benefits – Page 5

January 14, 2020June 29, 2023

Workplace Initiatives Helping to Fight Opioid Epidemic

In the months after John Hindman lost his son to a heroin overdose in 2016, he discovered that he was not alone in his grief. As word of the tragedy spread among his colleagues at Leidos, a defense, aviation and health tech firm, many came forward to share their stories of loved ones struggling with addiction. He was so overwhelmed by the breadth of the problem that he wrote to his CEO challenging him to do something about it.

In a lengthy email titled “A Father’s Request” Hindman told Leidos CEO Roger Krone about his son Sean, who died at age 30, and his struggles with opioid addiction and later, heroin. He wrote of his grief and explained that many other employees face similar challenges, either dealing with their own addictions or those of loved ones. A few weeks later Krone replied. Hindman said his exact words were, “You broke me down. We’re all in.”

“I’ve worked here since 1985 and I never knew how many people were impacted by this epidemic,” Hindman said. “I felt that Leidos’ leadership had no idea of what was happening within the company. I realized that I needed to communicate this within Leidos, not with criticism but with honesty.”

The email launched not only a companywide initiative to combat the opioid epidemic, but also a national movement among business leaders to raise awareness and provide resources to their workforces and communities. The Reston, Virginia-based company distributed a CEO pledge to end opioid addiction that 60 corporate leaders around the country have signed so far.

Leidos, which employs 33,000 people worldwide, also held town hall meetings to gauge the extent of the problem and launched an internal public awareness initiative. It also reexamined its benefits and began looking at ways to better control the prescribing of opioids.

Opioid addiction has ravaged communities across the country. The misuse of these drugs is also a contributing factor in heroin addiction. In 2017, more than 70,000 people in the U.S. died from a drug overdose, a record, according to the Centers for Disease Control and Prevention.

Opioids, which are a risk factor for heroin use, were involved in the majority of those deaths. This has a direct effect on the workplace, impacting health care costs, productivity, absenteeism and recruiting. Employers in states such as West Virginia, Pennsylvania, Ohio and Kentucky have been particularly hard hit, as have those in the construction, trucking and manufacturing industries.

Given that two-thirds of those who are addicted to opioids are in the workforce and that many get their prescriptions through their employers, corporate leaders have found themselves on the front lines of a public health crisis. According to a report by the Society of Actuaries, the prescription opioid epidemic cost the economy $179.4 billion in 2018. This includes $60.4 billion in health care costs and $26.5 billion in lost productivity.

Many employers are finding innovative ways to fight the problem, from public awareness campaigns to offering treatment programs to managing prescription opioids to seeking alternatives to pain pills.

“This is something we’re all coming to grips with,” said Lorraine M. Martin, president and CEO of the National Safety Council. “Issues in our community will end up in the workplace. This is the first year that opioid deaths eclipsed deaths by car crashes. That’s a big alarm bell. It’s tricky because most people become addicted to drugs that have been prescribed to them and many get those prescriptions through their employer.”

While 75 percent of U.S. employers have been directly affected by opioids, only 17 percent feel extremely well prepared to deal with the issue, according to a survey by the National Safety Council. More than a third have experienced absenteeism or impaired worker performance and have had an overdose, arrest or injury because of opioid use, they survey found.

“I think we’re all at different places on this journey,” Martin said. “In areas that are hard hit employers have put in place programs that address recovery. Others still don’t understand that this is happening in their workforce or the role that they can play in fighting it. It’s important that employers understand how it affects their bottom line. The numbers are startling. Various industries and employers saw it quicker and some have taken very creative actions.”

One employer that saw firsthand how a regional opioid crisis also affected its workforce was Belden, a manufacturer in Richmond, Indiana. In 2016 the company was facing a labor shortage and having a hard time finding qualified applicants. About 1 in 10 applicants failed their drug test, so the company developed a novel approach to the problem. In 2018, Belden began offering drug treatment to those who failed their drug screening with a promise of a job if they successfully complete the program. The program, called Pathways to Employment, was so successful that the company launched it at its New York and Pennsylvania locations a year later.

“The program has grown to 30 in Richmond,” said Ellen Drazen, corporate communications manager at Belden. “Our locations in Syracuse and Washington (Pennsylvania) were chosen because they were seeing a similar impact on hiring due to the opioid epidemic.”

Belden has also signed the CEO pledge launched by Krone at Leidos.

In other parts of the country, business coalitions are taking collective action to address the problem.

In Kentucky, which has the fourth highest drug overdose rate in the country, a group of employers launched the Opioid Response Program for Businesses, which helps companies develop policies that support recovery, such as addressing the stigma around addiction. The program is run by the Kentucky Chamber Workforce Center.

“Stigma is one the most profound obstacles in dealing with this problem,” said Natalie Middaugh, a project coordinator at the Kentuckiana Health Collaborative, a nonprofit organization focused on improving health care delivery in Louisville and southern Indiana. “We need to help employers understand that addiction is a chronic disease and not a moral failing or a criminal issue.”

The collaborative joined the effort in 2017 after a significant spike in overdose deaths. In February of that year, Louisville emergency services handled 43 overdoses in one day.

“That was a huge turning point,” Middaugh said. “It’s a community health issue and a business issue, but there is also genuine concern about employees and their families.”

In the past five years, large employers have made a number of changes in their benefits plans in response to the opioid crisis, according to the Kaiser Family Foundation 2019 “Employer Health Benefits” survey. Forty percent launched or revised an employee assistance program in response to the opioid crisis, nearly a quarter modified their health plans to incorporate step therapy for opioid use, 38 percent provided additional health information to employees, 8 percent required employees with high opioid use to obtain prescriptions from only one provider, 21 percent asked their insurer or PBM to increase monitoring of opioid use, and 2 percent increased the number of substance abuse providers in their networks.

The National Business Group on Health and a number of regional employer coalitions recommend working with health plans and pharmacy benefit managers to develop benefit plans that feature safeguards such as limiting coverage for certain prescriptions to small quantities.

Managing opioid prescriptions was a top priority for Leidos, which in 2018 began restricting prescriptions on long acting opioids, such as morphine, oxycodone and fentanyl, and limiting short-acting opioids to seven days. The most common drugs involved in prescription opioid deaths are methadone, oxycodone and hydrocodone. Leidos worked with its pharmacy benefit manager ExpressScripts to implement the changes, according to Karen Kanjian, director of corporate benefits.

“Our part in this as benefits people is to look at what we’re doing in our programs, and we know that the frontline of defense is our PBM,” she said. “They see claims coming in real time and they have access to data, such as which doctors are prescribing and how much are they prescribing.”

Leidos also plans to work with dentists, who often prescribe opioids for procedures such as pulling wisdom teeth.

“My husband had a tooth pulled and got six weeks worth of pain pills that he never finished,” said Heather Misicko, a benefits consultant at Leidos.

