The Family Benefits Bundle: Caregiving

This section shares best practices and opportunities in employer-sponsored birth parent/maternity benefits and benefits for fertility, adoption and foster care.

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November 11, 2022

Employers can play a key role in retaining and supporting the well-being of employees with parenting and caregiving responsibilities, and bringing those who left the workforce back, by offering needed, inclusive benefits that support the diverse experiences of employees and their families.

Since the pandemic started, 56% of unpaid caregivers have experienced anxiety or depression (2.5 times the rate of the general population), and caregivers have 10 times the rate of suicidal ideation. And caregiving today, which impacts one in four millennials and one in five Gen Xers, is undermining financial well-being. Caregivers are leaving the workforce, reducing their work hours and not taking promotions, all of which could have long-term economic impacts, disproportionately for women. This section includes ways to support caregivers of elders, adult dependents and children with disabilities, as well as other family health management tools.

We really need to expand the definition of health to include life, because when life goes wrong health goes wrong.


Alexandra Drane, Business Group on Health's Podcast

Elder and Adult Dependent Care

Even before the pandemic, an aging population, delayed retirements and a shortage of qualified caregivers have resulted in many employees taking on new and additional caregiving responsibilities. Employer support can help employees balance their work and home lives and avoid burnout.

Table 5.1: Benefits to Support Caregivers

BENEFIT  LARGE EMPLOYER BENCHMARK
Caregiver support or navigation tools 67%
Implemented a caregiving communication campaign 37%
Caregiver Employee Resource/Affinity Group 44%
Access to a dedicated care coordinator 11%
Digital app/tool to support employees with elder and adult dependent caregiving responsibilities 45%
Care coordination/navigation services (e.g., navigating benefits, Medicare, Medicaid, SS) 38%
Allowance for disabled dependents older than 26 to be enrolled in employer health plans 62%
Elder and/or adult care subsidies 5%
Backup adult care 38%
Legal benefit that covers health care powers of attorney, living wills, will and trust planning, etc. 82%
Long-term care insurance for parents and grandparents 2%
BENEFIT  LARGE EMPLOYER BENCHMARK
Second opinion benefits for adult dependents 32%
Caregiver leave (beyond unlimited, PTO or sick leave) 35%
Bereavement leave  100%
Grief counseling/coaching 60%
Training for managers and/or peers on supporting grieving employees 25%
Palliative care benefits 15%
Flexible work hours 78%
Flexibility to reduce work hours while maintaining benefits 34%
Onsite EAP  35%
Telephonic EAP  96% 
Teletherapy  88%
Digital cognitive behavioral therapy programs  36%
Sources: 2021 Family Benefits Quick Survey, 12th Annual Employer-Sponsored Health & Well-being Survey, 2021 Large Employers’ Leave Strategy and Transformation Survey, 2020 Supporting Employees with School-Aged Children During the Pandemic Quick Survey, Caregiving and Family Support Survey

Children with Disabilities or Unique Needs Care

Globally, approximately 93 million children live with disabilities, and those caring for them face numerous challenges.1 The caregiving responsibilities of these employees often impact work (e.g., passing up promotions, reducing hours) and well-being. The cost of caregiving caused roughly half the 16.8 million Americans caring for children with disabilities to reduce their savings for retirement or other major expenses, like education for other children.2

Table 5.2: Benefits for Caregivers of Children with Disabilities

BENEFIT  LARGE EMPLOYER BENCHMARK
Caregiver Employee Resource/Affinity Group 52%
Access to a dedicated care coordinator 38%
Navigation support to find specialists for children with disabilities 52%
Digital app/tool to support employees with children with disabilities or unique needs 24%
Access to specialty practitioners 46%
Care coordination/navigation services (e.g., navigating benefits, Medicare, Medicaid, SS, etc.) 36%
Allowance for disabled dependents older than 26 to be enrolled in employer health plans 86%
Access to diagnostic tools to identify development delays and behavioral health conditions early (e.g., for autism, ADHD, anxiety) 15%
BENEFIT  LARGE EMPLOYER BENCHMARK
ABA therapy coverage 77%
Mental health support 81%
 Access to pediatric behavioral health care 22%
Backup care 48%
Second opinion benefits 73%
Caregiver leave (beyond unlimited, PTO and sick leave) 35%
Flexible work hours 78%
Flexibility to reduce work hours while maintaining benefits 34%
Financial planning to set up a special needs trust 33%
Sources: 2021 Family Benefits Quick Survey, 2022 Large Employers' Health Care Strategy and Plan Design Survey12th Annual Employer-Sponsored Health & Well-being Survey, 2021 Large Employers’ Leave Strategy and Transformation Survey, 2020 Supporting Employees with School-Aged Children During the Pandemic Quick Survey, Caregiving and Family Support Survey

