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.
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?
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.
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.
Mental illness is an obstacle that impacts many individuals, communities and places of work. The Human Capital Media research department gathered national and international data to explore how prevalent mental illness is, how often people get help and how much mental illness impacts the global economy.
Becky Beach admits she doesn’t know much about Social Security, but she definitely thinks it won’t be around when she needs it. That’s why the 40-year-old lifestyle blogger plans to start taking the benefit when she turns 62.
“I plan to take it out as early as I can,” Beach said from her home in Arlington, Texas. “I don’t really know that much about Social Security, but I hear it’s going to go away.”
Lots of people like Beach think similarly. In fact, only 4 percent of retirees wait until the optimal age of 70 to take their Social Security benefit, a new study by robo-adviser United Income said. Retirees lose out on $3.4 trillion in possible income, which on average is $111,000 per household, because they don’t take Social Security at the best point in their lifetime.
“Most people don’t claim Social Security at the optimal age from a financial perspective because they may not be having the necessary retirement planning discussions,” said Jason Fichtner, former chief economist at the Social Security Administration, and co-author of the study. “Financial advisers, employer HR departments and policymakers could do a better job with educational materials and encouraging people to spend more time sorting through this important decision.”
Social Security provides more than $1 trillion in benefits to 64 million Americans.
Nearly all (92 percent) of retirees that took Social Security at the wrong time would have seen their income increase had they pinpointed the right time. In fact, more than half of these retirees could have increased their income by more than 25 percent in their 70s and 80s, the report said. That’s usually when people see spikes in health care costs.
Today, Social Security provides more than $1 trillion in benefits to 64 million Americans. It represents a third of retirement income for seniors, which averages $1,461 each month.
There is no doubt the system is being stressed with increased life expectancies, but the doomsday scenario of the system going broke isn’t exactly right, Fichtner said. The latest Social Security Administration report shows that the trust fund reserves are expected to be used up (if nothing is done) by 2035. If Congress chooses to do nothing to fund Social Security, it will still be able to pay out 80 percent of what working Americans are owed after 2035.
“The trust fund may become depleted, but once depleted, it will pay out what it collects,” Fichtner said. “By law, Social Security will pay out 80 percent of what is promised.”
The study showed that most people should wait until 70 to claim their Social Security benefit. While workers can start claiming their benefit at 62, the amount increases on average about 8 percent each year they delay the claim. The Social Security Administration reported a 62-year-old would receive a $725 monthly benefit if they claimed today. Choosing to delay the benefit until age 70 would increase the amount to $1,280, a 177 percent increase.
While waiting to get a bigger paycheck sounds great, it may not always be feasible, said Colleen Jaconetti, senior investment analyst at The Vanguard Group. It’s not wise to completely deplete an investment portfolio to accomplish this, she said. In addition, some people may not be able to work or earn enough money in their later years to get them to 70.
“A lot of people don’t realize that they need to figure out how they fill that gap” between 62 and 70, Jaconetti said. “It’s a complicated problem.”
Jaconetti pointed out that those who are able to bridge the gap and delay claiming Social Security can also see other benefits from their decision. Some may see a lower tax bill while in retirement because Social Security taxes may only come from 85 percent to 50 percent of that income. In addition, relying more on Social Security in later years may allow heirs to inherit unused assets from retirement accounts. The important thing, she said, is that people make informed decisions on their health, financial status and other factors to determine the right time to claim the benefit.
Fichtner and Jaconetti agreed that most people are like Beach, they really don’t think about Social Security and may only have time to hear or see the headlines. It would be helpful for human resources leaders and policymakers to help people understand the options well before it becomes their time to make this often permanent decision to claim Social Security benefits. The study looked at Social Security messaging and suggested that the Social Security Administration revisit how it describes claiming age. Currently, age 62 is labeled “early eligibility age.” Fichtner suggested age 62 could simply be labeled “minimum benefit age” while age 70 could be labeled the “maximum benefit age.”
“How we talk about this can change behavior,” Fichtner said. “The little things can make a difference.”
