Working While Caring with Karen Kavanaugh Rosalynn Carter Institute for Caregivers

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[00:00:56] Welcome to The Caregiver Community. This is a place where we talk about the joys and

[00:01:02] the challenges of caring for our aging parents and loved ones, as well as the care for ourselves.

[00:01:08] I am Frances Hall, founder and executive director of ACAP Community, adult children of aging parents.

[00:01:15] In this podcast, we're talking about the caregiver employee, challenges caregivers experience in the workplace,

[00:01:23] employer viewpoints and considerations to help lessen the impact of caregiving on the caregiver

[00:01:30] employee and the employer. I am delighted to be joined by Karen Kavanaugh.

[00:01:38] Karen is the chief officer for strategic initiatives at the Rosling Carter Institute for

[00:01:44] Caregivers. In her role, Karen provides leadership for the development and launch of the

[00:01:50] institute's initiatives that are designed to strengthen caregiver health, resilience and well-being.

[00:01:57] Her portfolio includes working while caring, an effort aimed at deepening research on effective workplace

[00:02:05] supports for caregivers and expanding access to those supports.

[00:02:10] Hi Karen, thank you so much for being with us.

[00:02:13] Hi Frances, it's nice to be here. Thank you for inviting me and a new

[00:02:19] caregiving institute for caregivers. Absolutely. Thank you. We're delighted.

[00:02:23] Okay, so let's start at the beginning. I know you all have done a lot of research.

[00:02:28] I'm so grateful for what the Rosling Carter Institute does.

[00:02:32] But let me hit some high points and then let's kind of unpack all of that.

[00:02:37] So what you all have found recently is that in addition to the paid job, one in five full-time

[00:02:44] caregivers who are employees also are providing care to someone who is aging ill or disabled, one in five, 20%.

[00:02:55] 60% of caregiver employees experience disruptions to their work because of caregiver responsibilities.

[00:03:04] And on an average, caregivers who also are employed miss 3.2 days every month because of caregiving.

[00:03:14] And one third of the caregiver employees have to leave work because of caregiver demands.

[00:03:22] That is I'm just like wow that is huge. That is that is just huge.

[00:03:31] So you had the research that you all did at working while caring.

[00:03:37] How about talking about what you found about the caregiver, the caregiver employee situation and just more of what you all fell?

[00:03:47] Sure. Yes, those are really significant numbers.

[00:03:54] I always like to start by stating out loud Mrs. Carter's famous quote that there are only four kinds of people in the world, those who have been caregivers, those who are caregivers, those who will be caregivers and those who need them.

[00:04:14] So so the numbers are not actually surprising.

[00:04:19] We have current demographics and aging population, people who have been in this space for a long time have been raising this flag that this day was coming when we were going to have a very significant older population, older adult population.

[00:04:39] And then even that is sequenced a bit into the very old and that's that's happening right now.

[00:04:47] So we like to talk about caregiving for someone who is aging ill or disabled as a life cycle event, not a one off an experience actually that many people will have more than once in their lives.

[00:05:03] But it's systemic treatment in public policy, healthcare and employment still does not recognize this is still treated as a one off experience with siloed supports and insufficient consideration.

[00:05:18] So what we are trying to do at the Institute and what Mrs. Carter taught us to do was to really center the person who is providing the care regardless of the relationship to the care recipient, regardless of the care recipients condition or disease state that there were while there are differences and complexity in the experiences of care, there are also a number of commonalities.

[00:05:46] And one of them is that the majority of people who are providing care are also working at a paid job.

[00:05:54] So our working while caring initiative is really designed to advance three objectives in service of two pretty significant goals.

[00:06:05] The first is to raise awareness of employee caregivers. Again, we define those as people who are working while also caring for someone who is aging ill or disabled.

[00:06:16] So it's not childcare per se unless a child is seriously ill or has some sort of condition that requires a

[00:06:29] sort of hesitate to say this, but a higher intensity or very different kind of care.

