The Broken System of Long-term Care in America

Posted Wednesday, September 18th, 2013  | Comments (6) rule
Employees and employers alike bear the costs

Donna L. Wagner, PhD

Associate Dean for Academic Affairs
College of Health and Social Services, New Mexico State University
Email: dlwagner@ad.nmsu.edu

If you’re helping an older parent or spouse meet long-term care needs, join the crowd. One out of five workers in the United States spends an average of 20 hours a week caring for elder family members. These unpaid services have an estimated value of $230 billion a year—$20 billion more than the $210 billion that Medicaid pays each year for long-term care.

Providing these unpaid services imposes high indirect costs on employers, in the form of reduced productivity, absenteeism, a workforce whose own health is compromised by neglect and stress, and higher turnover, as workers leave their jobs to devote themselves to caregiving. All told, these problems cost U.S. employers $33.6 billion a year.

ReACT (Respect a Caregiver’s Time) is a coalition of companies and organizations focused on employers and employed caregivers. In 2012 this organization commissioned the National Alliance for Caregiving (NAC) to examine “best practices in workplace eldercare.” The NAC studied the eldercare programs of 18 corporations in an array of industries with workforces ranging from 35 to 118,000 employees. The models were as ad hoc as volunteer programs managed by employees who had done caregiving themselves and as formal as paid time off for emergency eldercare situations. Interestingly, paid time off for caregiving was offered only by the smallest company (35 employees), which did so as a strategy for retaining valuable talent. Now ReACT is working with AARP to design a Web site with information and ideas for employers and employees.

Thirty years ago, Elaine Brody, a gerontologist, suggested that family caregiving was becoming a “normative” experience. Surveys confirm that increasing numbers of Americans care for an adult or elder with long-term care needs. As 70 million baby boomers lurch into late life, we can count on increasing demand for long-term care services for at least two decades. Absent a national system that provides high quality, long-term nonmedical and medical care, families will continue to underwrite the true cost of long-term care with time, money, and diminished retirement savings. Employers will also continue to subsidize informal caregiving indirectly, whether or not they also invest in support programs directly.

These facts prompt a host of questions and reactions. Do American families generally have even a basic understanding of how long-term care is delivered and paid for here? Many caregivers are stunned to discover that Medicare does not cover long-term care. Many find it repugnant that their elderly parents are required to spend all of their resources before they can qualify for help from the only public payer–Medicaid. And many caregivers pick up the costs of care themselves, regardless of the burden. Why is there no political demand for subsidized long-term care, given the large number of families coping with the fragmented system now in place? If care has become a normative activity, as Ms. Brody predicted, do families consider it only a personal matter—not a political one?

What about employers? How long will the nation’s employers subsidize the lack of a comprehensive system of long-term care?

This past January, Congress established a Commission on Long-Term Care, and gave it a 2014 deadline to develop a “comprehensive, coordinated and high-quality system” of long-term care. It’s time for a powerful partnership of voters, representing current and future caregivers, to join with employers to demand serious solutions for our long-term care problem.

Comments (6) for "The Broken System of Long-term Care in America"


Hitting The Intergenerational Sweet Spot

Posted Wednesday, September 4th, 2013  | Comments Off on Hitting The Intergenerational Sweet Spot rule
The following is reprinted with permission from Harvard Business Review.
Monique Valcour, PhD
Professor of Management, EDHEC Business School, France
Researcher, Sloan Center on Aging and Work, Boston College
Email: monique.valcour@edhec.edu

There’s no hotter topic in human resource management at present than how to manage Millennials (aka Generation Y), the age 30-and-under members of the workforce. Millennials are the “kids nowadays!” that managers from previous generations fret about. Typical challenges older people experience in working with Millennials surfaced during a conversation I recently had with a group of executives. For example: “I used to be able to give an order to a young employee and expect it to be carried out at once. Now I have to spend 20 minutes explaining why it’s important.”

The stereotype Millennials get tagged with goes like this: they are a generation of smartphone addicts who live for feedback and praise, lack appropriate deference, feel entitled to rapid advancement but are unwilling to “pay their dues,” prioritize personal life and work-life balance over employers’ needs, and think they should be able to work wherever, whenever, and however they want. Although this portrait drives a robust market for multigenerational workforce training, it misconstrues the qualities of employees born in the last two decades of the 20th century — while over-hyping the differences between them and older employees.

There is an intergenerational sweet spot we should aim for, a point of maximum engagement for all employees. But we miss it by fixating on minor differences and taking them out of context, and by failing to appreciate the similarities among employees of different ages. If you find it challenging to relate to and motivate your youngest employees, it’s likely that you attribute this at least in part to differences between your generation and theirs. After all, what generation hasn’t been baffled by the behaviors of the succeeding one or questioned its values? A recent Time magazine article on the Millennials offered this quote from a forty-something writer: “Veteran teachers are saying that never in their experience were young people so thirstily avid of pleasure as now…so selfish.” The source of the quote? A letter published in The Atlantic in 1911.

