Joseph Fuller: Employers started offering healthcare benefits during World War II, when labor demand was high and supply short. The economy is vastly different today, as are workforce demographics. Employees today, though, have a different set of needs that go beyond primary healthcare. Specifically, they face a wide array of caregiving obligations—for kids, chronically ill spouses, and seniors. Employers are experiencing those needs in lost productivity, absenteeism, and voluntary turnover. High demand for certain types of skills and the demographics of educational attainment mean that employers are going to have to start engaging workers on the care issue. Welcome to the Managing the Future of Work podcast from Harvard Business School. I’m your host, Harvard Business School professor and visiting fellow at the American Enterprise Institute, Joe Fuller. My guest today is Harvard Business School alum Lindsay Jurist-Rosner. She drew on her own caregiving experience to create the B2B benefits company Wellthy. Wellthy provides their clients’ employees with support, in the form of care coordinators. Those coordinators help arrange for and ensure the delivery of the services needed to meet the care needs of the employees’ loved ones. As the care needs of employees grow, Wellthy provides an opportunity for companies to differentiate themselves in the eyes of incumbent and potential workers. Lindsey, welcome back to HBS.

Lindsay Jurist-Rosner: Oh, thank you Joe. It's so great to be back.

Fuller: Lindsey, caregiving is a catchall term, which a lot of people just use to describe all sorts of different situations. When you think about it in the context of a corporate setting, an employment situation, what does it entail?

Jurist-Rosner: So, we very specifically define caregivers as employees or individuals who are taking care of aging, chronically ill or disabled loved ones. So, we think about it as folks who are involved in the care of a loved one with a complex, chronic or ongoing care need, or it could be an individual themselves.

Fuller: How is it that you came up with this idea? What inspired you to start Wellthy and also to think of it as something that could be offered by employers?

Jurist-Rosner: I got involved in my mom's care when I was a kid and so, I was a family caregiver for 28 years. She got diagnosed with primary progressive multiple sclerosis when I was nine. It took on a lot of different forms for me. So, I moved home after college and lived at home, and got Mom up in the morning and helped her with breakfast, and would go into the office and come home to help her with lunch, and then go back into the office and help her in the evenings. And I did that for years and then supported her through hiring and firing in-home aids and hospitalizations, surgeries, special treatments. And then the last year and a half of her life, she was on hospice. And it remains, taking care of my mom and being involved in her care remains the single hardest, loneliest, most stressful thing that I've gone through in my life. And the eye-opening thing for me was just realizing how many other families out there are similarly struggling. And, whether it's a parent with dementia or a child with autism or a spouse or a sibling with a cancer or Parkinson's diagnosis, the problem statement is the same—which is that it's just way too darn difficult for families to manage and navigate care. It's almost a second job. And so, when we launched the business, Wellthy, we were focused on supporting families directly. So, we were selling direct to consumer. And it was through that that we, in the early days, had a really satisfied early customer who approached us and said, "I work in HR for my company. You've changed my life, you've made me a better mom, a better wife, a better worker. And I work in HR for my company and I would love to be able to offer Wellthy support to our employees." And you know, admittedly we had thought that the employer channel might be a nice one for us, but she sort-of forced us or encouraged us into that, into exploring that path and we did.

Fuller: What is it that a company like Wellthy can do for individuals or families that they can't do for their own? After all, families have been caring for sick relatives, aging relatives for time immemorial.

Jurist-Rosner: What we see in the area that we support families with is the administrative and logistical aspects of care. So, what we've identified is that managing care has just gotten so much more complicated for families because people's care needs have just gotten so much more complicated. And so, we're seeing individuals who are living longer than ever before with more chronic conditions and more complex care needs. So, an example is an individual or an employee who comes to us and their dad has diabetes, prostate cancer, heart disease, and dementia. And that employee is trying to navigate support for Dad in the home, his appointments, maybe up to a dozen different specialists and providers, whether he should consider a move into a facility and then how the family is going to pay for all the care that he requires. And these are really complicated questions and decisions. And these are all considerations that impact not only the care needs of the individual, but also the family's finances. For an employee to pay for Dad's long-term care facility, that's a really significant amount of money every month. And so, we're supporting families in providing expertise and guidance on these questions and then also taking some of the time and administrative burden off of the family's plate by going ahead and getting things done for them.