[00:06:38] And again, this is a growing, a very significant part of the workforce and a growing cohort of the workforce.

[00:06:46] And so we're going to do this by working specifically with employers by trying to reduce the gap in what we know about the effects of providing care on both labor market participation and financial security on the employee side and for the employer affects on recruitment retention productivity and engagement.

[00:07:14] And because right now, while we know a fair bit about the experience and how difficult it can be to balance both.

[00:07:24] Although the majority of people who are working while caring want to do what they just want more supports.

[00:07:36] So again, while we know a fair bit about that, what we don't know a lot about are what are effective supports that keep somebody attached to the labor market while helping to reduce somewhat the strain that they feel of balancing both of the roles.

[00:07:57] And so the numbers that you cited were from our 2021 National Survey of Employee Caregivers that really sought to understand the experience in their own words.

[00:08:10] We also sort of probed on some public policy initiatives that were active at the time about support for those.

[00:08:19] We also released in 2021 a follow line report and in our working while caring series.

[00:08:28] They're really attempted to kind of set the table on again what we know and we don't know about the experience for both employee caregivers and the effects for employers.

[00:08:39] This report was entitled is entitled invisible overtime is really targeted to employers.

[00:08:47] And then finally, and this is the big piece in the most exciting piece of our initiative for me.

[00:08:54] We are working directly with employers through an innovation lab approach which brings them together with their peers to give some expertise and some time to really think more about this cohort of the workforce.

[00:09:10] What are they doing now? What are their challenges? What are their opportunities with the goal of really coming up with an action step that seeks to experiment with a new or slightly revised approach to supporting employee caregivers.

[00:09:31] So we just concluded or very close to concluding the first innovation lab with five employers located in Michigan. A few of them also have work forces in other states as well, but primarily in Michigan.

[00:09:49] And that is the topic of our last report that we just released last month on the innovation lab.

[00:09:58] And I want to talk more about that in a few minutes, but it's interesting. You're talking about the supports that caregivers are wanting and needing and trying to really understand better what that is just yesterday I heard.

[00:10:14] The Alzheimer's Association has just recently evidently done a survey and that they too are finding that the people of those who are caring for someone, a family member or a lot of one with Alzheimer's.

[00:10:28] But what they are saying is exactly what you just said that they want to be working, they want to be engaged, they want to for their lives to be and they need for their lives to be beyond the caregiver situation.

[00:10:43] But they what they are looking for is a support or support of some years that will help them to both to care well for their loved ones, but also to be able to be engaged in in their own lives and particularly work because then that starts impact with the statistic of the number of people whose whose jobs are jeopardized or are having to come out of work.

[00:11:08] Then that has all kinds of rippling effects, not only for right now financially but for their entire future.

[00:11:16] And so it's a huge issue that the people just are looking for the support.

[00:11:23] Yes, absolutely.

[00:11:26] And one of the things that employers can do is incredibly important and came out of our innovation lab as well, is to create an environment, a culture of inclusivity.

[00:11:44] And one that recognizes that employees will at some point in their career be providing care for someone who is aging ill or disabled.

[00:11:55] It's really normalize that within the workplace just like parenting is, you know do not treat it as a one off and that supervisors and managers are trained.

[00:12:07] So, it's actually trained, you know many of us working teams.

[00:12:11] And so if somebody has to take a day off, if someone needs some extended period of time off or if there needs to be flexibility in a schedule or the timeframe or if someone needs to work as they say in a synchronous way from time to time that that is simply expected and that there are actually supports in place to help managers.

[00:12:36] And supervisors and teams and employees.

[00:12:41] Adapt to that and adjust to that because again, likely all of us will cycle through this experience at least once in our lifetimes while we are working.

[00:12:51] Right, right. Yeah, and I love that comparison with the being a parent that that's that that since women have been in the workforce for so long and in such numbers that it's pretty expected.

[00:13:04] That that younger women are going to need to take time to have maternity leave and that to raise children that there's going to be that in that.