The Employer Role: Intervention and Inclusion

According to Fidelity Investments, the landscape for families with children with autism is changing. Early intervention is leading to better outcomes for children, and research shows early diagnosis and effective intervention costs are fully offset after 2 years of starting intervention. New savings options, like ABLE accounts and special needs trusts, are bolstering financial security. And inclusive work environments are driving change, such as the 50+ large U.S. employers with autism-specific hiring initiatives. Fidelity suggests that employers foster an inclusive workplace, strengthen the value of their current plan with education and resources for early screening and interventions services, review plan design regularly, and make educational outreach a priority. To learn more, review Fidelity’s Aging out: What does growing old with autism look like?.

The Impact of Caregiving on Work and Well-being

Only one in four employers (27%) in 2021 believe they have programs and policies in place to effectively support employees with caregiving responsibilities, a decrease from two in five in 2020.6

Who's Leaving the Workforce and Why?

One in three caregivers left a job due to unmet caregiving responsibilities, and highly titled, highly paid employees are most likely to leave a company because of work-family conflict.7 What’s more, the costs associated with turnover alone can run as high as 213% of an employee’s salary.8

According to McKinsey’s Women in the Workplace 2020, the following factors are predictive of whether an employee considers downshifting or leaving:

  • Lack of flexibility at work;
  • Feeling like they need to be available to work at all hours, i.e., “always on”;
  • Housework and caregiving burdens due to COVID-19;
  • Worry that their performance is being negatively judged because of caregiving responsibilities during the pandemic;
  • Discomfort sharing the challenges they are facing with teammates or managers;
  • Feeling blindsided by decisions that affect their day-to-day work; and
  • Feeling unable to bring their whole selves to work:
    • Mothers are more likely than fathers to worry that their performance is being negatively judged,due to their caregiving responsibilities.
    • Black women are more likely than women and men overall to feel like they can’t bring their whole selves to work.

Productivity and Career Goals

Productivity IconMore than 80% of employees with caregiving responsibilities said it affected their productivity; in contrast, only 24% of employers responded that caregiving influenced workers’ performance.7 Furthermore, 33% of caregivers report that their caregiving responsibilities lead to setbacks in their career or work goals. 9

Time

Time iconCaregivers are spending an average of 24 hours per week on caregiving tasks.10 One in five millennial caregivers spend 40 hours per week or more.11

Gender Disparities

Gender Disparities IconWorking female caregivers spend, on average, approximately 60% more time caregiving for aging loved ones, compared to their male counterparts, and women are three times more likely to retire earlier than expected to become a caregiver.15

Well-being and Mental Health

Mental Health IconCaregivers are twice as likely to develop chronic illness and 49% experience exhaustion, 27% stress on marriage/relationship and 60% are overwhelmed by financial stress.12,13,14 Furthermore, caregiving takes a toll on mental health, with 70% of caregivers reporting adverse mental health symptoms—55% reported anxiety or depression, 32% reported passive or serious suicidal thoughts. The effects are even worse for sandwich caregivers, those caring for people under and over 18, with 52% reporting serious suicidal thoughts, 12 times the rate of nonparents/noncaregivers.14

Racial Disparities

No racism Icon

Latinx families are significantly more likely to take care of a loved one than Black or White families. Black and Latinx caregivers are in high-intensity care situations more often than either White or Asian caregivers. During the pandemic, Black and Latinx families experienced a greater increase in time spent on care than White families.15

Income Disparities

Income Icon

Caregivers with higher incomes report significantly higher levels of health. Those with lower incomes are in high-intensity situations more often, provide greater hours of care weekly and feel less supported by their employers.16

Merck's Caregiving Success

When Merck implemented a comprehensive caregiving solution, they found that 88% of those who used the benefit reported better engagement and less stress at work, 65% reduced missed meetings and workdays, and 60% saved more than 10 hours of time.

Serious Conditions and Other Family Health Management Concerns

Working parents and caregivers, especially women, often have the second shift of managing their family’s health and well-being, from the daily nutrition, routine physical exams and immunizations to serious, and sometimes life-threatening, chronic condition management.

