Workplace Policy Solutions Needed for Working Family Caregivers

AARP released a report this week called Keeping Up with the Times: Supporting Family Caregivers with Workplace Leave Policies that shines a light on the number of working family caregivers and offers three policy solutions to help working family caregivers.
According to the report:

• close to three out of four women of prime caregiving age are in the workforce;
• 74% of adults with eldercare responsibilities have been in the workforce at some point in their caregiving;
• one in four retirees reports leaving the workforce earlier than planned to care for an ill spouse or other family member;
• one in five workers age 45 to 74 expects to take time off for caregiving in the next five years.

Policies to support better workplace benefits for families have traditionally limited their focus to an employee’s illness or to caring for children or other immediate relatives, the report notes. The Family and Medical Leave Act limits leave for caregiving for elderly relatives to parents or spouses, effectively excluding those caring for in-laws, grandparents, or aunts and uncles. In addition, because FMLA leave is unpaid, it is irrelevant to many low-income workers. It is also totally unavailable to those working for small companies with fewer than 50 employees. Nearly two-thirds of workers eligible for FMLA who didn’t take it reported they couldn’t afford to take unpaid leave or were afraid of losing their job. Many other low wage workers lack access to sick leave—paid or unpaid – the only other supportive workplace policies available to most family caregivers.

A number of other states and municipalities have established programs or regulations that enhance federal or workplace leave policies for caregivers, including:

• New Jersey, which enacted a family leave insurance program that provides benefits to family member caring for a child, spouse parent or domestic partner.
• The Rhode Island General Assembly, which is considering similar legislation, according to a recent AP story.

Keeping Up with the Times notes that paid family leave enhances employee loyalty, saves businesses the cost of turnover and can improve productivity as well as reduce employer health care costs.
Finally, Keeping Up with the Times: Supporting Family Caregivers with Workplace Leave Policies recommends a series of approaches to improve options for caregivers, among them:

• Expanding relationships covered by the Family and Medical Leave Act,
• Adoption of policies at the state level that exceed current federal eligibility requirements for the FMLA,
• Optimizing worker productivity and retention at both the federal and state level by promoting access to paid family leave insurance.,
• Public awareness campaigns to educate workers about existing family leave policies,
• Employer implementation of family-friendly workplace policies, e.g., caregiver support programs in the workplace, referral to supportive services in the community and flexible workplace policies,
• Improved data collection on working caregivers with eldercare responsibilities, especially by federal agencies, and
• Further policy research into the interaction of workplace caregiver policies and healthcare access.

Keeping Up with the Times is the third in a series of reports on caregiving and work from the AARP Public Policy Institute. Previous reports covered the challenges of juggling caregiving and work (Understanding the Impact of Family Caregiving on Work, and discrimination against caregivers on the job (Protecting Family Caregivers from Employment Discrimination.

What do you think of the report’s findings? And, do you agree with the suggested policy solutions?
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Why Listening Is a Caregiver's Secret Weapon

To listen fully means to pay close attention to what is being said beneath the words. You listen not only to the ‘music,' but to the essence of the person speaking.
- Peter Senge

"Real connections can't happen without effective listening," says Beverly Edgehill, president and chief executive of Partnership Inc. "Listening is more than hearing."

Listening is no passive state. We are never merely hearing someone else speaking. The way you listen changes the way someone else feels heard. The quality of your listening influences the way someone else interprets you.

Listening is an action. Your listening colors what you hear. What you listen for is a filter, limiting what you let in. Whether or not we know it, we are always actively listening for something. We may listen for someone to be critical, for their motives, or for their message. When in doubt, listen for a learning opportunity. Listen for what you can learn about your loved one or the healthcare professionals to shift the energy and outcome of a conversation, allowing it to move in surprising ways.

For instance, let's say you are caregiving for your mother who is chronically dissatisfied. You enter her room one day and she begins complaining, "That aide intentionally left my walker just out of reach!" You might write off to her bad attitude, if that is what you were expecting. Or you could listen for an underlying message. Could she be feeling lack of control over her life? You test it out by giving her a manual puzzle that she still is quite good at solving, and her attitude immediately shifts. Finally she has something she can do.

The way you listen can also shift the way someone feels about you. You can move a difficult conversation to constructive ground by cultivating a non-judgmental, compassionate, or learning listening. Take the time to ask yourself:

• What is important to this person?
• How would it feel to have their personality?
• What might have happened to have them speaking as they are?

Too often we rush to finish a conversation to get on to the next thing. Society gears us for quick communications. Our listening cannot keep pace. Move too quickly through caregiving and you may miss something important. You could overlook a chance to foster mutual trust in your healthcare team. You might miss your loved one's vague reference to a serious concern. You may lose an opportunity to let your loved one feel heard.

"Life is short so you have to move slowly," an old Thai proverb tells us. Slowly listen beyond anger. Slowly listen beneath judgment. Slowly listen for opportunities for learning and connection.


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The Adventure of Alzheimer's

It seemed to me that there were no adventures into the completely unknown left, nothing where you met challenges never before encountered.

During my career as a physician and especially during my fifteen years at Joseph's House (our hospice for the homeless), however, I began to recognize the last stages of death as a true adventure into the unknown—a frontier that never disappeared.

It's not that no one has ever died before, of course, but no one has returned to give us a map, so in our own dying each of us enters into the unknown.

Alzheimer's, too, is an adventure, the last stages of which are shrouded in mystery, and each of us with this disease will explore an unknown wilderness. There are lots of people who've gone this way before, of course. Of the 40 million US residents over age 65, almost five million have Alzheimer's.
And although I write this blog to dispel some of the mystery, ultimately neither will I be able to tell others what the last stages are like.

In a recent post on state of consciousness in Alzheimer's, I wondered whether I'll be conscious toward the end when I appear to be completely out of it and, if not, what it will be like.
We don't know.

My using the word "adventure" to describe my journey into the darkness might seem like a form of semantic denial, soft-peddling the likelihood of future suffering for me and people close to me.
I don't believe I'm in denial, but even if I were, does that change the reality that this process will be an adventure?

Perhaps we don't think of Alzheimer's as an adventure because we want happy endings and believe that the word "adventure" applies only to successful adventures, where the hero faces enormous dangers and suffering but eventually returns to tell the exciting story.
But what if the hero does not return from the mountain; or does, but without having reached the top; or does reach the top and returns, but emotionally scarred or physically damaged? Was it any less an adventure?

I'm grateful that I can still sense an excitement. Growing up, I felt cheated of uncharted territory. But each of us with this disease must explore it for the first time; each of us faces a unique adventure.

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