Zemplee Podcast : Episode 11

This is AI-Powered Caregiving, the podcast exploring how technology is reshaping the way we care for older adults. Today we're talking about something even more fundamental — the lived experience of care.

Our guest today is a mom of three, daughter to parents with dementia — may they rest in peace — and a sister and guardian to a brother with Down syndrome. She has a career as a social impact consultant working on social impact and gender equity worldwide, with a focus on Latin America. Her personal experiences with caregiving over the last decade have fueled her passion to build community and awareness around the needs of caregivers. She's a beautiful and passionate writer, and her Substack, Gen X Sandwich, is absolutely essential if you are any type of caregiver. Please welcome to the podcast, Anna De La Cruz.

Anna De La Cruz: Hi, Ishanya. Thank you so much for having me.

Ishanya Anthapur: Thank you, Anna, for joining us. I'm really excited to delve into our topics today. I'll start by just asking you a little bit about your caregiving journey.

Anna De La Cruz: Sure, yeah. My caregiving journey started about 12 years ago when my first child was born. At the time, that was my intro to caregiving — becoming a mother. And shortly thereafter, it got much more intense. I had a second child, and my parents up until then had been doing fine. They were aging, but shortly thereafter, when I had two young children, my mom went into the hospital and she started to decline. She had physical health issues, and it became clear that she also had dementia. And so I was kind of thrown into having to figure out how to handle the situation and get her the care she needed. We had to change her living situation. She was living alone and she could no longer do that. She needed help with her finances. So I had to jump in with small children and figure out how to manage all of that.

And then I had a third child, just to keep things exciting. My father sadly also started to decline. He started to have cognitive troubles and more health issues. Meanwhile, they were both guardians to my brother who has Down syndrome. And so I also became responsible for taking on more duties to ensure his care. I took over guardianship for him, which means overseeing his finances and his overall health and wellbeing, although he is cared for in a facility that takes great care of him. So that was how I was thrown into it, and over the past 12 years, I've been doing all the things for all the people.

Ishanya Anthapur: Something I love about your story — and you're so open to sharing, and I really appreciate it, I know other people out there really appreciate it as well — is that you have experienced caregiving from multiple angles. I think sometimes people think about it as just caring for aging parents, but a caregiver is anybody in any capacity who is taking care of another person, or even a pet. Because when you're in that responsibility role, you have to handle finances, people falling sick, their schedules — which sounds small but is a huge addition to managing your own life. Can you speak to that?

Anna De La Cruz: Yeah, it all adds up. It really does.

Ishanya Anthapur: So I'm wondering if being in the middle of three different types of caregiving is where the term Gen X Sandwich came from.

Anna De La Cruz: Yeah — I usually say Gen X Sandwich, but you can say it however you want. It's my term to describe those of us in the Gen X and older millennial category who are finding ourselves in this position. Like me, many are just kind of thrown into it. I never thought about sandwich caregiving — caring for young kids and aging adults at the same time — but there are so many people in this position. Once I was thrown into it, it opened up this whole world to me. There's actually a term for this: sandwich generation caregiving. And because of demographics today — people having kids later in life and our aging population — it's becoming increasingly common. That's what inspired me to start my newsletter and build community around it, because I realized I had no idea when I was thrown into it, and I would have loved to have more resources available, hear stories from others, and share experiences. It's a wild ride, but it's not that uncommon. We just don't talk about it enough.

Ishanya Anthapur: Maybe you could speak to that a little bit. When you started out, you mentioned there weren't a lot of resources. Do you think that landscape is shifting now, with more and more people becoming sandwich caregivers? Or is there still a lack?

Anna De La Cruz: I think it's both. It is shifting, but slowly. There's still not enough discussion about caregiving and aging — not enough visibility and representation in our communities, our businesses, and the media. People still end up coming into the situation very underprepared, without knowledge of resources, without having had conversations with their loved ones about what they want or how to handle various caregiving situations.

More and more, there's a growing contingent of people talking about paid family leave, motherhood, and the unaffordability of childcare, which is great — we still have a long way to go there. And more people are starting to talk about aging, but it's discussed even less. We still have a long way to go. It's challenging because it's not something that's typically glamorous to talk about, and people don't necessarily want to confront their own potential need for caregiving. But it's so important, because I think it would really help all of us do a better job when the time comes.

