The American Corporate Response to Caregiving of Elders

by Angela Heath*

American corporations are becoming increasingly sensitive to the needs of their aging employees. Hundreds of U.S. companies, both large and small, are developing various initiatives to accommodate older workers who are faced with the added pressure of balancing work and elder caregiving. The approaches highlighted in this article result from a growing value placed on mature workers by corporations and a knowledge of how creative benefits contribute to successful recruitment and retention of these workers. Companies that implement policies responding to the implications of the greying of America are hoping this will help create a strategic, competitive advantage for the 21st century.

Employee Caregiving and the Work Place

Five years ago, the first U.S. business began to receive media recognition for its efforts to assist employee caregivers. In 1985, The Travelers Companies released results of a landmark survey of employees at their home office in Hartford, Connecticut. According to the survey results, 28070 of respondents spent more than ten hours per week caring for an older relative, and 8~/0 spent 35 hours a week or more.

Despite these dramatic findings, many corporate decision-makers proved hesitant about implementing programs to assist their employees with caregiving problems, fearing that addressing the issue would raise employees' expectations of company-sponsored assistance for other personal problems. Many also felt that care of an older relative was the proper province of families and non-profit organizations. Few could see how it affected the corporate "bottom line."

Today, we know that employee caregiving does affect the work site. According to a 1988 national survey by the American Association o f Retired Persons, there are seven million caregivers of the elderly in the United States. Their average age is 45. Caters perform typical care-related activities such as bathing, dressing, household chores, managing finances, etc. These activities are not new. Throughout history, care has been provided informally to ill and disabled elderly. What is surprising is that 55070 of caregivers axe also employed outside the home. One-third of

*Angela Heath is the President of Aging Advisors, a consulting l'a-m in Washiagton, D.C.

survey respondents indicated that they have lost time from work due to the demands of caregiving. In addition, 15070 of previously employed caregivers had chosen early retirement and 12070 gave up working entirely at even earlier ages.

Over the past six years, hundreds of U.S. companies have investigated caregiving issues among their employee population. On average, most studies reveal that, of the employees responding, 2007o to 30070 are providing care to an older relative. Further, these surveys document that caregiving, like any other personal problem, causes absenteeism, inappropriate use of work time for personal telephone calls, a decreased capacity to concentrate at work and an increased reporting of stress-related illnesses.

A recent survey of 371 chief executive officers in the top U.S. industrial and service corporations, conducted by Fortune Magazine and John Hancock Financial Services, revealed that corporate decision-makers are well aware of the effects that caregiving has on work. Corporate executives estimate that about three out of ten employees are currently faced with elder caregiving responsibilities. Approximately 60070 report being aware of work-related problems experienced by employees who give care. About half of these executives had been involved in caring for an elderly person themselves within the two years prior to the study. Concurrently, approximately half expressed concern about being able to perform their own jobs while taking care of elderly relatives. Even though 80070 of these chief executive officers agreed that employers should establish policies or programs that enable employees to deal with family issues that impact on work performance, policies specifically designed to meet caregivers' needs are not yet widespread. Small percentages, less than 20070, of corporate officials indicated that they were actively considering offering a specific caregiving program at the work site.

Although U.S. employers appear to be cautious about adopting new benefits specifically designed for employee caregivers, an examination of useful initiatives instituted by American businesses reveal that they are, nonetheless, meeting employees' needs in important ways. For example, benefits such as liberal use of sick leave and flexible work scheduling allow employees to address family emergencies more easily. Although not designed specifically for employee caregivers, such policies arc extremely responsive. In fact, a 1988 survey of 225 firms around the country, conducted by the Bureau of National Affairs, reports that about two-thirds of all responding organizations offer

Ageing International Winter 1990 43

benefits that are of some assistance to employee caregivers of the elderly.

Programs for Caregivers

What about initiatives specifically designed for working caregivers? Corporate response in this area falls into four categories: l) providing information; 2) counseling; 3) direct services; and, 4) benefits.

1. Providing Information Providing information to employees is the most common response by corporations. There are several different models for providing information and these options are usually low cost and easy to implement. Usually, activities are made available at the work site during lunch time. A few employers, however, use company time to provide needed information.

Perhaps one of the most well known programs is the IBM Elder Care Referral Service established in 1988. IBM has 237,000 employees and 33,000 retirees all over the U.S. The company developed a national information network designed to offer information, make referrals and provide follow up. Trained counselors provide personalized consultation to help employees clarify their needs and those of their senior family members. Referrals are made to several community agencies that offer services for which the older person qualifies. Several weeks after the initial contact, the counselor conducts a follow-up call to make sure that the employee's needs are met. Employees also receive a comprehensive Elder Care Handbook that helps them understand the aging process and how to select and finance community services.