Fuller: So, it sounds like it's everything from dealing with insurers to coordinating across different physicians or healthcare channels to sometimes even arranging the resources just to keep life going. Is that a fair characterization?

Jurist-Rosner: That's exactly right. Yeah. And so, it's a range of areas where we support families, but what's unique about our model is that we employ social workers as our care coordinators, who partner with families to provide the support. And social workers are the skilled and knowledgeable workforce to be able to help families with these topics.

Fuller: Now, a lot of our listeners are going to be familiar with employee assistance programs. Those of us who work for larger companies have them available to us. I can't honestly say that I can rattle off the ones that are available to employees of Harvard Business School like me, but is this just a next generation employee assistance program?

Jurist-Rosner: You know Joe, in some ways it is. We found that as our team is almost all caregivers ourselves—and so, for many of us working for Wellthy is a mission-driven endeavor—and we've built the business we needed and wanted for our own families. And one of the things we've all observed in working for big companies is that EAPs just don't provide nearly the support we need or want. In a world where we can search at our fingertips and plug in mom with dementia in this zip code and get a list of memory care facilities, getting that—what EAPs refer to as resources and referrals as what they provide. That just seems like an outdated solution. And so, our model just goes way beyond resources and referrals. We find that it's not helpful for employees to get a list of memory care facilities. What they're looking for is what is the right option for my mom. She needs some support with dementia. She also is a big foodie and she used to be really into music. What would be the right place for her, and her personality, and her needs? And then also navigating really complicated questions around who pays. And how do we set up a Medicaid application? And these are all topics that an EAP just won't go far enough in supporting families. I think the other piece is just the modern style and communication that employees have come to expect. And so, calling an 800 line, talking to somebody who works in a call center, and getting an output of some resources and recommendations just doesn't feel like the experience that employees have come to expect with their modern consumer brand experiences. And so, one of the things we've modernized is just that overall experience for employees.

Fuller: Lindsay, tell us a little bit about how employers are making the choice to engage a company like Wellthy. What questions do they ask? And to put it bluntly, what's in it for them?

Jurist-Rosner: One of the things we're hearing from companies is that companies have spent the last couple of years really focused on how to support new parents. And so, what they've started to hear from employees on the other side of the caregiving spectrum is, "Hey, I'm not giving birth here, but I'm really involved in the care of my mom, and it's enormously stressful and difficult. Do you have any support for somebody like me?" And so, employers have started to recognize that this is a significant portion of their workforce. Roughly one in five, so 20 percent, of any given workforce that has employees who are taking care of an aging, chronically ill, or disabled loved one. And those individuals are stressed, they're missing work, their productivity might be impacted, but even more importantly they might consider leaving their company to move closer to Mom or Dad if they live across the country, they might consider taking a leave of absence, or they might be using their paid time off days to try to squeeze and time to support their loved ones. And so, our claim, and what we see is that by providing proactive and preventative support to employees, employers are able to reduce stress, increase productivity, and reduce a potential leave of absence.

Fuller: Lindsay, paid family leave and paid maternity and paternity leave has become an issue, a political debate. How is that affecting the behavior of employers and is that influencing also the expectation of their employees?

Jurist-Rosner: We see paid family leave impacting both employers and employees and in a big way. We see an increase of employees taking paid family leave in the states where it's now offered. And paid family leave, it's a great solution for new parents, makes total sense, but doesn't make as much sense for employees who are taking care of, for example, a parent with dementia or a child with autism, where the caregiving situation will continue for years, if not decades. And so one of the things we're working closely with employers on is supporting caregiving employees more proactively, so that they might not need to take a leave of absence or in case they do take a leave of absence, it's a little bit shorter. And also that they have an improved return to work.

Fuller: Lindsay, our research indicates that a lot of employees are hesitant to apply for leave, to raise caregiving obligations as an issue with their supervisors, employers for fear that they'll signal a lack of commitment to the organization, or that somehow it's going to affect their trajectory, their opportunities for promotion, or for assignment to interesting work. Is that consistent with what you're seeing and if so, what can employers do to reduce that hesitancy on the part of their employees?