There's a saying — I don't remember who said it — but it goes something like: all of us will be either cared for, a caregiver, or both, probably both, in our lifetimes. And so it's relevant to everybody. It's not a niche topic, but we sort of treat it like one.

Ishanya Anthapur: Your Substack articles are really helpful because they're so open. It's Gen X Sandwich — I want to make sure I'm saying that correctly. And yeah, I think you're so open in what you share. Do you find it's hard for people to open up about their caregiving experiences? And how did you end up being so willing to share and be vulnerable? Did you have to go through any sort of process to get there?

Anna De La Cruz: Writing about it has actually been really helpful for me — it's been a means to heal from some of what I've gone through. And then getting the positive response that I've received, people saying things like, "Your article really spoke to me," or "I'm in a similar situation, this was so helpful to read" — that's been really reaffirming. For people to be able to see themselves and their experience in other people's stories is so helpful.

And for me, it's just been a way to process everything I've been through, because a lot of it happened really quickly and I was just making decisions on the fly. I didn't have any plan for how any of this was going to unfold — and usually we don't, because caregiving journeys often start with some kind of dramatic event. A hospitalization, a fall, some kind of crisis. At least within elder care, it often starts that way. So we don't have a lot of time to process or think about how we'dlike to do things. And then there's a lot of thinking back: What would I have done differently? What would have helped me? How can I help other people not make the same mistakes I did? I spent hours researching elder care options, and I want to share that with others who may be where I was a few years ago, and save them some of the headache I went through.

Ishanya Anthapur: That's really amazing. Have you made new friends and new community through sharing your caregiving experience?

Anna De La Cruz: Absolutely. Substack has been a great place for that because there are a lot of caregivers who write about their experiences, who are very open and, I think, in a very similar position to mine — wanting to share, wanting to build community. So many of us have connected, follow each other, and support each other. We do collaborations, and I've participated in some of those. I have the goal of doing more interviews and collaborations myself — of course, all of us struggle with time as caregivers — but there really is an amazing community there.

And then there are also a number of organizations nationally and internationally that are working on these topics and gaining more momentum. It helps to have the community, because it can feel really lonely when you're thrown into these situations, trying to manage things for a parent who may not understand or may be struggling with the loss of independence. It's helpful to have people who are in the same situation to talk to.

Ishanya Anthapur: Completely. I think what I'm really hoping for is that, as time moves on, we normalize talking about caregiving in whatever capacity it is — the difficulties, the struggles. But I'm also curious about the joys of caregiving. It obviously has its downs, but it must have a lot of ups too. What are some of the joys you've experienced as a caregiver, a mom, a daughter, a sister?

Anna De La Cruz: There certainly are joys. I love being a mom. I love having three kids — I never thought I would have three, honestly, but now I love having a big family. It's amazing to see the three of them bond as siblings. And honestly, as my husband and I get older, I think about them having each other. It's not going to fall on any one person.

I mean, I am the only daughter who was able to support my mother, who hasn't been married since she and my dad divorced when I was young. So it's really fallen on me, and that has honestly been tough. Seeing my kids have each other has been really beautiful.

And I think also having them get to know my brother who has Down syndrome. He's 50 now, and he's doing well. He's in a great situation — there's a nonprofit that oversees his care, and he's able to live in his own apartment with care provided within that setting. It's great to see him living the best quality life he can. They have beautiful events and community there. My family is actually taking my brother to Disneyland next week. He's a huge Star Wars fan, so my kids and my brother are going to get to have some bonding time and go on all the rides together. That will definitely be a moment of joy for our family.

Ishanya Anthapur: You're the glue, honestly. You're the connection between them all.

Anna De La Cruz: I guess that is very true.

Ishanya Anthapur: I know from your writing that your father eventually moved to Mexico and was in a facility there. Your posts on care migration talk about the benefits of aging outside of America. What do you think are some of those benefits?

Anna De La Cruz: I'll start by saying a little bit about what happened in our situation. My dad started to decline — he also had cognitive challenges — and then he had a serious fall, broke his leg in several places, and wasn't really able to walk after that. His husband at the time made the decision to move him to Mexico, because they had always spent a lot of time there and really loved it. But while he was in a nursing home here in the U.S., there were several issues. One was that he was kind of locked away in a hospital-like setting — well cared for, but without much interaction with other people aside from visitors. And it was incredibly expensive.

