Solving an Age-Old Problem
An array of affordablealternatives areavailable to help yourfamily and youremployees cope withthe growing problemof "eldercare."
Honey Siegel is quick to tell you how lucky she is. Her 90-year-old mother, who lives with her, required emergency homecare after falling and breaking her arm, and then soon again after fracturing her hip. Both times Honey called an experienced eldercare consulting group retained for just such occasions by her employer, Fel-Pro Inc. of Skokie, Illinois. The consultant put her in touch with an emergency home healthcare service for the elderly which looked after her mother when Honey could not.
"I don't know how I would have managed otherwise," says Honey. She got through the emergency with only minimal time off from her job as assistant to Paul Lehman and the three other family members who preside over Fel-Pro operations. "Eldercare is one of the areas in which a company can help an individual solve problems outside the workplace that impact on job performance," says Lehman. "I know it was comforting to Honey not to have to sit at her desk and agonize over how her mother was making out. She cares about this company and gives 150 percent all the time," he says of his employee of 13 years, "so it was important to the company that we be able to do this for her peace of mind."
In providing eldercare services, FelPro is still a rarity in the business world. It has plugged into the embryonic, low-cost network of private and public eldercare service organizations serving businesses of all sizes. Tapping this resource, Fel-Pro has developed a package of eldercare information services that is nothing short of a lifesaver to those, like Honey Siegel, who need it. And Fel-Pro has done so at a surprisingly low cost — only $10 per employee for information and referral services.
Fel-Pro is in the forefront of what promises to become a major workplace issue of the nineties. Demographics tell the tale. Baby boomers, the largest single group in the work force, are buffeted on one side by the responsibilities of childcare and, on the other, by the obligation to care for aging parents. People have always had to deal with these problems, of course, but in today's typical family, in which both spouses work, problems with kids or seniors translate into time and concentration lost at work.
While giant companies are spearheading the development of formal eldercare support systems, it is small and medium sized family businesses that have the greatest need for affordable solutions. For most family businesses, lacking the management depth of large corporations, eldercare problems can have an immediate impact. Problems can occur when the older generation retires and turns the company over to the kids. Should the need for continuing care arise, the children are distracted from running the business. The family needs to know how to take care of the older generation and the business at the same time.
Family businesses can also be severely hurt when employees face eldercare problems, especially if the person is a high-ranking nonfamily executive. In a study by the American Association of Retired Persons and the Travelers Corporation, workers with eldercare problems reported devoting an average of 12 hours a week to caregiving. Many of those are spent during work hours, in endless telephone calls to doctors, agencies, and insurers available only during the day. Many are also spent during unscheduled days off, late arrivals, and early departures. Many caregivers spend less time with their own families, pay less attention to their own health, and not surprisingly, get sick themselves. Some leave their jobs or cut back on their hours.
It is up to companies, then, either to provide some measure of assistance to their employees or to absorb the costs associated with absenteeism and inattention. Providing such assistance need not be costly or difficult.
How toget started
"Smaller companies need to realize there are many alternatives between the extremes of doing nothing and picking up the cost of nursing homes or home healthcare — incredibly costly alternatives no one realistically expects corporations to adopt any time soon," says Christine DuSell, program director of the Aging and the Workplace Program at the Metropolitan Chicago Coalition on Aging (MCCA) that serves Fel-Pro. "It's important for every family business to understand that there are forms of eldercare services that are not beyond their budget."
In Fel-Pro's case these services include:
- A semiannual eldercare educational fair on Saturdays at the company.
- A weekday visit once a month in the company cafeteria by a counselor armed with brochures and advice.
- A quarterly newsletter designed expressly for Fel-Pro employees.
- Access via phone any time to the group's eldercare experts.
- Referrals to appropriate services (the services, not the referral, are paid by the employee).
- Follow-ups to help judge the effectiveness of the referral.
Bob O'Keefe, Fel-Pro's vice-president of industrial relations, is almost apologetic about the annual cost for this basic information and referral service for the company's 2,100 employees: "I wish I could tell you it was a big deal, but it's not. Only about $20,000 per year," or less than $10 per employee. Fel-Pro also goes the extra mile and pays up to 75 percent of the $8-per-hour cost of unskilled emergency homecare, such as Honey Siegel's mother received, up to a set limit.
DuSell estimates that the cost per employee for this package would not be much different for companies significantly smaller than the $230 million (sales) Fel-Pro.
Small and midsized family businesses have several sources of inexpensive eldercare services. Nonprofit groups such as MCCA, which assists Fel-Pro, are now marketing the services they developed for giant companies to smaller ones. And 670 Area Agencies on Aging, established under a 1965 federal law, are starting to create corporate packages based on the eldercare services they had originally developed for the poor and needy.