An employee suffering from epilepsy, migraines and heart condition asks (with a medical note) for two unpaid days off from work to treat symptoms related to her disabilities.
Instead of granting the leave, the employer assigns the employee points under its no-fault attendance policy and fires her for exceeding the allowable number of attendance points. The EEOC has sued the employer, alleging disability discrimination.
A no-fault attendance policy assigns points each time an employee is absent, with corresponding levels of progressive discipline automatically imposed at certain point levels. Employers like these policies because they simplify attendance issues.
These policies, however, carry, a certain degree of risk — namely in the handling of absences protected by the FMLA or ADA. If the FMLA or ADA protects an employee’s absence from work, an employer would violate the statute by counting the absence as part of a no-fault attendance policy. And, in this case (assuming the medical note is legit), and for this reason, it appears this employer has a big problem with the EEOC.
On a more basic level, where’s the humanity in denying two days off for an employee to deal with medical symptoms, especially when the request is accompanied by a doctor’s note?
The ADA requires reasonable accommodations. Unless the employee is a serial abuser of unpaid days off, it’s hard to imagine a situation in which two days is not a reasonable request.
The Mental Health Parity and Addiction Equity Act of 2008 was passed to ensure that insurers and health plans offer mental health and substance abuse benefits comparable to coverage of medical and surgical care. It has heralded some positive trends, but there are still areas in need of improvement, experts say.
Other than the 2008 act and its precursor in 1996, there has been no legislation in America regarding mental health care, said Mary Kay O’Neill, partner at Mercer.
Until recently, “We didn’t have the resources or cultural language to talk about this,” she said. “How we talk about behavioral health now is completely different than seven year ago.”
Tom Sondergold, vice president, global HRIS, Benefits and Mobility at Walgreens Boots Alliance, said that while his organization has always strived for parity, having the law on their side has helped a lot. The Mental Health Parity Act has highlighted that there aren’t enough providers, he said.
“The parity law has allowed us to have a little bit more weight in working with our carrier partners to make sure they strive to secure more providers,” he added.
Employers should not assume that their insurers or plan administrators are in compliance with parity, said Henry Harbin, a psychiatrist with over 40 years of experience in the behavioral health field.
Employers that have been sued for parity non-compliance include Microsoft Corporation, Marriott International, Indiana University and Boeing Corporation.
Self-insured employers are regulated under the parity law and a liability target. Financial and quantitative requirements — for example, that behavioral health copays must be comparable to medical copays — have been reasonably in compliance with health plans and employers, he said. But non-quantitative requirements are where most litigation is happening for failing to comply with the law because there aren’t numbers or data to directly compare, putting self-insured employers at risk.
These non-quantitative treatment limitations include areas like reimbursement rates and admissions standards to the provider network. While it’s generally clear if the health plan is complying with the quantitative parity requirements, with non-quantitative requirements, it’s harder to tell if the health plan is complying with the law.
Kevin LaBelle, a lab technician for mining company Cleveland-Cliffs, took occasional days off from work for approved intermittent FMLA leave for flare-ups related to a shoulder injury.
His employer noticed that LaBelle seems to always take his FMLA leave by combining it with scheduled days off and vacation days.
Noticing the pattern of suspected abuse, the company hired a private investigator to watch LaBelle during his FMLA leave, and twice found him playing golf. The employer concluded that if LaBelle was experiencing a shoulder flare-up that prevented him from working, he would not be able to golf, and that if he could golf, he could work. Accordingly, it fired him for FMLA fraud and abuse.
The 6th Circuit affirmed the trial court’s dismissal of LaBelle’s FMLA retaliation claim:
There is no evidence in the record to show that Cliffs’ proffered reason lacked a basis in fact. Cliffs approved LaBelle’s request for intermittent FMLA leave for two reasons: (1) attending medical appointments and (2) taking three days off per month for a “flare-up.” Even crediting LaBelle’s explanation of why it was ok for him to golf, or why he “stacked” his leave, LaBelle did not take FMLA leave for “flare-ups” or medical appointments. He took FMLA leave because he was in constant pain and would take leave around vacations or weekends to give himself as much rest as possible. But occasional rest to alleviate low-level background pain is not what his FMLA leave was for.… If LaBelle had constant pain that required occasional long weekends to mitigate, he should have requested FMLA leave for that purpose.