A 2018 study in the Journal of the American Medical Association found a link between use of opioids after tooth extraction and long-term use. With 3.5 million wisdom tooth extractions performed each year, that’s a lot of pain medication sitting in people’s medicine cabinets, according to Meg Moynihan, director of strategic marketing at Stericycle. Safe disposal of medications is an important part of addressing opioid addiction, she said.

“Because these drugs are prescribed by doctors for legitimate medical conditions people don’t think of them as a risk,” Moynihan said. “I lock the liquor cabinet but I never thought of locking the medicine cabinet. Having medications lying around makes them more accessible to friends of children, housekeepers and visitors, particularly during open houses when selling a home. It takes less than 30 days to develop an addiction.”

In fact, 20 percent of Americans hold on to their prescription medications because they don’t know what to do with them, and 1 in 10 have offered or given their unused prescription drugs to friends or family members for either medical or recreational use, according to a 2019 study conducted by Stericycle. The company offers envelopes that can be mailed to the company anonymously for safe disposal.

In September, Stericycle and the National Safety Council released a free online toolkit to help employers develop and implement policies and programs that support opioid addiction recovery. It includes sample policies, employee presentations, white papers, videos and other materials designed to support a drug-free and recovery friendly workplace, according to Martin.

The toolkit recommends using the NSC substance abuse cost calculator, which takes into account location, industry and number of employees, to determine the economic impact of drug abuse. After that it lays out a 12-month plan for developing and implementing an opioid policy, from education to communication to vetting the policy with legal counsel.

The NSC also recommends working with health care plans to ensure that mental and behavioral health services are covered, encouraging annual screenings for substance abuse, making sure that alternative pain management treatments, such as non-opioid medications, acupuncture, and chiropractic and physical and occupational therapy are covered, and providing or enhancing EAP services.

“If you don’t know where to start, go to the toolkit,” Martin said. “We advise employers to look at their own health care benefits and to look into alternative medicines. Opioids are not always the best drug for managing pain. Also, make sure to have naloxone in all your facilities. It should be in every workplace and office.”

Naloxone is a medication, either in the form of an injection or a nasal spray, that can stop the effects of an opioid overdose. Before implementing a workplace naloxone program Martin suggests consulting with an attorney to make sure it complies with federal, state and local regulations and training employees on how to spot and respond to an overdose.

While there are many tools and approaches to tackling opioid addiction in the workplace, Hindman said that the most important factor is having company leaders who are committed to the effort. While not every company has the resources of a Leidos, employers are in a unique position to make a difference, he said.

“A third of all addicts are functioning in society, which means that they are in the workplace,” Hindman said. “It’s very hard for the working world to come to grips with this problem. It boils down to a company’s core values. You need to commit it to paper and use it as a platform to attract talent and not treat it as rhetoric. The problem exists broadly and deeply in society and since you’re reaching into society for the employees you need, it makes sense to invest in solving it.”

November 26, 2019June 29, 2023

Please Tell Me Why Worksite Wellness Programs Are a Waste of Time and Money

My father passed away in October 1986 from a heart attack at age 49.

That was his last in a series of major and minor cardiac events. I was 21 years old when he died. At the time I perceived my father to be old (as do most children).

Now, at age 53, it’s an odd perspective to look back at his passing and reflect on where he was in his stage of life and career and consider his outlook on the future.

Gary Cassidy

My family has a history of heart disease and my father was no exception. As an engineer for General Electric, he worked long, hard hours and traveled frequently.

Physical activity, nutrition and doctor’s visits were not high on his priority list. I call this attitude the “I feel fine so I must be fine” mentality.

He enjoyed eating the crispy skin off the Thanksgiving turkey, fat from a well-cooked steak and ladles of cream sauces — all the good-tasting stuff that was loaded with calories, fat, cholesterol and sodium.

When my father had his first heart attack, the doctors found he had extremely high blood pressure and major blockages in all four of his arteries. By that time, too much damage had been done to his heart and there was nothing they could do for him. Still, my father started eating better, took up golf, spent less time at work and focused on reducing his stress.

It’s important to remember that during my father’s lifetime, 1937 to 1986, company wellness programs did not exist. He grew up with exercise guru “The Jack LaLanne Show,” hula hoops, calisthenics, the sauna suit, vibrating belts and other early fitness trends and fad diets. Most centered on the external appearance of fitness but lacked a focus on inner fitness, the biometric and lifestyle measurements that truly determine if one is healthy.

You would think I learned something from his experience, but you’d be wrong. When I was young I felt indestructible.

I had a high metabolism and didn’t gain weight no matter what or how much I ate. The good news: I was physically active in soccer, aerobics, long-distance running, weight lifting, competitive Taekwondo and many other activities.

The bad news: my diet was significantly less than stellar. It wasn’t unusual for me to have fast food for breakfast, lunch, dinner and a late-night snack all in the same day. I inherited my father’s “I feel fine so I must be fine” mentality.

In 1993, after eight years in the Air Force, I returned to civilian life to work at a large insurance carrier, where I learned about health care claims, annual employee benefit renewals and risk management, which drive and control an employer’s health insurance costs. I began to understand that the overall health of a workforce can affect an employer’s health care costs.

I learned about the decisions that organizations must make about health insurance cost sharing, like imposing premium increases, and that employee benefits are a large part of the workforce’s total compensation. I observed how employees who do not take responsibility for their personal health can cause others who do to pay more for their own health care benefits, something that always struck me as unfair.

At age 35, I finally visited my doctor for an annual physical, and the results were not good. My total cholesterol was over 300, my HDL was low and my LDL and triglycerides were high. I was also diagnosed with hypothyroidism.

While this was an “aha!” moment, I should have seen it coming. I knew that I had a family history of high cholesterol and most men on my father’s side of the family died young from cardiac-related causes. But “I felt fine so I must be fine.”

My doctor prescribed cholesterol and thyroid medication. I began to focus on nutrition and continued to be physically active. After one year, my numbers started to improve, but even now I still have work to do. Progress, not perfection.

While conditions like these may take years to produce symptoms and can initially go unnoticed, they are still incrementally causing damage to one’s health and well-being. This is why it’s so important to focus on preventive measures to manage a disease before it has the chance to cause a major medical event.

After my father had his first heart attack, he was released from the hospital and sent home. He walked slowly so as not to raise his heart rate. One day I watched him spend 20 minutes walking up 15 steps in our house. When we lose our health it’s the simple things we take for granted that are impacted the most.

Seeing first-hand the impact of how an undiagnosed heart condition affected my father’s health helps me stayed focus on wellness. In every wellness program participant, I see someone whose life can be positively impacted.

