MN Leadership Council on Aging

1. MN Leadership Council on Aging . 2010 Policy Summit: Caregiving Policy in Minnesota December 7, 2010

2. Michele Fedderly Mark Hoisser Co-Chairs MNLCOA Welcome

3. MissionMinnesota Leadership Council on Aging The Minnesota Leadership Council on Aging (MNLCOA) coalesces the resources and power of consumer, advocacy, social and health service organizations, to advocate boldly for and achieve positive system changes for older adults and their families.

4. MNLCOA Member Agencies AARP Minnesota Aging Services of Minnesota Alzheimer's Association Minnesota -North Dakota Amherst H. Wilder Foundation Care Providers of Minnesota DARTS ElderCare Rights Alliance Lutheran Social Service of Minnesota • Mature Voices Minnesota • Minnesota Association of Area Agencies on Aging • Minnesota HomeCare Association • Minnesota Medical Directors Association • Minnesota Network of Hospice and Palliative Care • Senior Community Services • Volunteers of America of Minnesota

5. 2010 Summit Agenda • Break • Value of Informal • System of Caregiving • Research on Effectiveness of Caregiver Support • Reactor Panel • Legislative • Leaders • Businesses and • Employers • Caregivers • Participation Survey • Welcome & Introductions • MNLCOA Overview • Supporting Caregivers in Minnesota • Variety Stakeholder - Broad Perspectives • Public Sector - Funding and Needs • Caregivers – Personal Stories and Issues • Leaders in Service - What’s Possible

6. Defining the Challenge: Need for Caregivers and Their Relationship to Formal Services Jean Wood, Director, Aging & Adult Services, Department of Human Services and Executive Director, MN Board On Aging

7. Defining the Challenge: Need for Family Caregivers and Their Relationship to Formal Services 2010 MNLCOA Summit Jean Wood Aging and Adult Services, MN DHS Minnesota Board on Aging

8. Who are Minnesota’s Caregivers? Source: 2005 Survey of Older Minnesotans

9. Who are Minnesota’s Caregivers? Source: MN Behavioral Risk Factor Surveillance System

10. Many Faces of Caregiving Between now and 2035, all regions of the state will become more racially and ethnically diverse. Important differences exist regarding need for support, preferences for support and acceptance of support among caregivers from different race and ethnic groups.

11. Economic Value of Caregiving Source: AARP Public Policy Institute, 2007

12. Demographic Pressures Source: MN State Demographic Center, 2007

13. Demographic Pressures Source: MN State Demographic Center, 2007

14. Demographic Pressures Transform 2010 Baby Boomer Survey If faced with health change, most would seek assistance in their home from family, friends and/or agency. More than 1/3 expect to spend some time providing care for friend or family member by 2020.

15. Impact of Economic Downturn Economic downturn has caused caregivers to: Spend more of their own money and savings to cover caregiving expenses Move into same household as loved one Ask for time off less often to provide care Experience more stress in caring for their loved one Experience reduction in outside help

16. Our Challenge Today We must reach more family caregivers with targeted and individualized support so that they can maintain their role longer and healthier. Bring current evidence-based efforts to scale Support a portfolio of interventions Reach across the lifespan to maximize resources Maximize opportunity with health care reform

17. CaregiverPerspective David Foster, Spousal Caregiver

18. What’s New in the Caregiving World?? Recent Changes and Trends in Caregiving and Caregiver Support Dr. Ed Ratner, Moderator Dawn Simonson, Overview of MN Initiatives Krista O’connor, Eldercare Partners Susan Bulger, Evercare Caregiver Solutions

19. Caregiver Support Initiatives in Minnesota Overview of services delivered through Minnesota’s Aging Network

20. Decade of Development National Family Caregiver Support Program created in 2000 by Congress Older Americans Act Program Provided a policy framework and funds for services to support family caregivers, primarily of older adults Necessitated a paradigm shift to focus on caregivers Grounded in long-standing recognition of caregiver burden and need for respite

