Eldercare Emergency: How Employers are Addressing an Urgent Need
Lindsay Jurist-Rosner was only 9 years old when she began her journey as a caregiver. Her mother had been diagnosed with progressive multiple sclerosis and needed help around the house, which Jurist-Rosner did without complaint. The debilitating disease continued to progress and, when Jurist-Rosner was in her 20s, she moved back home to become a caregiver for her mom, while still juggling her full-time job. “It was enormously distracting for me. It was overwhelming, exhausting and lonely,” she says. “I didn’t tell my colleagues or managers that I had this second job.”
Eventually, Jurist-Rosner hired help for her mom, but she remained the primary caregiver, responsible for hiring and firing aides, scheduling appointments, researching treatments and handling hospitalizations. During her 28-year journey as a caregiver, there was no formal infrastructure to help families like hers, she says, which made the process even more exhausting. But what surprised her even more was the sheer number of people experiencing the same struggles.
According to AARP’s Caregiving in America report, approximately 40 million Americans care for an adult; of those, about 34 million provide unpaid care for an adult age 50 years or older. The average age of caregivers is 49, but recent research from AARP finds that millennials are becoming caregivers at staggering rates—nearly one in four are caregivers, and 76 percent of them care for adults age 50 and older.
On average, American caregivers spend about 24 hours per week on caregiving responsibilities. On top of this, more than half of all caregivers work full-time, and greater than one-third of all millennial caregivers earn less than $30,000 per year. Additionally, millennial caregivers are less likely than older generations to inform their supervisors about their caregiving responsibilities (46 percent versus 60 percent, respectively) and are significantly less likely to talk about it with colleagues than baby-boomer caregivers (19 percent versus 47 percent, respectively).
It should come as no surprise, then, that employed caregivers report significant levels of stress, which negatively impacts their work. Six in 10 caregivers have experienced at least one caregiving-related effect at work, such as cutting back on their working hours, taking a leave of absence and/or receiving a warning about performance or attendance.
According to AARP, these factors, combined with lost productivity, presenteeism and increased medical spending, cost employers about $34 billion annually.
These data and her own personal experience led Jurist-Rosner to create Wellthy, a virtual platform that matches caregivers with a dedicated care coordinator, who becomes the family’s healthcare project manager.
“I built the business I needed and wanted for myself,” says Jurist-Rosner.
Given the projections of caregiver shortages and the size of the aging population, it’s likely that a significant percentage of employees will need to wear multiple hats—employee, caregiver, nurse, personal assistant. To meet the needs of these employees, now or in the future, and ensure that they can be both productive workers and caregivers, experts say employers should consider implementing elder-care (or caregiver) benefits, which can range from offering a flexible schedule to purchasing a care-coordination platform.
Caring for the Caregivers
Jurist-Rosner stresses that Wellthy was created to meet the needs of individual families—with a private-pay option—but it is also easily accessible by employers. Companies can purchase a plan on a PEPM basis, in which Wellthy estimates utilization and, depending on the size and demographics of the employee population, charges a per-employee, per-month fee.
It is also available on a per-utilization basis, where Wellthy will invoice the employer at the end of the month for employees who actively worked with care coordinators. Both options are offered at a discounted, volume-based price that is reduced from its direct-to-consumer rates.
Jurist-Rosner says employers are covering the cost of Wellthy for their employees, which she says is a “good investment, since [caregiving employees] will miss work, be distracted at work and have retention issues” without this support.
Wellthy clients are matched with a care coordinator, who becomes the family’s partner in care. Care coordinators work from home and often have a background in social work. The coordinator team is large and distributed throughout the U.S., which means family matching is flexible.
“Sometimes, a care coordinator is matched to a family based on geography,” says Jurist-Rosner. “Or the care coordinator has a specific area of expertise, such as cognitive decline or chronic disease. Once matched, the care coordinator is dedicated to the family, which helps build a trusting relationship over time.”
Care coordinators handle as much or as little as the family needs, from locating the best in-home aides or long-term-care facilities to refilling prescriptions, scheduling appointments and contesting insurance bills. Along with the human element is an online account that houses all pertinent information from the coordinator’s care plan as well as medical records, which are all encrypted and secure.
The virtual platform also lets primary users add others onto the account, giving everyone involved or interested in the wellbeing of their loved ones access to the same information in one secure location, says Jurist-Rosner.
Employer-sponsored caregiver benefits are relatively new, but vendors, including Jurist-Rosner, have seen a recent uptick in employer interest.
Stephen Kramer, CEO of Bright Horizons, says more employers are seeking out Bright Horizons’ Back-Up Care Advantage Program, which dispatches a vetted, experienced caregiver when an emergency arises. Though the benefit is available for both child and elder care, lately more clients are seeking the latter option.
“Our Back-Up Care Program is a stopgap for employees who are dealing with an unplanned breakdown in care arrangements or an emergent situation,” says Kramer. “The employee can call our contact center to speak with a care consultant. This consultant will ultimately match the employee with a caregiver who will be dispatched wherever they’re needed.”
Kramer says the employer defines the back-up-care benefit for employees, but on average, an employee is allotted 20 days of back-up caregiving per year. He says it may take longer for someone to secure a permanent elder-care solution because the need for elder care is often sudden and unexpected.