I often reflect on what would have happened if my father’s company had a wellness program. Knowing him, he would have been one of those people who wouldn’t want to participate. Because he was too busy. Because he didn’t have the time. Because it didn’t make sense; he “felt fine.” Because he had too many other things to do. Because it was his choice how he managed his health, not the company’s.

While all of this may be true, I think that if he had participated in a wellness program, gotten his blood work done and learned about his high blood pressure and high cholesterol before he had a heart attack, he would still be here today.

So I ask you, what’s the downside of participating in a wellness program?

Gary Cassidy is the director of employee education, communication and wellness for Camden, New Jersey-based insurance broker Corporate Synergies.

November 8, 2019June 29, 2023

A Page From My Working Mom Diaries

Stefanie Coleman, Workforce Game Changer 2019.

These are interesting times for a professional woman in her 30s.

For many, more than a decade has been invested in a career. Rungs on the ladder climbed, reputations established. Big responsibilities in tow … heck, some of us run departments, even companies!

And that is awesome — after all, the #futureisfemale. It is also the decade where women in big cities like New York and London most commonly start having children [1a] [1b].

Gender aside, it is my opinion that jobs get more rewarding with age. The more time you spend in the workforce, the more experiences you have.

In time (assuming these experiences are relevant), they will pave the way to enhanced responsibilities, usually coupled with better role titles, bigger teams to manage, and more generous compensation. Sure, the pressure is higher, but in the eyes of an emerging executive, the benefits of climbing the corporate ladder outweigh that burden.

But this poses an interesting challenge for professional women who want children.

Imagine this. After more than a decade of hard work, a woman in her mid-30s is breaking into leadership ranks. Established and credentialed in her field, she is scaling the corporate ladder — her eye on the prize, the next promotion in sight. But she knows she wants to birth children, and that window won’t stay open forever. So that is what she does, and while she will always cherish that decision, she wonders if it will hurt her career.

It shouldn’t. But for some women it does, particularly when the right support is not in place. And this is my reason for this blog post.

I don’t suppose to have all the answers — and as a mother of two currently on maternity leave, I’m still working this out for myself. But I do have some thoughts. And, if my thoughts help even one more mother assimilate back to work when it suits her, then I’ll take it.

I took interest in this topic in 2015 when I discovered my first child was on her way. I was 32 and living with my husband in New York City. Eyeing up promotion and facing the most challenging client engagement of my career, the discovery of my pregnancy was both thrilling and terrifying.

Among the excitement were the moments when I realised the “work hard, play hard” mentality that served me through my 20s was no longer an option. After all, a pregnant woman needs her sleep. The realisation was perplexing — I needed to reframe my attitude toward work and its role in my life, and I didn’t know where to start.

I’ve made a lot of progress since then. Two babies later, I am often asked how to juggle life as both a mother and a professional. It’s the impossible question as there is no simple, let alone right answer. Alas, I attempt:

It takes a village.This African proverb is profound. For me, that village is my husband, nanny, in-laws and sister. Put simply, I could not do my job without them. A working mother must identify her villagers — they must be strong and reliable, trusted to look after the most precious of possessions. They must be thanked and appreciated, for this group is the most important coalition for a working mother’s success.
We’re in this together. There are many allies to working mothers — both men and women. But other moms in particular truly get it. We must support one another. A colleague told me she thought of asking me for a change of clothes since her baby ruined her outfit in transit to an important meeting. I wish she’d have asked — I’d have moved mountains to help. Another colleague jumped on a plane to cover for me at a moment’s notice when I was too pregnant to travel across the U.S. for a meeting. Her words when I thanked her: “We must help each other out.” I knew exactly what she meant.
Find a supportive employer. I am lucky since my firm is consistently ranked a top company for working mothers [2]. A firm that takes diversity and inclusion seriously is more likely to support a working mother’s integration than one that does not. Look for flexible work policies and family friendly benefits, as well as a leadership culture that promotes wellness and work life balance.
Divide domestic duties. As articulated by Annabel Crabb in her quarterly essay on Men At Work [3], many working mothers continue to take on the lion’s share of domestic duties in the home. In fact, research from Manchester University and the Institute for Social and Economic Research at Essex University in the U.K. has shown that working mothers with two kids score consistently higher on chronic stress indicators, such as blood pressure and hormones, as compared to the general population [4]. In order to transition back to work in a way that is sustainable and healthy, we need to see more balance in the way domestic duties are divided between family members in the home.
Set boundaries and get to work. Working mothers are expert multi-taskers, whether it’s fixing the kids’ breakfast while taking a conference call or squeezing in a doctor’s appointment between meetings, one thing is for certain and that is that working mothers have very little time. This means that what time we do have reserved for work must be used wisely. For me this has meant less procrastination. If something needs to be done, it needs to be tackled fast. It also means that there is only time for the critical items. As a fellow working mother once coached me, “You can drop the rubber balls but not the crystal one.” Identifying what really matters at work is important, and de-prioritizing the rest is a necessary action for a working mother (even if it doesn’t feel natural).

This article might feel stereotypical to some. Of course, there are women who do not want children, and there are fathers who are primary caretakers. And, obviously, women give birth to or adopt children at all ages, not just in their 30s. I’m not ignorant to that. Take my thoughts for what they are worth. As one working mother to another (or, the partner, child or colleague of a working mother), I hope these thoughts help our working mothers transition back to work with grace. After all, we’re all in this together.

P.S., This post is dedicated to my own working mother, Dr. Cathy Allen, and inspiring friends: Liz Kreuger, Caroline Gatenby, Courtney Nolan, Joanna Bates, Sarah McGrath, Emma Fletcher and Dr. Patricia Davidson. Also, the countless working mothers at PwC who inspire me every day — there are too many to name, but they know who they are.

November 7, 2019June 29, 2023

‘Smoking Gun’ Email Revives Employee’s Disability Discrimination Lawsuit

Maryville Anesthesiologists fired Paula Babb, an experienced certified registered nurse anesthetist, because it thought she suffered from a visual impairment.

How do we know why it fired her? Because the day after Babb’s termination, one of her co-workers confirmed it in an email (written at the direction of one of the employer’s owners).

As most of you know, [Babb] has been having major issues with her eyesight and as of late, it has seemed to be getting even worse. We have had numerous complaints from [hospital] staff regarding her inability to read the monitor, etc. Over the past several months the group has given her several opportunities to provide documentation from her eye specialist saying that she was safe to practice. [Babb] was unable to provide this documentation. This, in addition to a few other issues, has forced the group to make a very difficult decision. As of today, she is no longer with our group. Sorry to be the bearer of bad news. This was one of the reasons that our meeting was postponed. See you all tomorrow.

Despite this email, the district court granted the employer summary judgment and dismissed Babb’s “regarded as disabled” ADA lawsuit.

On appeal, the 6th Circuit had little difficulty in reviving the claim, in large part because of what it described as the “smoking gun” email.

