Health Affairs Blog

Companies Must Approach Advanced Health Events As A Business Issue

Posted By J. Brent Pawlecki and Dan Morhaim  On April 16, 2014 @ 9:28 am In Aging,All Categories,Business of Health Care,End-of-Life Care,Long-Term Care,Policy | 

In the corporate world, every company has a chief financial officer charged with ensuring that the organization meets all tax and accounting mandates and to report the data to officers of the company, shareholders, employees and the general public.

Yet, while organizations expend great effort addressing these matters, many miss another opportunity to protect their employees’ well-being by failing to talk about end-of-life care.  Most companies consider advanced illness to be a private matter. But in fact, this hands-off approach most assuredly affects the financial health of any organization – and the emotional well-being of its workforce.

Beyond its direct impact on individuals’ health and well-being, advanced illness can take a heavy economic toll, including its effects on productivity, health and benefits costs, employee potential and engagement.  According to the MetLife Mature Market Institute study [2], the total estimated cost to employers for all full-time employed caregivers is a staggering $33.6 billion.  The average cost per employee for caregiving responsibilities ranges from $2,100 to $2,400.

Caregiving And Work Performance

The challenges of dealing with a loved one’s advanced illness also affects worker productivity. While almost all companies claim that their most valuable assets are their employees, most businesses have not yet fully recognized the impact of advanced illness on their employees’ performance.

Family caregivers provide more than 80 percent of long-term care services [2] in the United States (i.e., services for advanced illness), and more than 73 percent of those caregivers are employed [3] while caring for a family member.  As the population ages (“the silver tsunami”), this number will only continue to increase.

Further data [3] indicates that the percentage of adults with the dual role of caregiver/employee rose from 62 percent in 2005 to 69 percent in 2009.  These employees sometimes arrived late to work, left early, or took time off during the day to provide care.  A survey by one Fortune 500 corporation of its caregiving employees revealed that one in five were actively considering leaving the workplace because of their caregiving duties—a potential huge loss of talent.

In response to both the economic and emotional costs of dealing with advanced illness, some employers – such as GE, Goodyear, IBM, PepsiCo, and Pitney Bowes — have begun to address advanced illness as part of the normal course of life event planning along with help organizing college funds or retirement plans.  These employers incorporate the appropriate tools as part of their health and wellness offerings, and according to many employee surveys, their employees appreciate this recognition of reality.

Advance Directives

Research on advanced illness [4] issues indicates that when the time comes, we want to be at home, with family and loved ones, with our pain controlled, and we want to assure that our loved ones are not emotionally or financially devastated in the process.  Encouraging employees to complete an advance directive form is one simple step companies can take to help employees prepare to cope with advanced illness.

Advance directives provide a way for people to make known the values and choices that should inform their care and who should make medical decisions when they cannot. Advance directives protect individual rights and support families by easing decision-making during what is always a stressful time. These documents are free, straightforward, readily available, and legal in every state. And they are not just for “old people.” The three most famous end-of-life legal cases in the U.S. (Cruzan, Quinlan, Schiavo) involved people younger than 30.

Most people, when given a choice, prefer not to undergo extensive medical treatment that offers little or no hope of improving length or quality of life.  Yet, studies [4] show that only about one-third of Americans have completed advance directive forms, and the rate of completion is lower among minorities.  If instead completing an advanced directive was as commonplace as renewing a driver’s license or filing a tax return, our system could provide more personalized and humane medical care for far less money.

National Healthcare Decision Day

Every year, April 16 marks National Healthcare Decision Day [5], appropriately corresponding to the deadlines of tax season. This event provides a perfect opportunity for individuals and companies to begin the discussion about this challenging but important issue.

To some individuals, the thought of planning for a death may seem a bit macabre. In fact, it’s not planning that too often makes the macabre a reality for individuals and for their loved ones.

Employers cannot erase the tremendous challenges that employees face as caregivers or during a health crisis.  However, they can foster a positive and empowering environment that supports employees with the plans and tools that will help ease this burden.

Preparation is the key element, and there are numerous resources already available.  A wellness program that includes advanced illness and end-of-life care planning will enable employers and employees alike to prepare for the end of life.

Today, on National Healthcare Decision Day, businesses should take the lead. It’s the right and responsible thing to do, entirely consistent with sound management policies, and good for the well-being of their employees.

Related resources:

Article printed from Health Affairs Blog:

URL to article:

URLs in this post:

[1] April issue:

[2] MetLife Mature Market Institute study:

[3] 73 percent of those caregivers are employed:

[4] Research on advanced illness:

[5] National Healthcare Decision Day:

[6] The Conversation Project:

[7] The Coalition to Transform Advanced Care:

[8] It’s Always Too Soon Until It’s Too Late: Advanced Care Planning With Alzheimer’s:

[9] The Better End: Surviving (And Dying) On Your Own Terms In Today’s Modern Medical World:


Click here to print.