Category: Benefits

The first time Ken Dodson got lost, his wife Nikki chalked it up to stress. Ken Dodson, who was 28 at the time, was a supervisor at a Michigan steel company and often worked 12-hour days back in 2008, so getting a little turned around on his way home from the store didn’t seem like a big deal. But when it happened again on his way to pick up their daughter from school, Nikki Dodson’s gut told her that something was wrong — really wrong.

At work, Ken Dodson noticed that he tired easily and kept forgetting safety protocols that he knew by rote.

“I was having trouble doing things I did all the time,” Ken Dodson said in a recent Workforce interview, pausing a few beats after each carefully crafted sentence. “I usually never missed any time at work, but that last year, I didn’t have any energy. My mind raced to try to remember things, and it made everything worse.”

Over the next two years, the Dodsons consulted doctors who said depression was likely the problem and prescribed antidepressants, but nothing changed. Nikki Dodson feared a brain tumor. It wasn’t until the Dodsons insisted on a brain scan that a diagnosis was confirmed. One week before his 30th birthday, Ken Dodson was diagnosed with early-onset Alzheimer’s disease.

“I never in a million years thought Alzheimer’s, and I never thought that by the time I’m 40, I’ll be a widow with three kids at home,” Nikki said. (The average life expectancy for Alzheimer’s patients after diagnosis is eight to 10 years.) “People would say, ‘I hope you have money saved up,’ and I thought, ‘Are you kidding me? We were just starting our careers, we had just built a house, and we had just started our 401(k).’ ”

Alzheimer’s disease is an irreversible, degenerative disorder that destroys memory and can also affect problem-solving, behavior and speech. While it’s typically considered to be a disease of old age, approximately 200,000 of the estimated 5.3 million Americans with Alzheimer’s have been diagnosed under age 65. And that workplace number is expected to grow as baby boomers age, posing a challenge to employers who risk losing talented employees unless they are willing to help caregivers and those diagnosed with the disease to stay on the job as long as possible.

Early-onset Alzheimer’s, also known as younger-onset Alzheimer’s, can hit when someone is in their 30s or 40s, a time when families are least likely to have the financial and emotional resources to cope.

For the Dodsons, now both 37, it meant losing their major source of income and their health insurance. Ken Dodson lost his job during a series of layoffs shortly after his diagnosis, and Nikki Dodson, a teacher, had to quit her job to become her husband’s full-time caregiver. Luckily for the Dodsons, individuals with early-onset Alzheimer’s are automatically eligible to receive expedited Social Security benefits, though the amount was a fraction of their dual income.

“I know these are just material things, but we worked so hard to achieve them and now we have to work so hard just to make ends meet,” she said.

Working and Caregiving

Whether an employee has Alzheimer’s or is caring for someone with the disease, employers will feel the fallout, according to Dr. Lawrence Weinstein, chief medical officer at Humana Behavioral Health.

“Nearly 15 million people provide unpaid care to a person with Alzheimer’s or other dementias,” he said. “Many caregivers of people with Alzheimer’s reported making major changes to their work schedules because of caregiving responsibilities.” This includes going to work late or leaving early, taking a leave of absence, going from full time to part time or quitting, Weinstein said.

Employers will also see higher disability costs if more workers in their 50s and early 60s suffer from cognitive impairment associated with dementia as well as lost productivity as employees struggle to manage their treatment, their finances and family demands, he said.

While Alzheimer’s at any age is devastating, for younger adults with families to support, it can be even more overwhelming, according to social worker Susan Frick, co-founder of Without Warning, a support group at Rush University Medical Center in Chicago for people with early-onset Alzheimer’s disease. Getting a diagnosis can be difficult because no one expects a person in their 30s or 40s to have Alzheimer’s.

“It takes multiple doctors to see what’s going on,” she said. “Sometimes they’ll write it off as depression or, with women, as menopause. Sometimes it takes the caregiver a while, too. The person might seem more withdrawn or different, but that could be anything.”

Frick said often the first people to notice a problem are co-workers, which makes awareness important for employers.

“Often the workplace starts to notice the problem before the family does because it’s hard to hold it together at work,” Frick said. “Some people say they have to pull all-nighters to get the same level of work done. Anything new to the routine can become difficult. A lot of people say they try to keep it a secret but it becomes harder to do.”

