Employer Elder Care Nutrition Toolkit – Benefits for Employers

Therapeutic Nutrition Toolkit –
Benefits for Employers

Click on the headers below to expand the sections.


A Focus on Caregiving and Mature Workers

Click on the main headings below to learn more about the business benefits of supporting caregivers and mature employees in your workplace. You can download tools to help establish and maintain a successful therapeutic nutrition program for caregivers and mature workers. The Family Medical Leave Act is also explained because some states have extended this mandate to include even small businesses.

Caregiving as a Second, Full-Time Job

In the U.S. today, families are the primary providers of long-term care in their own homes and communities and providing care for older family members has become a way of life for millions of Americans.

  • 61% of homebound older adults depend on family caregivers.1
  • 1 of every 4 U.S. households is involved in elder care.2
  • 2/3rds of family caregivers also work.1
  • 1 in 6 American workers are caregivers.3
  • The segment of the population that is most in need of care (those aged 85 years and older) is also the fastest growing of any age group.4
  • 42% of American employees provided elder care for at least 1 person between 2003 and 2008.
  • Among those who provided care while working between 2008 and 2013, nearly half (44%) cared for ore than one person.
  • 49% of employees expected to provide care between 2008 and 2013.

Caregiving itself can be a full-time job. The combination of planning for care (including finding financial and legal help), providing hands on care (including medical treatments and shopping for/preparing meals), and managing medical care (including scheduling and providing transportation to healthcare appointments) can more than fill a caregiver’s day. Add to this the responsibilities of a full- or part-time job, and it is easy to understand why 29% of employed caregivers report needing support to keep up with their work and family responsibilities.1


Therapeutic Nutrition and Successful Caregiving

Many employers are now recognizing the myriad of issues associated with caregiving and are beginning to act. What is often missing in their programs is a focus on nutrition. Yet, nutrition significantly impacts an older adult’s health outcomes, and therefore ultimately influences getting caregiving employees back to work.

  • Positive health outcomes in many chronic diseases, such as diabetes mellitus, heart disease, renal disease, and obesity, are in large part determined by compliance with diet/nutrition guidelines and the provision of nutrition as therapy.
  • For older adults and those battling serious illness or chronic disease, poor nutrition or malnutrition can result in the loss of lean body mass, leading to complications that impact a broad range of health outcomes, from reduced recovery from surgery/disease to increased risk for falls.
  • Good nutrition can lead to an up to 56% reduction in overall complications, like infections.5
  • Good nutrition has also been documented to lead to an up to 50% reduction in avoidable readmissions.6

The increased health problems caused by inadequate nutrition make it more difficult for family members to successfully manage their dual roles as caregivers and employees.


Workplace Support for Caregivers and Mature Workers

When employees focus on their own nutrition and the therapeutic nutrition needs of their care recipients, health outcomes are improved, which ultimately influences getting caregiving and mature employees back to work.

Nutrition plays an important role in reducing the common caregiver burdens such as their own increased risk for chronic disease, emotional stress, and physical strain.


References

  1. 1 National Alliance for Caregiving and AARP: Caregiving in the U.S. 2004.http://www.caregiving.org/data/04execsumm.pdf
  2. 2 Kempthorne D: A Message from the Chairman. National Governors Association. A Lifetime of Health and Dignity Confronting Long-term Care Challenges in America Initiative, 2004.http://www.subnet.nga.org/ci/message.html
  3. 3 Witters D: The cost of caregiving to the U.S. economy. Gallup Business Journal, Dec 1, 2011.http://businessjournal.gallup.com/content/151049/cost-caregiving-economy.aspx?version=print
  4. 4 Werner CA: The older population: 2010. 2010 Census Briefs. U.S. Department of Commerce Economics and Statistics Administration, U.S. Census Bureau, Nov 2011.http://www.census.gov/prod/cen2010/briefs/c2010br-09.pdf
  5. 5 Stratton RH, Green CJ, Elia M. Disease-related Malnutrition: An Evidence Based Approach To Treatment. Wallingford: CABI Publishing; 2003.
  6. 6 Norman K et al. Three month intervention with protein and energy rich supplements improve muscle function and quality of life in malnourished patients with non-neoplastic gastrointestinal disease-a randomized controlled trial. Clin Nutr, 2008;27(1):48-56.

