Business Forum on Aging
BFA - An ASA Constituent Group

by Sandra Reynolds

Providing care to a frail older adult, whether a relative or a stranger, is a burdensome but rewarding task that frequently falls upon young to middle-aged employed people. Although the stereotype of caring for frail older adults involves placing them in a nursing home, 80-90 percent of caregiving is performed by family members.

For family members providing care to an older relative, the rewards of caregiving often come with significant costs, including health problems, fewer work hours or loss of employment, and time conflicts with other family commitments. All of the challenges faced by working caregivers potentially carry ramifications for the business communities of today and tomorrow.

Due both to a natural extension of their gender-specific nurturing role and to their historically lower participation in the labor force, women do the majority of caregiving. Although this fact was of relatively low concern for business in the first half of the 20th century, women's increasing participation in the workforce has made caregiving an increasingly important issue for employers and employees alike.

But despite the increasing numbers of employed women, older parents do not seem to be lacking for care. Working daughters are apparently able to cope with both job and caregiving duties through careful time management, including taking advantage of flexible work schedules; giving up free time; and purchasing care. The resulting costs to the caregiver, however, can encompass physical, economic and emotional setbacks, all of which can affect an employee's attendance, morale and productivity.

Caregiving, particularly for an older relative with Alzheimer's disease, can result in higher rates of depression, anxiety, self-rated poor health, and decreased cardiovascular and immune functioning for caregivers. Because they are often so busy taking care of their relatives, caregivers tend to neglect their own health, falling into bad habits such as insufficient sleep, lack of exercise and inadequate nutrition. Combined with decreased cardiovascular and immune functioning, caregivers tend to have increased rates of respiratory illness, and -- according to recent research -- slower wound healing and higher mortality.

All of these potential negative effects of caregiving have important implications for employers. Employees who are depressed, anxious, sleepy on the job, and subject to higher risks for cardiac or respiratory illnesses are likely to have difficulty maintaining productivity. In addition, caregivers' increased use of sick days, as well as their general malaise and fatigue, can affect not only their productivity but also their safety on the job, possibly putting other employees at risk.

The few studies done on the actual costs of providing care to an older adult differ somewhat on how economic costs are defined. For example, "National Estimates of the Quantity and Cost of Informal Caregiving for the Elderly" by Kenneth Langa and colleagues in the Journal of General Internal Medicine (November 2001) examined the cost of providing care to adults with dementia, defined as the incremental cost of informal caregiving time or the cost to hire someone to provide needed care. The findings suggest that the annual cost of giving care to an adult with mild dementia ranges between $2,500 and $5,000; for an adult with severe dementia, it rises to $12,500 to $23,000. A similar study, "Informal Costs of Dementia Care: Estimates From the National Longitudinal Caregiver Study" by Michael J. Moore, Carolyn W. Zhu and Elizabeth C. Clipp in the Journal of Gerontology: Social Sciences (2001), included two measures of the cost of caregiving: the cost of hiring a caregiver, as well as family caregivers' lost wages. Their findings suggest that the cost of giving care to an older adult with dementia ranges between $6,295 and $15,896 per year.

These results make it difficult to assess the actual economic costs of caregiving for the family -- costs that, combined with the physical and emotional costs, are highly likely to influence caregivers' participation in the workforce. Businesses that are better able to support these workers by offering flexible hours or eldercare employee benefits will have a decided advantage compared with those that are less forward-thinking.

Elder abuse can be one by-product of the stress of caring for an ailing older relative. In recent years, researchers have conducted numerous studies on elder abuse, focusing on physical and emotional abuse, neglect and financial exploitation. Interestingly, the typical types of elder abuse parallel the potential costs to caregivers: physical (physical abuse), economic (financial exploitation), and emotional (psychological abuse). Other reasons for abuse include family dynamics, such as a caregiver's mistreatment by the care recipient when the caregiver was a child; resentment at lack of help from the rest of the family; and family conflicts over appropriate care for the older adult.

Of the many articles generated in the last 10 years, most indicate that the typical abused elder is a woman who is widowed, either physically or cognitively impaired, and living with an adult child. The typical abuser is an adult child with a history of substance abuse who gives care to, is financially dependent upon, and usually lives with the older adult. Research also shows that whereas older whites represent the highest percentage of those abused, elders of color are abused in greater numbers than would be inferred from their proportionate share of the population. Although elder abuse is relatively rare in the U.S. population -- it is thought to involve between 500,000 and 2.5 million people -- the fact that elder abuse usually comes from a family caregiver implies that reported abuse is only the tip of the iceberg.

The business community can play an important role in supporting caregivers, and perhaps save some money at the same time. Interventions such as case management, support groups, respite, financial assistance, or counseling through flexible benefits packages and employee assistance programs will prove to be critical in the coming years. Businesses that provide employees access to these services will be rewarded with lower levels of lost productivity and employee turnover, as well as the satisfaction of having headed off the potential for elder abuse in these incredibly stressful situations.

The number of frail older adults will increase dramatically in the next 20 to 30 years, due to the aging of the baby boom generation. Older adults currently comprise 13 percent of the U.S. population, a figure that will nearly double to 25 percent by 2040. This means that -- regardless of whether older adults are living longer and healthier -- in the future there will be large numbers of older adults who will require significant care. Business will have plenty of opportunities to become involved in the caring professions, but in the meantime, businesses that offer benefits to help their employees become and stay fit will have a competitive advantage over those who do not.

In short, businesses today can play a vital role in terms of offering their workers employee assistance programs, benefits packages that include fitness and nutrition programs, flexible work hours and eldercare benefits options. The more support business gives to today's caregivers, the more productive they will be now, and the healthier they will be when the time comes for tomorrow's caregivers to care for them.

Sandra Reynolds is professor of gerontology at the University of South Florida and is a former banker with experience in trust administration and estate settlement.