"Over 90 percent of Area Agencies for Aging provide services for employees," estimates Edward Sheehy, manager of membership services for the National Association of Area Agencies on Aging in Washington. Some of the area agencies are private, nonprofit groups, but most are part of local governments. Some of the wide range of services that these area agencies offer are free to community residents. While the level of service varies from agency to agency, they are increasingly eager to provide a package of services to local companies, possibly on a contract basis. Compensation can vary. "You might reach an understanding that your company provides a grant or a contribution," says Sheehy, "or you might agree on a more structured fee, based on time and service."
Most agencies provide excellent information and referral services, including much information that allows the company to take additional action. Among the services area agencies may provide are interviews and consultation with experienced social workers, help in setting up caregiver support groups and training group leaders, educational seminars for caregivers at the worksite, training for supervisors who have to manage people with eldercare problems, financial and estate planning services for retirees who need to care for an elder, and publications and policy handbooks designed specifically for your company. To find out how to contact the area agency nearest you, call 1-800-Age-Help.
While the costs of information, referral, and support are modest, the returns are incalculable. "When we have our caregiver fair twice yearly on a Saturday, we get quite good attendance, even last February after a horrible snowstorm. We think we see a good feeling throughout the company based on the availability of these services, but it's hard to measure the overall impact," says Fel-Pro's O'Keefe ."We do know that for those who use them, the services are often an answer to their prayers," he says.
Honey Siegel agrees. She's now in the process of seeking long-term care for her mother. "Thank God for the program. Even with their help, this hasn't been easy.
Going beyond information
Beyond providing printed information or referrals for your employees, you can take action that shows your concern and support. You can provide a formal or informal setting in which employees can meet and bring their eldercare problems out into the open and get direct guidance on them. Perhaps the most supportive action is to allow employees reasonable flexibility in their work hours when they need to deal with eldercare problems. You might try some of the following:
- Give a seminar for employees, or provide space where interested employees can run their own, asking a representative of a local visiting nurse association, agency on aging, or family service agency to speak on eldercare issues such as housing, health, or finances. Some agencies will provide speakers free; others might charge a fee of $100 or $200.
- Sponsor a support group for caregivers, or simply make a room at the office available for interested employees — whether 2 or 20 — to meet and discuss the issues before or after work. Having a leader is helpful but not always necessary, since "sharing information," says Richard Beinecke of Great Meadows Associates, family caregiving consultants in Concord, Massachusetts, "can be as valuable as bringing in a professional information source."
- Join with other employers to sponsor a fair in which service providers in your area can show their wares. Such providers — senior housing sponsors, for example, or private geriatric care managers — can give you ideas on getting started, perhaps even organize the event.
- Distribute a handbook on coping with eldercare issues (see the resource list below). Or better yet, determine if a local agency publishes a handbook with local resources.
- Clarify company policy with respect to time off, adjusting work hours, and the like. If you are willing to have employees come in late or leave early when necessary to cope with caregiving, tell them so. They'll feel better being aboveboard — and you'll know what's going on. If it's a formal plan, with certain core work hours and flextime on either end, make sure the policy is clearly set forth and equitable. Is it only for eldercare? What about childcare? If it's an informal approach with supervisors making the decisions, be sure to monitor its implementation and impact. "It doesn't need to cost much," says Beinecke, "but flexibility can be the most valuable thing you can give an employee."
Alternatives to nursing homes
The average annual cost of sustaining someone in a nursing home is now close to $30,000, and double that in high-cost areas like New York City. Round-the-clock care at home can cost considerably more.
But many elderly people can get along very well at home — and be a lot happier — with periodic support services. The problem for caregivers is coordinating the services. Here's a sampling of what to look for in your community for both yourself and your employees:
- Community-sponsored senior centers provide a range of services: hot lunches, recreational programs, health screening, and more. Most services are free, although contributions may be requested toward meals and recreational trips. The centers are also an excellent source of information about support services for the homebound.
- Meals-on-Wheels and similar programs offer home-delivered hot meals five or more days a week in most communities. Funded under the Older Americans Act, the meals are technically free although a contribution of a dollar or so per meal may be requested.
- Volunteer chore services help elderly homeowners remain in their own homes when they can no longer keep up with home maintenance. Part-time homemakers, similarly, can help with cleaning, laundry, and food shopping.
- Adult daycare programs provide supervised full-day programs for frail or disabled elderly who can't be left alone while a caregiver is at work. More than a sitting service, they offer a range of services including recreational therapy, physical exercise, medical monitoring, and mental stimulation for early-stage Alzheimer's patients. Adult daycare costs an average of $30 a day, possibly as much as $50. But there is a severe shortage of facilities in some areas; only about 2,000 such centers exist nationwide.
