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Caregiving Crisis – Employers Beware

Iowa is fortunate to have many jobs available for applicants, but unfortunately, there are not enough bodies to fill those positions. According to a 2017 Wall Street Journal article, Iowa, and 11 other Midwestern states have experienced a net outflow of 1.3 million people between 2010 and July 2017. In fact, if every unemployed person in 12 Midwestern states was placed into an open job, there would still be 180,000+ unfilled positions. The Iowa Workforce Development recently announced the number of unemployed Iowans in December (2018) is 40,600, an historic low of 2.4 percent. Iowa has THE lowest unemployment rate in the U.S.  (The U.S. unemployment rate in December moved up to 3.9 percent.)

To combat low unemployment, Iowa along with other states have developed plenty of free programs to train low-skilled workers for higher-skilled positions. For the second consecutive year, Iowa was named by Site Selection magazine as the Midwest’s top state for workforce training and development.  Another 2018 Wall Street Journal article indicated that Iowa’s extremely low unemployment rate has drawn “thousands of workers off the sidelines…with the share of Iowa adults working or seeking work at 67.9 percent in February (2018), nearly five percentage points more than the national average.” Rural Iowa employers have it more challenging, as the pool of local talent is just not there to fill positions.

Caregiver Responsibilities at Home

Now comes yet another challenge, but not just for Iowa employers. A new national survey by a pair of Harvard Business School researchers found that employers are likely to underestimate the struggle their employees have when balancing their professional and caregiving responsibilities. Caregiver responsibilities include providing for children and elderly parents. In fact, about three-quarters of U.S. employees face caregiving responsibilities, of which, 32 percent have left their job because they were unable to balance work and family duties. If employers fail to provide support for caregiving responsibilities, they will pay the hidden costs of presenteeism, absenteeism, turnover and rehiring.

This study was based on surveys of both employers and employees. A key finding was that despite more than 80 percent of employees saying their responsibilities at home kept them from doing their best at work, only 24 percent of employers believed that caregiving was affecting their employees’ performance. This enormous divide is troubling, yet it can also help nudge employers to understand what they can do to retain employees, especially during a very tight labor market.

Other study highlights include:

  • Younger employees, ages 26 to 35, were more likely to leave a job because of caregiving responsibilities.
  • Hard-to-replace higher-paid employees and those in managerial or executive positions were also most likely to quit.
  • More men than women said they left a job because of family needs.
  • As the nation ages, caregiving responsibilities are expected to grow. The Census Bureau projects that for every 100 working-age Americans, aged 18 to 64, there will be 72 people outside that range by 2030, an increase from 59 in 2010.
  • With an increasing share of jobs expected to require a college degree or beyond, the loss of many women could exacerbate labor shortages in the future.

This study caught my interest because, for the first time since we began in our employer benefits study in 1999, we will ask a series of work-life and convenience questions in our 20th Iowa Employer Benefits Study©. Among asking many work-life benefit questions, we will learn about the prevalence of the following caregiver benefits offered by Iowa employers, such as:

  • Personal days
  • Sabbatical leave
  • Adoption leave
  • Foster child leave
  • Leave to attend a child’s activities
  • Maternity leave
  • Paternity leave
  • Child-care subsidies
  • Elder-care subsidies
  • On-site or near-site child and/or elder care
  • And more…

As we learned from surveying both Iowa employers and their employees in our 2007 Iowa Employment Values Study©, there can be a great disconnect between what employees’ desire at the workplace versus what their employers think is important to employees. The aging of the Iowa workforce, in addition to the challenges faced by young families can cause caregiver ‘tension’ that adversely impacts both employees and the unsuspecting employer. To address these challenges, Iowa employers must search for new ways to further accommodate the changing workforce environment pressures that are vital to employee well-being and, consequently, their productivity.

Sometime this summer, our 2019 survey will reveal new results about the prevalence of caregiver programs offered by Iowa employers. Such benefits, I suspect, will vary greatly by industry and by employer-size categories.

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A Fitbit ‘Nitwit’

Our motivations ultimately drive our behaviors – both good and bad. It’s just a fact of life. When it comes to living a healthy lifestyle, such as dietary and routine exercise, motivations can be very difficult to control and predict. It certainly has been for me.

I recently had lunch with a friend who was wearing the newest craze – a Fitbit device on her wrist. There are numerous wearable fitness devices on the market these days, with the Apple Watch about to make its highly anticipated debut in early 2015. I was keenly interested in how my friend was using her Fitbit, as I was expecting my Fitbit Charge to be delivered in the mail the following day. Her comment was very intriguing to me: “I am becoming more aware of just how active I have been throughout the day and I am more consciously connected to my daily progress.”

My friend then demonstrated how many calories, steps, miles and stairs she had performed throughout the morning – and the metrics were displayed on her iPhone. I was equally impressed just how little sleep my friend was receiving. My friend conveyed to me how this real-time information MOTIVATED her. Powerful stuff, don’t you think?

More and more, employers and even insurance companies are promoting wearable devices to challenge employees to be more active throughout their day. BP promotes a Million Step Challenge within their company wellness program. Wellmark also promotes Fitbit tracker bracelets to members enrolled in a newly-created health plan who demonstrate healthy behaviors. New stories are published everyday about how employers (and insurance companies) are embracing this new technology to get people moving.