21. Caregiver Support – Service Development Policies Recognizes the tremendous value of family caregiving Strives to be person-centered, affordable and accessible First sliding fee donation policy incorporated Important to meet unique needs of diverse caregivers and their families Goal was to develop a network of support through a statewide, coordinated system

22. Minnesota’s Approach Minnesota Board on Aging and Area Agency on Aging service development and provider Network Services developed and subsidized by Older Americans Act funds. Most became available in the LTC Waiver menu. Some expansion of existing models of respite care, education and training Early focus areas included statewide awareness campaigns to spur caregivers to self-identify

23. Minnesota’s Approach • Core Services Developed • Information about available services and supports • Assistance in finding and arranging services • Education and Training • Coaching/consultation • Support Groups • Respite • Adult Day Services • Supplemental Services

24. Minnesota’s Approach By mid-decade, established Network began integrating innovative practice models and evidence-informed and evidence-based services Tailored Caregiver Assessment and Referral (TCARE) Translation of the Mittleman-New York University caregiver counseling and support intervention Powerful Tools for Caregivers Refined family caregiver coaching and counseling Adaptation of some services and supports for ethnic caregivers

25. For Information Dawn Simonson, 651-917-4602 dawn@tcaging.org Leanna Smith, 651-917-4653 leanna@tcaging.org www.tcaging.org

26. 2010 MNLCOA Summit Caregiving Policy in Minnesota Tuesday, December 7, 2010 Wilder Center 451 Lexington Parkway N. St. Paul, MN 55104

27. Changes & Trends in Caregiving & Caregiver Support – Provider Perspective Krista O’Connor Administrator Eldercare Partners krista.oconnor@darts1.org www.eldercarepartners.org

28. Key Historical Events

29. National Family Caregiver Support Program (NFCSP) • 2000 • Under Older Americans Act • Title III-E Funding • Area Agencies on Aging • Program Development for Family Caregivers

30. Metropolitan Caregiver Service Collaborative (MCSC) • December, 2002 • Title III-E Funded • 20 Organizations • Vision- Community will recognize, value and sustain the work of family caregivers. • Purpose • Share knowledge • Promote caregiver services • Strengthen public policy

31. National Caregiving Award • November, 2006 • National Alliance for Caregiving • MetLife Foundation • Innovation, Responsiveness, & Effectiveness • Caregiver Coaching Program

32. Evidence Based Research • November, 2006 • 9.5 Year Study • 406 Spouse Caregivers • Community Dwelling Patients w/Alzheimer’s • Six Sessions of Counseling • Support Group Participation • Ad Hoc Phone Support • 28.3% Reduction of NH Placement • Caregiver’s Satisfaction Key Component

33. Transform 2010 • June, 2007 • Five Themes Identified • #2 Theme: Supporting Caregivers of All Ages • Increase Supply & Types of CG Support • Increase Public Awareness

34. Caregiver Service Delivery • 2000 – 2010 • Title IIIE Funds • EW/AC Coverage • CS/SD Funding • TCARE National Demonstration Project • Minnesota Family Memory Care • Creative Partnerships • MSCS Provider Trainings

35. Barriers to Caregiver Support

36. Administrative Inefficiencies • Authorization Requirements • County Contracts • DHS Registration • MN-ITS & Claims Submission • Health Plans • Reporting Requirements • Reimbursement per Session

37. Lack of Awareness – General Population • Role of the family caregiver NOT recognized • Value and burden of family caregiving NOT recognized/understood • Effectiveness of caregiver support programs NOT recognized/understood • Messages must be heard several times • Messages must be reinforced by health care professionals, employers, community resources • Restricts private pay market

38. Lack of Awareness - Health Care & Other Professionals • Focus is on the patient • Disconnect between CG health and patient’s health • Limited contracts between health plans, counties, DHS • Limited referrals for caregiver support services • Benefits exhausted or not offered

