How do we support the women who will be mobilizing for the coming battle against long-term care costs?
One possibility: Think not just about protecting your own clients against LTC risk, but maximizing a hidden national asset — your clients’ capacity to act as caregivers, both for members of their own households, and, perhaps just as important, for friends, neighbors and even strangers who have no one else to look after their interests.
Given women’s higher average life expectancy, and the fact that two-thirds of caregivers are women, the future caregivers you may most need to nurture may be the women who have turned to you for advice about life insurance, annuities, acute-care health insurance and LTC planning.
Private insurers are doing what they can to improve and expand their retirement planning and LTC planning programs. Officials in Washington are talking about improving government LTC support programs. But anyone who watched the Web video of the latest White House Conference on Aging, in July, and the webcasts of the regional meetings held before the main event, could see that policymakers were having a hard time coming up with big ideas the government can afford to implement.
Obama administration officials used the main conference as a platform to hawk a proposal that’s free for the federal government: a U.S. Department of Labor proposal regarding retirement plan investment advisor conflicts of interest.
Other speakers spent more time reminiscing about the Community Living Assistance Services and Supports (CLASS) Act voluntary LTC program — a component of the Patient Protection and Affordable Care Act (PPACA) so ugly even Obama administration officials admitted it was unlikely to work —than talking about private long-term care insurance (LTCI).
One of the few concrete ideas for expanding America’s caregiving capacity emerged in March, at a White House aging conference regional meeting in Phoenix.
There, speakers circled around the idea that relatively healthy older people who are retired, or semi-retired, may be able to fill in LTC gaps by volunteering for formal elder support programs, or serving as informal caregivers for frail and disabled people outside their families.
Wendy Spencer, the new chief executive officer of the Corporation for National and Community Service (CNCS), and Rhonda Hollis, a volunteer with a CNCS arm that manages an army of 12,000 senior companions, talked about how the CNCS senior companions are helping 43,000 older people who are still living in their homes with tasks such as grocery shopping and paying bills.
Spencer said other CNCS volunteers check the safety and accessibility of homes of frail older patients who are getting ready to leave the hospital.
“I think it’s a very, very valuable service,” Spencer said.
Spencer said she would like to recruit 30,000 more senior companions immediately.
Hundreds of thousands of Americans are already volunteers in other formal elder support programs. Millions more act as informal non-family caregivers.
Hard figures on informal non-family caregivers are hard to find. But, in 2009, the National Alliance for Caregiving (NAC) and AARP found that 14 percent of caregivers were providing care for friends and neighbors. Other surveys have found that about 50 million Americans are acting as caregivers for frail adults and adults with disabilities. Combined, those surveys suggest that about 7 million Americans are acting as informal non-family caregivers.
The increase in the percentage of adult Americans who have no spouse, no children and no siblings living nearby seems likely to increase the importance of volunteer care and informal non-family care.
Why should you care?
Because, if current LTC needs projections are accurate, soaring demand for volunteer care and informal non-family care will shape your future, and your clients’ future, whether you have been selling nothing but LTCI policies for 25 years or nothing but auto insurance, or title insurance.
The same insurers that have been donating generously to youth programs, and arts programs, and parks beautification programs since the 1850s will find more of their money and donor time going to elder support volunteer programs.
See also: In Japan, bank tellers become caregivers
If you work with individuals and families, chances are that the same types of industrious, well-organized, thoughtful people who send thank-you notes, keep their laws neat, and come to you to keep their affairs in order will be flowing into the formal volunteer programs, and quietly assuming new informal caregiving responsibilities for decades to come.
Many of the non-family caregivers will be men, but, again, this could be considered a women’s planning issue: remember, two-thirds of caregivers are women. Your female clients may be both users of care and desperately needed providers of care.
One way to shape your thinking about how to help the future non-family caregivers is to remember Rosie the Riveter.
The government used the image of Rosie the Riveter during World War II to encourage women to step up and keep America’s factories running while the men were fighting overseas. Rosie the Riveter needed child care, help with feeding her family, and help with running errands.
Soon, the government may need to mobilize Rosie the Caregiver (and Ross the Caregiver) to expand the country’s capacity to provide light elder support services, such as help with grocery shopping and paying bills, and let the professional caregivers focus on managing volunteers and serving older people with more complicated needs. Rosie the Caregiver is probably about the right age to be the daughter or granddaughter of Rosie the Riveter. And, just as Rosie the Riveter had new needs when she began riveting, Rosie the Caregiver will have new needs when she begins caregiving.
What can you do today to maximize her well-being, and her ability to help others?
For some ideas, read on.
1. Get to know your local home care providers.
Some of the volunteer caregivers of the future will work in nursing homes, adult day care centers and assisted living facilities, but most frail older people live in their own homes. Typical volunteer caregivers will probably help older non-relatives more with non-medical matters, such as shopping, cleaning and cooking, than with health care services.