“Elder care is episodic and doesn’t always follow a linear path,” says Kramer. “If an aging parent suddenly falls, family members are thrust into a situation where they need to be experts with all of the answers.”
Other issues arise if the caregiver doesn’t live near a loved one, and he or she must juggle caregiving across state lines. A back-up benefit allows the caregiver a moment to breathe as he or she makes a plan, Kramer adds, noting that determining the next steps is just as anxiety-inducing as looking for emergency care.
According to Adam Goldberg, CEO of Torchlight, a caregiver-support solution, employers have used varying means to cut away at employee stress and disengagement—yet have often ignored another factor: families.
Goldberg says “family baggage” is something everyone carries with them, but at some point, family life will encroach on productivity and engagement at work.
“Employers are slowly realizing the silent root cause of many employees’ stress is family,” he says. “We all live in a vicious cycle. We go to work to provide for our family, yet family members provide the ‘agita’ and make it difficult to balance going to work to perform appropriately and productively—it goes on and on.”
Torchlight Elder is a decision-support tool that helps guide caregivers through the care continuum. The digital platform offers directional guidance, day-to-day planning, appointment tracking, medication management and more, with an overall goal of empowering the caregiver to be a true partner in care and advocate for his or her loved one.
“Everyone talks about ‘one in six people is a caregiver,’ ” says Goldberg. “What we would maintain is that it’s one in six at any one time—it’s really all of us who are caregivers because the challenge is that no one knows when you’re going to become one.”
Proactively Addressing Employee Needs
Arleane Soto, vice president and head of benefits at Hearst, watched Wellthy take shape as it was incubating at HearstLab, which invests in early-stage, women-led start-ups working inside its Manhattan headquarters. Upon learning about Wellthy, Soto says, she had an “a-ha” moment.
“There are so many situations where [Wellthy] would have been such an asset,” says Soto. “I knew we needed to roll this out as a benefit for our employees.”
Getting key decision-makers on board wasn’t all that difficult, which was a true win for Soto, who became an “accidental” client of Wellthy. A few days before it was set to roll out companywide, she fell down the stairs and was able to take advantage of Wellthy’s self-care services.
“I had to catch a plane, so I couldn’t stop and think about what just happened,” she says. “I landed in Houston and went to the emergency department, where they told me I’d need surgery. My contact at Wellthy called me and asked how she could help.”
Soto was puzzled—how could they help her? She told the Wellthy coordinator that when she got back to New York she would need to find a surgeon for her broken ankle. Her coordinator immediately got to work, found one of the top specialists in New York (who was also in-network) and scheduled an appointment for Soto for two days after she returned.
Jurist-Rosner says about 26 percent of the company’s care projects involve self-care, including clients with chronic and acute needs. About 14 percent of customers are involved with multiple care projects, such as taking care of a child with autism and a parent with dementia.
Soto realizes there’s a challenge in getting some companies to implement elder-care benefits because of their “soft ROIs.” But she counters that an EAP also has a soft ROI, so why not take it a step further and implement a benefit with inherent features that an EAP or case management (in a healthcare plan) doesn’t have?
That is exactly what Erik Sossa, vice president of benefits and wellness at PepsiCo, and his team had in mind. He looked at the company’s healthcare plans, EAP and the Bright Horizons child-care program—which it already offered—and knew that elder-care benefits would be a natural extension.
“We noticed a trend toward family-friendly benefits and flexible-work arrangements,” Sossa says. “From this pattern, I identified an emerging need for elder-care benefits that would likely come to a head in three to five years.” Other senior leaders agreed, and the company rolled out Bright Horizons’ elder-care benefit this year.
Diane Terwilliger, manager of payroll and benefits at Boston Private, also recognized the need but was met with slight resistance from the executive team. They told her she could roll out Torchlight Elder for one year and, if employees participated, they’d renew.
As Terwilliger expected, there was modest participation that first year, which meant renewal. Now, she estimates that approximately 8 percent of employees participate in Torchlight Elder, which is well above the EAP participation rate of between 4 and 6 percent.
Terwilliger says employee engagement is a two-way street and “ideally, you’re offering benefits that hit someone where they are in the hire-to-retire spectrum. When this happens, the employee knows you care about them, which translates to engagement and retainment.”
The experts agree there is no one-size-fits-all benefit and that it’s important to understand employee needs before diving into elder-care benefits—but HR leaders should consider how few workers feel comfortable discussing their caregiving responsibilities at work. Elder-care and caregiver benefits may represent a silent need with a soft ROI—but they can pay off in enhanced loyalty and engagement.
According to Nancy LeaMond, chief advocacy and engagement officer at AARP, these benefits don’t have to be expensive to be effective. First, ensure company culture is sensitive to caregiving stigma. She says front-line managers must be empathetic and prepared to assist employees who require time off or a flexible schedule.
“Businesses offering flex time and telecommuting have seen an ROI of $1.70 to $4.45 for every dollar invested in these polices,” says LeaMond.
Hearst’s Soto says elder-care benefits are about enhancing the employee-value proposition.
“Employees are with you for eight to 12 hours a day. How many hours is someone stressed out about caregiver responsibilities? How many hours can they then really give you?” she asks. “For a nominal fee, you can help them through this process and improve productivity.”
Goldberg from Torchlight agrees: “Something we’ve learned is to view the entire workforce as either current or prospective caregivers,” he says. “If you look at elder-care benefits myopically, you’ve missed the boat.”