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

Michele Fedderly Mark Hoisser Co-Chairs MNLCOA Welcome

Mission Minnesota 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.

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 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 MNLCOA Member Agencies

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

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

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

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

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

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.

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

Demographic Pressures Source: MN State Demographic Center, 2007

Demographic Pressures Source: MN State Demographic Center, 2007

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.

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

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

David Foster, Spousal Caregiver Caregiver Perspective

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

Overview of services delivered through Minnesota’s Aging Network

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

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

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

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

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

For Information Dawn Simonson, Leanna Smith,

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

Changes & Trends in Caregiving & Caregiver Support – Provider Perspective Krista O’Connor Administrator Eldercare Partners

Key Historical Events Caregiving NFCSPMCSC National Award Research Transform 2010 Service Delivery

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

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

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

Evidence Based Research November, 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

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

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

Barriers to Caregiver Support Barriers Administrative Inefficiencies Caregiver Awareness Professional Awareness

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

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

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

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

Questions?

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

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

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

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

47 Key Findings What Caregivers Are Sacrificing

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.

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

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)

Tips for Developing an Eldercare Program Conduct an employee survey –Assess current and future needs of employees –Assess effectiveness of current programs Evaluate current Work/Life Programs –Reposition programs as part of eldercare and/or caregiving strategy (health and wellness, flexibility, etc.) Explore no-cost solutions –Voluntary Benefits –employees pay vs. employer –Host onsite events, fairs, seminars Leverage community and/or national partnerships –Explore programs and/or resources provided through local or national organizations

Making it Work Managers need to ENCOURAGE use of existing services –Elder care issues won’t go away PARTICIPATE in an open dialogue about challenges of eldercare –Employees need education on services EMBRACE flexibility in corporate culture

Caregiver Perspective Warren Wolfe, Parental Caregiver

Research on Effectiveness of Caregiver Support Joe Gaugler, Associate Professor/ McKnight Presidential Fellow at University of Minnesota

Presentation of Recommendations of Potential Changes to Public Policy on Family Caregiving and Caregiver Support Jeri Schoonover, Lutheran Social Services-MN

To protect and ensure current levels of funding for programs and services that support informal caregivers in their efforts to assist family, friends and neighbors to remain in their homes. Policy Objective:

Recommended Actions: Maintain current funding through the biennium. Assure continued state investment of match funds for caregiver services to assure continuing receipt of federal medical assistance funds.

Invest in an expanded, “statewide” caregiver support system to assure a full range of “core services” that are effective and sensitive to the diversity of caregivers to reflect the change in demographics. Policy Objective :

Recommended Actions: Encourage Minnesota State Agencies to work together in a planful way to develop a system that supports a diverse group of caregivers. Advocate for continued support of programs that support caregivers. Invest new funds to establish a Statewide Caregiver Coalition to develop new partnerships at the local and State levels with the purpose of presenting a coordinated approach to awareness building/ outreach, advocacy and service system development.

Recommended Actions:  Expand publicly funded service options to promote flexibility and consumer choice in service selection. Increase awareness and promote the use of services that support self-directed care, i.e. Fiscal Support Entities, Support Planners. Address administrative inefficiencies/barriers at the State level to increase flexibility for service providers which will enable caregivers increased access to services.

Recommended Actions: Promote “Communities for a Lifetime” which offers seniors home and community supports for aging in place, emphasizing the availabilities of the right services at the right time. These services would include caregiver support, encompassing adult day programs, evening and weekend respite options.

Promote caregiver friendly work environments in Minnesota in both the public and private sector (relates to the business community). Policy Objective:

Recommended Actions: Expand the approved use of existing sick leave benefits to include caregiving for adult son or daughter, spouse, sibling, parent, grand-parent, and stepparents both by passing legislation and encouraging employers to adopt these policies. Provide incentives to encourage adoption of flexible workplace policies to support family caregiving. Work with business community to share tools/information/best practices and policies.

Promote innovative service options and use of technology to maximize services which assist caregivers as they support older adults aging in their homes. Policy Objective:

Recommended Actions: Create incentives that support innovation and flexibility in the delivery of long-term care, to promote consumer choice, deliver better outcomes, and reduce cost. Create a technology inventory for caregivers including technologies used in the disability community to identify those with greatest impact/success. Maintain and promote funding within the public programs for the use/purchase of technology.

Reactor Panel to Potential Changes to Public Policy Warren Wolfe, Moderator Representative Diane Loeffler Representative Matt Dean David Foster, Caregiver Bill Blazer, MN Chamber Of Commerce

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Minnesota Leadership Council on Aging THANK YOU Summit Sponsors Amherst H. Wilder Foundation Minnesota Area Gerontalogical Educational Center (MAGEC) MN Leadership Council on Aging

Minnesota Leadership Council on Aging Speakers And Panelists Jean Wood, DHS David Foster, Caregiver Dawn Simonson, MAAA Krista O’connor, Eldercare Partners Susan Bulger, Evercare Caregiver Solutions Warren Wolfe, Star Tribune Joe Gaugler, Univ. Of Minnesota Rep. Diane Loeffler Rep. Matt Dean Bill Blazer, Chamber Of Commerce

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