Their insurance basically said they wouldn't cover any more days in the nursing home, but the nursing home staff said he wasn't strong enough to go home. So they were in the situation of having to pay $500 a day out of pocket for nursing care. People don't save up for that. When you save for retirement, no financial planner is advising you to set aside $500 a day for nursing care. And that's a big part of the conversation that needs to shift — the way we talk about money, retirement, and planning.

They had friends who had moved family members to a nursing home in Mexico that was a fraction of the cost — it could be covered by my dad's social security check every month, and it was full nursing care. So he moved there. The benefit was that he was able to spend a lot more time outside, in a community setting with other people. The downside was that it was a very tough situation to move in the condition he was in. The care was different — warmer in some ways, but culturally different in ways that were sometimes hard to adjust to. And at an older age, adjusting to very different cultural experiences is difficult.

But there were real benefits, and something we really need to tackle is the lack of affordable options in this country for elder care. It's an interesting and important trend: people actually leaving the country due to lack of options here in the U.S.

Ishanya Anthapur: Yeah, $500 a day is insane. And that's just the nursing home cost — there would be other medical expenses on top of that, I imagine.

Anna De La Cruz: I mean, once you're in a nursing home it's fairly comprehensive, but it's still completely unsustainable. Nursing care generally runs $10,000 to $15,000 a month. My mom is in a nursing home now — she started inassisted living, but that wasn't sufficient anymore. And she was also running out of money even in assisted living, because the care costs just keep increasing. She's now on Medicaid because that's the only way she can afford the level of care she needs. So it's a big challenge.

Ishanya Anthapur: And it's a challenge that every person getting older faces, at least in this country. Where are some of the countries people are choosing to relocate to for care? Mexico was mentioned — what about Canada?

Anna De La Cruz: I think if you're not part of the social security network, you can't just go to Canada and access socialized healthcare when you're already out of the workforce. Mostly it's countries where the out-of-pocket private costs are low enough to be covered by a retiree's income. Mexico is a big one for people in the U.S. — and even for Canadians; I've met Canadians whose parents have done the same. Other countries in Central America are probably an option, though perhaps less so than Mexico because of the healthcare systems there. And I've heard that India, Thailand, and Southeast Asia are also destinations for care migration.

Ishanya Anthapur: That makes a lot of sense. Most of these countries are also closer to the equator, more temperate. I imagine that brings some joy back to daily life — being able to be outside, a slightly slower pace. The U.S. can feel so fast-paced, and getting outside isn't exactly built into the culture here.

Anna De La Cruz: Absolutely. Our society is not really conducive to multigenerational interaction, and our public spaces are really built for people in their primary working years. Even children, I'd say, are not generally welcomed in public places the way they are in many other countries. The same is true for elders — they are much more respected and integrated into daily life in many other parts of the world than they are here.

Part of that, I think, is the culture of work above all else, of capitalism, of the focus on making money. But we are seeing some movement toward multigenerational living situations, which I think is really exciting. There's a preschool here in Seattle that's been highlighted in a number of news sources — it's located inside a nursing home, and there's a lot of interaction between the elders and the children. They do art projects together, play music, sing. It's really beneficial for everyone. It brings joy and a sense of purpose back to a lot of the elders living there, and it gives kids an opportunity to spend time with older people, which many children today have a lot less of than in previous generations. I'd love to see more of that — more opportunities for intergenerational communities and interactions in the U.S.

Ishanya Anthapur: Certainly. And being in the sandwich generation actually helps with that, right? Kids get more familiarity with aging. On a related note — we've talked about how expensive caregiving is, but it's also true that caregivers themselves are undervalued and underpaid. And there's a huge overlap with the fact that caregiving disproportionately falls to women — to daughters, to daughters-in-law — to navigate the sandwich generation conflict. Can you talk a little bit about the connection between the care crisis and women's equity?

Anna De La Cruz: Women have historically always done more of the care labor, both paid and unpaid. And in a society shaped by patriarchy and capitalism, that labor is less valued — it's paid less in the professional sphere, or it's simply expected that women will do the unpaid care work. In the U.S., women are doing two-thirds of the unpaid caregiving labor. Estimates put the value of that lost labor and economic participation anywhere from $450 to $700 billion.

