Two Out Of Three Women In The Sandwich Generation Reach A Caregiving Breaking Point

With escalating mental health strain, higher healthcare costs and workforce impact

Cleo’s 3rd Annual Family Health Index™ reveals that of women in midlife, ages 40-54, nearly half are at high burnout risk – rising sharply for those in the Sandwich Generation – threatening talent retention, institutional knowledge, and career advancement.

Cleo, a global family care platform, has released its 3rd annual Family Health Index™ report, an evidence-based, multidimensional risk assessment designed to proactively identify working family caregivers and parents who are at elevated risk for burnout and related health strain, enabling earlier, targeted support.

This year’s topline findings from more than 19,200 assessments revealed that 64% of working women in the sandwich generation are at a breaking point with escalating mental health strain, higher healthcare costs, productivity loss and attrition.  This burnout risk is not only disrupting workforce stability, but also accelerating preventable health decline for women in their peak earning and leadership years.

Forty-six percent of women ages 40-54 face the highest burnout risk across all age groups marked not just by exhaustion, but by measurable warning signs of health deterioration. Most report a significant decline in self care and overall health, and more than half screen positive for depression and anxiety on the Patient Health Questionnaire-4 (PHQ-4) alongside increased social isolation.

“Caregiving strain is no longer invisible, and neither are its health consequences,” said Cleo CEO Dr. Madhavi Vemireddy. “The Family Health Index continues to be indispensable in its ability to identify the real-time, evolving needs of working caregivers. Critically, our findings revealed an urgent need for women in mid-life, especially those in the sandwich generation, who are experiencing measurable declines in self-care, mental health risk, and overall wellbeing, alongside rising medical costs. By identifying risk earlier and delivering timely, personalized support, organizations can protect caregiver health, prevent avoidable escalations, and build a more resilient workforce.”

Women at greatest risk are often those managing the most complex caregiving load such as those in the sandwich generation (64%), taking care of neurodivergent children (59%), parenting a teen (52%), or navigating perimenopause and menopause while caregiving (51%). This heightened risk is not only personal, it is costly. Caregivers at high risk of burnout incur substantially higher medical spend (~ $1000 PMPM vs $600 PMPM for lower risk members), reinforcing caregiver burnout as a leading indicator for preventable healthcare utilization.  Caregiving isn’t a side hustle, it’s a second full-time job, and for many women it functions as a powerful social determinant of health that quietly compounds risk over time.

Importantly, women in midlife often represent a highly experienced, high-impact segment of the workforce – yet caregiving strain is showing up as a women’s health issue with downstream consequences for careers and healthcare costs. When employers invest in caregiving support the result is both human and financial:

• Lower avoidable healthcare utilization and spend

• Stronger health activation and screening adherence

• Fewer unplanned leaves of absence

• Reduced burnout-driven performance disruption

• Higher loyalty among employees carrying the heaviest load (while women remain the majority of family caregivers, these benefits extend to all family caregivers)

For many midlife women, caregiving responsibilities collide with perimenopause and menopause creating a perfect storm of stress, sleep disruption, and untreated symptoms. In a first-of-its-kind Mayo Clinic study, women managing both family caregiving and menopause face nearly double the risk of moderate to severe menopause symptoms including psychological and physical symptoms that often go unrecognized and untreated.

“We’re talking about millions of women who are the engine room of the paid workforce,” said Liz Powell, Esq., MPH, Founder & CEO of G2G Consulting and Women’s Health Advocates. “When they crash, the fallout is huge—families fracture, unnecessary and avoidable healthcare claims go up, companies lose talent, and communities suffer. Obesity, hypertension, depression, early retirement, financial strain—these are all symptoms of a system that fails to support women through predictable life transitions and ends up costing all of us more in medical expenditures.”

Other key takeaways from the Family Health Index™ include:

• Burnout worsened across all parenting stages in 2025, with the greatest increase among parents of younger children.

• Women face a compounding risk for depression and anxiety with each life stage. Women consistently screen at higher risk than men for depression and anxiety, and that risk increases with age, peaking at 63% of women 55+ in the postmenopausal phase scoring positive on the PHQ-4.

• High caregiving burnout correlates with higher healthcare costs. Caregivers at high risk of burnout incur higher medical costs—averaging $1,000 PMPM—compared to $600 PMPM for lower risk members, nearly a 67% cost delta tied directly to burnout risk.

• When burnout risk scores improve, outcomes improve. With improved burnout risk scores, working caregivers report a corresponding improvement in productivity, with 48% to 52% of members also reporting an improvement in emotional wellness, connectedness, confidence, and self-care.

Cleo recently confirmed an average 3x ROI for customers, including global enterprises, delivering savings across both healthcare spend and workforce productivity. Cleo also backs its contracts with a ‘Save More Than You Spend’ ROI Performance Guarantee – among the first of its kind in the caregiving space – reimbursing customers if they don’t save more with Cleo than without it.

Cleo’s Family Health Index™ methodology has been independently reviewed by The Validation Institute, which found the tool accurately measures caregiver health and that higher risk members’ Emotional Wellness (PHQ-4) scores improve with Cleo interventions.

“Our research at National Alliance for Caregiving reveals a crisis: nearly two-thirds of family caregivers, many of whom are women, face high emotional stress, losing a full week every month to poor mental health,” says NAC CEO Jason Resendez. “Crucially, over half of caregivers didn’t choose this role and they suffer the most from isolation. This isn’t a test of individual resilience; it’s a systemic failure to provide the support these emotional realities demand.”