Maryville has never tried to defend its termination of Babb on grounds that Babb’s vision created a safety hazard, and has instead insisted that Babb’s termination occurred solely because of clinical errors unrelated to her vision. But, yet, just hours after Maryville decided to fire Babb, Crystal Aycocke wrote an e-mail to her fellow CRNAs essentially stating that Maryville was firing Babb because of her impaired vision. More striking still, far from being mindless office gossip, Aycocke admits that she composed this e-mail at the direction of Dr. Proffitt—one of the key players involved in Babb’s termination—shortly after Dr. Proffitt informed her of Babb’s termination. And, of course, all of this occurred in a context in which Maryville’s physicians felt concerned enough about Babb’s vision to discuss it at the meeting at which they decided to fire Babb, and on the official evaluations they wrote about Babb. (“I see her questionable ability to see reflect on how surgeons and the medical staff lack accepting her.”). If this kind of “smoking gun” evidence cannot get an employment discrimination plaintiff past summary judgment on the question of pretext, it is hard to imagine what could.

Employers, if you are short-sighted enough to (a) fire an employee because you believe she suffers from a disability, and (b) confirm that belief in writing, then you deserve whatever fate you suffer in litigation.

October 9, 2019October 18, 2024

Employers: Here’s How to Avoid Getting Bitten by COBRA

COBRA benefits provide continued group health plan coverage after certain qualifying events, like termination of employment, and are a health care safety net for employees until benefits from a new job kick in.

But for employers, staying compliant with COBRA regulations can be difficult. Sure, COBRA — the Consolidated Omnibus Budget Reconciliation Act health insurance program that allows an eligible employee and their dependents the continued benefits of health insurance coverage — is for employees who no longer work at your company.

Since you might think of them as long gone, complying with COBRA might not be a priority. However, any employee who leaves on bad terms may be more likely to file a lawsuit against an organization if it mishandles COBRA. In fact, employers have recently seen an increase in the number of COBRA lawsuits filed against them for leaving out required information.

Outside of litigious former employees, COBRA is generally confusing to comply with and can carry heavy penalties for employers. These can add up — courts can assess up to a $110 per day penalty for each deficient COBRA notice per person.

Here are some commonly overlooked details.

Not understanding if your organization is subject to COBRA; not understanding eligibility. First, it’s important to understand which employers have to offer COBRA. The federal law says that employers with at least 20 employees in the prior calendar year must offer COBRA coverage starting the day employer-sponsored group health plan coverage ends. COBRA coverage can last up to 18 months under typical circumstances, or 36 months if certain events occur, e.g., the employee becomes entitled to Medicare, gets divorced or dies.

But it’s not enough just to follow the federal law. Employers often overlook that states can also mandate that group health plans offer continuation coverage much like COBRA — called “mini-COBRA” laws — that typically affect smaller employers and provide greater benefits to employees than the federal COBRA law. For example, the New York “mini-COBRA” law mandates 36 months of continued coverage for employers with fewer than 20 employees. In New Jersey, with some exceptions, the state’s mini-COBRA law applies to employers that employ between 2 and 50 eligible employees, and provides employees with:

18 months if an employee is terminated or their hours are reduced
29 months if an employee becomes disabled
36 months for the dependent spouse or child of an employee who dies; goes through a divorce, legal separation, dissolution of a civil union or domestic partnership or otherwise loses dependent status.

Many other states have continuing coverage laws in place as well. And as if understanding the state and federal laws that apply to your employees isn’t enough (and, it can be especially difficult if your employees live in multiple states) — there are also time-sensitive deadlines you must meet in order to stay in compliance with COBRA laws.

Not Complying with Notice Guidelines

One issue that’s landed some employers in hot water is failing to send notifications, or not including the right information in these notifications. Let’s start with the basics—employers that sponsor group health plans must send an “initial notice” or “general rights notice” to covered employees and their covered spouses within 90 days of the date that coverage under the plan starts or, if later, the date that is 90 days after the date when the plan first becomes subject to COBRA.

In addition, and with some exceptions, once an employee separates from the company, the plan administrator (or employer, if the employer and plan administrator are the same entity) must send a COBRA “election notice” within 14 days of receiving notice of a qualifying event, such as being terminated from employment or leaving the company. This notice describes the employee’s rights to elect COBRA.

For both types of COBRA notices, the penalty for not doing this (i.e., in addition to the potential litigation costs) is up to $110 per day.

The Department of Labor outlines exactly what should be included in these notices and even supplies templates called “model notices” to help employers comply with these guidelines.

Not Understanding What’s Covered

COBRA allows employees to pay for the same group health plan coverage they enjoyed during employment — but at their own expense. Unless the employer agrees to pay for all or a part of the COBRA premium, employees are responsible for the full premium amount (plus a 2 percent administration fee). Under COBRA, the term “group health plan” coverage is defined broadly, and includes medical coverage and, depending on plan design, could also include prescription, vision and dental coverage. Life insurance, long-term care insurance and other similar types of insurance aren’t considered “medical coverage” and aren’t included in COBRA.

Health reimbursement accounts, or HRAs, qualify as group health plans, so employees must still offer reimbursement for their expenses under COBRA. Health FSAs are generally included within the definition of “group health plan” and are subject to COBRA, unless the account is “overspent” as of the date of the qualifying event. In such cases, an employer’s COBRA obligations are more limited.

COBRA, Severances and Mergers

One frequently asked question is how COBRA works with severance packages. It’s not uncommon for employers to pay employees’ COBRA health insurance premiums on a pretax basis for a few months as part of a severance package. But if the employee is considered “highly compensated” by the IRS, and the employer’s health insurance plan is self-insured, the employee may be subject to paying tax on COBRA coverage as required under certain nondiscrimination rules under Section 105(h) of the Internal Revenue Code, which generally require that a self-insured employer can’t discriminate in favor of highly compensated employees. Employers can avoid this issue by paying the employee for their COBRA premium on an after-tax basis.

Another point of confusion is how COBRA is administered during a company merger or acquisition.

There are a number of issues to consider, including what type of acquisition, sale or merger a business goes through, and the employee’s status as a result of that event. These factors determine which entity in the M&A deal pays for COBRA, and which employees are eligible unless the parties to the deal have memorialized these terms in their relevant asset purchase or stock purchase agreement.

How to Stay Compliant

Managing COBRA properly can be onerous. Often employers fall into one of three categories when it comes to administering COBRA benefits:

Managing it in-house.
Relying on a broker.
Relying on a COBRA specialist.

Whether your organization takes on administering COBRA in house or relies on your insurance broker or other COBRA specialist, the potential liability for getting COBRA wrong is significant.

Harrison Newman is vice president and benefits consultant for Corporate Synergies.