- Homehealth workers can make it possible for an ill or disabled person to remain at home. Three homehealth aide visits a week for a year would cost about $5,000 even before being supplemented by periodic visits from registered nurses to perform such specialized tasks as taking blood. However, homehealth workers earn so little that turnover is severe and care is frequently inadequate.
Life care communities (sometimes called continuing care communities) offer the ambulatory elderly a range of housing options within the same facility, from independent living in their own apartment through assisted living to nursing home placement. Many are sponsored by religious organizations; the Quakers, for example, run a number of well-regarded communities that have long waiting lists for admission. Others are owned and operated by commercial hotel chains such as Hyatt and Marriott.
Some communities operate on a monthly rental basis; some require an initial fee of $150,000 or even more, followed by monthly fees. It's important to investigate the financial stability of a community that requires a large up-front payment — you might ask your accountant to review their financial statement — before signing a contract. You should also visit, talk to residents, and sample food and recreational programs before making a commitment.
For more information, send a postcard to AARP for its publication, "Continuing Care Retirement Communities" (D12181).
High-techhelp at home
An elderly person with health problems may not need round-the-clock company if an emergency response system is installed. These electronic tools consist of two parts: a lightweight battery-powered "help" button carried by the user (actually a portable radio transmitter), and a console connected to the user's telephone. If the wearer should trip in the bathroom and be unable to get up, for example, pressing the button activates the console to dial one or more preselected emergency telephone numbers. Most systems can dial out even if the phone is off the hook.
Emergency response systems may be one-way or two-way. In a one-way system, a call is generally made to verify the emergency; if the phone isn't answered, help is sent. In a two-way system, voice contact is established via speakers attached to the phone, and the need for help ascertained. Two-way systems are more expensive but may offer more reassurance.
Systems may be purchased at prices ranging from $400 to over $2,000, or may be rented, often through your local hospital (at $25 to $50 a month). Renting may be preferable. "So many companies are getting out of the business," says Lee Norrgard of AARP's consumer affairs department, "that you might buy a machine programmed to dial a number that no one is answering."
For more information, send a postcard to AARP Fulfillment (EE178), 1909 K St. N.W., Washington, D.C. 20049; ask for publication number D12905, "Meeting the Need for Security and Independence."
Begun just a few years ago, long-term care insurance is now offered by about 120 insurance companies. Following earlier abuses, the National Association of Insurance Commissioners (NAIC) has issued model legislation governing its terms; the model act, or similar statutes, are now in force in about two-thirds of the states.
Most policies are individually issued, but some companies are sponsoring group plans for employees. Not true group insurance — in part because Congress hasn't yet clarified the tax status of employer-paid long-term care benefits — most plans have employees paying the full cost. That cost may be less than that of an individually purchased policy, but it may be a case of comparing apples and oranges. Group policies tend to have a richer menu of benefits, costing more; they also tend to be taken out at younger ages, therefore costing less.
Because long-term care insurance doesn't have favored tax status, it can be offered as an executive perk for family members or key employees. It hasn't caught on as such, however, in part because it's still so new and in part because most employers are preoccupied with lowering the escalating costs of basic healthcare rather than taking on new obligations.
The Health Insurance Association of America reports that the average annual premium at age 50 for an individual plan providing $80 a day for nursing home care (with an inflation rider), a 20-day deductible period, and four years of coverage is $658. At age 65, the average annual premium for this constellation of benefits becomes $1,395, and at age 79 a staggering $4,199.
Group or individual, here's what to look for in a policy:
- Benefits, which may be paid for as little as one year to as much as the rest of your life, vary from a low of about $40 a day to a high of about $100 a day. Look for a policy that pays the highest benefit for the longest period, consistent with an affordable premium, and has a provision that raises that benefit to keep pace with inflation.
- Benefits may be paid for skilled, intermediate, and/or custodial care. Some policies pay less for custodial care, in a nursing home or at home, although over time custodial care may actually cost more.
- Deductible or elimination periods let you keep premiums down by self-insuring for the early stages of a covered illness. Bear in mind, though, that while most nursing home stays last less than 150 days, premiums saved by taking a longer deductible may pale beside the out-of-pocket cost of an extra month of nursing home care. Before buying, find out what local facilities charge.
- Find out what conditions must be satisfied before a claim is paid. Policies can vary greatly. Some companies settle for a doctor's note; others apply a "managing the routines of daily living" test before someone who needs help with bathing, feeding, and dressing is eligible.
- Look for a policy that is guaranteed renewable, which means that it cannot be cancelled by the company as long as you pay the premiums on time. But don't expect that premiums will necessarily remain level. Although premiums are determined by age at the time the policy is issued, insurers do retain the right to raise premiums for an entire class of policyholders. Given the newness of the long-term care product, and the lack of experience insurers have had with pricing and claims, prices may well go up.
