Sandwich carers, UK: January 2021 to May 2023

Sandwich carers provide care for sick, disabled, or older adult relatives as well as for dependent children. Of those aged 16 to 64 years: 

• Around 1 in 6 (16%) sandwich carers found it quite or very difficult to manage financially, compared with 9% of all adults; a quarter (25%) of those caring for 20 hours or more per week found it quite or very difficult to manage financially.

• Around 1 in 12 (8%) sandwich carers reported that they ran out of food in the last 12 months because of a lack of money or resources compared with 5% of all adults; those caring for 20 hours or more per week were more likely to report this (17%).

• Around half (53%) of sandwich carers reported that they were unable to work at all or as much as they would like because of their caring responsibilities for someone they live with; this increased to around three-quarters (74%) for those caring 20 hours or more per week.

• Around 3 in 10 (31%) sandwich carers indicated some evidence of depression or anxiety (GHQ-12 score of 4 or more) compared with 24% of all adults; around a fifth (19%) of sandwich carers reported being currently diagnosed with depression, compared with 13% of all adults.

Sandwich carers have dual caring responsibilities for dependent children and adult relatives. They have additional caring responsibilities beyond those experienced by others who only provide care to another adult relative or who only provide care to dependent children. In this bulletin, we look at the profile of sandwich carers aged 16 to 64 years, their experiences, and make comparisons with all adults of the same age.

There were an estimated 1.4 million sandwich carers aged 16 to 64 years in the UK between 2021 and 2023, based on the Understanding Society study. Most (61%) sandwich carers were female and, as they often provide care for their own parent, sandwich carers tend to be older than other parents of dependent children who are not sandwich carers. Around half (51%) of sandwich carers were aged 45 to 64 years, compared with 40% of parents who do not also provide unpaid care to another adult relative.

Around 7 in 10 (71%) sandwich carers provided care for less than 20 hours per week and a quarter (26%) provided care for 20 hours or more per week. A small proportion of respondents (3%) selected "Other" when asked how many hours they provided care for.

Just over 6 in 10 (64%) sandwich carers were "out-of-house" sandwich carers; they provided care for adult relatives living outside their home, such as a parent who lived elsewhere. Around 3 in 10 (30%) sandwich carers were "in-house" sandwich carers, providing care for adult relatives living in their home, such as a partner. A minority (6%) were "both in-and-out-of-house" sandwich carers, providing care to adult relatives living with them in their home as well as other adult relatives living outside of their home.

Out-of-house sandwich carers were more likely to be female (68%), aged 45 to 64 years (56%) and provide care for less than 20 hours per week (84%). In comparison, in-house sandwich carers were less likely to be female (46%), aged 45 to 64 years (40%), or provide care for less than 20 hours per week (48%).

Among both in-and-out-of-house sandwich carers, most were female (57%), aged 45 to 64 years (58%), and provided care for 20 hours or more per week (54%).

Figure 1: Out-of-house sandwich carers were more likely to be female, older and provide fewer hours of care than in-house sandwich carers

Proportion of sandwich carers by sex, age group and hours of care, UK, January 2021 to May 2023

Notes:

1. The response option 'Other' is excluded from this chart for hours of care.

Sandwich carers tended to have lower incomes than all adults. Around 4 in 10 (43%) sandwich carers had an annual gross household income of £20,000 or less, compared with 32% of all adults.

Those providing more hours of care per week tended to have even lower incomes. Just over 6 in 10 (64%) sandwich carers providing care for 20 hours or more per week had an annual gross household income of £20,000 or less, compared with 35% of those caring less than 20 hours.

Around 1 in 6 (16%) sandwich carers found it quite or very difficult to manage financially, compared with 9% of all adults. This increased to around a quarter (25%) for those caring 20 hours or more.