Carrie Richardson, 35, had no choice but to tell her employer that she has early-onset Alzheimer’s. In 2010, Richardson, a single mother of three living in Montgomery, Alabama, joined a federally funded study of a rare form of Alzheimer’s disease that is caused by a gene mutation. Richardson must take time off every few months to undergo rigorous cognitive testing; for a time, a nurse would show up at Richardson’s workplace to take her vitals and administer medication. Richardson, who teaches preschool, said her supervisors are supportive and give her the time off that she needs.

While she shows no symptoms yet, Richardson, who still teaches preschool, is preparing for the inevitable. Her mother moved in with her in August to help take care of her children who are ages 15, 13 and 9, and she has insurance policies and a living will in place. She understands what lies ahead all too well. Her father, grandmother, three uncles and a cousin all died from early-onset Alzheimer’s. Richardson has two brothers — one tested positive for the genetic mutation, and the other did not.

For now, Richardson watches for signs that the disease has progressed.

“I’m busy with three kids so I think some of it is normal, but I don’t want to push it aside either,” she said. “I forget names of bands that I like. I forget small stuff. This morning I couldn’t find my keys, and I was asking all the kids where my keys are. I spent 30 minutes looking. I put cream in the pantry. And over the summer, we moved into a new house and one day I pulled into the driveway and my daughter said, ‘This is not our house.’ ”

Richardson is lucky to have a supportive employer, but that’s not the case for many workers, according to Ruth Drew, director of family and information services for the Alzheimer’s Association in Chicago. Often employees who are struggling with job performance because of early-onset Alzheimer’s are afraid to ask for help or they are unaware that something is wrong, and colleagues are afraid to speak up, she said.

“If they get fired before anyone figures out what’s going on, then they can’t take advantage of the benefits they qualify for,” she said. “I love it when the family gets a diagnosis early on because that gives them the most options to work with HR and take full advantage of the benefits available to them.”

The association offers resources to employers to raise awareness of Alzheimer’s in the workplace to help human resources better understand the disease and develop support for employees who care for a loved one with Alzheimer’s.

“About 15 million working Americans are caring for someone with dementia, and we don’t see it slowing down,” she said. “They may have kids in college or younger kids at home. They will be both caregivers and ones being cared for. We are seeing a tremendous impact on caregivers. Without a cure it’s really incumbent on all of us to have awareness of this disease and how it impacts caregivers.”

But employers need to be cautious not to jump to conclusions and assume that signs of forgetfulness or cognitive lapses means someone has the disease, according to Peter Petesch, a shareholder with the law firm Littler Mendelson in Washington, D.C.

“A lot of us should stick to our day jobs and manage performance, but when someone is aware that an employee has a diagnosis, there are certainly accommodations that can be made,” he said. “But it’s incumbent on the employee to come forward. Ask for an accommodation before it becomes a problem. The safest and most proactive approach an employer can take when an employee’s performance is deteriorating is to confront them with performance problems and determine if there is any way to get them back on track. It doesn’t involve diagnosing the employee, but it involves throwing it back to the employee to ask for accommodation.”

While the Americans with Disabilities Act doesn’t issue a list of medical conditions that are covered, it has a general definition of disability that a person must meet to be covered. If an employee with dementia meets the criteria, they will be covered, Petesch said.

“If the condition substantially limits life activity and impairs thinking, reasoning and a whole variety of cognitive activities,” he said, “then it almost always rises to the level of a disability under the ADA.”

Petesch advises employers to consider accommodations like putting instructions in writing or working with the employee to set up deadline reminders on their online calendars.

What employers can’t afford to do is ignore the problem, Drew added.

“The number of people impacted by Alzheimer’s is going to increase as the baby boomers age,” she said. “Any employer that does not look at the issue and is not aware that they have employees who are struggling to care for someone with Alzheimer’s is at risk for losing really talented staff. People are able to stay in the workforce longer when they have flexibility, and employers should help them find a way to do that.”

Rita Pyrillis is a freelance writer in the Chicago area. Comment below or email editors@workforce.com.

SIDEBAR

Employee Benefits and Early-Onset Alzheimer’s

Getting an Alzheimer’s diagnosis among those under age 65 can be difficult because the condition is relatively rare, affecting about 5 percent of Americans with the disease.

But it’s important that employees seek a diagnosis as soon as possible to maximize the benefits available to them, said Ruth Drew, director of family and information services, at the Alzheimer’s Association in Chicago. The organization outlines the options available to those who have received a diagnosis.