[00:13:15] But that it's okay and it's expected.

[00:13:19] So yeah, I love that concept of making this as normal in the workplace and is normal very honestly and our thinking as as parenting is.

[00:13:32] Let's talk for a moment. You and you all, the rise in Carter Institute and Duke University are doing some collaboration and really making sure trying to make sure that the caregiver experience and impact are in the forefront as I'm understanding what you all were doing.

[00:13:53] Tell us more about about all of that because I think what you really are looking at is how and I think you're calling it profiles of a proposal courage.

[00:14:06] That's probably true. A profile of caregiving that how it jeopardizes not only the individual caregiver, but also how it how it jeopardizes our health system, our economy, our communities as well as the employer talk some about that please.

[00:14:28] So I'll back up a little bit also to tell you kind of where how we began thinking about this, which was also attached to the employer work or working while caring and so there.

[00:14:45] Well, no, caring for someone who was aging and disabled is not a homogeneous experience.

[00:14:54] There are there are different experiences of providing care.

[00:15:00] And if you don't spend time thinking about this or if you haven't had an experience yet yourself, it can get a little bit overwhelming when you start to consider this especially for policymakers or employers.

[00:15:17] One of the questions that we received from employers early on is, well, what am I trying to solve for? Does somebody needs weeks of leave? Does somebody need three weeks? Does does somebody need intermittent? Do they need flexibility? Do they need support in other ways of what we say, yes, all of those and more, but it's a really good question.

[00:15:43] So this complexity in care really challenges right the sort of a there's no silver bullet in in this space and it challenges us when we're thinking about programmatic and policy supports or solutions because of that complexity.

[00:16:07] That's one piece. The other piece for employers is industry sectors are really different workflow is really different flexibility remote work can be easily offered and adjusted to for some sectors that just like you and I are doing right now, but it's almost impossible for many others.

[00:16:32] I'm thinking about healthcare systems retail manufacturing where people have to be on the floor on the shop floor in the hospital in a clinic in the store.

[00:16:47] So these are two really significant pieces that we've been thinking about and just on the ladder want to point out that what we are focused on with working while caring is really on on those sectors where work cannot be done remotely or where flexibility needs to be thought about in a really different, more creative way.

[00:17:13] And with or so oftentimes that means small and medium sized employers sometimes crosswalks with hourly workers not always or larger organizations with a workforce again where work cannot be done remotely.

[00:17:33] So really trying to think through solutions for those employers and those employee caregivers.

[00:17:41] And now with the profiles, then the question is okay so what are what are we trying to solve for.

[00:17:49] So with our partners at Duke University, we started with how can we like put some organization around such a complex variety of experiences again for someone who is providing care for someone who's aging ill or disabled.

[00:18:07] How can we really move the caregiver from the margins to the center to really think about what is the experience for that person not that the care recipient is not important, the care diet certainly is.

[00:18:22] But how do we think about this while being.

[00:18:28] Describe it this way agnostic again to the disease state or the condition of the care recipient. And so with Duke we.

[00:18:39] We embarked on a very robust and rigorous process looking at the existing literature, and we also conducted a number of focus groups and conversations with a diverse array of caregivers.

[00:18:56] And we also set up an advisory committee. I just wanted to shout out to our amazing advisory committee. These are both who expertise in caregiving and oftentimes their own experiences providing care, and then some caregivers as well again caring for someone to mend a child with a developmental disability who is now.

[00:19:25] Not aging but is more than 18 years old cancer diagnoses.

[00:19:33] So what we have now are 10 profiles that really attempted to still the particular phase of care, the most salient goals of the care giver and care.

[00:19:54] And then the most significant sources of strain during each of these phases.

[00:20:00] So these profiles were not intended. Of course, they're not linear it's not like you progress through each of them. In fact, somebody may start kind of in the middle.