Jurist-Rosner: The stigma around caregiving is real. And employees, the most common question we get asked when we launch with a new employer and we're doing a lunch and learn or a webinar, the most common question is employees saying to us, "You're not going to tell my employer that I'm working with Wellthy are you?" So, employees certainly do feel that there is a stigma around this topic. And in fact, I'll even point out, if an employee is raising their hand and saying that they need a leave of absence or disclosing that they are caregiving, oftentimes those are employees who are incredibly stressed and overwhelmed and struggling. So those are the more severe caregiving situations.

Fuller: One thing we've seen is that employers actually often don't know, what we call care demographics of their workforce, are. They don't know that they've got, for example, a substantial percentage of their employees are living in this so-called sandwich generation where they're both taking care of older relatives, parents, in-laws, and they have kids still in the home. Do you find that most employers actually understand the scope of the problem? And is there any appetite for trying to, to do survey work or other kinds of data capture that allows them to understand what types of offers would be most beneficial to their workforces?

Jurist-Rosner: The HBS report that you put out Joe, did such a nice job of highlighting this disconnect and it's spot on. We see this with employers. It's changing. When we first started talking about caregiving to employers a couple of years ago, we did find that employers would say back to us, "I'm not sure if our employees are going through caregiving." And we would, sort of under our breath, say back to them, "Well we know they are." Right? We know it's roughly 20 percent of your workforce. But we have seen more companies start to tune into the topic and do surveys. One of the things that's critical, and I'll say to your listeners, if they are considering surveying their employees on this topic, it's critical to ask the right questions. So, one of the things we've seen is that employees don't self-identify as caregivers. They think of themselves as mothers or daughters, or husbands, or wives. And so, asking questions around whose care are you involved with? Are you involved with the care of an aging parent or a child with special needs? So, asking very specific questions like that will result in better answers and a better sense of the caregiving issue within an organization.

Fuller: Lindsay, our research showed that over half of the employees had some type of caregiving obligation. It can be anything from a newborn to a kid with a chronic condition, a spouse with a chronic condition. They were ill themselves, seniors... Does that number sound right to you?

Jurist-Rosner: It does sound right. And I want to point out though, that's employees who have one or more, right? So, within that number, we do see employees who are taking care of, to your earlier point, folks in the sandwich generation who are taking care of multiple family members. I'll also point out within hourly workforces, so companies that have large kind of shift workforces are hourly employees, we do see that those employees are oftentimes involved in the care of kids, parents or in-laws, as well as grandparents. And even having multi-generational households with multi generation family members within the same household. Which is incredibly overwhelming and complicating for that individual.

Fuller: Are the economics for the employer of getting the type of productivity improvement and reduction to absenteeism you referred to earlier, are they similar across industries? Are they as compelling for a company that does have a big hourly or shift workforce as they are for a company full of high-paid white-collar people whose productivity is essential to the company's strategy?

Jurist-Rosner: We see different impacts to different industries of having caregivers in the workforce. So, for professional services and financial services, pharma, tech, it's more straight-forward that there's lost productivity, that there could be issues of these high value employees. And then certainly there is kind of the issue of distraction. For other industries we see slightly different nuanced impacts. So, for oil and gas, one of the areas that HR leaders at an oil and gas company focuses a lot on is, anything that could potentially pose a safety risk. And bringing in outside distractions, stress, lack of sleep because of family care related issues is certainly a safety issue for an oil and gas company. We see for companies that have large retail workforces, hourly workers, shift workers, family care related issues are one of the main reasons for missed shifts. And so, those missed shifts are actually incredibly expensive for the company. So, it's a little bit less of a labor arbitrage, lost productivity argument for those workforces. And then certainly for any company that has an individual in a revenue generating role, so a law firm for example, not only are you getting the hit of the lost productivity, but you're also getting the double hit of lost revenue from that individual's distraction.

Fuller: It sounds like there are a lot of indirect benefits to these types of interventions. Try to help employers manage their employees care situations, but those are hard to measure. How should a company keep score on all this?

