Your Company Needs an Eldercare Policy

Idea in Brief The Problem Elder caregivers currently make up 14% of the workforce, and that number is only going to increase, because Americans aged 65 and older are the fastest-growing segment of the population. The Solution To meet the eldercare challenge, employers must step up, just as the majority have done for childcare. The business case for doing so is clear: Supporting caregivers improves productivity, retention, and recruitment. The Way Forward There’s no one-size-fits-all approach, but companies should consider offering these basics: Information resources to help with care coordination and legal matters; flexible work arrangements; financial support; employee assistance programs; and training for managers, supervisors, and HR. Decades ago, as women entered the workforce in large numbers, childcare became a growing challenge for employees, men and women alike. Today offering childcare support is integral to any smart organization’s talent strategy. But a new caregiving challenge has emerged for many workers, and it’s time for companies to get serious about helping them address it. That challenge is eldercare. Consider this remarkable fact: For the first time in U.S. history, the number of working adults providing care to an older adult (nearly 23 million) has surpassed the number providing care to preschool children (21 million). Elder caregivers currently make up 14% of the workforce, and that number is only going to increase, because Americans aged 65 and older are the fastest-growing segment of the population. By 2050 their numbers are projected to have increased by 30%, from 63 million to 82 million, accounting for nearly one-quarter of the total population. Growing even faster are the “oldest old” (aged 85+), whose numbers are projected to increase nearly 150% during that period, from 7 million to 17 million. Similar trends prevail in nearly all developed countries and many developing ones around the world. Unfortunately, “health spans” (the time people can expect to live free of disability) are not keeping pace with longer lifespans. Life expectancy in the United States is around 78 years, but older adults on average now spend the final dozen years of their lives coping with poor health, a number that has also grown in recent years. As we describe in our recent study “Meeting the Growing Demand for Age-Friendly Care: Health Care at the Crossroads,” more older adults than ever will need a complex spectrum of care and support in the decades ahead, and they’ll need it for longer. The supply of family caregivers—who provide the preponderance of eldercare—is also not keeping pace with growing lifespans. Families have gotten smaller, which means fewer children are available to care for their parents or other relatives. They’re also more geographically dispersed, which means fewer members live close enough to provide everyday care. A rough gauge of the shrinking supply is the U.S. Census Bureau’s “caregiver support ratio,” which compares the population most likely to provide care (those aged 45 to 64) with the population most likely to need care (those 80 and older). In 2010 the ratio was 7:1; in 2030 it will be 4:1; in 2050 it will be 3:1. This trend, too, prevails in developed and developing countries around the world. Paid caregiving won’t fill the supply gap, for two reasons. First, for the majority of American families, it’s unaffordable: Annual long-term-care costs, which Medicare generally doesn’t cover, average $104,000 for in-facility care and $69,000 for in-home situations. Second, to keep up with demand, the long-term-care workforce would need to grow by more than a million people over the coming 10 years. That’s not likely to happen. Expanding Medicare to cover long-term care would offer enormous relief to people shouldering the cost and effort of eldercare. And that idea is very popular: Recent research by Age Wave and the John A. Hartford Foundation found that 80% of all Americans are in favor of integrating long-term care into a new age-friendly healthcare system. Most U.S. workers will need to provide eldercare at some point during their careers. Even if expanding Medicare were politically and economically viable, however, many employees would still be responsible for coordinating care and other responsibilities. Eldercare would remain a part-time job for much of the workforce. To help employees meet the challenge, employers need to step up, just as the majority have done for childcare, and provide more support in the form of new and expanded policies, programs, and benefits. The business case for doing so is straightforward. According to Care.com, supporting family caregivers improves productivity, retention, recruitment, and diversity, and according to the Rutgers Center for Women in Business, the work of caregiving itself leads to growth: Caregivers have been shown to bring enriched capabilities to the workplace, among them empathy, efficiency, and persistence. The factors driving the need for eldercare support vary greatly around the world, and international organizations adjust their benefits offerings to local laws and circumstances. That’s because