Resources and Tools

Click on the headings below to expand them, and learn more about the Federal Medical Leave Act and how to access tools and resources to help you establish a successful program emphasizing therapeutic nutrition for caregivers and mature employees in your workplace.

How Do I Learn More About the Federal Medical Leave Act?


Where Do I Find Information on the U.S. Equal Employment Opportunity Commission’s (EEOC) Guidance?

Are There Model Employer Caregiver Programs and Resources Available and How Do Such Programs Link to My Employee Assistance Programs?

Center for Medicaid and Medicare Services: When Employees Become Caregivers A Manager’s Workbook, 2004.

The National Governor’s Association through its Health and Dignity Task Force reports that some “states including Delaware, Oregon and Texas encourage employers to develop corporate eldercare programs for their employees by holding statewide or regional conferences that bring together state agencies, advocacy organizations, providers and corporations to discuss employed caregiving issues.”

This is an on-line resource center from the University of Wisconsin-Madison, for employers on balancing work and eldercare.

National Business Group on Health: Impact of Advanced Illness on the Workplace: What Employers Need to Know, 2011.

National Alliance for Caregiving: Best Practices in Workplace Eldercare, March 2012.

Dembe AE, Dugan E et al: Employer perceptions of elder care assistance programs. Journal of Workplace Behavioral Health, 2008;23(4):359-79.


How Do I Set Up a Program Emphasizing Therapeutic Nutrition for Caregivers and Mature Workers?

  • Read and learn about different Employer Perspectives in the Company Successes section.

How Do I Communicate My Program to Employees?

How Do I Measure the Success of My Program?


Resources and Tools

Cost Issues

Therapeutic Nutrition

Statistics on Aging

Home and Community Care

Long-term services and supports (LTSS): National Council on Aging www.ncoa.org leads a national coalition of aging and disability organizations, called the Friday Morning Collaborative. It is working to protect LTSS for those who need it. The national Affordable Care Act has provisions that make it easier for people to access LTSS. Below is a list of LTSS programs:


Resources for Employers

Where to Find Information and Resources

Federal and State Family Medical Leave Laws

The Federal Family Medical Leave Act (FMLA) of 1993 provides for up to 12 weeks of unpaid leave during a 12-month period for employees who have family care issues, including the need to:

Care for a family member (spouse, son, daughter, or parent) with a serious health condition; or

  • Care for one’s own serious health condition.
  • The U.S. Department of Labor’s Fact Sheet #38 outlines the federal employer requirements under FMLA.

Additional information on the federal law is available at the U.S. Department of Labor’s Wage and Hour Division website and from the toll-free information and helpline, available 8 am to 5 pm in your time zone: 1-866-4USWAGE (1-866-487-9243).

The National Conference of State Legislatures website summarizes current federal and state laws on family medical leave. The FMLA allows states to set their own standards that are more expansive than the federal law. Many states have chosen to do so and both California and New Jersey offer paid, or partially paid, family and medical leave.

U.S. Equal Employment Opportunity Commission Guidance

In 2007, the U.S. Equal Employment Opportunity Commission (EEOC) issued guidance “explaining the circumstances under which discrimination against workers with caregiving responsibilities might constitute discrimination based on sex, disability, or other characteristics protected by federal employment discrimination laws.”

In 2009, EEOC issued a document to supplement the guidance, “providing suggestions for best practices that employers may adopt to reduce the chance of EOE violations against caregivers and to remove barriers to equal employment opportunity.”