Private insurance

• Disability insurance: Short term and long term.
• Family and Medical Leave Act, or FMLA: Employees are allowed 12 weeks per year.
• COBRA: Employees need to be aware that, to retain coverage past a certain point, they will need to provide the insurance company proof of disability to continue coverage until Medicare kicks in.

Social Security Disability

The U.S. Social Security Administration includes early-onset Alzheimer’s to the list of conditions under its Compassionate Allowance Initiative, expediting access to Social Security Disability Insurance and Supplemental Security Income eligibility. Social Security disability benefits will begin five months after an employee develops a disability. Payment should start during the sixth month of disability. Begin this application process when the employee goes on short-term disability and provide the written diagnosis to Social Security to aid in the approval process.

Medicare

Coverage will start approximately two years after the employee has been on disability.

Medigap

This program is available to employees when they start Medicare to bridge the gap in medical coverage. If the employee chooses one of the Medicare Advantage Plans, Medigap may not be available to work with their plan.

Medicare Managed (Medicare Advantage Plans)

Medicare has partnered with several insurance companies to provide Medicare coverage with the addition of prescription coverage.

—Rita Pyrillis

Corporate wellness has evolved in fits and starts since the first executive gyms appeared after World War II. But despite continuing concerns regarding the effectiveness of employee wellness programs, the industry has exploded in recent years.

Focusing efforts on the sickest workers and paying or punishing people to get healthy have become common practices, but some employers are taking a different approach and ditching financial incentives, embracing the importance of emotional health and redefining the concept of return on investment.

The hard-dollar approach of measuring money spent on wellness efforts against health care dollars saved is giving way to a more nuanced view that values softer benefits like employee morale and company loyalty. And more employers are abandoning carrot-and-stick methods such as offering or withholding discounts on insurance premiums to get employees to participate. Instead, companies are creating environments designed to make wellness easy and fun.

Even the term “wellness” is falling out of favor as more companies adopt a holistic approach that includes emotional and financial well-being, according to LuAnn Heinen, vice president at the National Business Group on Health, an employer advocacy group based in Washington, D.C.

“We’re moving from wellness to well-being,” said Heinen,who heads up the group’s Institute on Innovation in Workforce Wellbeing. “In traditional wellness programs, we measure success by participation and ROI on medical costs, but in today’s approach it’s not about ROI. It’s about productivity, and business metrics, and retention, and customer satisfaction. It’s not about health and benefits in silos, but about broader well-being, and that includes social connectedness, financial security, emotional health and job satisfaction. The old way of getting everybody to do the same thing is being abandoned.”

Value of Investment

The number of employers embracing this approach is growing rapidly, according to a 2015 survey by U.K.-based insurer Willis Group. Sixty-four percent of employers with wellness programs are more focused on “value of investment” compared with 28 percent who indicate that they are more focused on “return on investment,” the survey found. “More organizations are realizing that the expectation of an immediate return on investment (ROI) for their wellness programs through medical-cost reduction may be unlikely,” according to the survey.

At Kimberly-Clark Corp., which launched its wellness program in 1975, health care costs are a top concern, but ROI doesn’t factor into the wellness program, said Stephanie Pereira da Silva, health and wellness manager who oversees the company’s wellness initiatives.

“We don’t track it,” she said. “Companies can really manipulate those numbers in their favor. We look at participation rates and long-term behavior change. We have online medical records dating back to the ’70s, so we can see if a program is successful. Do we care about the numbers? Absolutely we do. We track health care costs, but it’s not tied to our wellness program.”

The Irving, Texas-based producer of personal care products also bucked the wellness incentives trend. That approach didn’t fit with the company’s philosophy that culture can be a greater influence on behavior than punishments and rewards, according to Pereira da Silva.

“We take a more reserved approach to wellness,” she said. “When everybody jumped on the bandwagon of tying health insurance incentives to behaviors, reward and punishment, we didn’t jump. If you look at the trend over the years, companies are backing away from that approach. We are trying to create a culture of wellness. We don’t want to penalize you.”

Kimberly-Clark, which has 43,000 employees in 37 countries, employs a cadre of health professionals and volunteers that operate its exercise facilities and wellness programs around the world, including a dozen occupational nurses.

The focus on and fretting over the return on investment of wellness is misguided, said Michael Staufacker, director of health management at Emory University.

“We look at things like reducing employee health risks, improving employee productivity, job satisfaction, business performance metrics,” he said. “Are we retaining and recruiting the employees we need? Are we improving employee morale? It’s not expected that we prove ROI for other benefits. We don’t expect the health plan or EAP to show ROI, so why should we expect it of wellness?”

