Elizabeth Dawn Jacobs-Ware, DSW ’26, knows firsthand the strain and lack of resources associated with being a sandwich generation caregiver, so named because they are simultaneously providing care to both elder relatives and children. Six years ago, she returned home to Sacramento to help take care of her mother, who had been diagnosed with breast cancer, while caring for her two small children as both she and her partner worked full-time. Even as a professional in health care policy, she found it difficult to navigate the systems to access the care and resources she and her loved ones needed. 

Jacobs-Ware’s experiences as a Black female sandwich generation (BFSG) caregiver inspired her capstone for her Doctor of Social Work (DSW) at the USC Suzanne Dworak-Peck School of Social Work. Her capstone, “Planted in the ‘Middle’: Developing an On-Demand Support Mechanism for Black Female Sandwich Generation Caregivers,” has received national attention, receiving an honorable mention in the 2025 Grand Challenges for Social Work Doctoral Awards in recognition of its support of the Grand Challenge: Advance Long and Productive Lives. 

“At some point, every adult will be a caregiver, to one extent or another,” said Jacobs-Ware. “I think it’s important that we pay attention to these individuals planted in the middle as the sandwich generation because it’s a population that is growing.”

A growing need with few available solutions

The proportion of sandwich generation caregivers more than doubled between 1999 and 2015, representing approximately 2.5 million people in the U.S. While the risk of burnout and stress involved with caregiving are well known, the burdens shouldered by sandwich generation caretakers can be even greater. One study found that 51% of sandwich generation caregivers had experienced serious suicidal ideation during the prior month, more than five times that of people caring for adults only. Sandwich generation caregivers often also experience greater financial stress and emotional difficulties. Research shows that low-income and Black and Hispanic caregivers face the heaviest caregiving burdens, with nearly a third of low-income families reporting daily eldercare, double that of high-income households. Jacobs-Ware also notes that these women face more adverse health issues and lower life expectancy, and yet, have to provide care for their loved ones. 

Despite this clear need, few programs exist to support the sandwich generation caregiver population and those for whom they care, and even fewer that are specifically tailored to cultural and geographic factors. 

“The Advance Long and Productive Lives Grand Challenge really resonated with me because it’s really about the entire lifespan,” said Jacobs-Ware. “I realized that while I was making sure everyone else in my life was good, I wasn’t always making sure I was good.” 

Combining her background in public health, psychology and social work with her experience as a leader in health care services for the state of California, Jacobs-Ware has created a program to meet the needs of this underserved population hiding in plain sight. Planted in the Middle is a culturally adapted, geographically specific online resource hub that meets caretakers where they are and provides practical, on-demand resources. 

“Dr. Jacobs-Ware’s Planted in the Middle nonprofit is both feasible and viable,” said Loc Nguyen, lecturer in the DSW program and Jacobs-Ware’s primary capstone advisor. “Her years working at the local, state and federal levels, combined with a solid DSW foundation from USC, make her the ideal person to offer a compassionate, evidence-based approach for her target population, Black women caring for at least two generations of relatives.”

Designed to be adapted to meet the need

Jacobs-Ware knows from personal experience that when people are stretched thin, what matters most are the small things that help them get through the day. That might be knowing where the best parking at the hospital is. Or it might be a respite program that bridges the needs of both childcare and elder care. It always means being locally focused and culturally tailored.

Her program focuses initially on Black female sandwich generation caregivers in the Sacramento area, but is designed to be adapted across a variety of populations. She has always been clear that the goal is to develop, research and disseminate the program in such a way that various communities can adapt it to their own social, cultural and geographic needs and resources. 

“Everybody’s journey is different and having the lived experience as a caretaker, the solution is not a “one thing fits all” model,” said Jacobs-Ware. “The long-term goal is to help individuals who are planted in the middle, no matter how they identify, to have a source of support that they can go to.”