[00:20:20] They'll back and forth through different phases. So for example, someone may overnight become a caregiver with no warning. Perhaps someone has been in a catastrophic accident that completely changes their mobility.

[00:20:39] And perhaps the caregiver is the wife of this person and there are young children in the home.

[00:20:49] So you just sort of think about there's an overnight change. There is a change in mobility.

[00:20:58] There is, you know, there are questions about the permanence of that change. There's treatment options at that point in time. There's potentially changes in the home.

[00:21:11] There are likely changes to consider about the work status for both the caregiver and the care recipient. There are then really significant psychological changes and stressors at that point in time.

[00:21:29] That's one profile. Another profile, maybe somebody who is in the kind of in the I'm going to say the middle of the journey taking care of someone.

[00:21:41] Let's say with a cancer diagnosis where the where the prognosis is somewhat unpredictable.

[00:21:50] And there may be a variety of treatment options. That change over time, depending on how the care recipient is responding.

[00:22:01] Certainly they would have, you know, the psychological strain.

[00:22:07] They likely also have financial strain workplace strain. So some of the sources of strain are certainly evident in each of the profiles.

[00:22:17] So we take a little bit of a different color or complexity based on the phase.

[00:22:26] And so that's another one. And yet another one is the end of life with someone where somebody is managing with someone who's at the end of their life.

[00:22:36] We did we thought that this was really important. It's showed up in the literature and it was really discussed a lot with our caregivers being a former your giver either because the care recipient has passed or because the care recipient

[00:22:55] has for example gone through cancer treatment and they are in remission and life. I'm putting this in air quotes because I know your audience can see us.

[00:23:08] It turns to normal, but actually having a very intense caregiving experience is defining.

[00:23:18] And you don't necessarily then switch back.

[00:23:23] So we thought that that was a really important profile as well.

[00:23:27] So we are, we did this again, you know, to help to answer some of the questions with employers what am I solving for?

[00:23:35] So how that might be implemented with an employer is to say, you know, okay here are the profiles of caregiving experiences.

[00:23:45] Do you have courts and accommodations that could help someone in each of these phases?

[00:23:53] So that is also where as I talked about former caregivers, this is also where we talk a bit about anticipatory grief and bereavement if that happens to be the case.

[00:24:04] And you know thinking about supports for those employee caregivers.

[00:24:08] We also think that this could be hugely important and impactful in the health care system, for example, for programmatic policy

[00:24:19] and to inform programs and policies.

[00:24:24] And then finally to target resources perhaps to anticipate where somebody might be engaged with them, rather than, you know, having a caregiver,

[00:24:38] having yet another to do on their to-do list, you know, how can the system or proactively engage and reach out and offer support to caregivers?

[00:24:52] There is so much in what you just said.

[00:24:56] Having been at somewhat all three of those points, a long way, you're absolutely correct.

[00:25:03] It is very different depending on where you are in that caregiver journey.

[00:25:09] It's very different and what the person with the caregiver is needing from the employer, from the whole community can be very different

[00:25:21] at those different places, the different points along the way.

[00:25:26] Yeah. Yeah, I applaud what you all are doing because it certainly gives voice to the caregiver in a very different way than just one person sort of raising the flag

[00:25:39] and saying, I need some help here. So thank you more than.

[00:25:45] We've talked a lot about the caregiver situation and what can be and what employers can do.

[00:25:56] Why? Why should they? How does it benefit the employer?

[00:26:01] I think that would be a really, I think in addition to what is the question we're trying to answer for the caregiver?

[00:26:09] I think that the employer, the day two or looking for what's in it for me? How does it help me?

[00:26:17] So can you speak to that? Sure. And I'm just going to pull from the voices of the employers we have been working with.

[00:26:30] When we first talked to them about this initiative, mostly we did not have to convince them that this was an issue.

[00:26:39] They were already seeing it within their workforce and they were already struggling with recruitment retention and engagement.

[00:26:49] And they just didn't really know well what should we be doing? What you know what what our effective supports? What can we experiment with?

