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Relocating CaregiversHandle With Care

March 1, 1997
Related Topics: Relocation Services, Featured Article
Bonnie Blank’s father—a retired San Francisco policeman—is 86 years old. Her mother is 75. Although [Blank’s mother] appears in good health, Blank worries that she’s being dragged down by her father’s dementia. "He wakes up five times a night yelling something," says Blank, HR manager for The Pasha Group, a transportation management company in Corte Madera, California. Seems like every time he goes out, he falls down. "The paramedics here know them very well."

Blank and her husband moved to Corte Madera years ago. Being in close proximity assuages any anxiety she has about emergencies. She would never consider relocating. "I just couldn’t move because my parents are too fragile. I don’t know how much longer they’re going to be alive. And if my company suddenly moved, I wouldn’t go. I’d quit."

Lorna Larson Paugh is in a different situation. Three years ago, she landed a promotion at Allergan Inc. as vice president of HR, Asian Pacific region. That meant a relocation to Sydney, Australia, where she and her husband recently welcomed the birth of their first child. But last October, Paugh was awakened by a phone call at 3 a.m. It was the family priest. He informed her that her mother, 75, had suffered a stroke and was in the hospital. Paugh immediately hopped on a plane to California. "It was quite distressing for me to come. Here I was, jet-lagged, and my mother was immediately released into my care. It was a nightmare. Now, I also was dealing with a person with dementia who was making all these unreasonable demands, although she didn’t realize it." Within a couple of weeks, Paugh was advised to seek a care-management service.

If you or your employees were in Blank’s or Paugh’s shoes, what would you do or advise? Clearly, both of these examples are only the tip of an iceberg. Elder care is an emerging issue. Until a few years ago, the term simply meant care for the aged. Today, HR professionals are extending its meaning to a variety of innovative programs designed primarily to help the approximately one out of four employees with caregiving responsibilities for an elder relative, according to Diane Piktialis, group manager at Work/Family Directions Inc. (WFD) in Boston. Caregiving, she says, may be causing your employees private anguish, emotional turmoil, guilt and lower productivity. One fall can turn an otherwise healthy senior’s life—and your employee’s—upside down. Relocation—just one work scenario—sharpens the issue. Why? Because mobile employees with elder-care responsibilities are suddenly forced to make some very personal and moral decisions—ones that all of your employees will eventually face. Should they place their loved ones in a nursing home? Who benefits from hospice care? Is long-term care affordable?

HR managers can help such employees resolve their work/life dilemmas. Fortunately, minimum-to-maximum elder-care services are available nationwide. And companies, such as IBM, AT&T, Texas Commerce Bank and others, are breaking ground by establishing broader dependent-care programs. The last thing you want are seasoned, valued employees refusing to move. "After all, not everyone is going to have children. But we all have parents," says Ellie Monty, of Orion Relocation Services in Chicago.

The graying of America hits the workplace. Just look at the demographic trends. According to WFD, today 12 percent of the U.S. population, or approximately 30 million people, are over age 65. By the year 2000, the percentage is expected to increase to 13 percent or 35 million. With a combination of increased longevity of today’s elders, aging baby boomers and more women in the workforce, it’s no wonder human resources professionals and relocation experts are concerned. "The elder-care issue is where child care was 20 years ago," says Piktialis.

H. Cris Collie agrees. As executive director of Washington, D.C.-based Employee Relocation Council, he’s both patient and optimistic about future elder-care assistance programs. Even if a company only offers research-and-referral services, he considers that innovative. "The elder-care issue has just gotten on our radar screen very recently. And we’re taking note because it’s a possible impediment to mobility."

Although some studies in recent years have minimized elder care as a major obstacle to relocation, HR would be naive not to dig below the surface. Employees could be addressing the issue on their own. Many could be in denial of their parents’ aging process. "A lot of kids don’t realize how much their parents’ health has deteriorated. Many times, things come to a crisis before one faces reality," says Roberta Probolsky, a certified gerontology specialist and bereavement facilitator at Heritage Pointe, a Mission Viejo, California-based retirement home.

Or employees may have self-selected themselves out of promotions, transfers or group moves. But these days, as more women—typically the main caregivers —enter the workforce, employees are abandoning any self-consciousness in exchange for help.