What have we learned from comparative research on generations? Large-scale studies using random samples and validated measures have found only slight differences in the job attitudes and values of Millennials and members of older generations. Furthermore, the differences are most often due to factors other than generational membership. For instance, take the common perception that Millennials are much more likely to hop from one employer to another. It turns out that tenure is a much more important predictor of intention to quit; i.e., people who have worked longer for an employer are less likely to leave. Millennials have shorter tenure than older employees on average simply because they have worked for fewer years. On this and other observed differences, mistaking correlation for causation contributes heavily to the Millennial stereotype. Understanding what’s behind the behavioral and attitudinal differences managers perceive among members of different generations is an important step towards reaching an intergenerational sweet spot.

One significant way in which Millennials are different from older generations is their relationship to and facility with technology. Using computers and social technology extensively since birth has shaped the ways in which they search for information, solve problems, relate to others, and communicate. They are adept at finding information and expect it to be readily available. They are comfortable reaching out directly to people in a way that can be disconcerting to older employees whose workplace relationships have traditionally been constrained by the organization’s hierarchy. As Nilofer Merchant has observed, social technology is changing the nature of power in organizations. When you are accustomed to and skilled at finding and freely sharing information, it makes no sense to have information locked up in various parts of an organizational structure. In fact, it feels frustratingly antiquated. What this means for older managers: they must shift from being controllers of information to facilitators of its sharing and collaborative use towards achieving organizational goals.

A second change that bears mentioning is the relative weakness of the psychological contract between Millennials and organizations. Contrary to the stereotype, this is not because people in this age range lack commitment or the capacity for loyalty. Rather, it’s a logical and predictable social evolution in response to the general weakening of the employment contract in our society, driven by management practices that have reduced job and employment security for most people in the workforce. Since individuals bear the ultimate responsibility for the management of their own careers, it is unrealistic to expect total devotion to an employer. On the other hand, if your organization wants to strengthen the psychological contract, it’s crucial to understand what motivates Millennials. The most powerful tool to build Millennials’ commitment to the organization is this: offering regular opportunities to learn and develop — not just through training, but through a variety of challenging tasks, the opportunity to work with people who impart valuable knowledge, and regular developmental feedback. As it turns out, this is how you build commitment in employees of all ages.

This brings me to my most important point: it’s essential for managers to understand and respond to the similarities among the generations currently in the workforce. Research from the University of North Carolina shows that Millennials want the same things from their employers that Generation X and Baby Boomers do: challenging, meaningful work; opportunities for learning, development and advancement; support to successfully integrate work and personal life; fair treatment and competitive compensation. What’s more, all three generations agree on the characteristics of an ideal leader: a person who leads by example, is accessible, acts as a coach and mentor, helps employees see how their roles contribute to the organization, and challenges others and holds them accountable.

So remember to ask yourself the following two questions when you start to feel frustrated by a Millennial employee: 1) What factors in the employee’s experience might be causing this behavior? and 2) Is this person really so different from older employees? Here’s a final example: the much-discussed desire of Millennials for flexible work options. First, consider things from the millennial perspective. One of the reasons why Millennials place so much value on flexible work is that they have been using technology to work flexibly all their lives. In some cases, they have a better understanding of how to work flexibly than do their managers. Second, are they unique in wanting flexibility? No. It turns out that Generation X and Baby Boomers value workplace flexibility just as much. Now consider why this similarity exists: at its basis, flexibility is fundamentally about having control over the conditions of one’s work and having the trust and respect of one’s manager and employer. Research established these as key factors in motivation and commitment long before the invention of the smartphone.

Regardless of what generation you represent, being self-aware and learning to understand others’ perspectives will make you more effective at work. If you are a Millennial, overcoming the negative stereotype requires that you convey the following core message through your behavior, day in and day out: I’m here to work hard, contribute to the organization, learn from you, and develop my skills. If you manage Millennials, your daily behavior should transmit this message: I value and trust you, am committed to helping you perform at your best, and care about the quality of your experience in this organization.

Improving your ability to relate to Millennials will make you a better manager of all your employees. Because despite what the stereotype might suggest, effectively engaging Millennials is not about letting employees wear jeans and bring their dogs to work, dude. The key is providing challenging, meaningful work, communicating, helping employees to see their contribution, and making sure they have opportunities to learn and grow. The best manager for Millennials, GenXers, and Baby Boomers is a person who has a coaching orientation, who is aware of employees’ talents and interests, who both supports them and pushes them to perform at higher levels than they believed they could, and who cares about the quality of their experience. Work towards that, and you’ll hit the intergenerational sweet spot.

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