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Stresses of elder care hitting the workplace

NEW YORK -- Ken Stikeleather has left his Upper West Side apartment six times this year to fly to North Carolina to help his brother and three sisters care for their 84-year-old mother, who has Alzheimer's disease.

Since last year, when Stikeleather and his siblings held a family meeting after their father's death, they have shared the work in providing her care, instead of burdening one of them. They have scheduled shifts to stay nights with their mother, Eva Mae Stikeleather, who was diagnosed with Alzheimer's five years ago. One daughter perms her hair, and another takes her to the mountains to enjoy the outdoors. Stikeleather, who at 50 is the youngest and has no children, has returned to the family's hometown of Waxhaw, N.C., near Charlotte almost every month to cook meals and take her shopping and on long walks.

''The guilt was strong," Stikeleather recalled. ''So it was at that meeting I said, 'I am coming home.' "

While the most common caregiver for a seriously ill or aging parent is still a middle-aged daughter, specialists on the elderly say that in the past decade more working men and a larger number of family members have been sharing in the responsibility, including ''suitcase" caregivers who log thousands of travel miles. Many, like Stikeleather, take repeated, extended leaves from work.

Employers concerned about the resulting financial toll on the bottom line -- nearly $30 billion in lost productivity a year, by one estimate -- have had to adjust to the newest frontier in workplace issues: elder care, which with the aging of baby boomer workers is likely to surpass child care as the most important family matter facing the employed. One major reason: The average couple have more parents and parents-in-law than they do children. About 25 percent of companies with 500 employees or more, including UPS, Morgan Stanley, and Fannie Mae, have instituted a variety of elder care services for their workers, from simple referral services to adult day care at work.

Some operations boast about their elder care programs as a way to recruit potential employees. According to the US Department of Labor, taking time off from work to care for an ill parent is one of the fastest-growing uses of the Family and Medical Leave Act of 1993, which requires companies with 50 employees or more to provide 12 weeks of unpaid leave for a serious illness, birth or adoption of a child, or care of a parent, spouse, or child. Two weeks ago, California became the first state to provide a comprehensive paid leave for all workers. A number of states, including Massachusetts, New Jersey, and New York, are considering similar legislation.

''To a large degree, this movement will parallel the child-care movement" of the 1970s and '80s, said Elinor Ginzler, AARP manager of independent living and long-term care. ''Not too many decades ago, it was hard and not particularly normal for parents to have a support system in the workplace and their community so they could work outside the home. Today, this is absolutely commonplace. We are not there yet in elderly care, but I think it is going to be the next venue that takes prominence in the workplace."

According to a recent study by AARP, about 34 million workers provide care for parents 50 or older. Ginzler said 57 percent of working caregivers say they have gone to their jobs late, left early, or taken time off for this purpose. An additional 10 percent have shifted to part-time work, and 15 percent left the workforce or turned down promotions.

Like many of his friends who are childless baby boomers living some distance from an ill parent, Stikeleather found that coming home was not easy. The schedule called for each of his siblings, who live in North Carolina, to rotate taking their mother into their homes a week at a time. But when Stikeleather went home for long periods, he said he found himself doing most of the caregiving in the family home.

''I think because they all have families and they are consumed with their lives, they probably thought, 'Well, he is in New York having a party,' " Stikeleather said.

Joyce Price, an older sister who lives in Weddington, N.C., had a different viewpoint. ''He was always away, so when he came back, I think he was a little overwhelmed," she said.

According to the National Alliance for Caregiving, 40 percent of caregivers for ill parents are men, and 50 percent of caregivers who also work are men. Studies indicate that 3 million to 7 million Americans involved in caregiving live a long distance from the parent.

Robert O'Toole, president of Informed Eldercare Decisions, a geriatric management company based in Dedham, Mass., said a combination of factors -- including low birthrates in the 1970s and '80s, dramatic growth in the number of older Americans, and an increasingly mobile society -- have contributed to elder care becoming a workplace problem. O'Toole said studies indicate that many baby boomers are considering early retirement or leaving their current jobs for more-empathetic companies.