Caregiver Programs, Employee Assistance Programs, and Other Resources


Employer Educational Materials and Resources

Cost Issues

Therapeutic Nutrition

Statistics on Aging

Home and Community Care

Long-term services and supports (LTSS): National Council on Aging (www.ncoa.org) leads a national coalition of aging and disability organizations, called the Friday Morning Collaborative. It is working to protect LTSS for those who need it. The national Affordable Care Act has provisions that make it easier for people to access LTSS. Below is a list of LTSS programs:

  • Money Follows the Person MFP gives states an enhanced federal Medicaid match to help people transition from a nursing home or other institution back into the community.
  • Balance Incentive Payments Program Eligible states can apply for federal grants to direct more funds to community-based care instead of institutions.
  • Community First Choice Option States can choose to provide a broad range of personal attendant services and supports to eligible individuals and receive additional federal funding.
  • Medicaid HCBS State Plan Option States have gained greater flexibility with this Medicaid state plan option thanks to health reform.

Talking Points and Considerations for Employers
“In the 1980s, American businesses adapted their human resource policies to accommodate the needs of workers with young children. Now, many of those same workers face a new responsibility: providing care for an older parent, relative, or friend.”1

Who is the Typical Working Caregiver?

In the U.S. today, families are the primary providers of long-term care in their own homes and communities. Providing care for older family members has become a way of life for millions of Americans as an estimated 61% of homebound older adults depend on family caregivers.2 Their care recipients may have recently moved in with them, may be just down the street, or live thousands of miles away. And the population segment most in need of care, those aged 85 years and older, is also the fastest growing of any age group.3

Recent research by Gallup found that caregivers are represented in each demographic group, with 17% of working whites, 21% of working blacks, and 20% of working Hispanics providing care. The research also showed a correlation between income, education, and caregiving. Specifically, as income and education levels increased, the propensity for an employee to also be a caregiver decreased.4

While typically employee caregivers have been in their mid-40s and thus more seasoned employees, the demographic trend of an increasingly older population means a greater number of employees of all ages and levels of experience will be taking on the role of family caregiver. And it is not just women who are in caregiving roles, combining full-time work and eldercare is becoming much more common for men too.


Who is the Typical Mature Worker?

Today, not all older adults are retirees. Increasingly, mature workers, those aged 55 years and older, are making up a greater percentage of the workforce. New findings from the Employee Benefit Research Institute showed there was a higher percentage of people age 55 and older (40.2%) in the work force in 2010 than ever in the last 35 years, even after the 2008-2009 recession.5 For many, it is a necessity to continue to work full- or part-time to be financially independent and more secure.

While a disability can arise at any age, the likelihood of having a disability increases with age. Reported rates of disability double from 19.4% for ages 45 to 54 to 38.4% for ages 65 to 69.6 Mature workers’ greater vulnerability to chronic diseases, such as diabetes, cancer, and heart disease, as well as acute problems such as the flu, pneumonia, and infections, can often be lessened by better attention to nutrition.


What Role Does the Employer Play?

Employees are often at a loss as to how to deal with the potentially overwhelming responsibilities of caregiving. The combination of planning for care (including finding financial and legal help), providing hands-on care (including medical treatments and shopping for/preparing meals), and managing medical care (including scheduling and providing transportation to healthcare appointments) can more than fill a caregiver’s day. Add to this the responsibilities of a full- or part-time job, and it is easy to understand why 29% of employed caregivers report needing help fulfilling their work and family responsibilities.2

It is not surprising then that the employer is one of the “key places” employees turn to when a caregiving episode occurs. Your Employee Assistance Program and workplace flexibility options may already provide employees with resources and support to be both reliable employees and attentive caregivers. Providing access to a therapeutic nutrition resources or programs that help caregivers keep their loved ones well-nourished, can further lighten the load by decreasing the likelihood of medical complications.


Understanding Your Employee’s Unspoken Concerns

Understanding your caregiving employees’ and mature workers’ concerns will help you better address their issues. Many employees may be afraid to share personal caregiving information with managers for fear of discrimination. Workers, particularly those in lower-wage and hourly positions, may hesitate to ask for the flexibility and support they need as caregivers or to attend to their own chronic health issues, because they are concerned:

  • Asking for time off or flexible hours to accommodate their caregiving responsibilities or health issues will jeopardize their job, limit promotion opportunities, or lead to a cut-back in their hours.
  • Handling caregiving phone calls at work will take too much time away from work or be viewed negatively by co-workers and supervisors.
  • Bringing up “family matters” in the workplace is just not done—particularly when it involves sharing sensitive medical, financial, and family relationship information.

