Gretchen Barry

BuddyIns partners with several companies to provide value-added services related to long term care. One such partner is TCARE, an evidenced-based high-tech platform plus human-touch way to support caregivers and prevent caregiver burnout. Recently, I had the opportunity to chat with Lindsey Niemeier, head of strategy at TCARE, to get more insight into the current caregiver crisis in the workplace.

As more employees are thrust into the caregiver role, interest in worksite/employer long term care benefits is increasing. My conversation with Lindsey focused on the caregiving crisis but also highlights the impact that employers can have in the long term care planning conversation.

Gretchen: Given that up to 25 percent of the workforce is a family caregiver, what do we need to understand about caregiver burnout?

Lindsey: I think it’s important to recognize based on our experience that a larger portion of the workforce is providing care to someone over the age of 18. This can have a huge impact on employers. On average between 20-25 percent of employees are family caregivers, however it typically is not talked about at work as they don’t want to be perceived as being distracted or disengaged, unable to take on more responsibility or a promotion, or potentially needing more flexibility and time away from work. If a group does not have a caregiver-friendly policy or program in place, there is more pressure for employees to manage these responsibilities on their own.

Gretchen: Your data certainly supports other reports I’ve seen. According to the Rosalynn Carter Institute for Caregiving, family caregivers comprise an estimated 22 percent of the US labor force. So, what are some of the challenges you see with employees who are caregivers for adult family members?

Lindsey: First and foremost, in many instances family caregivers do not necessarily self-identify as a “caregiver,” so they are sometimes balancing a career, family, and everyday responsibilities plus caregiving on their own, without realizing there are programs to help them navigate the complexities of providing care. This can lead to a significant amount of time and resources spent trying to identify how to access appropriate, high quality and cost-efficient services at the right place and the right time.

Caregivers tend to internalize these pressures leading to the higher rates of stress and depression, exhaustion, negative impact to their own physical health, and ultimately making tough decisions such as placing a loved one in a long term care facility. They sometimes feel like they can no longer manage their daily caregiving needs or may even consider leaving their current employer in order to continue to provide care at home.

Gretchen: Why does this have such a tremendous impact on the workplace?

Lindsey: When you are caring for a loved one, and depending on the care needs of the individual, you don’t just walk into work and leave the caregiving at home. When an employer does not have a top-down culture that embraces and supports employees who are managing caregiving responsibilities, then these employees tend to feel isolated. This is when we begin to see the disengagement rates climb, concerns about the ability to remain in a full-time role, reduced productivity, and distraction. Depending on the industry, this can create other pressures within the team, such as needing to fill missed shifts, reassign work, or maintain high standards of safety which can be negatively impacted by exhaustion and distraction.

Gretchen: I would imagine that has other financial impacts as well. What impact can caregiving have on health insurance premiums?

Lindsey: We have found that as caregiving responsibilities increase, the health status of the family caregiver tends to decline. They may miss their own doctor’s appointments, not follow their own medication adherence, or abandon exercise routines due to lack of time and energy. This can lead to increased rates of high blood pressure, higher prevalence of prescriptions for anxiety and depression, and higher rates of obesity and other health concerns.

When family caregivers are supported through a program such as TCARE, we are able to provide them with a care plan and targeted activities to support and mitigate these risk factors, so they can regain focus on their own health as they continue to provide care. We like to say better care starts with self-care. Maintaining the focus on the employee caregiver’s health results in improved health plan claims, risk factors, and ultimately premiums.

Gretchen: Is there advice you can give to an employer who finds out that someone on their staff is experiencing caregiver stress?

Lindsey: When looking at providing caregiver resources, it’s important to communicate that initiative throughout the organization, and foster a culture that supports those with caregiving responsibilities. This includes training for managers to understand what to listen for, which may help them identify someone is caregiving. This becomes the perfect opportunity to refer that employee into the TCARE family caregiver support program and position it as a commitment the organization has to embrace and support their employees who are caregivers at this critical time.

Gretchen: What is the TCARE mission?