Sandwich carers were more likely to show signs of food insecurity than all adults. During the last 12 months because of lack of money or resources, sandwich carers were more likely than all adults to report that they:

• ate less than they thought they should (15%, compared with 8%)

• were hungry but did not eat (9%, compared with 5%)

• ran out of food (8%, compared with 5%)

In-house sandwich carers and both in-and-out-of-house sandwich carers were more likely than out-of-house sandwich carers to show signs of food insecurity. They reported that they:

• ate less than they thought they should (24% of in-house and 31% of both in-and-out-of-house sandwich carers, compared with 9% of out-of-house sandwich carers)

• were hungry but did not eat (16% of in-house and 25% of both in-and-out-of-house sandwich carers, compared with 4% of out-of-house sandwich carers)

• ran out of food (15% of in-house and 20% of both in-and-out-of-house sandwich carers, compared with 4% of out-of-house sandwich carers)

Figure 3: Sandwich carers were more likely than all adults to show signs of food insecurity

Proportion of adults reporting “Yes” to the food insecurity related measure, UK, January 2021 to May 2023

Notes:

1. Question: During the last 12 months was there a time when you or others in your household…because of lack of money or other resources?

Around three-quarters (76%) of sandwich carers were employed or self-employed, similar to all adults (76%). Among in-house sandwich carers, around 6 in 10 (59%) were employed or self-employed and this increased to around 8 in 10 (84%) for out-of-house sandwich carers.

Sandwich carers were more likely to report family care or home as their employment status than all adults (13%, compared with 3%). Among in-house sandwich carers, around 2 in 10 (21%) reported family care or home as their employment status, compared with around 1 in 10 (9%) out-of-house sandwich carers.

Sandwich carers providing 20 or more hours of care per week were less likely to be employed or self-employed (49%) and more likely to report family care or home as their employment status (32%), compared with those caring less than 20 hours per week (86% and 6%, respectively).

Among sandwich carers looking after an adult or child in their household who is sick, disabled or elderly, around half (53%) reported that they were unable to work at all or as much as they would like because of their caring responsibilities (31% were unable to work at all and 22% were unable to work as much as they would like). This increased to around three-quarters (74%) for those caring for 20 hours or more per week.

When asked about how satisfied or dissatisfied they were with aspects of their current situation, sandwich carers were less likely than all adults to be satisfied (completely, mostly or somewhat) with their:

• house or flat (63%, compared with 69%)

• health (57%, compared with 63%)

• leisure time (50%, compared with 59%)

• income (49%, compared with 60%)

The more hours of care per week a sandwich carer provided, the less likely they were to report being satisfied with aspects of their current situation. Sandwich carers caring for 20 hours or more per week were less likely than those caring for less than 20 hours to report being satisfied with their:

• house or flat (43%, compared with 70%)

• life (54%, compared with 68%)

• health (40%, compared with 63%)

• leisure time (35%, compared with 56%)

• income (33%, compared with 55%)

Figure 5: Around two-thirds (64%) of sandwich carers were satisfied with their life

Proportion of adults reporting being satisfied (completely, mostly or somewhat) with aspects of their current situation, UK, January 2021 to May 2023

Notes:

1. Question: How dissatisfied or satisfied are you with your...?

Note that an age-standardised estimates dataset is provided alongside this bulletin for health measures. These estimates are similar to the non-age-standardised estimates presented in this bulletin.

Around 3 in 10 (28%) sandwich carers self-reported being in fair or poor health, compared with around 2 in 10 (22%) of all adults. This was higher among sandwich carers who provided care for 20 hours or more per week (42%) compared with those caring less than 20 hours (22%).

Physical health

Sandwich carers were more likely than all adults to have below average physical health using the 12-Item Short Form Health Survey measure (SF-12). Around 4 in 10 (41%) sandwich carers indicated this, compared with 31% of all adults. Sandwich carers more likely to report this included:

• in-house sandwich carers (51%), and both in-and-out-of-house sandwich carers (74%), compared with 34% of out-of-house sandwich carers

• those caring 20 hours or more (63%), compared with 33% of those caring less than 20 hours

Mental health

Around 3 in 10 (31%) sandwich carers indicated evidence of depression or anxiety (GHQ-12 score of 4 or more), compared with 24% of all adults. Around a third (34%) of in-house and around half (49%) of both in-and-out-of-house sandwich carers reported this, compared with 27% of out-of-house sandwich carers.

Sandwich carers were also more likely to report being currently diagnosed with depression by a doctor or medical professional (19%, compared with 13% of all adults). Around half (52%) of both in-and-out-of-house sandwich carers reported being currently diagnosed with depression, compared with 20% of in-house sandwich carers and 15% of out-of-house sandwich carers.

