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Featured Guest Blogger June 11th, 2009

Cali Williams Yost is the founder and CEO of Work+Life Fit Inc., a consulting firm that specializes in developing innovative business-based work-life flexibility strategies for organizations and individuals. She is the author of Work+Life: Finding the Fit That’s Right for You (Riverhead/Penguin Group 2005). Yost writes the Work+Life Fit Blog and is an expert blogger for Fast Company magazine. She can be reached at cali@worklifefit.com. Please note that the views of our guest bloggers do not necessarily reflect the views of the Sloan Work and Family Research Network.

For the past few months, a friend cared for her mother through the final stages of ovarian cancer under a best case elder care scenario: 1) she is a stay-at-home mom who lived close by and had the flexibility to provide care, and 2) her mother had adequate financial resources to pay for the care she needed.  Yet, the reality of elder care was, according to my friend, “a nightmare.”  As I found two years earlier when I cared for my mother before she died of lung cancer, she was blindsided by the lack of support.  Or, let me restate, the lack of elder care beyond family caregivers.

This brings us back to the original questions:  who will provide the majority of care for the rapidly aging baby boom generation, and who will pay for it?  The answer for the most part is no one beyond family members,  and that already tenuous support is fraying with the recession.

I believe we have two choices: 1) either fundamentally overhaul the way the country provides and pays for the care of aging adults or 2) level with current and future caregivers, as well as the organizations that employ them, so they understand the hard facts and begin to plan accordingly.  Otherwise, they, too, will be blindsided.

The good news is that innovations related to elder care are emerging; however, they must take into account the realities that my friend, countless other caregivers, and I learned the hard way if they are going to have a meaningful impact:

“There are going to be more people to take care of than there are people” to provide care says Bob Caffrey, CEO of Seacoast Hospice in New Hampshire.  According to the U.S. Census Bureau, by 2050, there will be 88.5 million people who are 65-and-over, which is “more than doubling the current 65-and-over population.  Meanwhile, the number of working-age people between 18 and 64 is projected to decline from 63% to 57% in 2050.”  This doesn’t even include the number of adult children or other family members under 65 who need care. Simply put, the care requirements of aging adults will put greater demands on a dwindling supply of family care providers.

Current and future caregivers may not see themselves as the primary providers of care for their aging family and friends, but the system does.  We need to get on the same page.  As noted in the recent Evercare Survey of the Economic Downturn and its Impact on Family Caregiving, “Family caregivers are the backbone of our health care system by providing long-term care to those with chronic illness or disabilities.” I have to say that this was news to me and my sisters before we started to care for our mother, and I’m an “expert” who thought I understood elder care.  The Executive Director of a New Hampshire community-based nurse and hospice organization stated an important fact in a recent article when she said, “Family members and friends need to play an active role in the care of a loved one at home…No home care agency can do it all.  Families really are the primary caregivers.”  The system that provides care will support you.  It doesn’t expect to cover all of the care—family caregivers need to know that.  I would imagine most don’t.

Because of the recession, a majority of those caregivers are much less likely to take a break from the workforce to provide care.  In other words, even though they are expected to be the primary care providers, family members who might have quit in the past, won’t.  When it’s needed the most, there will be less family caregiver time available because the recession has made them feel they need to keep working:

• 2009 Work+Life Fit Reality Check, a nationally-representative survey of full-time employees reported that 47% of respondents were less likely to voluntarily leave the workforce for periods of time or take a career break, for example to raise children or care for an aging parent.
• The Evercare Survey of the Economic Downturn and its Impact on Family Caregiving found that 50% of working caregivers said they were less comfortable taking time off from work to provide care.

Assuming outside support is available, no one seems to have the money to pay for it—not Medicare, not the aging adults and not the adult children providing the care.

• Medicare:  Over the past two years as I’ve pondered the question of who will pay for elder care, I’ve asked experts in the subject what they thought and most say the same thing: Medicare. My usual response is, “Really?” One expert stated, “The public will demand it.”  Okay, we can demand all we want, but what if there’s simply no money?  A recent government report shows Medicare is projecting trillions of dollars of unfunded liabilities in the not too distant future.  I’m not sure Medicare is going to be the answer.
• Aging Parents: According to a recent study by the National Bureau of Economic Research (NBER), households headed by people between the ages of 55 and 64 reported the median value of all retirement accounts of approximately $100,000.  Assuming aging adults need to use their funds for care over a limited period, it may be adequate.  However, the problem is that many will need care for years, and then $100,000 will not be enough.  There’s long-term care insurance, but that can be very expensive.
• Family Caregivers:  According to the Evercare study, six out of ten caregivers who reported increasing their care giving spending also reported having difficulty paying their own basic necessities.  And 63% were saving less for retirement.  Considering that the NBER research reported that 53% of households with at least one retirement account had a median balance of “a mere $45,000,” this is not good news.  Also, many of the caregivers who are spending more on care giving expenses, are using up their savings (47%) or are borrowing money and using credit cards (43%).  Double trouble.

Aging adult care is perhaps the greatest, yet the least discussed, work+life fit challenge we face governmentally, organizationally, and individually, especially when coupled with child care.  Finding solutions begins with asking the right questions.  And those questions need to be based on fact-based assumptions.

As I’ve shown above, the system seems to expect families (or friends) to function as the primary caregivers, even if they don’t realize it. Those families are not going to be able to provide 100%, full-time care, because they must continue working.  They must help pay for the care of the aging adults in their lives because the government may not be able to step in.  And do this while saving for their personal retirement and future elder care needs.  It goes without saying that these caregivers will need a great deal of flexibility in how, when, and where they work if they are to fulfill their responsibilities on the job and at home.

Who will care for the rapidly aging baby boom generation, and who will pay for it?  The answer: Employers, communities, families and individuals creatively working together on all levels.  It’s the only way.  It’s not happening right now, and it needs to start…soon.

• Elder Care , Organizations , Scheduling , Workplace