You can see how that's a huge opportunity cost for women. Women who are doing all the unpaid caregiving are not fully participating in the labor force, and that has enormous consequences for their ability to get ahead financially and professionally. This is why I believe we really need public support for care infrastructure — paid maternity and parental leave for both men and women, for a start. In countries where that's offered, particularly in Scandinavia, gender equity is much higher. There's a direct correlation.

We also saw last year that return-to-office mandates really kicked in, and a large number of women — particularly in higher-paying positions — left the workforce, with caregiving as the main reason. When we have flexibility and the ability to work remotely, which doesn't impact productivity in most positions, women are able to stay in and continue their paid work. So there are a lot of considerations that need to be factored into policy decisions at the national level, as well as how businesses manage employees, the benefits they provide, and how our communities make care labor visible and recognize it as a valuable contribution to society. That benefits everyone, and gender equity as a whole.

Ishanya Anthapur: Definitely. Do you have any advice for a woman who is currently carrying most of the caregiving load — advice on how to navigate a conversation with a partner or someone else in her life to help share that burden?

Anna De La Cruz: It really depends on specific circumstances, but I think starting those conversations as early as possible is key — ideally before the caregiving gets to be too much. Saying something like, "I see these responsibilities coming in the future. Which ones would you like to take on? I can do this — how should we handle these other things?" Making it a we. We have this responsibility. Let's map it out together, rather than silently doing it all. Because silently doing it all creates the expectation and the dependence.

On a broader level, I'd also say: look for resources and really try to take advantage of the support that's out there. There isn't enough, but there are resources. There are care consultants who help people navigate these situations, and sometimes they're really worth spending money on. You can't do everything. You're going to burn out, and you need to take care of yourself. Sometimes you need to say no, set limits, or outsource things. I've felt a lot of guilt about that, especially early on — I felt like I could just do one more thing, I didn't need to hire someone for that. But once I did engage a care consultant, it took so much weight off my shoulders, both physically and emotionally.

There were also certain situations where, depending on your relationship with your loved ones, it can be harder for a child to navigate removing some independence from a parent's life than it would be for a neutral third party. Having someone more objective helped me navigate some of those conversations and just talking me through some of the decisions. So I would really encourage that if you're starting to feel overwhelmed.

Ishanya Anthapur: I love that advice. Even though all women are superwomen, we can't do it alone. It's totally okay to ask for help, initiate these conversations, reach out, and like you said, turn to an expert when you can.

Anna De La Cruz: Yeah, absolutely. We shouldn't expect ourselves to be superheroes. We're all just normal people trying to take care of our loved ones, and we need to lean on the resources available to help us get through it.

Ishanya Anthapur: Well, Anna, you've managed to navigate this — not perfectly, because there's no such thing as perfection — but beautifully. And in sharing your stories, you're helping so many others. We're really glad to have access to your insight and your writing. I'll wrap up with a few quick questions for a personal touch. Is there anything you're reading or watching right now that you'd recommend?

Anna De La Cruz: Sure. There are a number of caregiving shows and documentaries out there right now that are on my list — I haven't gotten to them yet, but I do have a post about them on Gen X Sandwich if you want to check those out. I think there really is more momentum gaining in the media around these topics.

A book I read recently that I loved was Crying in H Mart by Michelle Zauner. She's known as the musician behind the band Japanese Breakfast, and the memoir is about caring for her mother through cancer and through her death. She writes beautifully about the experience — it's nonfiction in that it's a memoir, but it reads like a beautiful story too. I recommend it to everyone.

And on the nonfiction side, I always recommend Being Mortal by Atul Gawande. On the subject of having these conversations early, he does a beautiful job illustrating why it's so important — talking about what we really want, what quality of life actually means as we age. It's not simply about making sure everyone is medically cared for. It's about asking: what does quality of life mean to you when you're older? And having those conversations. If you're thinking about how to start those conversations with loved ones, that's a great place to begin.

Ishanya Anthapur: Oh my gosh, yes — both are great recommendations. Crying in H Mart is so impactful. I was crying reading it. And that's so funny you mention Being Mortal — I'm actually reading a different book by that author right now.

Anna De La Cruz: He's a great writer.

Ishanya Anthapur: He really is. Well, thank you so much, Anna. I've really enjoyed getting to talk with you, and I hope your journey continues fabulously.

Anna De La Cruz: Thank you so much, Ishanya, and thanks for having me. It was really great to join you for this conversation.

Ishanya Anthapur: Of course. Take care!

Anna De La Cruz: You too.