[00:26:59] And they would also say that those who are providing care for someone who is aging ill or disabled in general,

[00:27:08] and this is a broad stroke I understand are not as vocal as perhaps apparent to a child about what they need.

[00:27:18] There's a lot of still stigma around providing care and particularly if you're thinking about someone who's providing care

[00:27:27] to someone with a mental health condition or substance use disorder, people don't really want to talk about those details.

[00:27:37] So what's in it for the employers if it's done in a high quality way is first and foremost again a recognition that we will all have this experience at least once in our lifetimes

[00:27:55] and we are normalizing this within the workplace. And so we are engaging you as a whole human as you are, or as you might be with this experience which when employees feel that they are seeing when they feel that their host selves are considered not just their work self if you will.

[00:28:20] This has been shown to increase engagement, loyalty, productivity, creativity.

[00:28:30] I just this morning was reading something about interdependence and you know folks don't often want to talk about this in the workplace but we are all interdependent regardless of where we are in our lives.

[00:28:48] So there's that just setting an organizational culture that you know recognizes and supports employee caregivers.

[00:28:58] Again employers were telling us too that they were losing really key skills talent institutional knowledge because they could not figure out how to help somebody who had to make a decision

[00:29:17] of whether to stay within the workforce or leave separate to provide care.

[00:29:25] So that is really, really important to employers and as you know,

[00:29:32] recruitment, retention, retraining.

[00:29:37] These are really expensive endeavor so if employers can keep somebody even if they have to provide accommodations of some sort that's far more efficient for them and it really helps their bottom line.

[00:29:54] So that's with what is for them but I do want to say this Francis because we didn't talk about the top of the conversation part of our initiative with working while caring is to engage employers directly to partner with them to learn more about what is effective for this cohort of the workforce.

[00:30:20] But we always say that while we know employers can do more for their employee caregivers or do some things differently and that's not a criticism.

[00:30:32] We also recognize that they cannot solve for all of the outcomes that result from such a fragmented and dysfunctional long term care system.

[00:30:44] You know, I even don't even like to call it a system that we have in this country.

[00:30:51] So as you know, navigating the healthcare system is really, really difficult and is a significant source of strain for caregivers whether they're employed or not.

[00:31:04] The lack of financing options is another so those are public policy issues that really have to be solved.

[00:31:14] So our theory of change, if you will, is to engage employers sort of appeal to their self interest on workforce retention recruitment productivity engagement.

[00:31:27] And then over time to help them to understand and to connect the dots between what they are seeing in their workforce and the public policy context.

[00:31:37] And so could we organize them to become more vocal agents for reform and change at that level?

[00:31:45] Yeah, it would you just said really reminds me you were talking earlier about the interdependence of all of us, but it's almost like our systems also are interdependent.

[00:31:56] Yes, happening in healthcare is affecting what's happening in the employer for the employer and vice versa.

[00:32:05] And assuming all of these systems, all of these different pieces that think so completely separate and disconnected are very much connected.

[00:32:17] Yes.

[00:32:19] So all of this is really, really good information and it really does make sense to care for the caregiver for the employer to be attentive and caring for the caregiver because not only is it caring for the caregiver caring for that person who is part of their their family, their team.

[00:32:40] But it also very honestly is good for their bottom line, but the company's bottom on.

[00:32:46] Yes, talk about what kinds of policies and practices sort of typical policies practice both health, both support caregivers as well as throw up some little obstacles.

[00:33:02] There's some kind of typical ones that that surface in both of those categories.

[00:33:10] Yeah, so again, I want to start with the organizational culture which you know it gets overlooked sometimes, but it's really, really critical normalizing this type of care within the workforce.

[00:33:31] Now, it does have to be backed up though with real supports and you know you can't just say yes we see you and then have no supports available when someone needs that.

[00:33:46] So I will say that but I just want to underscore how important that is.

[00:33:52] And sometimes that you know it that gets entitled as organizational culture or caregiver friendly workplace.

