Part 3&4 of four
part article
Several companies have
attempted to provide solutions to both stressed out employees and to employers concerned
with the associated costs in the form of lower productivity, reluctance to re-locate, loss
of workers-especially women- who feel they must resign to care for aging parents, and the
increased incidence of "presenteeism", a corollary of absenteeism where the
employee, having used up all of their sick leave and vacation time continues to come to
work but is too preoccupied with chronic elder caregiving issues to be very productive.
Many large corporations are
now responding to these pressures by retaining the services of "Work/Life"
companies to help them to ease the caregiving burdens faced by their employees. The costs
of these services, however, make them out of reach for many employers who are struggling
to keep up with employee health care costs that are rising once again, after several years
of stability.
The reluctance of family
caregivers to use services for which they are eligible and the preference of caregivers to
solve problems on their own present challenges to those trying to provide services to
family caregivers. Caregivers who have little time to meet their family, work, and
caregiving responsibilities often feel they do not have any time left for support groups
or other interventions. Simply locating family caregivers in need of support and getting
them to accept such support may prove difficult. Many family caregivers do not seek
outside help until they have reached a crisis point.
Since the Fall of 1998 a
group of elder care and elder life planning professionals have been working to develop an
effective, affordable solution to the complex needs of working caregivers, many of whom
live a great distance from the elder or disabled family member they are concerned about.
The result "Elder Life
Planning in the Workplace" is an employee benefits program that has been designed to
help employers to address a costly and growing problem.
Using a consortium of
independent nurses, social workers, financial, legal and insurance specialists a
comprehensive package of elder and disability services can be offered by employers, trade
unions or associations at an affordable cost. Instead of a "one size fits all"
approach, "Elder Life Planning in the Workplace", which will be available
nationwide on September 1, 2001 can be customized for the unique needs and budget of each
employer or sponsor who wishes to offer the service.
Using a decentralized
network of strategic partnerships with work family and elder and disability programs
around the country, the costs of administering a large central bureaucracy is drastically
reduced.
One call to a toll free
call center staffed by experienced, highly trained professionals will allow working
caregivers to get a customized information kit about resources to meet their specific
needs in the community where the help is needed. Local eldercare agencies will also
provide on site educational programs concerning health care, legal and financial issues of
aging and long-term care, including access to several top rated long term care insurance
products.
There are essentially 3
major 'stressors' associated with employed caregivers; the emotional stress involved when
a family member becomes seriously or chronically ill; the shock of how costly elder and
disability care is and how little of the cost is covered by any insurance plan-including
Medicare; and the frustrating complexity caregivers encounter when attempting to put a
suitable plan of care in place since very little assistance is offered by physicians or
hospitals.
To be effective in reducing
the stress of working caregivers and associated lost productivity and morale, work/life
eldercare programs must offer solutions that specifically address these 3 issues. It's a
daunting challenge that is best met with a comprehensive and well coordinated network of
local service providers and specialists who are willing to offer a prompt and sensitive
response as well as discounts on their services in exchange for the cost savings they gain
by participating in a national provider network.
Participation in a national
provider network offers significant benefits to elder and disability care professionals.
They receive an increased volume of referrals without incurring additional marketing
costs. Working caregivers can reach them via a national toll free number as well as
through web based technologies that allow each provider a high degree of visibility that
would otherwise be very costly for each provider to replicate. Local providers maintain
their professional identity and autonomy because they are not required to adopt a
cumbersome set of of clinical and administrative forms and reporting procedures imposed on
them by an external bureaucracy.
By carefully screening
professionals and service providers and requiring each one to be highly qualified and to
meet recognized standards of professional ethics and practice, this model of workplace
elder care provides quality assurance to employers and employees while generating
substantial savings over more bureaucratic and proprietary work/life programs.
---------------------
Robert E. O'Toole, LICSW,
is President of Informed Eldercare Decisions, Inc., a private company specializing in elder life
planning. A founding member of a national network of social work and health care
professionals known as the National Association of Professional Geriatric Care Managers,
he is a former editor of the Geriatric Care Management Journal.
Prior to founding Informed Eldercare Decisions, Inc. Bob worked for 10 years as a senior administrator in the Massachusetts
Home Care System and for one of the leading private long term care consulting firms.
Bob has contributed
chapters to two books on elder care and geriatric care management issues to be published
in 2000, and has written numerous articles on the delivery of elder care in the private
marketplace. His articles have appeared in Geriatric Care Management Journal, Health
Insurance Underwriter and Inside Case Management. His E-mail address is Bob@elderlifeplanning.com.