Figure 6: Sandwich carers were more likely than all adults to indicate evidence of depression or anxiety and currently be diagnosed with depression

Proportion of adults reporting a GHQ-12 score of 4 or more and being currently diagnosed with depression, UK, January 2021 to May 2023

Notes:

1. GHQ-12 score is based on the General Health Questionnaire which asks respondents 12 questions about their recent feelings. These questions are scored and a score of 4 or more indicates mild to moderate illness such as anxiety or depression.

2. Currently diagnosed with depression is derived from a respondent answering “Depression” to the question: “Has a doctor or other health professional ever told you that you have any of these conditions?” and “Yes” to “Do you still have depression?”.

Dependent child

A dependent child is defined as one aged under 16 years or aged 16 to 18 years and in school or non-advanced further education, not married and living with a parent. It does not include any children who have a spouse, partner or child living in the household.

GHQ-12 score

This measure is based on the 12-Item General Health Questionnaire (GHQ-12), which asks respondents 12 questions about their recent feelings. Once all 12 questions are scored, these scores are added so that each individual has a score that ranges from 0 to 12. A score of 4 or more has been shown to indicate that the individual has symptoms of mild to moderate mental illness such as anxiety or depression.

Sandwich carer

A sandwich carer is defined as having a dependent child aged 18 or under living in the household and providing unpaid care for an adult relative that is sick, disabled or elderly living inside or outside their home.

In-house sandwich carer

An in-house sandwich carer is defined as having a dependent child aged 18 years or under living in the household and providing unpaid care for at least one sick, disabled or elderly relative living inside their home.

Out-of-house sandwich carer

An out-of-house sandwich carer is defined as having a dependent child aged 18 years or under living in the household and providing unpaid care for at least one sick, disabled or elderly relative living outside their home.

Both in-and-out-of-house sandwich carer

A both in-and-out-of-house sandwich carer is defined as having a dependent child aged 18 years or under living in the household and providing unpaid care for at least one sick, disabled or elderly relative living inside their home, and at least one sick, disabled or elderly relative living outside their home.

The 12-Item Short Form Health Survey measure (SF-12)

This measure is based on the 12-Item Short Form Survey (SF-12), which asks respondents about their physical and mental health. Once all 12 questions are scored, these scores are added so that each individual has a score that ranges from 0 to 100 for each of a physical component and a mental component. This bulletin discusses the physical health component where a score of below 50 indicates that the individual has below average physical health.

This bulletin builds on our previous article, More than one in four sandwich carers report symptoms of mental ill-health, but uses an improved methodology. It provides data on working-age (aged 16 to 64 years) sandwich carers and different aspects of their lives, using data from the Understanding Society study.

Households are surveyed each year through face-to-face interviews, online surveys and telephone surveys. Data collection is intended to take place over a 24-month period, however, some interviews cannot be conducted during the intended fieldwork period and are followed up later. The analysis in this bulletin covers the period January 2021 to May 2023.

Any estimate of the number of sandwich carers depends on how respondents are asked about the unpaid care they provide. The definition of unpaid care used in Understanding Society is broad. When asked about care provided to others living outside their home, respondents are guided to include things such as keeping someone company, checking whether they are alright, sitting with them or completing household tasks. When asked about care provided to others living with them, respondents are encouraged to include forms of help which they might consider to be "normal" or a "natural obligation" and which they might not necessarily consider to be care. Interviewers are encouraged to probe if they believe respondents provide care even if, at first, the respondent does not think of the support they provide to be care.

The estimated number of sandwich carers presented in this bulletin is calculated from the 2022 mid-year population estimates of adults aged 16 to 64 years, divided by 100 and multiplied by the weighted proportion of sandwich carers in the sample.

The methodology is similar to that used for our article More than one in four sandwich carers report symptoms of mental ill-health, however, the analysis here is based on working age adults (16 to 64 years) rather than adults aged 16 to 70 years. Age-standardised estimates for health-related measures are now also provided in the accompanying dataset. Age-standardised rates allow comparisons between populations that may contain proportions of different ages. Age-standardised rates were calculated using the 2013 European Standard Population (ESP).