But O'Toole added that employers -- who are realizing that there are not enough younger workers to replace baby boomers leaving to care for ill parents -- are doing everything from opening adult day-care centers at job sites to hiring management companies that help employees plan elder care.

O'Toole said Boston's large health-care industry provides a good example of the trend. The average nurse in Boston is 44, and many leave nursing to care for parents. Some hospitals have offered bonuses to recruit replacements and have begun to realize that they must find flexible ways to allow workers to do their jobs and care for parents, he said. The hospitals are facing ''what other industries in the Boston area, like [information technology] and tourism, will be facing a few years later," O'Toole said.

For more than a decade, a coalition of social workers and labor officials in Massachusetts has pushed the issue of paid leave for caregiving. State Representative Patricia D. Jehlen, Democrat of Somerville, introduced a bill this year that would allow employees to receive through a disability program two-thirds of their pay for 12 weeks of leave to recover from a disability or care for an ill relative. Jehlen said she does not anticipate action on the bill this year but plans to reintroduce it in 2005.

James T. Bond, vice president of the Families and Work Institute, said a recent survey by the organization indicated that most workers found their employers sympathetic about elder care needs. He said many supervisors themselves are baby boomers.

Yet critics say many employers are not as generous as Stikeleather's.

Shortly after the terrorist attacks of Sept. 11, 2001, Stikeleather was laid off from his job as a manager at a New York City tour agency. He was called back to work but delayed his return by taking several leaves so that he could spend more time caring for his mother. Eventually, his company paid for several trips to North Carolina so that he would return full time.

''When I wasn't there with my mother, I was always thinking of ways to make it better for her," he said.

Many workers, particularly men, keep their caregiving a secret from employers for fear they will be penalized somehow. A growing number of specialists say companies are being supportive only because they have to. According to a recent study by MetLife, elder-care needs cost employers at least $29 billion annually in lost productivity and wages.

Donna Wagner, director of gerontology at Towson University in Maryland, has studied the evolution of elder-care programs in the workplace and said the first programs created in the late '70s mirrored child care in providing referrals, but employers soon learned that elder care is more complex and draining for employees. They have begun to offer a broader range of services.

''There is recognition on the part of employers that the situation is a complicated situation, and you have to provide support in a way that takes care of everyone rather than 'one size fits no one,' " Wagner said.

O'Toole said caregiving is particularly draining for family members who have to crisscross the country to visit an ill parent, or who have more than one parent needing care.

Karl Case, an economist at Wellesley College, said he travels to Ohio at least once a month to help his 90-year-old father, who resides in an assisted living center. His wife makes frequent trips to Ohio to care for her two parents. Case, 58, said his situation is common among friends of his generation. The mother of one of his colleagues lives in the same facility as Case's father.

Although middle-aged women working part time or not at all provide the most intensive care, other family members are increasingly playing a role as well, specialists say.

''In our case, it was a family effort so that no one would be carrying the entire burden," said Terri Calderon, 53, who along with her brother and sister pledged to share responsibility for caring for their 73-year-old mother when she was hospitalized for several months last year in California. ''It was a 24-hour shift, and we divided it among the three of us," she said.

But Calderon, who lives in San Jose, Calif., worked for a telecommunications company with strict rules on when an employee could take vacation or other time off. She turned to the Family and Medical Leave Act, which allowed her time off without reprimand but also without pay.

Critics say the law exempts most Americans, who work for companies with fewer than 50 employees. For those like Calderon who can take leave under the US law, most cannot afford the time off. Fortunately, the law allowed Calderon to be paid for unused vacation time while on leave. ''If I had already taken my vacation, I would have had to file bankruptcy," said Calderon, whose mother died before she left the hospital.

During a recent family meeting in North Carolina, Stikeleather's oldest sister, Joyce Price, agreed to have their mother live with her so that she would not have to move around so much. The other siblings will alternate having her stay with them on weekends. Stikeleather will continue to spend time in the state to help get the family house ready for sale and give his siblings a hand.

But his trips will be less frequent because his employer needs him at work full time.

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