Why Don’t Employees Use Eldercare Benefits?

Some don’t understand them, and some don’t even know they exist. Either way, it’s costing employers a lot of money. New research from the New York Business Group on Health clarifies the problem and suggests solutions.

By Ariella Levy, MPH

Large numbers of baby boomer employees who once looked forward to early retirement now expect to work well past 55 and must cope with caregiving responsibilities for their parents as well as children, and will eventually phase into a generation that will need care themselves. As more employees face eldercare issues, employers will feel an increase in productivity losses that are already significant.

More than 14 million U.S. workers care for older relatives, contributing to lost productivity and costing as much as $29 billion per year, according to the 1997 study, "Employer Costs for Working Caregivers" by MetLife Inc/National Alliance of Caregivers. Moreover, unlike childcare responsibilities, eldercare responsibilities increase rather than diminish over time. On average, employees caring for an aging relative spend approximately eight hours per week over a period of eight years on the task. The National Council on Aging discovered that approximately 25 percent of employees are responsible for the care of relatives who reside more than an hour away and miss at least one day of work per month. Fifteen percent take unpaid leave.

Employees often make informal adjustments by making phone calls, arriving late and/or leaving early, taking time off during the day and making up for work time lost during evenings and weekends. Employees may use sick days and vacation time, decrease the number of hours worked, change from full to part-time hours, quit working all together or retire early.

Employer-sponsored eldercare programs help employees find care for elderly relatives so that they worry less about their loved ones and are able to focus on work. Typical benefits include resource and referral services for caregiving programs such as geriatric care managers and facilities, job-related services such as family leave, flex-time and job sharing, and financial services such as a dependent care assistance programs.

Evidence shows eldercare programs yield positive financial returns for sponsoring companies. Yet, in spite of the need for eldercare and the potential for cost savings, employers offering such programs experience only a two or three percent utilization rate.

Low utilization

What deters employees from using employer-sponsored eldercare programs when the need is so great? Research is scarce, but anecdotes abound. People often fail to identify themselves as caregivers or underestimate the obligation they face. Some view their responsibility as a highly personal matter. Even if they want help from their employer, they may fear that personal information would be used against them or that they will be perceived as undependable — and therefore unpromotable — if they discuss problems caring for ailing relatives.

Companies and managers send conflicting messages. An employer may fund caregiver programs, for example, but also have a strict attendance policy that discourages employees from accessing services during hours. In some organizations, employees perceive the corporate culture as non-supportive of employees who take time off for caregiving.

In the fall of 2002, the Eldercare Task Force of the New York Business Group on Health set out to learn more about the disconnect between availability and use of eldercare benefits through a series of three focus groups. The 28 participants mirrored the profile of typical caregivers. The majority was between the ages of 35 and 54, and female participants outnumbered male by a 2:1 ratio. Five people formed a group of current or past users of their employers’ eldercare services. The rest were divided into two non-user groups. Half the participants were managers, and half held non-management positions. Approximately half were Caucasian and half were African-American. Most participants were involved in caregiving for six months to three years and were the sole active caregiver for a parent or the parent of a spouse. They reported a broad range of responsibilities for the elderly, whose levels of health and need for assistance varied widely.

Here are the key points derived from the focus groups and the implications for employers.

1. Lack of understanding

Many employees don’t understand what eldercare is and what benefits are available.

Focus group participants offered varied definitions. Some see it in terms of care options: therapy and outpatient sessions, assisted living and nursing home facilities, and practical daily services such as aides, transportation, housecleaning, shopping and meal delivery.

Others see eldercare more conceptually as filling in the gaps where care is needed either by helping the elder herself, or as a referral service to hire hands-on help. One participant described eldercare as: "Taking care of parents after they can’t take care of themselves." Within this broader definition, specialized services can be tapped such as financial advice and estate planning, elder law services and help navigating through Medicare.

Not surprisingly, users had a more accurate understanding of eldercare than non-users. The latter expressed confusion as to what the definition of eldercare might be, even if they had heard of the benefit offered by their employer. They misunderstood the benefit’s parameters, how it is paid for and how it is designed. Some imagined that eldercare covers specific features these programs did not have such as discounts on medications. Others confuse eldercare benefits with long-term care insurance.