although the demographics of population aging are common across developed countries, many countries have longer health spans and better public-health outcomes than the United States does, in part because of more-comprehensive public healthcare systems and more provisions for long-term care. Japan, for example, makes long-term-care insurance mandatory for citizens aged 40 and over, and the Netherlands has included long-term care in its national healthcare system since 1968. Compared with most developed countries, the United States faces more eldercare support needs, which employers can help fill. But much of what employee caregivers need—education, navigational guidance, personal support, workplace flexibility, and time for caregiving—is consistent across the world. We’ve been researching, working with, and writing about the aging workforce for decades, and recently we’ve devoted considerable attention to the growing demand for eldercare support and how it can be met. In this article, we’ll offer practical guidance to leaders who want to prepare their organizations for this unprecedented challenge. Who Provides Eldercare? According to the U.S. Bureau of Labor Statistics, nearly half (45%) of all elder caregivers are between the ages of 45 and 64, which means many are at the height of their earning power and organizational responsibility. They and their employers therefore have a great deal at stake in avoiding disruptions to their employment. As with childcare, women who provide eldercare are those most in need of support. They make up the majority (59%) of providers and spend more time in their caregiving roles than men do. As a result, by our estimate, they are responsible for providing at least two-thirds of eldercare in the United States. Many elder caregivers (21%) have children under 18, which means they’re sandwiched between the generations and have a great need for flexible support on the job. Karsten Thormaehlen creates portraits of centenarians around the world for his series Aging Gracefully. The work that elder caregivers do is varied, and the mix often changes over time. But here’s a representative sampling: They provide emotional and social support, including companionship, conversation, and meaningful activities. They provide household support, including cooking, cleaning, shopping, and transportation. They provide medical care, including managing medications and appointments, monitoring health conditions, and performing basic nursing procedures. They provide hands-on care, including for such personal needs as eating, bathing, dressing, toileting, and mobility. They provide financial care, including the management of household expenses and larger financial matters, and even make their own direct contributions. And they provide the coordination of care, organizing the activities of other caregivers and overseeing the overall caregiving process. Whether it’s eldercare, childcare, or both, the demands of caregiving can be overwhelming. A 2024 survey from AARP and S&P Global found that half of working caregivers have to make changes to their work schedules because of caregiving responsibilities. Many also have to make drastic adjustments, such as taking a leave of absence (32%), reducing hours or shifting from full-time to part-time (27%), turning down a promotion (16%), or not working for a period (16%). One in six retirees today cite family caregiving responsibilities as a key motivation for retiring earlier than planned. Those who don’t take such measures often struggle to meet their work commitments and maintain work-life balance. The majority report being distracted at work or being unable to do their best. This disruption takes a toll on employers in terms of lost productivity and lower operational performance. Caregiving also takes a toll on caregivers’ health: The Employee Benefit Research Institute has found that working caregivers report lower physical, mental, and financial well-being than non-caregivers; the U.S. Centers for Disease Control and Prevention has found that caregivers are more likely to experience frequent mental distress and depression; and the Rosalynn Carter Institute has found that the biggest challenge for caregivers who work full-time is the emotional stress of handling both job and caregiving responsibilities. All told, according to estimates from the Blue Cross Blue Shield Association, if you factor in lost employment, higher absenteeism, and compromised employee health, family caregiving costs the U.S. economy $264 billion annually. Means of Support Our recent study surveyed 800 employed adults who serve as elder caregivers, and 92% said they wished they had more support. Their needs varied with individual and family circumstances, but some of the most common elements on their wish lists were: a trustworthy source for reliable and affordable professional caregivers (33%) financial assistance (32%) more support from family, friends, and others in the community (30%) people to step in to give the caregiver a break (28%) a professional to help create a care plan and work through any family disagreements regarding the recipient’s care (28%) training and support regarding