Communicating to your employees the support your organization offers before a caregiving episode emerges is the first step in creating a caregiver-friendly workplace. If employees are aware of the available options they are more likely to use them and consider the organization a potential source of support. When an employee first becomes ill or begins providing care, take time to talk and listen to their perspective. Many of the complications of combining work and caregiving can be resolved when employees can constructively discuss challenges with employers and look for mutual solutions. Address performance concerns in an open and honest way and consider using coaching instead of corrective actions.

Workplace flexibility can have a great impact on caregiving employees in how they perform and how they feel about their caregiving responsibilities and their commitment to their employer. In interviews conducted by Families and Work Institute, the three most common wishes among caregivers were:

  • greater schedule flexibility and options for managing time;
  • time off, especially paid time off, without having to use up vacation time; and
  • more understanding of their situation from management.

While each individual who is caregiving has different approaches to managing his/her situation, your engagement may help give caregivers the guidelines they need to set reasonable expectations with family members. For example, it could be helpful for a caregiver to tell their loved one,

“My boss said I can only use my personal phone on breaks—so I will be calling you once in the morning and once in the afternoon.”

Or the caregiver could say to a sibling,

“I can’t be gone as much from the office, so you’ll need to take Dad to his appointments some of the time.”


Providing Information and Support for Your Employees

Providing support for caregivers and mature workers with health issues may help keep employees on the job longer. Talk openly with your employees and let them know you value them as employees and people. Since you likely want to do whatever you can to keep good employees, let them know about available resources and explain temporary and ongoing adjustments you can or cannot make to provide workplace flexibility.

Caregiving employees may need more information about:

  • Their rights under federal law;
  • Your company’s Employee Assistance Program resources and flexible work options, and how they can be used to support caregivers; and
  • Free resources, referrals to more information, and federal, state and local hotlines and other information.

All employees need information about:

  • The benefits of therapeutic nutrition for recovering from an illness and staying healthy, whether they are providing care or have been ill themselves; and
  • Your company’s therapeutic nutrition program for caregivers and mature workers.
  • Currently, 41% of employers provide information about services for elder family members (Elder Care Resource and Referral). This is a significant increase from 29% in 2005 (2012 National Study of Employers).

Start the Conversation

Recognizing that employees, especially hourly employees who may be worried about their jobs, may not seek out answers to their unspoken concerns, supervisors may need to start the conversation. This may be a daunting prospect for managers who are not experts in therapeutic nutrition or are wary of intruding on an employee’s privacy. It is therefore important for employee orientations to mention how employees can tap into supports for caregiving and recovery from illness should they need it. Since caregiving can be intermittent or start well into an employee’s tenure it is important that they know about how to access support before they are too overwhelmed by caregiving and work responsibilities to seek out help.

When employees mention their caregiving needs or seem to be struggling with managing work and caregiving managers can explore whether accessing the organization’s therapeutic nutrition resources would help the employee succeed with the following conversation starters. Note that these conversation starters can also be included in wellness program emails and newsletters to help prompt an employee to start the conversation.