[00:34:01] That sort of thing so, so some of the easier lives there are supporting and employee resource of caregivers providing them with the time paid to come together providing them with some resources.

[00:34:18] You know, space a lunch to share with their peers that's that's an easy thing having a CEO or executive team talk about their own caregiving experiences.

[00:34:32] Again, all in addition to having real supports flexibility in the workplace is is the top request of employee caregivers.

[00:34:46] And again, even if you cannot work remotely there are ways to incorporate flexibility through schedule autonomy.

[00:34:56] For example, being able to switch shifts with someone without having to seek permission to do that and being able to do that in a short period of time.

[00:35:09] You know, maybe you learn oh I'm needed with mom in an hour and and you're able to swap with it.

[00:35:20] So that type of flexibility flexibility in terms of the actual work you might.

[00:35:27] So that's what it means, you know, can you when when someone needs to go out or there needs to be a adjustment in their schedule.

[00:35:36] How can you sort of adjust the workflow in a way where the work still gets accomplished but it may be getting done in a slightly different way.

[00:35:46] So really important piece. There's a few things that kind of occur outside of the employer context to be well, but that employers can influence and shape so one of them is ensuring that you have care coverage that has mental health parity real parity.

[00:36:09] And that cycle therapy counseling is covered a sufficient number of sessions, not just three and done.

[00:36:19] In that there's you know there are experts in here who can provide this kind of support to an employee caregiver.

[00:36:31] So again, employers can do that through their healthcare coverage. They can also require that you know many employers have EAPs and they are under utilized.

[00:36:46] That's correct. Often employees do not want to use them, but if they have them, they should ensure that the services that they provide really include those who have expertise in caregiving they understand the stresses they understand this journey and that they understand the local context of home and community based services that they understand Medicare Medicaid private insurance coverage.

[00:37:15] They understand some of the even the appeals process to help an employee caregiver navigate that.

[00:37:25] There's a couple of other evidence based activities initiatives that really help caregivers. One of them is ensuring that they are really part of the care team that they are seen.

[00:37:44] And that they are respected and heard. That's something that you know again that occurs outside of the employer context, but it's something that employees could talk about as being really, really important.

[00:37:58] You know with their peers within that broader sort of ecosystem right.

[00:38:04] Another one is when employee caregivers or any caregiver connected to a formal service. So it may be a support service for themselves, or it may be access to in home care.

[00:38:24] And ensuring again this starts to get into the public policy and programmatic context that's outside of the employer environment, but as where employers can begin to push to ensure that there are high quality services.

[00:38:42] So that's why we are accessible and affordable and also navigation, helping employees to navigate that healthcare system.

[00:38:54] Some of these things are not going to happen overnight. Some of them we've been talking about for a very, very long period of time right and they still need some some work but you know two things that are very encouraging the CMS has now launched the dementia guide pilot that includes requires robust caregiver supports.

[00:39:21] And so they will be evaluating that and hopefully that can be expanded to caregivers of those.

[00:39:31] You know with other types of conditions and diseases outside of dementia, the other one is a 2024 physician fee schedule which for the first time we'll cover.

[00:39:43] Physician training for the others. Now there are some there's some pretty significant structural issues there but this is pretty much just you know this is a really big change that we should be paying attention to and helping to support in any way that we can.

[00:40:04] I love that list because there really are so many things that employers can do from almost benign to some really some really pretty extensive and involved pieces that they can offer that all of these support caregivers kind of wherever they are.

[00:40:25] Interestingly, you're very first your very first one was about allowing employees to gather and to share and to talk and that that really is how a cap began.

[00:40:38] So it's so it's interesting that that was the very yeah yeah I would I should I would also be really remiss if I didn't say you know if we could have a paid family and medical leave policy in this country that it you know

[00:40:54] that it's a national policy that is uniform for all employees for all sectors across states. That would be really helpful as well when when people need that.

[00:41:09] So so we hope that that day will come.