simple medical tasks, such as medication management, injections, wound care, and managing medical devices (26%) greater work flexibility (in daily schedule or leave of absence) (25%) a healthcare adviser or advocate to help navigate the medical system (23%) Driven by the exigencies of the Covid-19 pandemic, in 2020 many companies began to help employees meet at least some of those needs, offering them more work-from-home and flexible-scheduling options and responding to their need to care for family members recovering from Covid. Those were steps in the right direction, and there are signs that organizations today are placing a higher priority on eldercare benefits than in the past. Half of the HR leaders surveyed by Care.com, for example, reported that their organizations are doing so. But in practice we have a long way to go: According to the AARP and S&P Global survey mentioned earlier, only 25% of organizations offer paid family leave for elder caregiving, and only 19% offer subsidized eldercare. Employers should be aware of common disconnects. Companies tend to underestimate the number of employee caregivers, in part because employees themselves often see themselves not as caregivers but as responsible family members. Employees’ responsibilities as caregivers may accumulate gradually, so they may be slow to voice a need for support. Employees are also often unaware of the benefits available to them, and the gap between benefits offered and benefits utilized can be large. This is particularly true of new benefits. It’s not enough for employers just to offer eldercare support; they also have to commit themselves to educating employees and enabling them to take advantage of available benefits and services. Promising Models As part of our investigation into the eldercare challenge, we’ve examined several companies that are leading the way, either by redesigning their approach to caregiving benefits or by offering new benefits specifically for elder caregivers. Bank of America, for instance, provides benefits to support employees across all stages of life, with the goal of enabling productivity, increasing engagement, and encouraging lengthy careers. The company’s support for eldercare has been evolving since 2010, and today its eldercare benefits include information resources and referrals, such as access to senior-care specialists who can research care options and issues on employees’ behalf; care managers who visit caregivers and recipients, at home or in-facility, to assess their needs; backup eldercare for up to 50 days a year, with a modest employee co-pay; and legal services related to eldercare. For caregivers’ emotional wellness, the company has created an employee assistance program, which offers workers and their household members a dozen counseling sessions per issue (for example, relationships, grief or loss, anxiety, and caregiving) per year. To help employees find information and share experiences, it hosts a global forum called the Parent and Caregiver Network. “Adult caregiving requires thoughtful planning and finesse,” we were told by Anne Oxrider, a Bank of America senior vice president and benefits executive. She listed several key elements of the company’s approach: “Getting the right support to teammates at the right times in their lives. Packaging benefits in ways that make them very easy to understand and access. And helping teammates anticipate their needs, including facets of caregiving they haven’t considered yet.” Karsten Thormaehlen During the past five years, the biopharmaceutical company AbbVie has expanded its health, well-being, and leave benefits to offer holistic support to all types of caregivers, both in and outside of work. According to Demetris Crum, a vice president at the company who oversees this effort, the logic behind it is simple and unassailable. “Almost everyone will have caregiving responsibilities at some point in their professional life,” he says. “When their family’s needs are met, employees can perform at their best.” AbbVie’s offerings include support for finding caregivers and backup care, help navigating elder healthcare and legal matters, flexible work arrangements, paid and unpaid leaves, at-work concierge services, and access to mental and emotional support for employees and their families. The company has also created an employee resource group to provide a community for caregivers and is working to hone its communications to make caregiving benefits easier to find, understand, and use. The personal impact can be profound. As an AbbVie employee relates, “I found myself unexpectedly thrust into the role of caregiver. My mother was diagnosed with pancreatic cancer, and I found myself struggling under the emotional impact of the diagnosis. I found a lifeline with my company’s caregiver leave benefit—one that gave me time off to fully focus on being with my mother during her most vulnerable moments, from doctor’s appointments to hospice.” See more HBR charts in Data & Visuals Microsoft has offered benefits and discounts since 2006 for care-related services to employees who serve as primary caregivers. In response to employee feedback, the company has in recent years