IBM contracted with an organization called Work, Family, Elder Directions, Inc. to help them establish the referral service. It, in turn, subcontracts with 175 local information organizations in areas where large numbers of IBM employees are located. Staff of these subcontracting organizations are trained extensively to assure that the services provided are consistent around the country. Employees access the service by calling the local subcontracting organization directly or by calling a toll free number at Work, Family, Elder Directions, Inc. During the first five months of operation, 56,000 employees and retirees used the service.

Several companies have produced booklets on caregiving that are distributed to workers upon request. For example, Champion International published a booklet entitled "Caring for the Elderly." The booklet covers legal and f'mancial issues and state- and community-long term care services. Workers find the guidebook quite useful because it serves as a reference to be used at their convenience.

Numerous fin'ms offer lunch-time educational seminars on various topics. Businesses either hire consultants from local aging agencies or universities as facilitators or in-house staff conduct pre-packaged workshops, such as those

available in the AARP Caregivers in the Workplace kit. The most popular sessions discuss legal and financial issues.

Perhaps one of most successful lunch time information programs was hosted by The Travelers Companies. The company invited representatives from 20 adult care services to distribute literature and answer employees' questions during a "Caregivers Fair." Approximately 700 employees attended the Fair. Workers reported that the program allowed them to identify more different types of services in twenty minutes than they could have located on their own had they taken several days off work.

2. Counseling Both individual and group caregiving counseling services are offered on the job. Employee assistance programs (EAP) offer employees one-on-one support with their personal problems. Both in-house and contracted trained counselors confer with employees and make necessary referals to community resources. These programs were initially developed to help employees deal with substance abuse issues. However, in recent years, EAP's have broadened their mission to address family issues, such as caregiving, as well as many others.

Although not yet widespread, support groups are currently being offered by both private and public sector employers. The U.S. Library of Congress, the Environmental Protection Agency, Phillip Morris and Southwestern Bell are examples of employers who offer lunch time support groups for employee caregivers. Support groups offer employees the opportunity to share coping skills and information. These groups are often facilitated by a staff resource person. Many are started by employees and evolve out of lunch time seminars.

Nonetheless, support groups are difficult to start and maintain in the workplace. Employers show little support for the concept. Businesses feel more comfortable providing information rather than emotional support. According to one facilitator of a company-sponsored caregiver support group, employers shy away from anything that could be considered "touchy, feely." In addition, employees may feel uncomfortable sharing personal family details with co- workers, supervisors and subordinates. Confidentiality is a tough issue to deal with on the job. Yet, although these groups only reach a very small proportion of employee caregivers, users report that they are truly beneficial.

3. Direct Services Very few corporations have become involved in providing direct services to employee caregivers. One of the most impressive examples was recently developed by Stride Rite, a manufacturer of children shoes. This past February, Stride Rite opened an intergenerational care center located on the fourth floor of their corporate headquarters in Cambridge, Massachusetts.

The facility is designed to encourage informal interactions between the children and the older persons while

44 Ageing International Winter 1990

Bringing Children and Elders Together An outstanding example of what can be done by corporations is the Stride Rite Intergenerational Center in Cambridge, Massachusetts. Best known as a manufacturer of shoes for children, the company has been providing on-site child care since 1971, and opened its intergenerational center in February 1990.

The brainchild of Stride Rite's chief executive officer Arnold Hlatt, the center is a spacious wen- lighted facility with separate wings for children and elders, and a common dining area. Although efforts are made to control noise, the firm's management prefers that the center remain within the main Stride Rite building rather than in a separate structure because, according to Hiatt, it's the "soul" of the corporation.

In developing the center, Stride Rite collaborated with Somerville-Cambridge Elder Services Inc. and Wheelock College.

Among the center's objectives are: �9 p rov id ing a rep l i cab le model for

intergenerational day care, �9 studying social effects and policy implications of

work-based intergenerational day care, and �9 meeting the local community's immediate elder

care and child care needs. To Karen Liebold, Stride Rite's director of Work

and Family Programs, the most important outcome of the center will be a "blueprint" that can be used for developing intergenerational day care programs for other organizations and communities. Included in such a model would be program curricula, staff training manuals, evaluation tools, written research plans, documentation of implementation steps, and consultation services.

However, Liebold points out that the concept of intergenerational day care is presently being explored primarily in hospitals, universities and community settings rather than within the corporate workplace. While some existing day care centers for either adults or children have begun expanding their programs to encompass intergenerational participants, there has been little interest expressed in developing totally new intergenerationai centers. At the same time, some nursing homes have begun providing day care for children, principally as a benefit to retain their own employees, and not necessarily for intergenerational interaction.