October 4, 2019June 29, 2023

The Past and Present of Mental Health Treatment

My most recent Workforce print feature story is about mental health parity, and that’s one of the topics I love writing about as a benefits reporter: the need for quality, accessible, affordable mental health coverage.

My preliminary research steered me to a new book, “Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness.” It explores scientists’ ultimately unsuccessful attempts to figure out the cause of mental illness.

The argument is that even though ideas or theories in psychiatry have prevailed in certain moments of history, all of them have been proven inadequate or outright wrong. And we’re still uncertain about both the cause of mental illness and why treatments work on some people but not others.

This sounds cynical, but I love a book that rationally explores the highs and lows of a scientific goal (in this case, to pin down the cause of mental illness). This isn’t discouraging as much as it is proof that people will constantly try to progress their understanding of the world in order to help people with a disorder. It’s more promising to me to see people admit their miscalculations and be determined to move forward than to see people stubbornly hold on to ideas from the past.

There are a few reasons I want to write about this book. The history of mental health treatment and theory is simultaneously fascinating, inspiring and upsetting. Especially in this context, history gives us many examples of how some of the mental health trends we’re now seeing in the workplace may not be exactly new.

I’ve gotten press releases about how people are more depressed or anxious now than ever before — especially millennials (or whatever young generation is being picked apart at the moment). I’ve spoken to people about how prevalent mental illness is and how that has changed over time. I’ve always been skeptical about the idea that it’s more common than in the past. My theory is that it’s more talked about now, more diagnosed now and less stigmatized now, and so the numbers just seem higher. (Feel free to argue against me on this, of course!)

What interested me about “Mind Fixers” was the section about the Cold War Era and how it was seen as the “Age of Anxiety” at the time. Many people relied on the “minor tranquilizer” Miltown, a predecessor of Valium, to deal with that anxiety. Meanwhile, in the 1980s depression became “the common cold of psychiatry.”

Comments like this make me wonder how current trends compared to other periods of history. This isn’t to minimize the impact that mental illness has on people and communities in the present. I bring this up so that we don’t talk about the history of mental health in a way that romanticizes the past. People in the 1950s, the 1800s, and before that had mental disorders, too. The treatments just weren’t as advanced.

According to the National Institute of Health and the Centers for Disease Control & Prevention, 41.2 percent of adults with a mental illness have received mental health services. And, more importantly, this statistic is very gendered if you dissect the data further. While 47.6 percent of women have received this type of health care, only 34.8 percent of men have.

That’s a big gap. Why don’t men get mental health care as much?

There’s a lot written about this already (see the National Alliance on Mental Illness, National Institute of Mental Health and Psychology Today, for example), but here’s a historical angle that shows how deep this goes. “Mind Fixers” briefly explored a 20th century mental disorder known as hysteria.

It was “associated with women and weakness” and men did not receive this label. Fast forward to the 1970s, when people were talking about a new trendy topic called “stress.” It was thought that women were twice as likely to experience stress and depression than men.

This is just a snapshot. Still, it shows how deep these roots are that may tell men that they’re weak if they admit certain things.

Finally, “Mind Fixers” mentioned the unwillingness of insurance companies to cover psychiatric services in 1970s. Lack of benefits coverage of behavioral health is something that even today — after the passage of the Mental Health Parity and Addiction Equity Act in 2008 — is still sometimes an issue.

Also read: Mental Health Parity Law Successes and Challenges

According to “Workforce Attitudes Toward Behavioral Health,” a February 2019 survey from behavioral health company Ginger, 35 percent of the 1,214 U.S. employees surveyed reported that they had to pay directly for behavioral health services their benefits didn’t cover. Further, 85 percent of people said that behavioral health benefits are important when evaluating a job, and 81 percent of people said they face barriers in accessing behavioral health care. The most common barrier (28 percent) was that providers aren’t available in their benefits plan.

I’d strongly recommend this book to anyone interested in the science behind mental health. It brings up a lot of interesting talking points like, How much has stigma improved in the past 200 years, and where is there still room for improvement? Which issues still exist that caused people problems all those years ago as well?

While this isn’t a book about the workplace, you’ll read about certain historical trends and movements that sound a lot like some of the “innovative” solutions you’re hearing about now. Maybe you’ll learn a couple lessons from history.

September 12, 2019June 29, 2023

The Mental Health Parity Challenge

It’s been a decade since the Mental Health Parity and Addiction Equity Act went into effect, with the goal that insurers and health plans offer mental health and substance abuse benefits comparable to coverage of medical and surgical care.

Despite progress made since the law’s passage, some barriers to equality still exist. As vital as behavioral health care is for people with substance abuse and mental health disorders, unlike their physical health needs, employees with employer-sponsored coverage may face challenges in accessing and affording quality mental health care coverage.

The current environment sees employers, employees, the government and individuals spending more money on behavioral health than ever before, but the results just aren’t there, said Henry Harbin, a psychiatrist with over 40 years’ experience in the behavioral health field.

Harbin, whose experience includes senior positions at public and private health organizations, said that while fatality rates for many medical issues are decreasing, fatality rates from suicide and opioid overdoses — two major issues in behavioral health — are increasing. Between 2004 and 2014, the death rate for heart disease decreased by 16 percent and for stroke by 19 percent. In the same span, the death rate climbed by 17 percent for suicide and over 200 percent for opioids, according to the Centers for Disease Control and Prevention.

For employers, genuinely caring about their employees’ mental health issues is a good start, but providing quality coverage is important as well. Behavioral issues among employees are prevalent. According to the National Institute of Mental Health, 1 in 5 adults in the United States have a mental health disorder. Meanwhile, 1 in 22 adults have a serious mental illness like schizophrenia, major depression or bipolar disorder, the study noted.

Access Issues

There is a national shortage of seasoned behavioral health professionals in the United States, which can “constrain access to essential care and treatment for millions of individuals with mental illness of substance use disorders,” according to the Health Resources and Services Administration report “Behavioral Health Projections, 2016-2030.” The agency, part of the Department of Health and Human Services, focuses on improving access to health care services for individuals who are uninsured, isolated or medically vulnerable. The report stressed the fact that certain areas of the United States have few or no behavioral health providers available.

The shortage of behavioral health care providers impacts a majority of employer-sponsored health plans, according to Mercer’s May 2019 “10-Minute Survey on Behavioral Health” that surveyed 523 employers. Sixty-three percent of respondents reported that they lack adequate access to outpatient behavioral health care in some or all of their locations.

Some 74 percent of employers said they are taking action to improve employee access to quality behavioral care. Most commonly, 49 percent addressed this by enhancing their employee assistance program services or changing their EAP provider. Only 12 percent of these employers conducted a network analysis to identify gaps in behavioral health care.

Early intervention can be vital for behavioral health, especially for patients with a severe disorder, Harbin said.