A recently published study reported that prolong sitting at work or at home can adversely affect our health – even for those who exercise daily. This report states that we must move more frequently throughout the day and not just rely on our regular workout routine (for those who do). The report suggests the following:

  • Take a one- to three-minute break every half-hour during the day to stand (which burns twice as many calories as sitting) or walk around.
  • Stand or exercise while watching TV.
  • Gradually reduce daily sitting time by 15 to 20 minutes per day, aim for two to three fewer sedentary hours over a 12-hour day.

A Wall Street Journal article recently indicated that one in 10 U.S. adults now own a fitness tracker, which tracks footsteps, calories and other metrics. Yet, the precision of such devices are not as accurate based on a study from Iowa State University. Researchers at ISU tested the accuracy of eight activity trackers in measuring energy expenditures and found that most were off by 10% to 15% compared to a precise laboratory measurement. The worst was off by 23.5%.

The article summarizes any inaccuracies of such devices this way: “…But that’s beside the point. The devices are motivational tools to promote fitness, and the numbers they generate are good enough for that.”

I agree.

After receiving my Fitbit a few weeks back, I am now measuring my days considerably differently than before. Since the age of 12, mainly due to playing football and participating in track, I have made a daily routine of running and biking. Yet, I’m finding that, due mainly to birthdays, my metabolism is slowing down and it is becoming increasingly difficult to keep my weight (and waist measurement) under control.

Again, even though the metrics are far from perfect, having this wrist tracker on 24/7 allows me to establish a consistent log that is valuable for quantifying changes in my daily activity.

At work, I spend a great deal of time on my computer. I have now developed a routine to get up and take a 20-minute walk around the neighborhood by my office. At home, when I’m short a few hundred (or thousand) steps from my daily goal, I have found to be more motivated to take our dog outside for a walk, put dishes away in the kitchen, or even help put laundered clothes away upstairs.* With this new urgency, I get no complaints from my wife! She once called me, ‘Silly,’ – perhaps she really meant, ‘Nitwit!’

Measuring my day in steps or calories is beginning to redefine my routine motivations, which ultimately impacts my behavior(s). I’m quickly becoming convinced that having a wearable fitness device is changing my behavior.

Would it change yours?

*CAUTION TO MEN:  Please consult with your medical physician first, as this type of work may be hazardous to your mental health.

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Shifting Health Costs to Employees – Pre vs. Post ACA

Consumer-Driven Health Care in IowaAccording to various media reports and a recent USA Today article, Americans continue to pay more of their own healthcare costs.

But there was one sentence in a December 3, 2014 Wall Street Journal article that got me thinking. The sentence reads: “The trend is being accelerated by the Affordable Care Act (ACA) because many private plans sold by the law’s health exchanges come with high-deductible health plans.”

Can this be true? If so, what is happening in Iowa with employer-sponsored health plans since the ACA was passed in 2010? From our vault of study data, I decided to perform a quick ‘audit’ of pre-and-post ACA trends in Iowa on this particular issue.

My findings appear to be a bit different than conveyed by the WSJ article – at least for our state of Iowa.

To clarify, our survey does not exclusively analyze the health plans offered within health exchanges. After all, the ‘public’ exchange has only been operating since the beginning of 2014. But rest assured, because we randomly select employers to participate in our surveys, a few employers may have purchased their group health plans through the Iowa Partnership Exchange and participated in our 2014 survey. Realistically, a scant number of these employers would have affected our overall findings.

PRE and Post ACA Deductibles
The chart below illustrates the average single health plan deductibles offered by Iowa employers during the period 2005 to 2014. All group medical plans within our data include PPOs, HMOs, Indemnity and consumer-driven health plans. Looking at the five-year period prior to 2010 (the year the ACA became law), the deductible increased from $750 in 2005 to $1,061 in 2009 – an increase of 41 percent. Yet, when we look at the five-year period that follows 2009, the deductible growth appears to be more tame – increasing only 13 percent ($1,247 in 2010 to $1,410 in 2014).

All Medical Plans DeductiblesPNG

Many key ACA provisions did not take effect until sometime after 2010, so we cannot completely comprehend how the ACA will ultimately impact employer-sponsored plans on cost-sharing arrangements and cost. When attempting to clearly understand the ACA impact, this comparison is only one of many metrics that will need to be assessed in the years to come.

PRE and Post ACA Out-of-Pocket Maximums
Similar to the above deductible chart, the chart below illustrates the average single out-of-pocket maximums (OPMs) offered by Iowa employers from 2005 to 2014. Again, the five-year period prior to the 2010 ACA implementation year shows that OPMs increased by 19 percent, compared to 13 percent since 2010.


There are many variables to consider that are not addressed in this blog, such as average health plan designs within the public exchange versus outside the public exchange. Assuming a healthy number of employers enroll in the public exchange, it will take a few years to have a better accounting of such differences. At this point, plan design changes continue to show additional cost sharing with employees and their dependents, just not at the accelerated pace that some may think.

What will the future eventually reveal about our ever-changing health insurance world? Stay tuned…

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