While the center has the capacity to serve 55 children and 24 adults, only 12 elders are currently enrolled. Children range in age from 15 months to six years. Approximately two-thirds are children of employees, with the rest coming from the community. For employees, the weekly cost of care for children is US$20-130 on a sliding scale based on household

income, and $85 for elders. Community participants are charged $140 a week for both services, but subsidies may be available to some. Although transportation services are not currently provided, referrals are available.

To be eligible to participate in the elder care program, the center requires that elders be at least age 60, physically able to take care of personal needs (with reminding if necessary), and capable of benefitting from a structured day and the companionship of others. Since interaction between children, elders and staff is carefully planned and structured, the center prefers that participants like and be comfortable with children.

No one has been turned away yet, but some case managers have felt that their clients and the center would not constitute an appropriate match. However, Stride Rite's view is that cognitive deficits are only important if they affect a person's ability to perform activities of daily living (ADLs). While the center's present model is social day care, a health care model will follow.

Stride Rite has indicated a willingness to do whatever it takes to make its program a model for emulation. Development of the center, which is incorporated separately as a non-profit entity, required three years for planning and US$800,000 in start-up funds for renovating the facility's 8,500 square feet of space. Stride Rite provides about US$400,000 worth of in-kind administrative support (phone, postage, copying, insurance, etc.) and the company's Charitable Foundation provides an annual US$400,000 grant to cover other operating expenses. The center's staff receives the same generous corporate benefits provided to all Stride Rite employees.

Marketing the center's services to the community has been limited to letters to social service agencies and personal visits to businesses. With 12 enrollees and five staff members (two full-time and three part-time, plus the center's full-time director), the elder care program is currently a bit overstaffed, but this is expected to change as the enrollment continues growing and staffing is adjusted to maintain the 8:1 ratio that is the center's goal.

There has been no indication thus far as to whether the center has helped Stride Rite attract or retain employees. And, although shoe sales axe up, there is no research being done which might show a link between Stride Rite's image and increased sales. Perhaps the greatest benefit--and the essence--of what Stride Rite is attempting to achieve through its intergenerational program was captured by poet Steven Rafiner in the following which was written especially for the center's dedication.

Ageing International Winter 1990 45

THE TWO OF US

Your hand, small as a birch leaf, skittery fingers, finger-paint-green.

My hand, blue-veined, pliant, like a garden bed after rain.

Your hand disappears inside mine-- a wren into shadow, a penny in a pocket, safekeeping.

Then my hand grasped firmly by yours-- the latch on a locket, an autumn cloud anchored by a thread.

We make quite a pair, the two o f us, two paths through a single story-- not beginning, not ending exactly, more like turning.

You move East, darting, weaving, unpredictable as weather.

I drift West, gradual, measured steps, persistent as a river.

We're good company, don't you think. Without us, mornings

wouldn't hold half the pleasure. Where to today, little breeze? Really? How curious, t Let's go there together.

Steven Ratiner

also providing each group with privacy. Structured activities such as reading stories, celebrations of holidays and birthdays, arts and crafts and field trips encourage interaction between the generations. Karen Liebold, director of the center, reports that the older children and the elders very much enjoy one another's company.

4. Benefits

Unfortunately, the U.S. falls far behind other countries in assuring family leave--even on an unpaid level. (Sweden, for example permits employees up to one month's paid leave for caregiving of elders.) Many American companies fear that family leave policies would hamper their competitiveness and have lobbied actively against national legislation that would assure this right. In the spring of 1990, the President vetoed the Family and Medical Leave Act enacted by Congress which would have provided up to 12 weeks of unpaid leave annually for workers in companies with 50 or more employees who wish to care for newborn or adopted children or the serious illness of a spouse, child or parent. Employees would have been guaranteed their old jobs or a similar position when they returned to work.

Despite a delay at the federal level, 25 states have legislated some form of unpaid job-guaranteed medical or family leave policy. And numerous corporations offer flextime, part-time work and work-at-home options. Although these benefits were not specifically developed for

employee caregivers, they are definitely helpful to caregivers, as well.

In a desire to further alleviate the time pressures facing employee caregivers, some employers are now also offering tailor-made dependent care leave benefits. The first leave programs were merely short periods of time off without pay, usually up to three months. Leaves were granted to employees most often to hdp them deal with child care crises. Today, the illness of a spouse or elderly relative is sometimes covered.

