Manage stress of caregivers in the workplace

MMI’s 2010 study of “Working Caregivers and Employer Health Care Costs” found that “absenteeism, workplace disruptions and reduced work status of working family caregivers [resulted in] business losses of between $17.1 billion and $33.6 billion per year.” Also, caregivers’ stress resulted in $13.4 billion per year in additional health care costs to U.S. employers, and two-thirds of elder caregivers will either seek schedule accommodations from their employer or leave the workforce, the study found.

These statistics reveal an emerging trend worth attention, but do little to explain the circumstances behind them. Consider the following fictional case study, which is a common scenario in Central Pennsylvania.

Mary is a 52-year-old vice president of marketing for a small business in Carlisle. She re-entered the workforce in 2006, prior to the recession, when the youngest of her children entered middle school. Mary’s salary was considered a supplemental family income, and was budgeted to pay for the children’s college educations. When her husband lost his job in 2009 at the only company for which he had ever worked, Mary’s salary became the primary family income. Her daily routine has been to prepare her children for school, to encourage her husband through his mid-life crisis and employment change, and to stretch her employer’s diminished marketing budget creatively. Many evenings, she felt exhausted and discouraged. But usually after a phone call with her widowed and supportive mother, Mary would feel encouraged.

During a phone call a few weeks ago, Mary noticed her mother did not seem quite right. Her mother’s responses, usually quick and witty, were flat and slurred. Mary visited her mother the following weekend, then called her brother, John, her only sibling, who lives in California. When her mother had knee replacement surgery a few years ago, John had a knack of calling Mary late in the evening at a time convenient only to him to offer unneeded advice and seek detailed updates on their mother’s condition. Unfortunately, John has always been too busy with work and family commitments to incur the travel expense for only a few days, so now he advises Mary: “I’m sure you can handle things if you just don’t make the issues bigger than they need to be.”

That Saturday, after a one-hour drive from her home in Shippensburg to her childhood home in Hershey, Mary discovered her mother walking with a limp and unable to use her left hand. Mary suspected a mild stroke, or transient ischemic attack. After some resistance, her mother agreed to go to the hospital for treatment. On Monday, Mary was surprised to learn that her mother would be discharged later that week to a yet-to-be determined rehab facility. The hospital discharge process felt sudden and caused stress for both Mary and her mother.

Mary planned a personal leave day to help her mother transition to the rehab facility. After two weeks, her mother was starting to adjust in the rehab facility, even though she talked daily about going home. Then, a late afternoon meeting with Mary’s staff assistant was interrupted by a phone call from the rehab facility’s discharge planner, who said there would be a care plan meeting tomorrow to discuss her mother because Medicare would no longer pay for care after the end of next week.

The rehab facility held care plan meetings at a set time each week; and tomorrow’s meeting happened to be at the same time that Mary was scheduled to present her strategic marketing plan to her boss and other members of the executive team. Although the care plan meeting was optional, Mary felt a need for more information before choosing from the options of her mother staying at the rehab facility at an uninsured cost of over $335 per day (more than $10,000 per month), being sent home if an adequate care plan were in place, or being discharged to a personal care home at a cost of $4,000 per month.

That unexpected phone call not only interrupted her meeting but caused Mary’s pulse rate to increase rapidly as she felt torn and confused about which of tomorrow’s meetings would be most important for her to attend.

Mary’s assistant, a recent college graduate who was a close friend of her boss’s daughter, seemed to sense and be frustrated by Mary’s inability to listen and provide a helpful response to her recommendation for the upcoming quarter’s advertising buy.

After the meeting with her assistant, Mary pondered whether she should go to the East Shore rehab center to see her mother to discuss the impending discharge, or stay late in Carlisle to finish the strategic marketing plan for tomorrow’s meeting.

Almost lost in all of this was Mary’s guilt that her preoccupation with balancing her mother’s needs and job responsibilities had caused her to miss yet another of her children’s track meets yesterday, as well as to derail a promise to help her husband to prepare a family meal.

Not expecting her mother’s crisis, Mary had already used her discretionary time off to attend her children’s school functions and to go on a family vacation. Should she risk asking her employer for permission to reschedule the meeting and take an uncompensated half day to attend her mother’s care plan meeting? Should she skip her mother’s care plan meeting? Or should she be secretive at the workplace and use illness as an excuse to miss an entire day of work tomorrow?

Some of Mary’s co-workers knew enough about her mother’s issues that they would suspect a false excuse, and Mary had never lied to her boss. Although everyone at the office had been on friendly terms, Mary sometimes felt threatened by her assistant’s ambition and familial relationship with her boss. Her boss had been fairly sympathetic during Mary’s other family challenges over the past couple of years, but the company was now facing some critical, recession-related challenges.

The boomer generation has never been taught how, as caregivers, to address the issues of post-stroke diminished capacity and dementia. From “Ozzie and Harriet” to “Modern Family,” television has avoided the reality that these issues affect nearly every family sometime. No high school curriculum addresses the issues of long-term care and dementia, and few college survey courses provide enough practical information to prepare a person for the challenge of caring for aging parents. What can an employer do to salvage a valuable employee whose role as a caregiver for an elder parent is causing her job performance to decrease unacceptably?

Caregivers can benefit from a relationship with an experienced elder care coordination team to understand what is normal, and how to communicate constructively with care providers and facilities about what is less than satisfactory. Gaps in the systemic care process exist, more so than redundancies, both because of Medicare cost-containment issues and institutional fears of avoiding unnecessary professional liability. Those gaps cannot be anticipated by a novice caregiver, and they can result in sudden and stressful schedule interruptions for the caregiver, and extra expense for the employer.

Employees who affiliate with a care coordination team can benefit emotionally and practically from such service, which often pays for itself through assistance with obtaining available benefits from the Veterans Administration or Department of Public Welfare.

Employers who encourage employee-caregivers to attend a seminar — on company time — to learn the resources available to caregivers can make a non-cash investment to improve productivity in the workplace.

Employees and employers who do neither are likely to experience higher degrees of expensive and frustrating dysfunctional circumstances which, in most cases, can be avoided or at least managed with support from an experienced care coordination team.
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David D. Nesbit is an accredited Veterans Administration attorney. Keystone Elder Law is a member of the National Academy of Elder Law Attorneys, Elder Counsel and the Life Care Planning Law Firm Association. Nesbit can be contacted at [email protected] or 717-697-3223.