For a patient with schizophrenia, for example, screening by one’s primary care physician or pediatrician can help identify the problem early on. The patient can then see a specialist sooner and will likely see better outcomes, Harbin said.

Tom Sondergeld, vice president, global HRIS, benefits and mobility at global pharmacy giant Walgreens Boots Alliance, said that one of the biggest priorities in their carrier analysis was to evaluate access. Employees with a behavioral health issue often face long wait times to see a behavioral health specialist such as a psychiatrist. “To me, that’s not parity,” Sondergeld said.

Walgreens has been pushing hard on its insurance carriers in recent years so that employees can find coverage for the care they need in a timely manner, Sondergeld said.

While larger organizations may have more resources to negotiate with insurance carriers, he suggested that small organizations can join coalitions such as the National Business Group on Health, allowing their voice to be heard within that larger pool of companies.

He also said that using data to tell a powerful story is a way smaller organizations can influence their carriers. Employers can get this information through their health plan, which can use its data to analyze utilization and costs across the various benefits to get a better picture of the overall spend and areas to concentrate on to improve spend.

For example, if a third of the workforce needs access to behavioral health care for themselves or their loved ones, but the data show that a majority of people can’t access care in a timely manner, that’s a powerful, data-supported story.

Also read: Managing Mental Health Crises at Work

The human impact of mental health problems is notable, as mental illness impacts how people handle stress, how they relate to others and whether they make healthy choices, according to the Centers for Disease Control and Prevention. Still, HR can use the business case to support the need for better access.

Poor mental health and stress can impact an employee’s job performance, their relationship with co-workers and their physical capabilities and daily functioning, according to the CDC. Depression interferes with a person’s ability to complete physical job tasks about 20 percent of the time and reduces cognitive performance about 35 percent of the time, the agency notes.

“When [employees] can’t find the care they need, the business suffers because they aren’t engaged,” Sondergeld said.

Network Issues

A host of issues exist even when an employee does access care for behavioral health problems. A majority of people with behavioral conditions are screened and treated through primary care and not a specialist, Harbin said. The quality of this behavioral health care is often low, with many people not necessarily even getting a diagnosis but getting a prescription for a psychiatric drug. Harbin noted that the patient’s response to the drug may not be tracked efficiently, the drug and dosage may remain unchanged, and this may help lead to low efficacy outcomes.

Employers should urge employees to use specialists if they want improved outcomes, he said.

Patients accessing out-of-network providers is another issue, he added, citing a 2017 Milliman Inc. report, “Addiction and Mental Health vs. Physical Health: Analyzing Disparities in Network Use and Provider Reimbursement Rates.”

Patients seeking behavioral care more often need to use an out-of-network provider than patients seeking medical or surgical care, according to the report, which also found that medical and surgical providers are paid at higher rates than behavioral providers. The lower reimbursement rates are one reason for low network participation rates among behavioral health providers, making it difficult for patients to find more affordable in-network care.

Employers can work with their providers or vendors to understand if there are places where there are more complaints about access issues than others, said Mandie Conforti, a licensed clinical social worker and senior consultant at Willis Towers Watson.

Even though the mental health stigma is lifting, it’s still there, she said. Many employees hesitate to call HR to complain about not being able to find a behavioral health provider.

“We’ve been asking behavioral health centers to do more customized networks, enhancing the network in locations where employers may have a larger base of employees,” she said.

Quality Control Issues

It’s difficult for a patient to find the right provider for their unique situation or one who can get them the best results.

Employers have historically not asked their insurers many questions about behavioral health or the quality of these provider networks, said Sandra Kuhn, Mercer’s national lead for behavioral health consulting. This is an area in which they have potential to be more proactive and really push for more information from their insurers.

Questions can include: What quality measures do you use to bring carriers in and keep them in-network? Can you share with us at the end of the year a data set to show how many people were in treatment and the average length of time people stay in treatment? Also, did people improve while they were in treatment?

“Tools exist to measure those things, they’re just not being uniformly applied,” Kuhn said.

Also read: Lessons on Addressing Mental Illness in the Workplace

She also suggests that employers look for specific data points as indicators of whether the health plan is adequately addressing behavioral health, starting with data on what the employee population looks like. Then, look at EAP utilization. If utilization is low but a lot of people are using the behavioral health network in the health plan, then perhaps employees aren’t aware of the EAP services. That knowledge could give employers the opportunity to close the gap.

Data can also educate employers on how much out-of-network behavioral health care employees are getting. Maybe employees are having access issues, or maybe they’re unsure of how to go about finding care. They could be relying on friends’ referrals rather than something more evidence-based.

“If [employees] don’t have a clear way to obtain information about the network, the types of providers and what provider is good for what types of challenges, they’re just randomly picking, and that’s problematic,” she said.

She continued that quality metrics are “reasonably established” for certain areas of the behavioral health system. The type of care people may need ranges from outpatient care for mild or moderate cases to more complex and higher levels of care for more severe conditions. This inpatient care is where quality metrics are consistent, but most people come into contact with behavioral health services at the outpatient level, Kuhn said.

There are some insurance carriers and tech solutions like Ginger.io and Lyra Health that are using their own measures, but these aren’t consistent with each other, she said. This can lead to inconsistency and member confusion.

“They don’t know if they’re going to a quality provider or not, and oftentimes they don’t know how to judge if they’re improving,” Kuhn said. That may lead to people thinking that if they go to their friend’s therapist, they’ll get the best care.

“There are all sorts of wives tales that come out of there not being a good way to determine quality,” she added.

Employers can also push vendors on how they assess quality, said Conforti. Many times providers self-report quality to behavioral health centers. Whether they actually have the competencies to do so, they could simply check the boxes that they can work with any disorder.

“There has to be a better way at assessing and making sure that providers are doing good, sound, evidence-based care,” she said.

September 11, 2019June 29, 2023

When Alcohol Is Involved, the ADA Distinguishes Between ‘Having a Disability’ and ‘Disability-related Misconduct’

Alcoholism is an ADA-protected disability.

Yet the ADA does not require that employers accommodate alcoholics by permitting them to drink, or otherwise be intoxicated, on the job.

Case in point? Dennis v. Fitzsimmons (D. Col. 9/5/19).

Jared Dennis was employed as a deputy in the Summit County, Colorado, Sheriff’s Office. He’s also an alcoholic. While on administrative suspension following his wife’s allegation of domestic violence, Dennis got drunk at home the night before his criminal arraignment. The following morning, he failed his intake breathalyzer. Thereafter, the Sheriff’s Office terminated him for, among other rules violations, conduct unbecoming of an officer and being impaired while on duty.

Dennis sued his former employer for disability discrimination, claiming that it fired him because of a protected disability — his alcoholism.

The court disagreed, and dismissed Dennis’s lawsuit.