2. Period of evaluation

Both users and non-users go through a period of evaluation before seeking employer-based resources.

Most employees attempt to handle their elder situation themselves at first, viewing the issue as a personal matter and often underestimating the time and financial burdens of care. Most caregivers spend substantial time providing care and do not realize that they need and can get help. Juggling the responsibilities of work and caregiving may contribute to the delay in seeking assistance, rendering employees unable to do either very well. In some cases, particularly those involving dementia, denial about the burden of caregiver responsibility may further delay outreach.

The point of entry for most users of these services occurs when caregiving activities have disrupted the employee’s personal and professional lives and the need for respite becomes critical. An early entry into employer-sponsored eldercare services may decrease lost productivity at work and prevent caregiving crises.

3. Ineffective communication

Ineffective communication is clearly linked to low utilization.

The mere existence of a program does not mean it will be used. Eldercare may be covered in the initial hiring kit, but few employees read benefit information thoroughly unless it pertains to a current need.

There were obvious differences among corporations in benefits communication and employee awareness of eldercare programs. Simply, employees working in an office, plant or other company facility have an advantage over employees who are out in the field. They are much more likely to be aware of eldercare services, and those aware of eldercare are more able and more likely to access the benefit. Non-users often reported not being aware of the existence of eldercare benefits.

Four of the five user group participants worked in human resources departments. "In HR, we know our legal rights," is how one of them put it. Working at the source of benefit information for all employees, these users were naturally more aware of available services.

Non-management field employees may be at a disadvantage in accessing services compared with those who have office jobs and easy computer access. Several mentioned the value of benefits fairs and/or seminars on specific topics, but these also may favor those in major offices where such programs are typically held.

Newsletters and e-mails can be strong reinforcement. They can be modeled after solicitations for wellness programs, asking employees if they have the symptoms of a caregiver of an aging loved one and if so, leading them to the eldercare benefit as a solution to these symptoms.

Even those with access to benefits fairs or e-mail bulletins, however, thought that these messages are not sent out frequently enough.

4. Limited information and misconceptions

Limited information and misconceptions about the program are frequent barriers to access.

Many employees did not think they qualified for the services. Misconceptions about eligibility included believing that eldercare benefits only applied to employees living with the elderly relative, that the relative in need must be 65 or older, and that the program only applied to employees’ parents. Some employees believed there is a cost to access the service and reported that as a barrier.

For those who are aware of and understand their employer’s eldercare benefit, navigating through the benefit can be a challenge. The Employee Assistance Program (EAP) is seen as the main information source, and employees use the toll-free number as the first and ongoing information point. While some use their employer’s intranet website to gather information, many prefer a human voice.

Those satisfied with the service spoke of the importance of establishing a relationship with a particular representative. These best-case scenarios provided rich information, saving the employee many telephone calls and trips. Simplicity is important to reducing employee frustration. Complicated telephone and Web menus with long lists of service options can discourage accessing services.

5. Workplace disruptions

Employees report that caregiving responsibilities cause significant disruption in their work.

Many indicate that they are unable to perform at their optimal level while in the office (presenteeism) or that they do not show up to work (absenteeism). On a five-point impact scale, with a one being very little and five being the highest, the average response was four. One respondent reported: "I lost a promotion. It took me a year to get back on track."

A large majority of the focus group respondents take personal and/or vacation days to fulfill their responsibilities, as well as unplanned absence for health or services-related emergencies such as an unexpected no-show of an aide. Telephone calls and fact-finding, planning, transport to medical appointments and caring for housebound elderly relatives during the day were some examples of activities caregivers find themselves involved in while at work.

The initial caregiving period may be extremely difficult and disruptive, and may have serious consequences on the caregiver’s job performance. "I needed therapy for myself. I wasn’t sleeping, not eating, (always) worrying," recalled one participant.

