1. The Effect of Informal Caregiving on Work Productivity Erin Rand-Giovannetti, Jennifer L. Wolff, Ph.D., Kevin D. Frick, Ph.D., Chad Boult, MD, MPH, MBA Presented by: Erin Rand-Giovannetti 9:45am, June 9, 2008 Supported by the John A. Hartford Foundation, the Agency for Healthcare Research and Quality, the National Institute on Aging, and the Jacob and Valeria Langeloth Foundation

2. Background Majority of long-term care provided by families Informal caregiving may influence employment  Missed work time – Absenteeism  Reduced productivity – Presenteeism Measurement Issues  Limited generalizability  Lack of appropriate presenteeism/absenteeism measurement tool

3. Objectives: Validate a measure of work productivity loss due to caregiving Estimate the impact of informal caregiving on workplace productivity.

4. Methods: Study Sample Guided Care Study  308 Caregiver/Patient Dyads  Patients age 65+ in top quartile of risk of health service use 55% female Mean age = 79  Primary caregiver assists with health tasks 71% female Mean age = 61 45% adult children Mean hours of care a week = 25 61% helped daily

5. Methods: Work Productivity and Activity Impairment Scale (WPAI-CG) Are you currently employed?  40% yes During the past 7 days how many hours did you miss from work because of your caregiving?  1.5 hours (4.9% of work time) On a scale of 0 to 10, during the past 7 days, how did your caregiving affect your productivity while you were at work?  1.8 (18% reduction in work productivity)

6. Impact on Work Productivity in Past 7 Days No Impairment at Work (48%) Impacted by Caregiving at Work (52%) Productive Time Presenteeism (35%) Absenteeism (9%) Employed Caregivers Work Time 38% Productivity loss for impacted caregivers 20% Productivity loss for all employed caregivers

7. Impact on Regular Activities in Past 7 Days On a scale of 0 to 10, during the past 7 days, how did your caregiving affect your ability to do your daily activities? 60% reported some impairment 27% productivity loss

8. Validation of WPAI-CG Productivity Loss WorkRegular Activity Depressionr=.23 p<.05 r=.27 p<.001 Caregiver Strain r=.41 p<.001 r=.59 p<.001

9. Validation of WPAI-CG

10. 20% productivity loss National Impact Patients with no caregiver 6.1 Million Non-employed caregiver 1.9 Million Employed Caregiver 1.3 Million Productive Time Absenteeism 5% Presenteeism 19% Equivalent to 250,000 Full Time Employees Lost per Week Policy Level All High-Risk Medicare Patients 9.3 Million (25% of 37 Million) Employer Level Work Time of Caregivers to High-Risk Medicare Patients

11. Caregiving vs. Chronic Illness ConditionLost Work Time Lost Work Productivity Lost Regular Activity Productivity Caregiving5%14-28%21-33% Allergic Rhinitis020-40%20-50% IBS2.9-4.3 %21-32%24-41% GERD6%23%30% Chronic Hand Dermatitis 4%29%34% Panic1.9%26-29% Asthma2.4%14-28%21-41% Nocturnal GERD1.4%25.9%40.2%

12. Conclusions The WPAI-CG is a valid for measuring productivity loss due to informal caregiving. The WPAI-CG is sensitive to care-recipient medical complexity  Work productivity loss ranges from 14%-28%  Regular activity productivity loss ranges from 21-33% Impact of caregiving is comparable to impact of chronic illness WPAI-CG is a valuable tool for measuring cost- effectiveness of employer based interventions

13. Acknowledgements The guided care team (Sara Palmer, Lisa Reider, Katherine Frey and Tracy Novak) Johns Hopkins Community Physicians MedStar Battelle Centers for Public Health Research The Centers for Medicare & Medicaid Services Kaiser Permanente Accumen ResDAC The University of Minnesota Survey Research Center The study consultants (Jean Giddens, RN, PhD; Kate Lorig, RN, DrPH; Richard Bohmer, MD, MPH, MBA; Mary Naylor, RN, PhD), The nurse managers (Lora Rosenthal and Carol Groves), All of the participating patients, caregivers, physicians, and Guided Care nurses. Please contact Erin Rand-Giovannetti with questions erandgio@jhsph.edu