dramatically expanded support offerings, which now include several concierge services and information resources designed specifically to support elder caregivers. These services and programs help caregivers find, plan, and utilize tailored options for care in assisted-living and hospice facilities or at home, and some are designed specifically for patients with dementia or Alzheimer’s. Microsoft has launched a support group for elder caregivers and encourages eligible employees to apply for family caregiver leave. It also offers employees in the United States and members of their extended families access to a program that provides confidential expert advice and advocacy for anyone facing important medical decisions or healthcare crises. There’s no one-size-fits-all approach to providing eldercare support. But as a general rule, companies that hope to institute an effective practices-and-benefits program should at least offer these basics: education to help employees anticipate and prepare for caregiving responsibilities, and to learn as they go as their responsibilities increase over time assessments of recipients’ and caregivers’ situations and support needs navigation support, through guidance and referrals, across the many decisions related to care arrangements, care coordination, and associated legal matters time for caregiving, starting with flexible work schedules, remote work options, and time off or leaves of absence financial support, typically subsidies for paid care, although some employees may be eligible to utilize Dependent Care Assistance Plans or Flexible Spending Accounts for caregiving self-care and mental health support, and peer support through employee assistance programs and employee resource groups training for managers, supervisors, and HR counselors to help them understand caregivers’ situations and encourage and enable them to make use of services Companies don’t have to do all of this themselves. They can avail themselves of third-party providers of eldercare education, assessment, and navigation, offered by such organizations as Bright Horizons Family Solutions, Care.com, Cariloop, Family First, Homethrive, and Wellthy. To understand how one third-party provider aligns its offerings with the benefits programs of its employer clients, we looked at Bright Horizons. Nearly two decades ago, it began to offer eldercare support as an extension of childcare services, and it now provides that support to more than 1,000 employer clients. Today Bright Horizons offers three main eldercare services to employees of client companies: direct caregiving when employers offer subsidized benefits; coaching and planning to help caregiver families navigate the challenges and ongoing coordination of care; and assessments to connect the right caregiver to the needs of the recipient, focused on the instrumental activities of daily living and how people can age in place as long as possible. The company flexibly bundles its services in ways that enable employers to offer holistic benefits packages and that allow employees to use the services easily. Lessons for Leaders We’ll close with three lessons for organizations that want to support employees who have eldercare responsibilities. Recognize the enormous variety of employee needs. Benefits must be comprehensive, to cover a full range of possible employee situations. Benefits must also be adaptable—individual needs should drive assessment and navigation services. The means of delivery must be adaptable, too, so that employees can not only get institutional guidance and support but also learn how to take action on their own. And benefits must be packaged for ease of understanding and use. The variety of needs and benefits makes this a challenge, but employees should be well briefed on available support and able to easily navigate the benefits landscape. Enlist everyone in supporting elder caregivers. Managers should be equipped to work effectively and empathetically with employees who are balancing caregiving and their everyday work tasks. Employees should be encouraged to seek out coworkers with personal experience they can draw upon. There are also many benefits to forming an employee resource group specifically for eldercare or for family caregiving and family matters generally. Employees appreciate peer experience and support. Lead by example. If you’ve provided eldercare yourself, consider sharing your experiences. Join the employee resource group. In whatever ways you can, publicly support the development of eldercare benefits and help make clear that at some point, everyone needs a little extra support. . . . Childcare support has become essential to employee productivity, retention, engagement, and well-being. The massive demographic shift that we are now living through makes eldercare support just as essential to talent strategy and organizational performance. Providing it is the right thing to do not only for companies but also for employees of all ages and responsibilities, especially those in midcareer whose work contributions are growing as rapidly as their caregiving responsibilities.

Your Company Needs an Eldercare Policy

Summary.

Partner Center