In contrast to the work issues, on a scale of one to five, most rate the impact of caregiving on the quality of home life as only a one or two (where one is "very little"). Handling these issues from home may be less stressful, but some employees miss a real leisure element in their lives as they rush between home, workplace and elder’s residence, attending to chores at all three. Caregivers who live with an elderly relative reported feeling frustrated and resentful of their reduced privacy, flexibility and an inability to escape from caregiving responsibilities.

6. Varied perceptions

Employees’ perceptions of corporate receptivity to employee caregiving activities vary.

In this study, participants did not report the perception of "stigma" attached to taking time for eldercare issues seen in other studies. According to some organizations, childcare is okay, but eldercare has not achieved the same acceptance in the corporate environment.

On average, respondents in this study rated their company’s receptivity to eldercare issues a three, on a scale of one to five. While users rated receptivity a four (above average), the non-users rated the receptivity a three (average).

At professional services firms, the pressures of meeting client deadlines discourages handling eldercare needs during work hours. Participants who worked in field offices felt there may be more flexibility at corporate headquarters and that they are less able to take time off or to learn about options. Others suggested that union workers might be worried that they would receive less opportunity to work overtime.

7. Employee/supervisor relationship

Corporate culture aside, the relationship between employee and immediate supervisor appears to have the most significant impact on the use of services.

Indeed, a well trained supervisor may be more helpful than a distant human resources department or EAP in encouraging appropriate use of services. By the same token, no amount of e-mail and program publicity will undo the damage of an insensitive manger.

If the supervisor is seen as unaccommodating, an employee — even one who is well aware of available services — is less likely to communicate caregiving needs. In such circumstances, childcare or personal health concerns are often used as excuses for taking time to care for one’s elder. A telling comment: "I say, ‘It’s me. Not my elderly parents.’ I make sure others know [think] it’s myself."

Some feel that older managers are often more receptive. One respondent remarked: "Older people [who are supervisors] are more attentive. They have more elderly parents."

Another said: "My younger supervisor says that the young have no such problems." Rather than telling managers about their needs, some employees choose to handle them silently.

The key training points for supervisors are:

• The personal impact of caregiving responsibilities

• The potential impact on the bottom line of the company

• The value of early and continued use of available eldercare services

• The power of verbal and non-verbal messages to caregivers.

The bottom line

Corporate-sponsored eldercare benefits can lift the burden of caregiving from employees and reduce the cost of lost productivity for employers, but these mutually beneficial programs are simply not being accessed.

Our findings indicate that the reasons for this disconnect are both organizational, rooted in the way benefits are communicated and delivered, and personal, pertaining to the employee and the caregiving experience.

The value of any benefit lies not in its existence, but rather its use. Many employers have recognized the plight of employee caregivers and taken the first step of providing eldercare services. Minor changes in benefits design, communication and attitudes in the workplace can improve the way eldercare programs are utilized and foster a more productive workforce.

Ariella Levy is a health care analyst at Mercer Human Resource Consulting in their national practice. Prior to her position at Mercer, she interned with the New York Business Group on Health. Ariella received an M.P.H. in Health Policy and Management from Columbia University’s Mailman School of Public Health and received a B.A. from University of Pennsylvania. This article is adapted from a report by the Eldercare Task Force of the New York Business Group on Health (NYBGH), a nonprofit coalition of businesses in the New York Metropolitan area that seeks solutions to various healthcare issues such as cost, quality and wellness. For the complete report, visit http://www.nybgh.org/articles/eldercare.html

Resources:

Centers for Medicare & Medicaid Services Online Workbook for Employers: When Employees Become Caregivershttp://www.cms.hhs.gov/partnerships/tools/materials/caregiversresources/Final_Wkbook_online_version.pdf

New York Business Group on Healthhttp://www.nybgh.org/

Metlifehttp://www.metlife.com/

National Alliance for Caregivinghttp://www.caregiving.org

International Longevity Center — USAhttp://www.ilcusa.org/

More Business & Health Articles About This Topic:

Why Employers Should Care About Elder Care (Sep. 15, 2003)

Caregiver Coverage, 24-7 (October 2000)

Ariella Levy. Why Don't Employees Use Eldercare Benefits?

Business and Health

Dec. 10, 2003;21.