[00:41:12] So on the flip side should we even dares talk about any any of the policies and practices that can be really difficult you've talked about culture.

[00:41:25] And certainly the culture that says it's okay for a caregiver employee to say this is what's going on or to say I may need to come in leave leave early take some time off and they need some time during the work day to make some appointments or whatever I'll make up the time we're not asking when we're not asking for people to be allowed not to produce.

[00:41:55] Not to be productive in their jobs that's not that's not what what this is about it is simply really to provide the supports and in the structure so that employees who are also caregivers can be the maximum.

[00:42:12] But that they continue to produce for the employer but they also are taking care of their model.

[00:42:20] There's some there's in particular things employers kind of need to it would be helpful for them to be on the lookout for anything in particular.

[00:42:32] Do you mean again policies or policies practices.

[00:42:39] But is there anything that has served this a number of times beyond which you've already said, are there is there anything that has surfaced to number of times that employees are saying if my company would do X it would be really helpful to me.

[00:42:59] Probably that's paid leave.

[00:43:05] You know, that is in part why I think it has not passed yet in this country is for some employers they believe it will just be impossible for them to remain competitive.

[00:43:22] They don't believe that they can incur those costs through you know not having a person sort of in the seat or on the line.

[00:43:38] That is not you know, employers we have worked with they all have paid the policies and they and they will say that you know it is helpful to people.

[00:43:54] Again, it's not a silver bullet though.

[00:43:58] But that it can be difficult to implement.

[00:44:04] Sure, sure and one of the things that happened for me that was extremely helpful and just so incredible was that author I was on small university campus and other faculty instead or staff I guess could donate some of their hours which was just so helpful and it was it was just really great.

[00:44:27] Yeah, some employers definitely are offer that and yes the public sector that appears to be a pretty prevalent benefit within the public sector.

[00:44:44] Yeah, Karen all of this is such good information. Is there anything that we haven't covered or let me take that back there's a lot we haven't been able to cover I know that but there's some other things that we really need to talk about and make sure that people know about and specifically employers are aware of through this through this podcast.

[00:45:07] I don't think anything other than what I've already said again that this is a really critical cohort of the workforce.

[00:45:16] It's really important to normalize this and to recognize this type of care within the workforce to offer supports to train supervisors and managers and to have an eye out on the public policy context as well.

[00:45:34] But I would love to ask you Francis after spending the last 50 minutes with me what is there anything that we are not considering through this work that you would like us to consider is there something we've sort of overlooked do you think or or you know what resonated or not with your own experience.

[00:45:59] I think that you are really on target of providing the research, the real underpinnings and the data that helps that helps give a voice to caregivers.

[00:46:14] And I recently heard a statistic and I haven't had a chance to really follow up with this but the statistic was that 50% of people over the over the age of 45 are in a caregiver situation not for as a parent, but for an older one.

[00:46:34] I thought holy matter just the implications of that so I think that what you all are doing is really vital because the reality is those of us who were working or are working and caring for someone.

[00:46:56] There are so many different pieces of that and if we are in a culture and employer or an employment culture that doesn't understand or that we feel like we can't share that and we can't be honest and transparent about what all the implications for our lives and how we may be on the job.

[00:47:18] But we may not be able to give full attention because mom or dad or spouse or partner or loved one is in this other place and you have to be looking both ways all the time and concerned for both situations all the time.

[00:47:41] So everything that you all are doing I think just is monumental in terms of helping address the dire situation, particularly knowing that the cost of care giving professional care giving the cost of assisted living and long term care and memory care.

[00:48:02] So he is absolutely prohibited from many.

[00:48:08] So families are having to step up or friends are having to step up and assume responsibilities and tasks that they are absolutely not prepared for.

[00:48:21] And so what you are doing is really helping bring that into forefront and to normalize that because it is normal.

[00:48:33] And it has 50% of people over the age of 45 that's that's a lot of our workforce particularly.

