Benefits Column Benefits Lessons from My Mother

There are several practical things HR leaders can do to help employees reflect on life's death and dying phases -- both their own and the lives of those they love.

Monday, May 6, 2013
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My mom died.

I'm sharing this information with you for several reasons; the primary being that my mother was an educator and encouraged me to talk about any lessons I learned from her experiences. I've used her permission with carte blanche over the last decade or so. And since I've entertained audiences with vignettes from my mom's life, I figured I should equally inform people with the stories associated with her dying.

As coincidences sometimes happen, I became more motivated to discuss my observations due to a question I was asked. In the midst of my mom's last few weeks, Bob Cochrane interviewed me about my viewpoints on health, wellness and prevention. He posed one question I did not anticipate: Should death be part of the conversation about health?

I answered, "Yes," and recognized it was time to take what is often a private conversation and make it public.

I believe our discomfort with death allows politicians to use terms like "death panels" and prevents many from discussing the full spectrum of health -- what some call the "womb to the tomb" conversation. This discomfort is also why an audience hesitated when I asked them to stand up if they thought they would die someday. It was both a funny and poignant moment.

Let me assure you of something. We're all going to die. But as Elizabeth Kubler-Ross wrote in On Death and Dying, "In simple terms, in our unconscious mind we can only be killed; it is inconceivable to die of a natural cause or of old age."

The employee-benefits lessons I've learned from my mother fall into two buckets: my mom's personal benefits experience throughout her life, and what I've learned as a working person who was also my mother's primary support.

For the purpose of this column, I'll focus on my experience.

It starts with "the conversation."

As long as I can remember, my parents openly discussed how they wanted their lives to end. They weren't fatalistic. In fact, they were just the opposite. My mom and dad believed they would live reasonably long lives and were equally comfortable that at some point they would die. My parents explained how they wanted that part of their lives to play out.

Decades later, this information helped me tremendously when it was time to support my mom with the execution of her wishes.

There are several practical things HR leaders can do to help employees reflect on life's death and dying phases -- both their own and the lives of those they love:

*  Consider including death and dying as part of your company's health and wellness initiatives. As Cochrane suggested, death should be part of the health discussion.

*  Introduce employees to The Conversation Project -- an initiative "dedicated to helping people talk about their wishes for end-of-life care."

One of the best ways to get employees to consider this topic is to ask them if they've discussed this subject with their parents or siblings. Employees will often reflect on their own wishes during or following this exchange.

*  Offer caregiving workshops at least once a year. It gives workers a chance to think about the final phase of life.

As Kevin Sypniewski, president and CEO of AGIS and the AGIS Network explained in a prior column, most employees don't understand when they are in caregiver roles until they're two to three years into the process.

According to Sypniewski's surveys of more than 10,000 employees across all industries and demographics, 44 percent currently are or were recently in some caregiving stage. The average worker will spend four to five years doing it. It is better to speak with loved ones early in caregiving about their wishes -- if it wasn't done beforehand -- than in an intensive care unit.

Use the workshops as a way to discuss how caregivers may be neglecting their own health. Caregivers consume as many as 30 hours each week in the process of helping loved ones on top of their normal work and home obligations. Cooking meals, exercising and seeking preventive care aren't high priorities on their lists.

Finally, caregiving workshops are a great lead-in to effectively discuss long-term care insurance and asset-based long-term care insurance, including life insurance with a LTC rider.

Once caregiving education is part of an HR executive's overall health and wellness program, caregiver support takes on an important role.

It may be easy to think that all the boxes are checked in the support category if the employee assistance program offers eldercare and legal advice. But keep in mind that EAP utilization is extremely low in most companies. I led a four-year research project on EAPs and found usage ranged from 1 percent to 5 percent in most companies.

Geriatric care manager programs can provide a more detailed level of help around specific medical issues. However, much more is involved in the last stage of life.

For example, healthcare is expensive even when Medicare covers a loved one.

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If an employee's parent needs a brief period of care at a skilled nursing facility and either enters the inpatient service directly from home or a hospital with fewer than 72 hours as an admitted inpatient, the parent pays for the care out-of-pocket. Medigap policies largely do not cover SNF stays. If the parent's resources can't cover the bill - which easily total thousands of dollars - and she or he isn't Medicaid-eligible, the children often step in. Few employees have the $6,000 on hand necessary to pay for a three-week SNF stay.

There is no off-the-shelf solution to assist employees with the unexpected financing of their parents and loved ones' care and medical needs. Sypniewski related that these extra expenses often range from $10,000 to $30,000 every year. At one time it was possible to offer employees the option to purchase LTC insurance for their parents. This employee benefit essentially no longer exists.

I've spent time discussing strategies to address this concern with HR leaders. One suggested that an employer could establish a foundation from which employees could apply for a grant to cover all or a portion of the expenses.

Employers could also refer workers to a growing number of crowd funding sites - the majority of which list "medical, illness and healing" as the site's most popular category. The families of many victims from the Boston Marathon tragedy are turning to these crowd-funding efforts to cover mounting medical bills that insurance will not reimburse.

The unaddressed financial and emotional strain of caregiving on employees can have grim consequences. The Centers for Disease Control and Prevention recently released a disturbing report regarding the nearly 30 percent increase in suicide rates in Americans aged 35 to 64 years old.

The CDC's deputy director, Ileana Arias, noted in a related New York Times article that the higher suicide rates might be correlated to a series of life and financial circumstances, including the stress of caring for aging parents while still providing financial and emotional support to children.

HR leaders are uniquely positioned within corporations to initiate a public conversation with their executive team, health and wellness leaders and employees about death and dying. The outcome could push employee benefits design toward including life-stage factors into how we ultimately support our workers.

Carol Harnett is a widely respected consultant, speaker, writer and trendspotter in the fields of employee benefits, health and productivity management, health and performance innovation, and value-based health. Follow her on Twitter via @carolharnett and on her video blog, The Work.Love.Play.Daily.

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