Lindsey: Our mission at TCARE is to serve as many caregivers as possible, identifying their needs and providing tailored care plans and advocacy to prevent their burnout. We support individuals as they navigate their caregiving journey and empower them to balance caregiving with their professional and personal responsibilities.

Gretchen: What is TCARE’s process once an employee reaches out?

Lindsey: Employees access TCARE primarily through our digital platform but can also schedule directly with a TCARE specialist for more urgent support. Once an employee is engaged, we encourage them to complete our proprietary, evidence-based screener to help us understand their current caregiving status, identify their leading factors to burnout, and provide a caregiver burnout risk score. Those identified at high risk are connected to a certified TCARE specialist, who becomes their caregiver advocate and establishes an ongoing relationship, developing a personalized care plan for the caregiver to specifically address those leading factors, and reducing their risk for burnout. We also leverage our mobile app to support ongoing engagement with all caregivers, provide self-navigation resources, content, ability to manage
caregiver tasks and responsibilities, and access to local services and resources.

Gretchen: How does a program like TCARE impact the outcome for employers?

Lindsey: We previously identified several ways caregiving impacts employers, and introducing a family caregiver support program such as TCARE works at addressing these factors and helps to reduce those risks to the employee, as well as the employer. From a policy perspective, many groups have implemented programs to support young, growing families, but many do not have policies or programs in place to support families caring for aging family members; caregiving programs support more inclusive benefits. Additionally, providing a robust and effective program that targets individual needs will support overall health improvement of the caregivers, physically, emotionally, and financially. Finally, organizational outcomes such as improved productivity, reduction in time away from work or missed shifts, and improved retention and engagement of those working family caregivers support workforce optimization and financial objectives.

Gretchen: How do you see technology helping caregivers in the future?

Lindsey: Technology really enables tailored care delivery and the ability to meet individuals where they are. Caregiving is personal, and everyone’s experience will look different and could change at any moment. Intelligent technology and robust digital tools support improved engagement, predictive analytics to provide appropriate response to changing needs, and provide desired outcomes by reducing the risk for burnout.

As more Baby Boomers require long term care, and many of them are without the financial resources to afford robust care options, more employees will face the prospect of caregiving. Providing employees with tools to manage these responsibilities, then offering them their own long term care planning benefits will go a long way to helping employers reign in the costs of absenteeism and burnout. For additional information regarding caregiver support, please visit: https://tinyurl.com/4rx74vbm. For information on long term care planning as an employee benefit, read our Long Term Care Insurance Guide for Worksite: https://www.buddyins.com/worksite/.

(Reprinted from the CLTC Digest in cooperation with Certification for Long-Term Care, LLC, www.ltc-cltc.com. Email Amber Pate at apate@ltc-cltc.com for a more than 20 percent discount on CLTC training for Broker World subscribers—just mention code BWMAG.)

It’s no secret that long term care costs will continue to rise. Start with an aging population, add to that a shortage of caregivers, and sprinkle it with two and a half years of COVID and that gives you all the ingredients needed for an almost worst-case scenario for long term care costs. As a result, some states are considering ways to provide minimal long term care benefits to their citizens.

There’s an opportunity and not just for long term care insurance specialists.

Depending on how states structure the legislation, these new state benefits could have a considerable impact on the long term care insurance market for a few reasons:

• The developments will be newsworthy because anything related to an increase in taxes hits the news with a vengeance.
• As experienced in Washington State, there will be a limited number of products available.
• It creates a sense of urgency for a solution and a need for information.

Let’s begin by understanding the proposed legislation in two significant states.

Washington and California Move Forward
Washington was the first state to get serious about long term care costs. That’s partly because the state has some of the highest long term care costs in the nation, according to Genworth’s Cost of Care Survey. One of the reasons may be that it also has one of the most generous Medicaid waivers. Medicaid programs are strained in states around the country, but especially in Washington.

In 2019, the state passed a law to fund a public long term care program through a mandatory payroll tax on every W-2 employee. The only exception offered was to opt out by purchasing private long term care insurance. Things were relatively quiet until the state amended the law in April 2021 that shortened the time available to purchase private LTCI. People had about six months to find a specialist, explore available products, and apply if they had any hope of qualifying for the payroll tax exemption.