  • If you are caring for a loved one, check out the resources we offer that have information about how better to support them and lessen their chances for delayed healing with therapeutic nutrition.
  • Because you are new to the company, you might not be aware of our therapeutic nutrition program for caregivers. Let me know if you would like more information about it.
  • Nutrition is one of the most basic needs. If you could use help in arranging for meal delivery and therapeutic nutrition products for your loved one, our therapeutic nutrition program can give you more information, including local contacts and resources.
  • When you or a loved one have a serious illness you may have an unintended weight loss, which can:
  • Make it harder to recover from surgery and disease;
  • Make it more difficult to heal wounds;
  • Increase risk for infection;
  • Increase risk for falls; and
  • Decrease strength needed to take care of yourself.
  • You can tell someone is at risk for poor nutrition, if they:
  • Eat poorly or have lost their appetite;
  • Have chewing and swallowing problems;
  • Take multiple medicines;
  • Have had an unintended weight loss.
  • If a loved one or you yourself are recovering from a hospitalization or illness consider the potential need for therapeutic nutrition. Therapeutic nutrition is a good way for you to care for your own health or that of a loved one. Therapeutic nutrition cannot prevent health problems, but it may help reduce medical care, complications, and hospital stays.
  • When you are sick, your body needs extra nutrition as fuel. If you or a loved one does not have enough fuel, your body may break down the protein in the muscles and use that as fuel. This can leave you feeling weak. Therapeutic nutrition provides fuel to help keep muscles strong and help you recover more quickly.
  • Therapeutic nutrition can help other treatments work better and may cut down on the length of hospital stays and reduce costs. Some therapeutic nutrition products are created by nutrition specialists to help in the dietary management of specific health problems like cancer, kidney and lung disease, and other conditions. Be sure to talk to your loved one’s doctor or registered dietitian for more information. You can find an RD in your area by visiting the Academy of Nutrition and Dietetics at www.eatright.org and clicking on “Find a Nutrition Professional” or look in your phone book under “Registered Dietitians.” Another resource for finding diabetes and renal disease-specific resources, especially if insurance does not cover for nutrition counseling is Medical Nutrition Therapy from the Center for Medicaid and Medicare Services (CMS).
  • To learn more about therapeutic nutrition products for specific health problems and for a store locator, visit www.AbbottNutrition.com or call 1-800-227-5767 Monday through Friday, 8:30 am to 5:00 pm est. You also can chat live with a registered dietitian online at http://ensure.com/ask-a-nutritionist.

References


Basic Steps for a Successful Caregiver and Therapeutic Nutrition Program
  • How many employees are providing caregiving?
  • Screen for caregiving issues when employees are referred or self-refer to your human resources group.
  • Consider caregiver needs. For many caregivers, flexibility is their primary desire. Information, emotional support, and other types of tangible assistance (like support groups, financial and legal advisors) can be important too. A recent Gallup research poll highlighted how effective U.S. employers were in addressing caregiver needs and the hidden costs of caregivers missing work. While nearly three in four (72%) of employees have access to unpaid vacation that can be used for caregiving, less than half (46%) of U.S. workers who are also caregivers have access to support groups or health counselors who can answer any questions about providing care.1 Families and Work Institute has also published an employee guide to workplace flexibility that can help them consider the kinds of flexibility that would best support them in their roles as employee and caregiver: http://www.whenworkworks.org/downloads/workflex_employee_toolkit.pdf.
  • Build caregiving and therapeutic nutrition programming using existing Employee Assistance, Eldercare, and Workplace Flexibility programs and services as a foundation.
  • Programming ideas can include caregiver fairs and dependent care accounts.
  • Suggest caregivers can start by calling 211. 211 is an information and referral network developed and sponsored nationally by United Way and is available in larger cities and counties.
  • Suggest caregivers call the Eldercare Locator, 1-800-677-1116, which puts them in touch with their local Area Agency on Aging (http://www.eldercare.gov).
  • Consider training a key HR staffer to specialize in caregiving
  • Provide this staffer with resources to develop caregiving and therapeutic nutrition communications.
  • Contact the Aging and Disability Resource Center (ADRC) or the Area Agency on Aging (AAA) for support and resources for training.
  • Promote the Program
  • Measure Outcomes and Program Results

Needs Assessment Worksheet
Therapeutic Nutrition Tips for Your Loved One to Help Recovery
Nutrition is one of the most basic needs. When a loved one is sick, their body needs extra nutrition as fuel. If they do not have enough fuel, his/her body may break down the protein in muscles and use that as fuel. This can leave your loved one feeling weak and lead to weight loss, which can:

  • Make it harder to recover from surgery and disease;
  • Make it more difficult to heal wounds;
  • Increase risk for infection;
  • Increase risk for falls; and
  • Decrease strength needed to take care of yourself or your loved one.