39. MNLCOA Policy Proposal • Ensure Funding • Ensure Availability of Services • Increase Awareness • Address Administrative Inefficiencies

40. Questions?

41. 2010 MNLCOA Summit What’s New in the Caregiving World? • Employer and Employee Perspective Sue Bulger, Sr. Director Evercare Solutions for Caregivers UnitedHealth Care

42. How Caregiving Impacts Employers Bottom Line: Productivity Caregiving employees are costing U.S. businesses $33.6 billion per year in lost productivity Almost all caregivers made informal adjustments to their work schedule 84% phone calls 69% arrive late, leave early 67% time off during the day 29% make up work (evenings and weekends) 84% made at least one formal adjustment 33% decreased hours 22% leave of absence 20% moved from full to part time 16% quit job and 13% retired early Met Life Caregiving Cost Study: Productivity Losses to U.S. Business (July 2006) 42

43. How Caregiving Impacts Employers Bottom Line: Health Care Costs The average additional health costs to employers is 8%  more (or $13.4 billion annually) for employees with eldercare responsibilities Excess employee medical care costs associated with eldercare were higher among younger employees, males, and blue collar workers Excess Medical Costs reached almost 11% for blue collar caregivers and over 18% for male caregivers Eldercare may be closely associated with high-risk behaviors like smoking and alcohol consumption Younger caregivers (ages 18-39) demonstrated significantly higher rates of cholesterol, hypertension, chronic obstructive pulmonary disease (COPD), depression, and kidney disease, and heart disease, in comparison to non-caregivers of the same age. Employers need to: Recognize Respond Results = Reduced costs Met Life Study: Working Caregivers and Employer Health Care Costs (February 2010) 43

44. Findings from a Society for Human Resource Management Eldercare Survey Conducted in 2003 • The greatest impact of eldercare issues in the workplace: 1) absenteeism (partial and full days); 2) workday interruptions and 2) mental/concentrations issues (not being to focus on work). • 27% of HR professionals “agreed” and 5% “strongly agreed” that employers have an obligation to provide resources and assistance for employees facing eldercare issues. • Nearly half of HR professionals indicated that there has been an increase in the number of employees dealing with eldercare issues. • Only 11% of organizations train managers to help them understand and deal with employee eldercare issues.

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46. Key Findings Job Situation 46

47. Key Findings What Caregivers Are Sacrificing 47

48. Employees want… • Benefits that are relevant to their life-stage needs (46%) • Employer benefits objectives to align with Employee NEEDS Benefits Strategies for Engagement and Personal Responsibility; MetLife 2009.

49. Why Employers Need Eldercare Initiatives • Address the needs of aging workforce. • Decrease employee stress • Boost productivity • Support employee engagement and retention. • Reduce absenteeism and workplace disruptions. • Support Work/Life and “Great Place to Work.” • The total estimated annual cost of lost productivity to U.S. businesses from full-time employees who are caregivers ranges from $17.1 billion for those with intense caregiving responsibilities to a total of $33.6 billion, for all caregivers. Source: MetLife Mature Market Institute

50. Employer Recommendations:Integrated Eldercare Resources • Position existing programs & resources to improve accessibility: • Information and Education (online resources, seminars/webinars, resource library) • Benefit Programs (Dependent Care Assistance Program, Flexible Spending Account) • Paid or unpaid time off (family leave, personal leave, sabbatical) • Employee Assistance Program (Resource & Referral, emergency and back up dependent care, counseling services, Case Management) • Explore and/or add new programs • Voluntary Benefits (Long-Term Care Insurance, Group Legal, Critical Illness Insurance) • Life Event Leave –personal leave focused on caregiving needs • Work/Life Expos, Eldercare/Caregiver Resource Fairs • Support Groups • Leverage internal initiatives and programs • Health for Life (focus on health & well-being) • Flexibility (informal arrangements, telecommuting, reduced work schedule ) • Digital Health (technologies)