- Before you decide, obtain a copy of the "Shopper's Guide to Long-Term Care Insurance," published by NAIC, and fill out its worksheets. The guide must be given out by insurance agents or direct mail companies before an application for long-term care insurance is made. It is also available free to consumers from state insurance departments and at a still-undetermined charge for business from Publications Department, NAIC, 120 West 12th St., Suite 1100, Kansas City, Mo. 64105.
As you consider various policies, be careful. There are a number of situations that should be avoided:
- Don't accept a policy that requires hospitalization before nursing home admission. Most people enter nursing homes directly and not from acute-care hospitals. Older policies in some states may contain this provision although it's prohibited by the NAIC model.
- Don't accept a policy that requires you to receive skilled nursing care for a specifled period before you are eligible for benefits for intermediate, custodial, or home care. Such policies, says the NAIC, "may be of little or no value."
- Don't accept a policy that rules out coverage for Alzheimer's disease. Some policies exclude treatment of mental and nervous disorders, but in states that have adopted the NAIC standard, Alzheimer's disease must be covered.
- Don't accept a policy that rules out preexisting conditions longer than the six months recommended by NAIC.
- Don't be talked into switching policies, unless your older policy requires a prior hospital stay, and you are in good health and qualify for a new policy.
A guide to eldercare resources
You may not be able to provide an onsite adult daycare center for relatives of employees, but you can ease the frustration your employees experience in trying to locate appropriate eldercare services. You might simply make an information sheet available, listing locally available support services. If you'd like to do more, read on.
Where to start
- The local Area Agency on Aging should be your first call, for information and possibly more. There are 670 area agency units across the United States funded by federal, state, county, and municipal governments, which provide information and, increasingly, referral services on eldercare, though the level of services may vary. The National Association of Area Agencies on Aging provides a toll-free telephone number (1-800-Age-Help) for information on your local agency. Complete information on all 670 agencies is contained in the NAAAA's annual publication, "Directory of State and Area Agencies on Aging: A National Guide for Eldercare Information and Referral." Cost is $30. To find out more, write to the National Association of Area Agencies on Aging, 1112 16th St. N.W., Suite 100, Washington, D.C. 20036.
- Every state now has a long-term care ombudsman, to investigate neglect, exploitation, and abuse of older adults in nursing homes and at home. The ombudsman is the person to call if you suspect, for example, that a nursing home is applying unnecessary restraints. The services are free, and you can locate your state's ombudsman through the Area Agency on Aging.
- The Alzheimer's Association, which provides literature and sponsors support groups, is at P.O. Box 5675FB, Chicago, Ill. 60680-5675. Or call 1-800-621-0379 (in Illinois, 1-800-572-6037).
- Hospital discharge planners can assist with post-hospital arrangements, putting you in touch with both nursing homes and homehealth agencies. Although their assistance can be valuable, the National Consumers League points out that they are often pressured by cost-conscious hospitals to make quick placements. It's up to you, therefore, to evaluate their recommendations.
- A private geriatric care manager can be very helpful in evaluating your personal eldercare situation, and can make recommendations, at a fee of up to $400. The service can be particularly valuable if you live in one state and your relative in another. If desired, a care manager can also monitor ongoing care when you can't, at rates ranging from $50 to $100 an hour. The National Association of Private Geriatric Care Managers, 655 North Alvernon Way, Suite 108, Tucson, Ariz. 85711 (telephone 602-881-8008), has just published a free referral guide to help you locate care managers in your area. And AARP has a new booklet (D13803), "Care Management: Arranging for Long-Term Care."
- A "Primer on Long-Term Care," recently published by the National Consumers League, contains a state-by-state list of Area Agencies on Aging along with much other useful information. It is available for $4 from NCL, 815 15th St., N.W., Suite 516, Washington, D.C. 20005. Bulk prices are available should you want to distribute it to your employees.
- The American Association of Retired Persons publishes a number of helpful free booklets, including "Making Wise Decisions for Long-Term Care" (D12435), "The Right Place at the Right Time — A Guide to Long-Term Care Choices" (D12381), and "Housing Options for Older Americans" (D12063). A free copy of each may be obtained by sending a postcard to AARP Fulfillment (EE178), 1909 K St., N.W., Washington, D.C. 20049. Use the order number shown, and allow several weeks for delivery.
- The Health Insurance Association of America publishes "A Consumer's Guide to Long-Term Care Insurance." The guide, and a list of companies that offer long-term care policies, is available at no charge from the HIAA, P.O. Box 41455, Washington, D.C. 20018.
- A comprehensive resource, covering the whole range of issues you'll face as your parents (and you yourself) age, is When Your Parents Grow Old, by Florence D. Shelley (Harper & Row, 1988). Check your library or bookstore, or order a copy, at $10.95, by calling 1-800-638-3030.