Instead, the university is focused on creating an environment that encourages employees to get healthy by making it convenient and fun, Staufacker said. It launched its wellness program, called Healthy Emory, in 2013.

The university provides maps of campus art walks and green spaces to employees and students, it deploys employee volunteers to promote various wellness programs and events, hosts a weekly farmer’s market, offers discounts on bikes and Fitbit wearable fitness trackers, sponsors health challenges throughout the year, and provides healthy food in its cafeterias and vending machines, among other initiatives.

“When we developed Healthy Emory, we thought about how to positively influence behavior, and we identified several areas, like environment, culture, community and using the resources we have as a world-class health care system,” he said. “Traditional wellness programs that only focus on a small aspect of health and well-being probably have only a small positive influence on health and productivity.”

It’s About Health, Not Money

Ann Mirabito, a Baylor University business professor, said the most effective wellness programs — ones that lower health care costs, increase productivity and improve morale — have certain traits in common.

The best ones actively involve the CEO and other leaders, are in sync with the company’s mission and business goals, recognize the importance of emotional health and are fun, she said.

“The ideology behind successful workplace wellness programs is that employees deserve to be healthy, not that this is a great way to save money for the company,” she said.

She likens the most successful wellness programs to social movements, which grow from the ground up.

“Wellness programs cannot be imposed from the top down because they won’t be accepted by the employees,” Mirabito said. “Successful programs are created by the employees. Organizations that have this culture have created social norms around healthy behaviors. They have worked hard to reduce barriers to wellness by making healthy food convenient and available, making it easy to exercise, to get flu shots or to take care of their chronic illnesses.”

Punishing employees who fail to change their behavior is sure to fail, added Henry Albrecht, CEO of Limeade, a Bellevue, Washington-based company that offers an online platform that encourages employees to adopt healthy habits.

“For the last 15 years, wellness was focused on singling out the weak and reducing health risk and cost,” he said. “That makes sense on paper, but it doesn’t make any sense from a behavioral science point-of-view. People don’t change because there is something wrong with them or by giving them lots of money. That’s only good for one-time tasks like screenings.”

Limeade’s platform allows employees to create personalized health plans based on their location, job and health assessment data, among other factors, and to track their progress. Incentives are part of the program but are tied to reaching various health goals. Employees can earn cash, gifts or paid time off.

“Our philosophy has always been to find fun and simple technology-based ways to help employers get people to improve their health, not because they are expensive to insure but because they believe that an engaged, high-performing, high-morale workforce drives business,” Albrecht said.

That is especially true among health care providers where burnout is high and stressed-out workers can affect patient care. At Cincinnati Children’s Hospital Medical Center, nearly 80 percent of its 15,000 employees are women, and the average age of its workforce is 39, which means a good number are caring for both children and parents, according to Rachael Grile, a human resources specialist who manages the hospital’s wellness programs. Not surprisingly, a large number of employees struggle with anxiety, depression and insomnia.

So when the hospital began developing its wellness program in 2010, addressing those needs was a top concern. “Our population works with complicated and difficult situations involving children so we wanted to focus on the emotional aspect of health,” she said. “For our employees, work-life balance is a blur. What happens at work comes home and what happens at home comes to work.”

The hospital partnered with Limeade to launch MyHealthPlan in 2011. Before then, there was no formal wellness program, “just a few lunch and learns and some fitness classes,” she said. Nearly 80 percent of the hospital’s workforce participates in MyHealthPlan, Grile said.

While the program started with a focus on physical health, it evolved to include programs that address emotional needs, like stress management, financial health, career growth, and social and community connections.

“We have a variety of different financial seminars on budgeting, raising money-smart kids, and we push employees to volunteer, to participate in the United Way or Paint the Town, which is an effort to beautify neighboring communities,” Grile said. “We opened an employee care clinic with on-site mental health counselors, health coaches and nurse advocates.”

This spring, the hospital plans to offer a six-week cognitive behavioral class to treat insomnia. Participants will learn relaxation techniques, habits for good sleep and how to cope with nightmares.

With workplace stress levels rising and costing employers billions in lost productivity each year, the demand for programs that help employees manage their mental health is growing. The concept of mental resilience is generating interest among employers looking to teach employees how to weather tough times.

