Sunday, Sept. 10, 2017 was Grandparents Day. Many grandparents received loving cards, calls and emails from their grandchildren.

However, a significant number of grandparents – approximately 2.9 million – will do exactly what they do every day. They will make their grandchildren breakfast, organize their activities and help with homework in the evening.

So-called “custodial grandparents” have primary responsibility for raising one or more of their grandchildren. As researchers and health and social service professionals, we know that this is a growing group of often invisible caregivers.

Grandparents Day is a fitting moment to take a closer look at the social contribution grandparents are making and the impact of unexpected caregiving – often in later stages of life.

Not a new phenomenon but a changing one

Custodial grandparents are represented in all races and ethnicities. However, grandparents in racial and ethnic minority groups are overrepresented in the population of caregivers. It’s also worth noting that 67 percent are younger than age 60, and 25 percent live in poverty despite the fact that about half of custodial grandparents are in the labor force.

Barack Obama with the grandparents who raised him. Senor Glory, CC BY-SA

Grandparent caregiving is not a new phenomenon: Kin care has historically been part of family life. Former President Barack Obama chronicled his early life experiences being raised by maternal grandparents. In a bestselling book, JD Vance writes about his childhood in Appalachia being raised by his “Mamaw.”

While it’s not a new trend, the reasons for and experience of raising grandchildren have changed over recent decades.

Consider, for example, the African-American community. In her 2010 Pulitzer Prize-winning book, “The Warmth of Other Suns,” Isabel Wilkerson documents the great migration of African-Americans from the South to other regions of the United States between World War I and the 1970s. During this time, grandparents and other relatives served as substitute parents as families resettled and secured employment. In this care-sharing tradition, grandparents and other families were available during times of transition and relocation.

Since the mid-1990s, several social conditions have caused the number of grandparents who are raising their grandchildren to increase.

Addiction and incarceration, child abuse and neglect, and economic factors all have contributed to a rise in the number of custodial grandparents. A recent Pew Trusts report documents how the current opioid epidemic is contributing to this trend. According to the CDC, drug overdose deaths in the United States have more than tripled from 1999 to 2015, and often leave children parentless.

The number of children placed in foster care has sharply increased, partially fueled by opioid and other drug use. When children are removed from their birth parents, federal law requires that state child protective services give preference to placement with relatives who, more often than not, are the grandparents.

Additionally, increased incarceration rates for women have changed family life. In the 1990s, female incarceration rates skyrocketed compared to the rate for fathers. Incarceration, addiction and neglect are often interconnected.

How caregiving affects health

In addition to dealing with the challenging dynamics of child care, many of these grandparents are starting to experience their own age-related changes in health and functioning.

Compared with noncaregiving peers, grandparents who are raising their grandchildren have more extensive health problems. When there are limited resources – whether financial, time or energy – grandparents prioritize their grandchildren over themselves. This situation can lead to undiagnosed health problems, untreated chronic diseases and undesirable health practices such as poor nutrition and lack of exercise.

In addition, grandparents can experience depression and anxiety from the stress of child care. In one study of grandmothers raising grandchildren, approximately 40 percent scored in the clinically elevated range on measures of psychological distress.

In spite of these challenges, grandparents report rewards and joys that give them a sense of purpose. One grandparent put it this way:

“And she’ll come around once in a while and she’ll say, ‘I’m so glad. I’m so lucky I have you and Grandma.’ And I’ll say, ‘We’re lucky we have each other.’”

Keeping grandchildren in their own cultural community is another important motivation for many. For example, research has demonstrated the historical commitment to care-sharing in African-American families:

“Because I came from a bonded family, a really bonded family… We always pitched in and took care of each other. My mother, my grandmother took care of me. Let me see. There was my nannie, my nina, my mother, my uncle and aunt. We all lived together…”

Grandparents and policy

From a policy perspective, grandparents provide the safety net for children who might have otherwise entered the foster care system. Nationally, it is estimated that grandparents and other kinship care providers save the government more than US$6 billion annually.

But in caring for these children, grandparents pay a high price, especially those who are raising the children alone.

What can be done to support these grandparents?

Because of increased recognition of both the prevalence and urgent needs of grandparents raising grandchildren, many communities have created grandparent support groups and “kinship navigator” programs that help identify and access much-needed public and private resources.

Programs such as Project Healthy Grandparents at Georgia State University offer support and health interventions to help grandparents remain healthy and effective care providers. Support includes home visits, early intervention services for children with developmental disabilities (which are often related to prenatal substance abuse exposure) and support groups and parenting classes. Other programs are growing such as Grandhousing, which provides apartments specifically for grandparent-headed families.

Programs for grandchildren are also crucial. In one initiative that replicates our Atlanta-based model in rural Georgia, a van transports the children to an activity day so they can be with others who are are cared for by grandparents. As the driver pulled up to the second house, the two sisters already in the van exclaimed:

“Look – those girls are being raised by their grandma, too!”

Clearly, seeing other children in families like theirs was surprising and important to the sisters!

For many, Grandparents Day is celebrated one time per year. And grandchildren’s visits are a “delight” lasting just a few hours. But for about three million children, being with grandparents is a daily fact.

The ConversationWe believe it is time for these families to be recognized more formally by policymakers and service providers. Without more extensive official responses, grandparents may receive little or no support until they experience a physical or mental health crisis.

Nancy P. Kropf, Dean and Professor of Social Work, Byrdine F Lewis College of Nursing and Health Professions., Georgia State University and Susan Kelley, Associate Dean and Chief Academic Officer for Nursing and Director, Project Healthy Grandparents, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University

This article was originally published on The Conversation. Read the original article.