New research shows caregiver burnout among sandwich generation working women is driving higher healthcare costs, rising depression rates and growing workforce retention risks.
The latest data from Cleo’s third annual Family Health Index, based on more than 19,200 assessments of working caregivers and parents, found that 64% of women in the sandwich generation are at high burnout risk, a level of strain researchers warn is destabilising the workforce. Women aged 40 to 54, often in peak earning and leadership years, show the highest burnout risk of any age group, with 46% falling into the most severe category.
The findings reinforce several other studies on the mounting strain facing working caregivers. One analysis from AARP and S&P Global, found that seven in ten working caregivers struggle to balance career and caring responsibilities, highlighting the scale of the work–care collision reshaping workplaces.
“This isn’t just exhaustion,” said Cleo’s Chief Executive, Dr Madhavi Vemireddy. “Caregiving strain is no longer invisible, and neither are its health consequences. We’re seeing measurable declines in self-care, mental health risk and overall wellbeing, alongside rising medical costs.”
HIGH BURNOUT RISKS
The strain is translating directly into higher healthcare spending and performance disruption. Caregivers at high risk of burnout incur average medical costs of about $1,000 per member per month, compared with $600 per month for lower-risk members – a 67% higher spend tied directly to burnout risk, according to the study. Burnout is also associated with:
- Productivity loss
- Unplanned leaves of absence
- Attrition and early retirement
- Reduced career advancement
- Loss of institutional knowledge
The workforce consequences are already visible. A recent study from Catalyst, found that nearly half a million women exited the US workplace in 2025 as caregiving pressures mounted, underlining the retention risk employers now face. Midlife women frequently represent a highly experienced, high-impact segment of the workforce. Yet caregiving strain is increasingly surfacing as a women’s health issue with downstream economic consequences.
The study suggests that when employers invest in caregiving support, the results include lower avoidable healthcare utilisation, stronger screening adherence, fewer performance disruptions and higher loyalty among employees carrying heavy caregiving loads. The company cites an average three-times return on investment, and backs contracts with a “Save More Than You Spend” guarantee.
MENTAL HEALTH MATTERS
Beyond economics, the report highlights worsening mental health outcomes. More than half of midlife women screen positive for depression and anxiety using the Patient Health Questionnaire-4 (PHQ-4), alongside rising social isolation and declines in self-care.
The risk compounds with age, noted the study. Among women 55 and older in the postmenopausal phase, 63% screen positive for depression or anxiety, the highest rate across demographics measured.
Burnout risk intensifies for those managing the most complex caregiving loads:
- 64% of sandwich generation caregivers
- 59% caring for neurodivergent children
- 52% parenting teenagers
- 51% navigating perimenopause or menopause while caregiving
Broader workplace data mirrors this strain. Another survey found that one-third of UK workers feel overwhelmed by job pressures, with women and caregivers disproportionately affected. For many women, caregiving responsibilities collide with perimenopause and menopause, creating what researchers describe as a “perfect storm” of stress, sleep disruption and untreated symptoms. A first-of-its-kind Mayo Clinic study found women balancing caregiving and menopause face nearly double the risk of moderate to severe menopause symptoms, both psychological and physical.
WORKPLACE SYSTEMS FAILING TO SUPPORT WOMEN
“We’re talking about millions of women who are the engine room of the paid workforce,” said Liz Powell, Founder and Chief Executive 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.”
Jason Resendez, Chief Executive of the National Alliance for Caregiving, said nearly two-thirds of family caregivers face high emotional stress, effectively “losing a full week every month to poor mental health”. More than half did not choose the caregiving role and report the highest levels of isolation. “This isn’t a test of individual resilience,” Resendez said. “It’s a systemic failure to provide the support these emotional realities demand.”
BURNOUT FOR WORKING PARENTS
Burnout worsened across all parenting stages in 2025, with the sharpest increase among parents of younger children. When burnout risk scores improve, however, so do outcomes. In fact, 48% to 52% of working caregivers report gains in productivity, emotional wellness, connectedness, confidence and self-care.
With nearly half of midlife women at high burnout risk, and 64% of sandwich generation women at breaking point, the data suggests caregiving strain is no longer a private struggle. It is a structural workforce challenge with rising healthcare costs and long-term economic consequences.
BETTER SUPPORT FOR CAREGIVERS
The data makes clear that caregiver burnout is not an isolated wellbeing issue. It is a measurable driver of healthcare costs, productivity loss and attrition among a highly experienced segment of the workforce.
If caregiver burnout is driving a 67% increase in healthcare costs and threatening talent retention among midlife women, experts say the response cannot be symbolic. It must be structural.
Based on the findings from the Family Health Index, employers seeking to stabilise their workforce and reduce avoidable health spend should prioritise the following:
1. Treat caregiving as a workforce strategy, not a perk
With 64% of sandwich generation women at high burnout risk, caregiving support cannot sit inside optional wellbeing programming. It should be embedded into core workforce planning, talent retention strategy and leadership development.
That includes:
- Recognising caregiving as a predictable life stage
- Building it into succession planning and promotion pathways
- Normalising disclosure without career penalty
2. Identify risk early
The data shows burnout correlates directly with higher medical spend. Prevention is significantly less costly than crisis response. Employers can:
- Use evidence-based screening tools to identify high-risk employees earlier
- Integrate mental health check-ins into benefits navigation
- Monitor trends in leave, claims and productivity loss as early warning signs
3. Expand flexible work beyond rhetoric
Midlife women balancing caregiving and menopause are facing a “perfect storm” of stress and sleep disruption. Flexibility is not simply about remote work, it’s about control. Flexibility should protect advancement, not sideline it.
Practical measures include:
- Flexible start and finish times
- Reduced-hours leadership tracks
- Temporary workload rebalancing during peak caregiving strain
- Manager training on empathetic workload planning
4. Integrate menopause support into health strategy
With 63% of postmenopausal women screening positive for depression or anxiety, and caregiving compounding symptom severity, menopause support must move from taboo to policy. Menopause and caregiving often collide, so benefits design should reflect that reality.
Employers can:
- Provide menopause-informed healthcare navigation
- Offer education for managers and HR leaders
- Ensure coverage for mental health, sleep and hormonal treatment options
- Create peer support networks without stigma
5. Address mental health as a productivity driver
More than half of midlife women screen positive for depression and anxiety. Nearly two-thirds of caregivers report losing a full week per month to poor mental health. Mental health support should be preventative, not only crisis-based.
Effective responses include:
- Fast-access mental health services
- Proactive outreach to high-risk groups
- Coaching and resilience resources tied to caregiving challenges
- Confidential counselling that accounts for cultural and generational expectations
6. Measure ROI and hold programmes accountable
The data suggests that when burnout risk improves, 48% to 52% of caregivers report gains in productivity, emotional wellness and self-care. Cleo reports an average three-times return on investment when caregiving support is implemented. What gets measured gets funded.
Employers should:
- Track healthcare utilisation and absenteeism pre- and post-intervention
- Measure engagement and retention among midlife women
- Tie caregiver support metrics to executive performance goals
7. Reduce stigma at leadership level
When caregiving is acknowledged as a social determinant of health and a workforce reality, not a private burden, organisational culture begins to shift. Perhaps most critically, caregiving strain must be visible at the top.
Senior leaders, particularly women in executive roles, can:
- Speak openly about caregiving realities
- Model healthy boundaries
- Advocate for structural policy change rather than informal accommodations
Download a full copy of the report, here.
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