[00:48:40] In key positions in our work groups, they are being affected so significantly then of course the employer is going to be affected so.

[00:48:51] Yeah, yeah. And you know just as you were saying that I am reminded that in the last few weeks, nor could put out an update to their study on the forgotten middle which is that vast swath of the population that are not eligible for Medicaid and will never be eligible for Medicaid.

[00:49:19] As well as you know the cohort that could spend down to be eligible for Medicaid but that it's just huge and there are very few supports for that population.

[00:49:36] And therefore the financial labor market psychological effects are really significant.

[00:49:43] All that to say we would never say you know Medicaid does have a long term care system of sorts, we would never say that that's sufficient or but there's this huge swath and most of them are working many are working.

[00:50:03] Oh absolutely and then we combined that with the crisis in terms of the number of people who are profiliting the care, who are the national caregivers.

[00:50:16] Yes I mean we have a convergence of I'm not sure that any but certainly we have known of the silver soon off you know we were the ones who created all that we did relative to children.

[00:50:32] And now as we have moved through and we are now aging and all that that means for us as an aging as an aging population.

[00:50:42] And yeah I we were aware of that but I don't think that we really completely figured in all the other pieces that are now coming together to make a true crisis.

[00:50:55] Yeah yeah we're not meaning to end of it on a really difficult note but but the fact is as you have said so so so beautifully there are there's lots to do and lots that needs to be done.

[00:51:14] So that those those who are caring for some of our most vulnerable in our population the older adult that the caregiver is cared for so they can do what they need to do for their loved one but also keep our keep our economy afloat.

[00:51:37] Yeah yeah and you know the other way that we think about this as well is that caregiving can be it I do not want to suggest it always is but it can be a very rewarding meaning experience for people.

[00:51:54] And yet and yet by taking on that experience there are real risks to one's physical health mental health financial health and labor market participation so how do we think about you know really making this experience one where somebody can derive that meaning in that connection.

[00:52:23] And that reward and joy and not be and not you know remain healthy and told so that that's how I'm not saying this very eloquently but that's what I've been thinking about as well.

[00:52:38] Absolutely absolutely caregiving affects every single part of one's being and even with that the vast majority of caregivers once the caregiving once the caregiver journey is finished they look back and go yes I would do it again.

[00:52:57] And yes to be able to support and to make sure that they are able to do all of that would be huge is huge so thank you but what you personally are doing and what the Ross Carter Institute is doing it in all kinds of different ways thank you for that.

[00:53:20] Thank you Francis for this opportunity to share the work and Mrs Carter's vision.

[00:53:26] Absolutely absolutely we also we thank you we thank the RCI the Ross and Carter Institute for caregivers we also want to thank you our listeners we hope this information has been helpful to you both as as an individual and as a caregiver but also particularly if you are if you are our employer if you are in a company and you have others working with you.

[00:53:54] The jurors supervising or working in a team with you please do please do hear this and if you have any questions please reach out to either Karen or to me.

[00:54:08] You can find Karen at info at rosling Carter dot org info at Rosling Carter dot we also want to be sure that we that we thank the mesh the mesh the mesh network is our is our recording studio for all of our online for online shows and podcasts.

[00:54:36] We will find more of our caregiver community podcasts on any of the platforms where you get podcasts. You also can find it on our website ww.acapcommunity.org that's the a cap community or the a cap website ww.acapcommunity.org we certainly want to thank asa home in Hickory North Carolina they are the sponsors with the sponsor for this podcast and all of our podcasts.

[00:55:06] We began this podcast with Mrs Carter's wonderful quote and I want to end our podcast with that we continually say an a cap that caregiving isn't everybody issue and that definitely is what Mrs Carter's quote is.

[00:55:24] There are only four kinds of people in the world those who have been caregivers those who currently are caregivers those who will be caregivers and those who will need care a caregiver.

[00:55:39] Karen thank you so very much for being with us know each of you thank you say well everyone bye for now.

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