If a loved one is recovering from a hospitalization or illness, consider the potential need for therapeutic nutrition. Therapeutic nutrition is the use of specific nutrients and food products in the right quantity to help manage a health problem. It provides fuel to help keep muscles strong and help speed recovery and is a good way for you to help care for the health of a loved one. Therapeutic nutrition cannot prevent health problems, but it may help reduce medical care, complications, and hospital stays.


In the Hospital

  • Be sure to talk to the doctor, nurse, or registered dietitian (RD) about any special nutrition needs and how therapeutic nutrition can help your loved one recover. You can also request a nutrition screening and assessment to help identify specific nutrition problems.
  • Often, when your loved one is in the hospital for surgery or other medical treatments, he/she may not feel up to eating very much. But a poor appetite will not help recovery. And this is not the time to lose weight—particularly since the weight loss is often muscle, not just fat!
  • If your loved one is losing weight, talk to the doctor right away and try to identify why your loved one is losing weight.
  • Maybe medications or medical therapies are decreasing your loved one’s appetite or digestion. Ask what changes can be made to help stimulate appetite and help with digestion.
  • Can your loved one easily chew and swallow? Talk to a dentist about how to treat mouth pain or chewing problems. Ask for a referral to a speech pathologist to help with swallowing problems (often called dysphagia)
  • Special diets needed to help treat chronic disease or medical problems may be limiting the foods your loved one really likes to eat. Talk to the registered dietitian about how your loved one’s special diet can be adapted to include the foods he/she most enjoys
  • Are there therapeutic nutrition products like Ensure or Ensure Plus that can be offered between meals to help increase nutrition?
  • Therapeutic nutrition can help other treatments work better and may cut down on the length of hospital stays and reduce costs. Some therapeutic nutrition products are created by nutrition specialists to help in the dietary management of specific health problems like cancer, kidney and lung disease, and other conditions. Be sure to talk to your loved one’s doctor or registered dietitian for more information.

At Home

  • What your loved one eats often affects how his/her body responds to treatment, so it is important to plan for your loved one’s nutrition.
  • At home, your loved one will not be seeing a doctor as often; be alert for signs of nutrition problems like the following and be sure to talk to your loved one’s doctor or health care professional when they occur:
  • Eating poorly
  • Change in appetite or digestion (may occur because of taking multiple medicines);
  • Chewing and swallowing problems; and
  • Weight loss: You may first notice this when your loved one’s clothes no longer fit.
  • When your loved one first arrives home from the hospital, it may be difficult for him/her to shop for and prepare food. Also, your loved one may not have the strength or appetite to eat very much at a meal. Here are tips to help increase his/her nutrition:
    • Plan small meals and snacks (don’t forget bedtime snacks) that are packed with nutrition—make sure everything your loved one eats has plenty of calories and protein.
    • Offer favorite foods and encourage him/her to eat something, even if just a few bites at a time.
    • Prepare and offer foods that are at the right consistency and temperature and look appealing.
    • Try to not have a lot of diet restrictions, if possible (talk to your loved one’s doctor or registered dietitian).
    • If you need to offer bland foods, give them flavor with spices.
    • Encourage drinking plenty of water and other fluids.
    • Offer therapeutic nutrition products, like Ensure or Ensure Plus, which can help supplement meals.
      Encourage daily activity and exercise if possible; this will help increase appetite.
    • Arrange company for meals—you or someone else can offer conversation and encouragement to eat.
    • When you are not there, make sure that the available food is easy to eat and prepare.
    • As your loved one recovers at home, you may no longer always be there to help with meals. Here are some tips to continue to provide good nutrition:
    • Shop for foods that are easy to prepare yet still packed with nutrition.
    • Make sure packaging is easy to open.
    • Provide therapeutic nutrition products, like Ensure or Ensure Plus, which can help supplement meals.
    • Consider hiring outside help: home health aides can shop for food and prepare meals.
    • The Eldercare Locator connects you to local services including home-delivered meals, transportation, community centers, etc., for older adults and their families. 1-800-677-1116 (toll-free) or http://eldercare.gov/.

Therapeutic Nutrition Can Help You or Your Loved One Heal
Click here to see a template of a break room poster that you can use to announce an upcoming meeting.

 

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