Major corporations lead the way. Four years ago, 21 U.S. corporations jointly launched a $25.4 million initiative to develop dependent-care projects in communities across the country. They call themselves "Champions" of the American Business Collaboration for Quality Dependent Care (ABC). Its CEO roster includes leaders from: IBM, AT&T, Aetna Life & Casualty Co., Exxon, Xerox and Chevron Corp. In four years, ABC has enlisted 156 businesses, government entities and not-for-profit organizations to invest more than $27 million in 45 communities located in 25 states and the District of Columbia. Some of the elder-care initiatives include consultation services, reimbursement accounts, intergenerational day-care centers and emergency financial assistance, according to Ted Childs, IBM’s director of workforce diversity. Last year, ABC entered phase two with a $100 million initiative to further its mission over the next six years. HR, he says, must play a key role in implementation. "The continuing focus of HR is to help employers attract and retain the most talented people they can. We’ve already attracted the person. This [ABC’s mission of assistance] gets at keeping them productive."

One corporate example is AT&T’s Family Care Development Fund. Its director, Skip Schlenk, drives the program with professional zeal and personal experience. As a baby boomer, she’s already faced the death of her mother to cancer. Then she became a caregiver for her mother-in-law who lived with her for a while, tried independent living, used field nursing and returned to assisted living. "My husband and I didn’t have a vacation for five years because we couldn’t leave her for any length of time."

The fund, she explains, can assist others in a similar situation. Launched in 1990, the fund is a grant-making program that allows employees to create community-based solutions to their dependent-care problems. AT&T, the Communications Workers of America (CWA) and the International Brotherhood of Electrical Workers (IBEW) invested $25 million in 1,700 programs for child care and elder care across the country. The fund addresses employee needs by: providing information and support; offering financial assistance (reimbursement accounts allow employees to set aside up to $5,000 a year in pre-tax dollars for child- and elder-care expenses) and flexible work arrangements; and improving local community services through the Fund.

Thus AT&T also runs focus groups in various locations, offers caregiver support groups in 10 cities and sponsors elder-care fairs. One year, the company offered 24 seminars to reach out to its employees. "A lot of people come to those, but don’t have to necessarily identify themselves as needing help," says Schlenk. Once they’re introduced to various programs, they can determine what works for them.

Mobile employees have different needs. HR managers need to be particularly sensitive to individuals facing relocation. According to a recent report from the New York City-based Conference Board’s Work-Family Roundtable, 36 percent of responding companies said that employees chose not to relocate because of elder-care responsibilities. And employees from some cultural backgrounds were responsible for elder care even if the elder was capable of self-care. So don’t be surprised if a relocating employee requests to bring his or her parents along, or lobbies to maintain the same quality of elder-care accommodations when the elder decides to stay behind.

Keep in mind, too, that domestic relocations impact elder care differently than international relocations, says Jacqui Hauser, director of international assignment practice for Prudential Resources Management in Shelton, Connecticut. "In a domestic relocation, you’re dealing with a permanent move," she explains. Domestic relocatees also have an advantage over international relocatees. "Because the relocation is in the same country, there’s a lot of consistency," says Hauser. One expects that any medical situation can be dealt with in a way one is accustomed to. The way the elderly are treated is a cultural issue. "None of those rules apply in an international assignment."

First, the expat is going to a foreign country with a foreign language and culture. The role of the elderly and the family will be different. In some foreign countries, governments assist in health care. Expat tag-alongs may not qualify for health care under such regulations. This is why very few, if any, expats have elders going abroad. "It’s very unusual," says Hauser. "And rare for a company to include a nonchild dependent in its definition of an eligible family member for international assignment. Moreover, an accompanying spouse who might have found another job in the United States may become homebound and the primary elder-caregiver. In an international situation, these changing family dynamics can create additional stress on an expatriate’s success.

Global companies, therefore, are tackling elder-care issues with greater flexibility. When an expat is leaving an elder behind, HR managers need to listen to and address such concerns. In the past, companies expected their expats to rent their home-country residence to help defray housing costs abroad. If an expat’s elder relative lived with the family, the elder had to be moved elsewhere—typically, for three years. That’s not the case today. "Companies have become more family-friendly. They’re saying, ‘Your home is your home. You’re on a temporary assignment. You continue to take full responsibility for your home-country housing. If you want an elder to continue living there, it’s none of our business. We’ll simply pay for your host-country housing because we’re putting you there.’" Such flexibility, Hauser says, offers global employees greater ease of mind and options to accept overseas assignments.

By giving your alternatives for elder care, you minimize their jumping ship to a family-friendlier competitor.

When Paugh accepted Allergan’s offer as HR manager for the Asian Pacific region, she had no idea her mother would face dementia. "It was the furthest thing from my mind," says Paugh. "My mother was extremely healthy. She walked four miles a day. We were sure my mother would be fine." After two years abroad, her mother’s health gradually declined. Then came the crisis last October.

Through a very close friend, Paugh was referred to Emily Stuhlbarg, partner of Long Beach, California-based SMS Associates, which offers care-management services and conservatorships. As conservator, SMS is professionally libel to assume responsibility for Paugh’s mother’s medical, financial and personal care. "We oversee all of the services," says Stuhlbarg.