Intermittent leave is (one of) the biggest FMLA-management problems for employers. And the “stacking” of intermittent leave against other scheduled days off is one of the biggest intermittent-leave management problems. This case gives employers a great tool to combat this form of FMLA abuse.
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.
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.
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.
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.”
Mani Mueller is one of the millions of Americans who has cared for an elderly parent or children while working a full-time job. Photo by Paulius Musteikis
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.
Mani Mueller was the primary caregiver for her father. Photo courtesy of Mani Mueller.
“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 studyreleased 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 paperon 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
“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, right, cares for her son Adam, who is physically and developmentally disabled. Photo courtesy of Deb Notstad.
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 cares for her mother who suffers from dementia. Photos courtesy of Katie Boer.
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.”
Employees may be lured by the idea of unlimited paid time off but the reality is unlimited paid time off is often an egregious fabrication that employers tell their workforce.
What is usually lost in the conversation is what employees are forced to give up when their organization decides to implement an unlimited system. There are plenty of legitimate business reasons to stop offering — and stop being enamored by — the allure of the unlimited PTO promise.
“It’s great to not have to pay out [accrued vacation] when people leave,” said Maggie Grover, a partner at Wendel, Rosen, Black & Dean LLP in an interview with website HR Dive. “Because people are so connected and working even when they’re technically off, they tend to take fewer full vacation days. So even if you cap a vacation bank at 1.5 or 2 times the annual accrual amount, the payout at the end of the employment relationship can still be significant.” And just to note, not all states require employers to pay out accrued vacation.
Recognizing that this is a large financial obligation, many companies are relieving themselves from these obligations by offering unlimited policies.
Employees also can’t save or accrue “unlimited” vacation time to use next year. When it comes time to transition from the company, the employer has no obligation to pay out the extra hours of productivity that were used in lieu of taking a break.
According to outplacement firm RiseSmart, an unlimited PTO policy “significantly reduces the costs of having to pay employees for unused PTO and may be one of the most compelling factors for companies considering an unlimited PTO policy.”
Unlimited vacation is a work-around, plain and simple. By offering this perk, companies get away from tracking and accruing a liability that in some states, once accrued, is considered earned wages. And once wages are considered earned, they must be paid out at departure or termination.
Less Time Off for Employees
Some studies show that American employees today often end up taking little or no more time off in an “unlimited” system compared to when they have a set number of days off each year.
In a study by HR platform Namely, research suggests that employees with “unlimited” vacation actually take fewer days off (13) on average than those with a limited number (15).
Unlimited PTO Is No Win-Win for Today’s Talent
Unlimited PTO sounds generous on a job description, but employees by and large end up getting paid less with no value attributed to their PTO while companies gain more of their employees’ productivity.
This latest benefits trend is harming the workforce and leading mass groups of employees to forfeit the second most important job benefit with no way to monetize or reutilize the value of their PTO.
Companies need to ask if they’re making these changes for employees or for their bottom line. If, let’s say, employees are using 100 percent of their PTO and a company wants to decrease expenses, then perhaps such a program makes sense. However, this is generally not the case today. Employees thus leave billions of dollars worth of unused PTO on the table.
Are benefits a meaningful way to attract, engage and retain employees? Absolutely.
Will unlimited PTO be a mainstay of the future of work? Absolutely not.
Instead of unlimited, employers — and talent — should be thinking in terms of flexible, diverse and portable benefits to mirror the workforce today.
“I plan to take it out as early as I can,” Beach said from her home in Arlington, Texas. “I don’t really know that much about Social Security, but I hear it’s going to go away.”
“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.”
“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.”
Employees also can’t save or accrue “unlimited” vacation time to use next year. When it comes time to transition from the company, the employer has no obligation to pay out the extra hours of productivity that were used in lieu of taking a break.