Older and Younger People with
Disabilities: Improving Chronic Care Throughout the Life Span
One false step on a cellar
staircase, an automobile accident, a stroke, and overnight, any of us could end up with
disabilities that make us dependent on others for the simplest tasks. We are all
vulnerable to the effects of disability, whether it's a matter of caring for an elderly
parent devastated by a stroke, supporting a co-worker who has Parkinson's, or hearing
about a neighbor's baby born with mental retardation.
As the population ages,
more Americans will have illnesses and chronic conditions that limit their ability to
carry out ordinary tasks--bathing, rising from a chair, opening a window, and walking to
the grocery store. With a current life expectancy of 75 years, newborns, today, can expect
to experience an average of 13 years with an activity limitation. Because the 85 plus
group is the fastest growing segment of the population, many Americans may live with
activity limitations for 20 years or more.
Technological and medical
advances have made it possible for Americans to live longer but have not been matched by
improvements in the delivery of chronic care services. As Chronic Care in America: A 21st
Century Challenge, a recent report from the Robert Wood Johnson Foundation, sums it up,
"There is no effective system to care for those with chronic conditions in the United
States. As a result, much of the care that is available is fragmented, inappropriate, and
difficult to obtain."
One in Six Americans Has a
Chronic Condition According to Chronic Care in America, "In 1995, one in six
Americans--41 million people-- had a chronic condition that inhibited their lives to some
degree." Among the conditions counted are arthritis, cancer, heart disease, diabetes,
emphysema, Alzheimer's disease, blindness, hearing impairments, mental retardation, mental
illness, cerebral palsy, and spinal cord injuries. The report says, "At least 9
million people with disabilities need help either with personal care or home management
(40 percent are under age 65)."
Disability rates increase
with age. According to the report, in 1994, nearly 40 percent of the elderly not living in
institutions--12 million seniors--were limited by chronic conditions. Of these, 3 million
(about 10 percent of all elderly) were unable to perform such activities as bathing,
shopping, dressing, or eating.
The number of older persons
with functional problems in 1994 was 7.1 million, rather than the 8.3 million who would
have been impaired, if the health of older people had not improved. Nevertheless, the
growing number of Americans 85 and older means that there will be a continuing and,
indeed, growing need for services and supports.
Lifestyle Changes To
Prevent Disability Heart disease accounts for 13 percent of all activity limitations, and
injuries cause 13 percent of all disabilities. These two facts, alone, point to the large
potential to reduce disabilities by convincing Americans to adopt better nutrition, health
and exercise habits and to think ahead about building or retrofitting homes to make them
safer and more convenient.
Use of assistive devices
rises with age, but this is not true of home accessibility features. It is estimated that
one million people nationwide need home modifications and without such changes will remain
in unsafe environments or end up in institutions.
The frail elderly may have
much to learn from younger people with disabilities, including an attitude that refuses to
allow society to relegate them to the sidelines and to view them as unfortunate, passive
recipients of services. The nationwide network of services to the elderly, led by the U.S.
Administration on Aging (AOA), has much to offer the growing numbers of people with
life-long disabilities who are living into old age.
Aging and Disability
Coalitions Want Shift to Home-Based Care A National Coalition on Disability and Aging was
formed in 1994 and today includes 50 organizations from the disability and aging
communities, including the AOA. The Coalition held its first summit on disability and
aging before the White House Conference on Aging in 1995.
One of the key objectives
of disability and aging coalitions at the federal and state levels is to shift the bias of
publicly-funded federal and state programs away from institutional care to home and
community-based services. Another is to reverse the medicalization of services to the
elderly and to people with developmental disabilities.
According to Chronic Care
in America, the direct costs of medical services for persons with chronic conditions
amounted to $425 billion in 1990, and 65 percent of those costs were for hospital care and
physician services (39 percent to hospitals and 25 percent to physicians).
Home health care
expenditures, however, have increased dramatically, rising from $9 to $24 billion between
1989 and 1993, and the number of home health care agencies providing Medicare-reimbursed
services doubled between 1979 and 1990. This trend isn't just due to increased use of home
health care by elderly people with chronic health problems. It is also due to rules that
now send patients home from the hospital "quicker and sicker" to receive
services from a home health agency that used to be provided in a hospital.
Services for seniors with
chronic conditions, however, are still concentrated in the periods when they need acute
care rather than in phases when prevention or rehabilitation services would be beneficial.
Costly hospitalizations might be avoided if certain types of services were more affordable
and available--transportation to the doctor; installation of railings and ramps; physical
therapy to strengthen muscles to prevent falls; education in use of assistive devices;
counseling to prevent malnutrition; and provision of home care aides to shop, prepare
meals, and assist with personal care. |