Typically, a relocating employee or long-distance relative meets with an SMS counselor. Private assessments are conducted at the home of the elder. "You can’t really know what the person needs until you see him or her function in his or her own home." Then, the counselor begins to map out a care plan of what will happen once the employee moves out of town.

Care management, for domestic or global employees, is truly a godsend, says Paugh. But it doesn’t come cheap. According to some estimates, care management can range anywhere between $200 a month to several thousand, depending on the extent of care needed. Nursing homes can cost $40,000 a year. Assuming an elder relative lives until the mid-80s, such costs are enough to make baby boomers shuck any dreams of retiring under a palm tree. Your company, however, can offer additional financial options, such as long-term care insurance. By giving your employees alternatives, you minimize their jumping ship to a more family-friendly competitor.

Organizations explore long-term care insurance. Long-term care is the type of care received when someone needs assistance—either at home or in a facility—with activities of daily living due to an accident, an illness or advancing age. It doesn’t apply only to elders. Long-term care insurance is paid when one loses the ability to perform at least two activities of daily living—known as the basic ADLs: bathing and dressing, transferring, toileting, continence and feeding.

Most employees may not realize that Medicare—health insurance for people over the age of 65—covers less than 5 percent of long-term health costs. Medicaid, on the other hand, pays approximately 45 percent of long-term care costs. But one’s assets must be depleted to welfare levels and care must be provided in a Medicaid-approved facility to qualify for benefits, according to Portland, Maine-based UNUM Life Insurance Company of America, one of the first insurers to offer long-term care insurance.

That’s why companies, such as Houston-based Texas Commerce Bank offer long-term care insurance for their employees, says Stephanie Lappin, vice president of HR. Last year, HR recognized that many of the company’s employees were in need of elder-care assistance. The bank already was offering reimbursement accounts, but that wasn’t enough. So HR conducted a series of meetings, circulated in-house bulletins and provided toll-free numbers to its insurance vendor, Boston-based John Hancock Mutual Life Insurance Co.

The insurance plan features coverage for the employee, one’s spouse or both—paid through payroll deductions. Parents and in-laws, once approved for insurability—are covered through third-party billing. "It’s a brand-new program, and our employees were very interested in this," says Lappin, adding that premiums are based on the age of the person when accepted into the plan. If an employee leaves Texas Commerce Bank—and relocates—an employee can still keep the coverage by paying premiums directly to John Hancock. The different types of care covered by this option include institutional care, noninstitutional care and respite care. Because seniors are living longer, chances are they’ll require long-term care and will benefit from such programs.

Elder care requires employer/ employee responsibility. As with any work/life issue, such as spouse assistance or child care, talk precedes action. "Elder care requires nothing less," says Monty, of Orion Relocation Services. "I don’t think everything is in place yet. There’s still a lot of talk." But as companies continue to survey their employees’ needs, more will follow the Champions’ lead. Minimally, HR can immediately expand its resource-and-referral lists, explore hospice services, establish hot lines to elder-care specialists and insurance vendors, and benchmark those companies involved in the American Business Collaboration, which provides a list of names, phone numbers and descriptions of various elder-care programs. "The first step of problem solving is problem recognition," says Childs. "If an employer has extended the understanding to the employee that he or she recognizes the problem—at least they’re trying to have a dialogue. That’s the most important step to take."

Then HR must also reconcile employee need with employer benefit and cost. Elder care is a very personal issue that will affect workforce morale and productivity. But it’s not an entitlement. Given that reality, the responsibility must be shared by both employer and employee. Corporations have some responsibility to build the social infrastructure of this country. But companies have to be mindful of costs, too, says Myra Marshall, corporate compensation manager at Boston-based Cabot Corp. "Elder care has to be balanced with what the company can afford. And employees have to be careful not to create so many substitutes in caring for people in their lives. Not everything can or should be done by a stranger."

For long-distance and mobile employees, these personal choices are even tougher to make. "Now, people are dealing with elders for years and years," says Diane Showalter, executive assistant for personnel, city of Cheney, Washington. Relocation or long-distance care forces one to take a closer look at one’s values. Hopefully, it’s not in contradiction to one’s job. HR managers must always protect the bottom line, but human resources isn’t only about money. With innovation, creativity and flexibility, you can help reconcile your employees’ desire to work with their personal values. Says Marshall: "I always ask myself, ‘If I were to die tomorrow, what would I be most regretful of?’ and begin there, figuring out what’s important to me." The ultimate solution, she says, is not a go or no-go situation.

Workforce, March 1997, Vol. 76, No. 3, pp. 46-55.

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