the working-age population shrinks. In many regions, that means fewer caregivers per elder. The traditional model of family-first care simply won’t scale.
What’s emerging? Countries are exploring:
Paid family caregiving programs (e.g., France, Canada)
Caregiver pension credits (South Korea, UK pilots)
Tech-enabled home monitoring, from AI nurses to sensor-equipped wearables
📉 Big picture stat: According to the WHO, by 2030 the global shortfall of formal caregivers could reach 18 million—a silent crisis in the making.
Whether you're deep in the caregiving grind or simply sensing it on the horizon, this story is yours.
The Sandwich Generation isn’t just a phase—it’s a global turning point. How we handle it will redefine family, work, and aging itself.
The burden is growing. So is the need for bold ideas.
Let’s stay curious. Let’s stay ready.
Warm regards,
Shane Fulmer
Founder, WorldPopulationReview.com
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