The people with the clearest, most hard-headed ideas about future non-medical home care needs are home care agency owners and managers.
Jeff Bevis, president of FirstLight HomeCare, a home care franchise company, said in an interview that, at this point, he has not yet noticed any increase in the number of volunteers providing high-quality support for older non-relatives. But he said he welcomes the idea that the supply of volunteers interested in helping older friends and neighbors might expand.
“They are certainly able to complement what we do as there is only a very rapidly increasing demand for quality care for seniors, as well as those with disabilities,” Bevis said.
An influx of volunteers could help paid providers meet market demand for care more effectively, he noted.
2. Sign up for Uber and TaskRabbit. And buy a Bitcoin.
Consumers are getting used to the idea of getting and providing “gig economy” services through automated exchange systems. Today, the spouses in two-career families may use such services to find babysitters and people who can pick up their dry cleaning. Twenty years from now, those same people may use similar systems to get and provide unpaid elder care.
Today, for example, an adult child may live in New York and have frail elderly parents in Los Angeles. Another adult child may live in Los Angeles and have frail elderly parents in New York. Soon there will be apps to give long-distance caregivers an easy way to trade care duties with other, well-vetted caregivers.
Daughters with aging parents in other cities may trade their ability to care for strangers nearby for care for their own parents.
3. Look for ways to identify, and honor, your clients who are already participating in formal home care and community care volunteer programs.
Volunteer caregivers may have good ideas about what they need, and what kinds of support products and services could expand the volunteer pool.
Insurance marketers might be able to work with volunteer caregivers to get high-quality leads for themselves while giving the caregivers access to more potential volunteers.
4. Keep an eye out for clients who are informally helping older adults outside their household.
Caregivers who “just do what’s right” for friends and neighbors, without going through special programs, may be at risk. These informal non-family caregivers may need special types of prepaid legal counseling services and even ethical counseling services.
The law sets responsibility and information-access rules for the close relatives of older people. Volunteer organizations set guidelines for volunteers, and also give volunteers help with managing complicated, troubling situations.
Informal non-family caregivers may have no official standing or right to information whatsoever, and they may need help with deciding what to do if, for example, they suspect an older neighbor has been the victim of financial fraud, or that an older friend is no longer capable of living independently.
5. Think about the other people you know who are likely to be healthy, and a little bored, in their later years.
This might be a good time to plant the idea that helping frail older people after retirement might make a good second act.
See also: So begins the second act
Image: Matt Collins Illustration
6. Work extra hard to make sure the auxiliary caregivers of the future will have adequate retirement income.
Bevis noted that, if the government or a nonprofit agency sent him 20 enthusiastic, untrained, uncredentialed volunteers, he would probably be able to find some way to put them to work. But, to protect the clients, the volunteers would have to go through the same background checks and pass the same tests that comparable paid workers get.
In the future, bigger elder support volunteer programs might pay for background checks, training and testing, but would-be volunteers might find that they have to get themselves credentialed for the most attractive volunteer caregiving positions.
Would-be caregivers may also have to be prepared to pay for appropriate clothing, transportation to clients’ homes, and organizational dues.
7. Get auxiliary caregivers streams of retirement income plans that are compatibility with the possibility that a client may end up with more wage earnings than expected.
The boundaries between true, unpaid volunteer caregiving and paid caregiving may be permeable.
Some non-family caregivers may prefer to supplement their retirement income by collecting pay for providing care. Other non-family caregivers may find that earning modest caregiving pay could increase their income tax obligations and disrupt their retirement income arrangements.
Planners working with potential non-family caregivers may want to try to minimize the effects that working for pay, or not working for pay, will hurt the caregivers’ retirement income.
8. Look for ways to increase the quality and flexibility of the future auxiliary caregivers’ post-retirement medical, dental and vision coverage.
Medicare plans and other health plans for older Americans often seem to operate under the assumption that older Americans have nothing better to do than to spend their days at doctors’ appointments.
Older Americans who have significant caregiving responsibilities may not have time to pitch tents in doctors’ offices.
9. Team up with lawyers and property-casualty agents to bulletproof future non-family caregivers against litigation.
Non-family caregivers may need extra advice about how to avoid legal trouble, and prepaid legal advice services they can tap if trouble finds them.
10. Remember that doctors often make the worst patients, and that, too often, the “cobblers’ children have no shoes.”
Some people who are busy providing support for older non-relatives may skimp on long-term care (LTC) planning for themselves. Advisors need to remind those Rosie the Caregivers that they need to take care of their own needs, not just support others.
Some of the saddest feature stories of the 2050s might be about women like Rosie the Caregiver who helped countless older frail people, and then spent their own last days in misery. As health insurance and life insurance agents, don’t let any of your clients be the stars of those feature stories.
Image: Matt Collins Illustration