“Employers are making the connection that our heads are connected to our bodies,” said Jan Bruce, CEO of MeQuilibrium, a Boston-based firm that developed an online employee stress management program. “We spend a lot of time motivating people, creating incentives to take better care of themselves physically but it doesn’t get the job done. The prevalence of stress has changed radically in the past five years, and that has catapulted employers and people in HR to think about the importance of addressing the emotional well-being of the population.”

All of these developments — from dropping the carrots and sticks to recognizing the effect of mental and emotional health on the bottom line to redefining value — is a sign that wellness programs are maturing, and that bodes well for their future, Mirabito said.

“Wellness experts and employers have a deeper understanding of how wellness contributes to the organization,” she said. “There’s a better understanding of the costs of chronic illness, not just in terms of out-of-pocket health care costs, but the human toll and impact on the organization.”

The steady erosion of health care benefits comes as no surprise to employers and industry experts who have watched health care costs spiral upward for years, but the news may still be sinking in for workers as they take on a greater share of those costs.

“Employees have been hearing that health care costs are unsustainable for many years, but it’s a message that gets tuned out if it doesn’t impact them directly,” said Joann Hall Swenson, a communications consultant at Aon Hewitt. “When it starts to impact them personally, then they start to pay attention and they expect their employer to have an answer.”

As companies continue to push high-deductible health plans, which offer lower premiums but higher deductibles than traditional plans, employees are finally feeling the pinch in their pocketbooks.

“It’s one thing to hear about unsustainable health care costs, which sounds like rhetoric, but when people try to manage their HDHPs, that’s where rubber meets the road,” Swenson said.

And as the cost-shifting trend continues, employees will be faced with some tough realities as their health care spending skyrockets.

The average amount that workers need to contribute toward their health care costs has increased more than 134 percent in the past decade, according to a recent report by Aon. At the same time, large employers have seen record low increases in their health care costs. In 2015, the average rate increase was 3.2 percent, according the report.

“We’ve seen this trend for a very long time, and we will continue to see benefits decrease especially with the excise tax looming in 2018,” said Mike Morrow, a senior vice president at Aon Hewitt, referring to the so-called “Cadillac” tax. “We will increasingly see those benefit levels decline at the same time; we don’t expect inflation or wages to kick up.”

One reason for this slowdown in rate increases is that some employees are forgoing medical treatment because of a sluggish economy, Morrow said.

And that is a problem not only for employees who can’t afford to get the treatment they need, but also for employers who could see their cost-containment strategies backfire down the road, said Cheryl Fish-Parcham, private insurance program director for Families USA, a nonprofit consumer health organization based in Washington, D.C.

“Studies have shown that many working families don’t have enough savings to meet their health care needs until their health plan starts kicking in,” Fish-Parcham said. “We’ve seen a number of surveys that as many as 50 percent of low to midrange income don’t have the assets they need to meet a deductible. We’re really concerned about how the workforce is faring, and employers should be too because healthy employees means a productive workforce.”

She pointed to a recent survey by the Commonwealth Fund, a private, nonpartisan research foundation based in Washington, D.C., that shows that 25 percent of privately insured adults had premiums, deductibles or out-of-pocket costs that are unaffordable. Workers struggled most with paying their deductibles, with 43 percent of those surveyed saying that their deductible was “difficult” or “impossible” to afford, including a large share of workers with higher incomes, according to the survey.

That has led to a growing number of employees who are avoiding or delaying needed medical care. About 40 percent of workers with deductibles higher than 5 percent of their income reported that they had not gone to the doctor when sick, skipped a preventive-care test or a follow-up test, or didn’t go to a specialist, according to the Commonwealth Fund report.

Adding to the problem is confusion about which services count toward deductibles and which are provided at no cost. Many employees are avoiding free preventive care because of their deductible, the report said.

But there are several things that employers can do to help workers navigate the changing and often confusing health care system, like explaining the reasons for any changes, Swenson said.

“It’s a very complex topic, and it’s not just about cutting health care costs,” she said. “When people get the broader business reasons for why their deductibles are going up or why costs are going up and understand that the employer is trying to do right by the employee, it’s easier to digest.”

How much you tell employees depends on the company’s culture, according to Swenson.

“We have clients who are very forthright and frame it within the business context, and others are careful to steer away from that discussion,” she said. “If you have a culture where employees are used to leadership giving them straight talk, then use that cultural framework to talk about health care costs. If the message is not in line with how you usually talk, then it won’t sound authentic to employees.”