The challenges that working caregivers faced over the last decade gained some attention prior to COVID-19. After COVID-19, that caregiving crisis has exploded as more and more people strive to keep their loved ones out of facilities and instead care for them at home or tap a relative to care for them at home. These same caregivers are also trying to juggle work-from-home and often have children at home. The caring for parents and caring for kids situation has long been described as the “sandwich generation.” Now COVID-19 has made that sandwich even more difficult to swallow. I had a caregiver tell me she thought that the “sandwich generation” terminology made it sound like she was caught between two fluffy pieces of bread. It’s not soft fluffy bread squishing you! It’s being sandwiched between two rocks. It’s like the trash compactor in Star Wars that almost smashed Luke, Leia, Han and Chewy. For too many, dual caregiving can feel like steel walls closing in.
As a trusted advisor, finding support for working caregivers has not historically been something that most have spent much time on. Employers did not inquire about it as a hot topic. Caregiving was not recognized as a huge workplace issue until recently, but the data has been there for decades! Some of the oldest data has been around since the 1990’s with efforts by organizations like the MetLife Mature Market Institute, National Alliance of Caregiving, Caregiver Action Network, AARP and others. Studies quantified the billions of dollars in lost productivity each year due to these caregiving pressures upon employees. These billions of dollars lost do not account for many of the other more direct costs, things like increased healthcare costs, increased disability costs and FMLA costs.
Healthcare is one of corporate America’s largest financial expenses. Clearly, if I am working full or part-time, spending 20-30 hours per week helping mom and doing my normal childcare duties, something has to give. What gives is I stop exercising, I stop eating right, I stop sleeping as much and stress builds and builds. A study done in 2012 using 2010 data analyzes this challenge and the numbers. Cigna subsequently also reported much higher rates of behavioral illnesses for adult caregivers. As a caregiver I see doctors all the time, but they are my mom’s doctors, not mine, because I am too busy going to Mom’s. I skip my physical, skip my colonoscopy and all things related to “my health and well-being.” What happens next? My borderline diet and exercise-controlled diabetes progresses and now I am fully insulin dependent due to weight gain. Caregiving is a marathon, not a sprint. It lasts not months but years. We start putting off our health exams and tests thinking, “I can do that next month.” But the months become years and employees that previously were doing preventive exams develop colon cancer, breast cancer and a variety of other serious conditions after skipping medical tests and self-care for years. These are the issues that the NAC 2012 study pointed out and quantified. The total increase for corporate healthcare expenses exceeded $13 billion per year! That is data from a decade ago. Factor the average medical cost increases in the last 10 years and the rate at which employees have caregiving events due to the aging of the millennials, boomers and beyond and we have a big corporate cost issue.
Now with insurance carriers managing Family Medical Leave (FMLA), we also have insight into what happens when someone takes FMLA to help a “parent or spouse” versus FMLA for children. For parents and spouses, we wait long into the event to take FMLA. We do not use FMLA as respite, i.e. giving ourselves a break. We push ourselves and burn the candle at both ends until we are a puddle of wax on the floor; then we take FMLA. Not surprisingly, two large carriers report four times and five times higher disability claims after the FMLA event for employees using it for parents or a spouse. For your clients, consider requesting several years’ worth of the managed FMLA data for “days lost to parents and spouse” and for clients with higher average ages (45+) you often will see dramatic changes over a 24–48-month period. We had a large client with an average age of 49, mostly male population that saw a 200 percent increase in days lost to parents and spouses over 24 months. That led to “mandatory” education across their entire workforce for caregiving education and support along with long term care financing education.
The first and most important thing an employer can do is begin to talk about this issue in their workplace. AARP reports that 50 percent of working caregivers indicate that their supervisors do not know about their caregiving responsibilities. Talking about my kids at work is normal but talking to my 35-year-old supervisor about my mom’s dementia is not yet normal, but we could make it so! Caregiving hits all levels of the workplace and I am more likely to discuss it if I hear my leadership talking about the same issue. This problem is increasing rapidly across working America. Fortunately, just talking about it can help. If you have been through something, I can learn from that. I can learn from your successes and your mistakes. If we can help someone based on our own hard-fought experiences, most of us would love to have that discussion.
Fortunately, there are now a variety of providers to help with this issue. It is becoming a burgeoning section of the employer marketplace. Ranging from self-serve web-based solutions to concierge level human support to a combination of solutions. To not alienate or misrepresent any provider, I will avoid naming specific company names but describe genres of provider solutions as we have organized them for some of our clients. Some of these players pay advisors commissions, many do not, but there is still great value for an advisor in knowing about the solutions to a growing need.
We have organized many of these providers into three or four buckets. Those that go deep, those that go broad and those that are self-serve web only solutions. There are also those that in addition to providing web-based or phone-based support also provide paid-caregiver sourcing, meaning they help a family find an actual in-home caregiver or provide a “safe place” platform where families can select from listed caregivers, some formal and licensed and others informal. This can be extremely helpful since many families still rely on want ads, Craig’s List and referrals from friends.
The Workplace Caregiving Support Providers typically charge a per employee, per month (PEPM) cost. The cost ranges from as low as 25 cents PEPM to three dollars PEPM. Most have “add on” services for additional fees paid by either the employer or employee. Samples might be the first three hours of one-on-one phone support are part of the employer’s package but for families wanting additional phone support there are additional fees. One of the providers that goes much “deeper” will put a geriatric RN in your loved one’s home for a face-to-face assessment anywhere in the country and, after doing the home visit and evaluation, will then review all doctors’ records, prescriptions, the home situation and provide a plan back to the family/individual. Even more, they then help source providers, negotiate rates with service providers and follow up with the family and patient for the next 90 days to assure things are going right. Most doctors spend minutes with patients and have no idea what the home situation looks like, i.e. stairs, bathrooms, lighting, throw rugs and extension cords. Having a geriatric medical professional spend an hour or two with someone going through their home can make the difference between remaining at home or ending up in a facility, as a high percentage of nursing home placements are due to falls and in-home accidents.
Many of us that have tried to advise our own parents in need of support have found that having a medical professional advise them always goes better than the children telling them the exact same thing. Your parents might listen to you now but as they lose abilities and independence, parents do not like being told what to do by their children. While it is extremely frustrating, I am pretty sure we will be the same when we arrive at that place in our lives.
How can you steer your clients in the right direction? Just like funding for long term care, something is always better than nothing. If your client is unsure, start small and work your way up. Even if the starting small means no hard dollar investment but instead instituting policies and workplace education that can make a difference. Discussions on caregiving let employees know their employer gets it and cares. Several of our employers have started in-person or Zoom-based support groups for their working caregivers. That costs nothing, but certainly helps start the journey. For many of us, the journey is started without warning and without support. Now is the time to help employers start that journey so employees won’t be going it alone!