It is generally recognized that alcoholism can constitute a disability entitling the employee to protection under the ADA…. The more difficult question is whether Deputy Dennis has come forward with evidence that his termination resulted from his disability, rather than his conduct.…[W]hen the disability at issue is alcoholism, the ADA … draw[s] a distinction between “having a disability” and “disability-caused misconduct.”

It is undisputed that the SCSO based its decision to terminate Deputy Dennis’ on the fact that he reported for his arraignment in an intoxicated state. Thus, there is no dispute that SCSO’s decision arose from his unsatisfactory conduct on the morning of July 28, not from his abstract status as an alcoholic. As noted, the ADA … do[es] not extend protection to actions of alcohol-influenced misconduct, even if the employee’s alcohol use is related to the disability of alcoholism. Accordingly, Deputy Dennis has not come forward with evidence that indicates that his termination was based on his status as a disabled person (as opposed to his conduct).

Addiction is a protected disability. But it does not mean you have to permit its use to accommodate the disability. Under the influence at work does not equal a disability, ever.

September 10, 2019June 29, 2023

What Color Choice Can Do for Your Workforce

Color choice can help enhance the mood of an office setting.

Boosting productivity and wellness is a challenge for which organizations are looking to more creative solutions.

Color choice of the office is one relatively simple yet impactful tool that organizations from hospitality to tech are implementing to elevate the level of productivity, wellness and experience in their spaces.

“People are starting to see the psychological effects that color has on us, especially in the workplace,” said PPG Color Design Manager Vanessa Peterson. “It can really spark certain emotions and spark certain responses from people because they’re integrated into a space for so many hours.”

This reaction, Peterson said, has to do with what certain colors communicate in a space and how that communication works with other elements of office design to create an overall atmosphere. For this reason, blue is often chosen over others for interior design.

“Many of the colors that we find in nature, specifically blue, have caused a lot of really great health and mental benefits because of its serene and peaceful nature,” Peterson said. “It reminds people of the sky, or it reminds people of the ocean, in a very calm and tranquil space.”

Even within the color spectrum of blue, slight variations in shade can communicate different things, which in turn affects how people might feel in a space.

“One of the great things about blue is that for the most part, each version of blue has an identity of its own but also reflects the idea of either calmness or wellness. That idea of wellness can be integrated into an atmosphere where it gives you this feeling of power and it can feel very regal,” Peterson said. For example, a stronger blue such as cobalt is often used in sports companies’ marketing and darker shades of navy that exude a sense of maturity are used by universities.

The design industry is also seeing a heightened interest in color choices for products, Peterson said.

“Not only are you having desk and wall colors and furnishings go into this more serene setting, but you’re having tech companies do this with their products as well,” she said. “They’re going into a lot more beiges and a lot more soft corals, mints and blues, even into the actual technology to give that overall feel.”

The search for the equilibrium of office color and design is also about more than just improving productivity. Creating a sense of serenity in a space that people go to everyday can improve mood, too.

A study conducted by the University of Texas found that more bland colors such as beige, gray and white induced feelings of sadness and depression, particularly among women. This was in contrast to colors like blue and pale green, which produced feelings of productivity and peace in study participants.

PPG also named “Chinese Porcelain” its color of the year, which is a rich, natural blue and was selected with the idea of serenity and clarity in mind.

“With everything that we’ve been seeing happen socially and culturally around the world, we really felt that that shade of blue emoted that sense of serenity that people are looking for in this day and age,” Peterson said. “They want to have that sense of wellness, that sense of peace and they want to see a color and feel something that’s outside of that idea of intensity or anything that would make you feel disturbed.”

September 6, 2019June 29, 2023

Facing the Caregiving Crisis

When Mani Mueller landed a plum job at a biotech firm in Wisconsin in 2013 she brought her parents from Pennsylvania to help care for her two young daughters while she found her footing at work.

The timing was perfect. Her mother had just retired and her father, who suffered from Parkinson’s disease, was doing well and looked forward to spending time with his granddaughters. But what promised to be a dream scenario fell apart within a few months as her father’s condition declined and her mom couldn’t keep up with his care.

Parkinson’s is a progressive nervous system disorder that affects movement, and her father began falling frequently, requiring constant supervision. Soon, Mueller was tackling not only the demands of a new job, but also working a second shift as her father’s primary caregiver and power of attorney, shuttling him to doctor’s appointments, researching treatments, and learning to navigate the Medicare and Medicaid systems. Since her father, a Laotian immigrant, spoke little English she also became his translator.

At 37, Mueller had joined the ranks of 44 million adults in the United States who provide unpaid care for a loved one who needs support, according to AARP. She also became a member of the “sandwich generation,” caring for both a parent and children. Like many caregivers in the workplace, she never told her employer for fear of damaging her career. Instead, she used her vacation and personal days to meet the demands of caregiving.

In January 2018, five years after she placed her father in a nursing home, her company, Promega, introduced a caregiver leave benefit that provides employees with an additional two weeks of paid time off a year to care for a sick parent, spouse or child, or to welcome a new child. But even then Mueller was reluctant to come forward.

“I didn’t want to advertise that I was dealing with all of this or put on paper that my dad has this condition and my kids have that condition,” said Mueller, now 43 and a manager in supplier quality at Fitchburg, Wisconsin-based Promega. “I keep everything to myself. I thought sharing this information would negatively impact my career. I’m very quiet and private, but internally, I thought ‘How much more can I deal with?’ I was exhausted and stressed out.”

Mueller’s story illustrates the dilemmas faced by many caregivers who must choose between what’s best for their families and what’s best for their careers. It also sheds light on the complexities of caregiving in a time of great demographic change. Older people will outnumber children for the first time in U.S. history by 2030, traditional family structures are changing with families getting smaller and more geographically dispersed, and thanks to medical advances people are living longer with disabilities and chronic conditions.

This is resulting in a caregiving crisis that many employers are failing to acknowledge or understand, according to a Harvard Business School study released in January. “The Caring Company” report highlights a disconnect between the kinds of supports caregivers in the workplace need and what most companies provide.

Fear Factor

One reason that employers don’t understand the impact of caregiving on their businesses is that many employees are afraid to tell them, according to Linda Roundtree, an HR consultant who specializes in the aging workforce.

“When people don’t feel free to come forward, they have to make an excuse for why things happen or why they’re distracted at work,” she said. “There’s fear about hurting their careers. You see that fear when women are afraid to disclose that they’re pregnant.”

Only 28 percent of employees who care for a loved one were willing to admit that their family responsibilities harmed their careers, according to the Harvard Business School report. Around half of caregivers surveyed were afraid of being overlooked for challenging assignments, or missing out on salary increases or bonuses. And while 80 percent of employees admit that caregiving has affected their productivity, less than one-fourth of employers said that caregiving influences employee performance.