Suddenly, everyone in Washington was rushing to find a long term care insurance specialist.

When all was said and done, of the nearly 4 million W2 employees in the state, 450,000 purchased a long term care insurance or hybrid policy with a long term care rider that qualified them to opt-out of the payroll tax in Washington. Most of them purchased during the four-month period prior to the deadline. To put that in perspective, we estimate that less than 200,000 purchased long term care insurance in the entire country during all of 2021.

At BuddyIns, we took a conservative approach in Washington and encouraged people to obtain meaningful coverage rather than just choosing something for the sake of opting out of the payroll tax. One of the biggest and most surprising outcomes was that hundreds of thousands of younger employees used this as an opportunity to purchase life insurance sooner than they might otherwise have done. The demand for both traditional LTCI and hybrid LTCI was extraordinary.

Next up is California. With approximately 16.5 million W-2 employees, the number of employees who might be suddenly interested in planning for their life or long term care needs is staggering.

California continues its push toward a payroll tax model that is similar to Washington that would fund a minimum long term care benefit. The California Long-Term Care Insurance Task Force recently provided recommendations regarding the legislation.

On October 6, 2022, the Task Force released its draft Feasibility Study for Assembly Bill 567. The study recommends options for establishing a statewide long term care insurance program. Early indications are that a proposed tax would be on earned income for W-2 employees. It is unclear yet how an exemption would work if someone owned a qualifying long term care insurance policy. However, the task force recommendation currently includes opt-out language just like Washington State. The final study is scheduled to be completed by December 31, 2022.

Notable draft program design elements per the California Long-Term Care Insurance Task Force:

• May split the cost of the payroll tax between employer and employee.
• May allow an opt-out provision or a reduction in the payroll tax if the employee has a private LTCI policy.
• No firm details on what the California payroll tax exemption will look like.
• Benefit eligibility of two of six activities of daily living (ADLs), or severe cognitive impairment.
• Benefits available outside of California with some exceptions.
• Family caregiver support includes reimbursement to informal or family caregivers subject to completion of certified caregiver training.

A Practical Sales and Marketing Strategy
California has the potential to create a flood of activity in both long term care insurance and life insurance. At BuddyIns, we’re working hard to get ahead of that challenge. Keep in mind that our goal is to encourage consumers to purchase meaningful coverage.

BuddyIns recommendations:

• Be proactive. It’s important for employees to obtain meaningful LTCI coverage and to start the process before any final state announcements. This helps to avoid the rush for long term care insurance coverage that we saw in Washington.
• Start identifying your portfolio of solutions. There may be slightly fewer group and individual products and carriers in California than in Washington because product approvals from the state take longer.
• Understand the group market. Hybrids are the most likely solution in this space. We expect the capacity of individual products in California to be limited, but group products with guaranteed issue or streamlined underwriting may have more availability.
• Be prepared to offer both life insurance and long term care insurance options. As experienced in Washington, life insurance will see a surge in sales due to younger employees needing life insurance and long term care insurance.

Create an effective outreach strategy. At BuddyIns, we will model what we did in Washington with a few modifications:

• Create an outreach process and campaign that targets employers, business owners, and higher-earning professionals who would be good candidates for coverage.
• Establish a dedicated team of long term care insurance specialists.
• Make it easy for employees to educate themselves on long term care planning and solutions using webinars, articles, and videos that plug into an employer’s established communication channels.
• Simplify the application process through technology as much as possible, including pre-underwriting, pre-quoting, and streamlining the application process.

More than a dozen states, including Minnesota, Pennsylvania, and New York, are considering this type of legislation as they seek to manage long term care costs that continue to climb. It’s an opportunity for financial planners, insurance agents, and long term care insurance specialists to lead the conversations with clients about how long term care funding should be part of a comprehensive financial strategy. Now is the time to get ahead of those conversations by building out your marketing and sales strategy.