In 1989, American Telephone and Telegraph, Inc. reached a collective bargaining agreement with the Communications Workers of America and the International Brotherhood of Electrical Workers which represented a giant step forward in the arena of work and family. Through the Family Care Leave policy an employee can take leave without pay for up to 12 months within a two year period to care for an ill family member, subject to benefit committee approval. Family is defined as spouse, children, parent and grandparent. The employee is assured reinstatement to the same or a similar position at the end of the leave.

The employee must present evidence of the seriousness of the illness, the expected duration and the reason why the employee must be involved in providing care. While on leave, death benefits and basic group life insurance continue at the company's expense. The company also pays medical and dental benefits for the first six months.

Other companies, such as Johnson & Johnson and The Travelers Companies have similar programs. In addition, both Travelers and John Hancock Financial Services allow three paid Family Care Days a year. At Dow Chemical Company, employees are allowed up to 12 weeks unpaid full-time leave or individualized work schedules, such as part-time work or job sharing, to accommodate short-term family needs.

Dependent Care Assistance Plans (DCAP) provide some lrmancial relief to caregivers of young and the old. Roughly 1,000 employers currently offer DCAP as a benefit. DCAPs allow employees to set aside up to $5,000 of their pretax income into a special account held by the employer. The DCAP account is used to pay for any expense that assures the well-being and protection of the dependent or allows the employee and spouse to work.

Unfortunately, most caregivers of the elderly cannot take advantage of DCAPs unless the older person meets the strict definition of dependency of the U.S. tax code. Under this code, elderly persons axe deemed dependent if another person provides 50% of their support and they are unable to provide self-care. In addition, the older person must spend at least eight hours a day in the employee's household.

Another option for providing employees with some financial relief is the long-term care insurance offered by some employers. According to Susan Van Gelder of the Health Insurance Association of America, as of June 1990, 153 employers were providing such coverage as an employee benefit. In most cases, long-term care insurance is offered to

46 Ageing International Wimer 1990

both the company's retirees and current employees and extends to spouses and parents and parents-in-law. The employee usually has to pay the entire premium.

Most experts agree that family care initiatives need support from the top of the organization down if they are to be successful. In addition, employees must feel that utilizing company support will not in any way reflect negatively upon their careers. Consequently, companies like John Hancock and Johnson & Johnson have internalized their support for work and family initiatives. These corporations instituted training for their managers to help them understand and appropriately respond to family issues. This is an important step which highlights the company's commitment to caregiving issues and sends a clear message to employees that the company recognizes their efforts to remain productive while balancing family concerns.

Conclusion

The issue of elder caregiving is a growing one in the United States as well as many other industrialized countries. The problems associated with caregiving are not new but, this is the first time in history when large numbers of carers are also working outside the home. The impact on business is evident. Yet, most corporations in America are not fully convinced that they should address this issue and, more importantly, few are aware of the various responses available.

Nonetheless, businesses that are currently confronting this concern through creative initiatives are developing a firm knowledge base, as well as a reputation for being "family friendly," which should serve them well in the years to come. It is predicted that competition for mature workers will increase due to labor shortages over the next couple of decades. Employers who offer policies and programs to attract and retain older workers will establish a competitive advantage.

The challenge for American companies is how to provide support for employee caregiving in a climate of downsizing, rapidly growing health care expenditures and economic uncertainty. The search for adequate programs is most difficult for small companies that do not have the resources to offer costly new benefits and whose staffing patterns cannot accommodate employees being absent from work.

In developing elder caregiving initiatives, companies would be wise to solicit the expertise of the public sector. The public sector should serve as a resource to companies and help them explore the many easy-to-implement options for assisting their employee caregivers. There is an aging network in America consisting of information and referral

organizations, direct services providers and researchers. This network is mandated by law to serve the older population and is eager to work with the private sector. Companies can work with their local service agencies to provide employees with literature, seminars, counseling, and the like. Public and private partnerships have often resulted in high quality, yet cost-effective solutions. And employers will be happy to note that the price tag on the majority of these ventures is minimal.

Bibliography

AARP. The Working Caregivers Report. Washington, DC: AARP, 1989.

John Fernandez. The Politics and Realities of Family Care in Corporate America. Massachusetts: Lexington Books, 1990.

Fortune Magazine: John Hancock Financial Services. Corporate and Employee Response to Caring for the Elderly: A National Survey of U.$. Companies and the Workforce. New York: The Time Inc. Magazine Company, 1989.

Buraff Publications. "Work and Family Special Report." The National Report on Work and Family. 1989 June: 1-2.

Buraff Publications. "Working Caregivers." The National Report on Work and Family, March 1989; 3(2):224

Bureau of Business Practice, Inc. "The Challenge of Eldercare." Employee Relations and Human Resource Bulletin. 1989 Special Report No. 1652: Section III.

Ageing International Winter 1990 47