Table 5.3: Benefits for Family with Serious Conditions and Other Family Health Management

BENEFIT  LARGE EMPLOYER BENCHMARK
Medical decision support/second opinion services 73%
Employee advocacy tools/services for claims assistance (e.g., bill play, claims resolution) 79%
High-tough health concierge services (e.g., full-service program that helps employees navigate the health care system) 58%
Steerage to high-quality care for:  
          Bariatric Surgery 58%
          Cancer 53%
          Cardiovascular/cardiac 32%
          COVID-19 long-hauler 5%
          Kidney disease  17%
          Mental health and emotional well-being  28%
          Musculoskeletal conditions/procedures  64%
          Substance use disorder  34%
          Transgender health 11%
Centers of Excellence (COE)   
          Bariatric surgery  69%
          Cancer  50%
          Cardiovascular/cardiac  46%
         Long COVID 9%
          Mental health  32%
BENEFIT  LARGE EMPLOYER BENCHMARK
          Musculoskeletal conditions/procedures 47%
          Substance use disorder 34%
          Transgender health 27%
          Transplants 72%
Travel to and from COEs paid for employees and family members 49%
Lodging paid for employees and families during treatments at COEs 43%
Emergency relief fund 36%
COVID vaccination education 70%
COVID vaccines available to employees and family members through employer  21%
Other vaccination education  43%
Mental health supports (e.g., EAPs, virtual mental health services) available to dependents under 18  91% 
Access to providers with pediatric mental health expertise at no or low cost  32%
On-site or near-site clinic available to dependents (including children)  17%
Obesity screenings, treatments and visits with dietitians for children/adolescents 49%
Financial incentives for spouses/partners for health and well-being  45%
Sources: 2021 Family Benefits Quick Survey, 12th Annual Employer-Sponsored Health & Well-being Survey, 2021 Large Employers’ Leave Strategy and Transformation Survey, 2023 Large Employers' Health Care Strategy and Plan Design Survey

Recommended Business Actions to Support Childhood Vaccinations

According to a World Health Organization (WHO) survey, more than a third of responding countries report disruptions in their routine immunization services due to the COVID-19 pandemic.16 Employers have an essential role to play in supporting working parents and reducing barriers to getting eligible children and dependents vaccinated. Here are recommended practices from the Health Action Alliance and American Academy of Pediatrics:

  • Offer paid time off or flexible scheduling
  • Help schedule vaccine appointments or provide access to vaccines for eligible children and dependents (e.g., free or discounted childcare while parents with multiple children attend vaccine appointments, transportation benefits)
  • Reinforce (and make sure) COVID-19 vaccines are free for employees and their families
  • Plan an on-site COVID-19 vaccine clinic open to all employees and their families
  • Offer modest incentives to encourage working parents to vaccinate eligible children

Learn more about recommended actions, key messages and sample communications by exploring Resources to Help You Take Action: Business Action on Childhood Vaccinations and the Business Group’s National Immunization Awareness Month: Addressing Gaps in Child Immunizations blog.

Taking on the Obesity Epidemic

New data and research are upending traditional thinking about weight and weight loss and informing new ways to address the escalating obesity epidemic. Whether obesity affects an employee or a family member, it can take a toll on their well-being. For employers seeking to align their weight management strategy with the latest evidence, the Business Group’s Practical Playbook: Managing Overweight & Obesity offers recommendations for creating a comprehensive benefits package to treat obesity, including behavior-based interventions and pharmacological and surgical treatment.

Meeting the Mental Health Needs of Kids and Teens

Seventy-one percent of parents believe the pandemic has taken a toll on their child’s mental health, increasing the time, stress and energy they spend on caregiving.17 

According to the World Health Organization (WHO), half of all mental health conditions start before age 14, but unfortunately, most cases are undetected and untreated.18 Employers can support employees and their children by expanding provider networks, promoting easier access to virtual care and helping parents navigate the complex care system.

Below are specific employer recommendations:

  • Where possible, make mental health supports, such as EAPs and virtual mental health services, available to kids under 18 through health plans or standalone providers. Services that can be provided through text can be a good way to increase utilization by younger people.
  • Consider reducing or eliminating cost-sharing for mental health services, or specifically for pediatric mental health.
  • Push health plans to audit their mental health provider networks for pediatric mental health expertise. One large employer found that several of its in-network mental health providers actually had the ability to treat kids/adolescents but weren’t tagged as such in their provider directory.
  • Consider emerging vendors focused on kids’ mental health.
  • Communicate, communicate, communicate to employees about child and adolescent mental health and what benefits are available to support them.
  • Support parents and caregivers which can have a positive trickle-down effect on kids, because parents will then have more capacity to take care of their dependents without getting burned out in the office and at home.

To learn more, watch Nurturing Young Minds: Employer Support for the Mental Health Needs of Kids and Teens from the Business Group’s Mental Health Summit.

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TABLE OF CONTENTS

  1. Elder and Adult Dependent Care
  2. Children with Disabilities or Unique Needs Care
  3. Serious Conditions and Other Family Health Management Concerns