Mueller said that if Promega had a caregiving benefit when she started there it’s unlikely that she would have taken it. But by 2018 Mueller had been a manager for two years and was confident in her position. So, when her dad’s condition worsened again that May and her daughter was diagnosed with a kidney infection she signed up for time off under the company’s caregiver leave policy. Her father died the following November.

“Exceptional caregiving” is the term that Roundtree uses to describe the new realities for caregivers who are caring for loved ones with a host of cognitive impairments, physical disabilities and chronic conditions.

“There is a huge chunk of the workforce that will be taking care of a child with special health care needs or an elderly parent,” said Roundtree, who co-authored a 2018 paper on the changing nature of caregiving for Boston College Center for Work and Family. “Today even young, single people understand that complex things will happen either to themselves or to a partner or spouse and they need employers that know how to support them.”

The Young Caregivers

While the typical caregiver is a white woman in her late 50s, about one-fourth of all caregivers are between the ages of 18 and 29, according to AARP. They are also the fastest growing and most diverse demographic in the workplace. Employers need to understand that caregiving affects workers of all ages, Roundtree said.

The scope of the problem came as a surprise to executives at Promega when the company surveyed its own workforce in 2017 to better understand the caregiving needs of its employees.

It looked at all kinds of situations from parents of newborns to parents of children with special needs to children caring for parents and adults caring for a spouse, according to Promega benefits manager Diana Clark. She said that everyone was surprised by the variety and intensity of the demands on employee caregivers. They discovered a hidden population of employees who were spending about 29 hours a week on caregiving duties, basically working a second unpaid shift.

Also a surprise was the average age of their caregivers: 33 years old.

Promega Benefits Manager Diana Clark caregiving — Promega Benefits Manager Diana Clark

“I would have thought three years ago that average caregiver is 55 or 60 years old and nearly retired, but it’s a parent with kids and an elderly parent who is struggling with cancer or some other health condition,” Clark said.

“When you talk to people in those roles they will tell you that’s just what they do and that it’s not a burden. They’ll say that ‘dad just needs me to get groceries, or he can’t drive, or I have to make sure that mom takes her meds.’ There so many tactile details involved that we couldn’t help but see the strain.”

This led Promega to launch caregiver leave benefits in January 2018 that provide employees with an additional two weeks of paid time off a year to care for a sick parent, spouse or child, or to welcome a new child. The benefit can be used in daily increments or all at once. So far, 120 employees, or 12 percent of Promega’s 1,400 employees, including subsidiaries, have used the benefit.

Employees Open Up

Clark said that the program has taken on a life of its own with employees coming forward to share their stories and even launching their own initiative called Circle of Caring. The initiative connects caregivers and employee volunteers willing to help with meals, shopping, lawn care, transportation and other errands. One group of volunteers even planted a garden for an employee who was an avid gardener but was unable to use his arm after a surgery.

This year, the company also began offering free onsite psychological counseling one day a week for caregivers and plans to offer health care navigation services, among other supports for caregivers, such as bereavement support and financial counseling.

Deb Notstad, 57, a complaint investigations specialist at Promega, is grateful for the benefits, even though they came too late to help her. In 2016 her elderly mother was dying and she was caring for her 28-year-old son Adam, who is physically and developmentally disabled. Notstad, a single mother, is also the legal guardian for her brother who is a critical diabetic and is developmentally disabled. While she thinks that two weeks of paid leave is great, it’s not nearly enough for those with complex caregiving needs.

“When they introduced the benefit I had already spent weeks in the hospital with my son,” she said. “My first reaction was, ‘Are you kidding? This is a drop in the bucket.’ But I don’t know too many businesses that offer something like this.”

While a growing number of companies including Starbucks, Cigna, Best Buy and Microsoft offer caregiver supports such as extended paid leave, long-term care insurance for parents and grandparents, and counseling, the vast majority do not offer benefits that are valued by caregivers, according to the Harvard Business School study.

The top reasons that caregivers quit their jobs is the high cost of paid help, the difficulty in finding trustworthy support, and the inability to manage the demands of work and home — all areas where employers could provide support, the study found.

Those that fail to address the problem will pay the price in “hidden costs” such as turnover, loss of institutional knowledge, absenteeism and other factors that are difficult to quantify, according to the study.

Katie Boer, 31, never thought that two years after landing her dream job as a broadcast journalist she would be quitting to look after her 71-year-old mother. In 2016, shortly after she began working at a Las Vegas television station, Boer’s mother, who lives in Seattle, was diagnosed with Lewy body dementia, which can cause hallucinations and Parkinson’s-like symptoms such as body rigidity, tremors and balance problems.

At first, Boer handled things by phone and took paid time off for regular trips to Seattle, but as her mother’s condition worsened the situation became unmanageable. Her mother would call her at work several times a day confused and agitated, often minutes before she went on the air. Eventually, Boer installed a video camera in her mom’s apartment to keep a closer eye on her. But when she saw her mom lying on the floor in the middle of the night crying out Boer’s name for hours, she reached a breaking point.

“I’d be lying in bed watching her not sleeping with tears falling sideways down my cheeks,” she said.

“I’d cry all night and go to the bathroom and throw up. Even though I had a dream job I felt like I was selfish for not being there. So I sacrificed my job and moved to Seattle.”

For employees at smaller companies without caregiving supports or benefits like flex time or paid time off the burden of caregiving can be especially crushing.

Amanda Smith, 34, works at a small nonprofit arts foundation on the East Coast that is not required to provide leave under the Family and Medical Leave Act. With a toddler who has cerebral palsy along with other disabilities and requires round-the-clock care, managing a career is an enormous challenge.

While her boss was initially accommodating, allowing her to work from home one day a week, he has become impatient with the lack of flexibility in her schedule, she said.

“He’d like me to come in without any warning but our lives our very, very choreographed because of all the doctor’s appointments, services and nursing care that my son needs,” she said. “We can’t just call a babysitter. My husband would have to call in sick or my mother-in-law would need to come because she’s the only one besides us who knows how to take care of him. I don’t think employers really understand how complicated caring for a child with a disability can be.”

But many are trying, according to LuAnn Heinen, vice president at the National Business Group on Health, a coalition of large employers.

“It’s definitely on their radar,” she said. “We did a survey in 2017 and 88 percent of employers think caregiving will be a big issue over the next few years. Paid leave is important but we know that it won’t solve the problem if you’re caring for someone over a number of years. There must be more supports like flexible work arrangements, health care navigation, and services to help employees find caregiving services. Employers realize this.”

For those that fail to address the needs of caregivers, Clark warned that companies like Promega will be happy to hire their employees away.

“Unemployment is low and there are great people out there who are not getting their needs met and will want to work for an employer who recognizes them as a whole person,” she said. “You lose so many aspects of what that person can bring to the table when they are trying to take care of their families and are not supported.”