Jurist-Rosner: We're looking for better measurement in this area. And so, if your listeners are interested, we're interested in engaging on this topic. When we work with an employer, we can provide really detailed information on the number of hours that our team is spending and the types of tasks we're working on for families. And we can roughly equate that to the hours that were saved by that employer’s employees and at the hourly average salary of those employees, what the cost of those savings would be. That's a pretty imprecise and rough way of measuring the ROI for the employer. But what we're excited about is we are partnering with one large employer, a tech company on the West coast, to do a study where we're going to look at, and we're working together to look at the impact of offering Wellthy to reduce paid time off and leave. And this is going to be set up as a scientific study with a control group, and a group that gets offered Wellthy. And we'll be able to measure the difference in the impact with that group. So, we'd love to do more work around those topics with employers that are interested in understanding the impact of care support.

Fuller: Lindsay, we're all familiar with things like HIPAA [Health Insurance Portability and Accountability Act], the health information privacy act, increasing burdens on employers to protect data about customers and employees, really worldwide. How does that affect the ability and willingness of either employers to gather information about their workforces or employees' willingness to share it?

Jurist-Rosner: Data and privacy is certainly something we think about in our business every day. We're HIPAA compliant, we go to great lengths to train our team on security measures and we're always mindful about not collecting any PHI, protected health information, or PII, personally identifiable information from our customers unless we absolutely need it in order to get something done for them. But we do see heightened sensitivity, especially on the part of employers. When we engage with an employer, a company will put us through a really rigorous info sec, or kind of vendor procurement process, that involves a lot of steps around security and privacy. We've had to go through penetration tests and other measures that an employer puts us through to ensure that our platform is incredibly safe and secure for their employees' data. By the way, we're not even gathering any information or data directly from the employer. This is just the company being incredibly mindful about any data we might collect directly from the employees. We do see that given that employers will put their stamp of approval on Wellthy, employees are comfortable with sharing and disclosing any PHI or PII with us because they feel like we're able to get things done for them, so it's worth the exchange.

Fuller: So, they'll take the risk.

Jurist-Rosner: They'll take the risk.

Fuller: So, another feature of our research, Lindsay, was that caregiving obligations are actually much more evenly spread between men and women than I would have anticipated and that men reported the propensity to seek different employment options for example, due to care concerns, at an equal rate with women. Is that what you were seeing and what's the breakdown in terms of support you're providing to the employees of your customers by gender?

Jurist-Rosner: We do see that the number one relationship in the individuals who we support with Wellthy, the number one relationship is a daughter. So that's a female employee who's taking care of one or both parents. We do then see that the second most common relationship is a son, so a male employee taking care of parents. And so, we do see that there is a slight skew toward women, but we see both women and men engaging. And I'll share, in our data, we just see men and women taking slightly different types of caregiving roles within the family. So, women might be more involved in the day to day care needs and men might be more involved in managing finances or making the financial decisions. But to your point Joe, one of the things that's promising or encouraging is that for millennials, and this data is AARP data, we see that one fourth of caregivers are millennials and that it is very much 50/50 split between men and women among millennials.

Fuller: And that pattern's pretty common across industries of different types with different workforce structures?

Jurist-Rosner: We see slight differences across different types of companies and different industries. There are some companies that we support that skew very heavily male and it just so happens that there are more stay-at-home spouses. And so, in those companies and those industries we'll see women much more heavily involved than men. In certain other industries, or companies, we'll see pretty equal contribution and involvement by both men and women. So, it does break down by company and industry.

Fuller: Lindsay, we're talking in the early days of the Covid-19 outbreak in the United States when we're in that ramp period that we're all so nervous about. How are employers responding? What have been the implications for Wellthy, and what type of tasks are you being asked to do?

Jurist-Rosner: We've seen companies step up in a really significant way to really support employees through the crisis. And it's been exciting to see. Wellthy got involved in helping employees across a whole variety of areas, in helping employees prepare for the crisis, so finding backup care for loved ones, getting medication and incontinence supplies ordered and ready to go, meal delivery and making sure that an older adult is set up to be able to be quarantined and live safely. That's just an example there. And then we've supported employees through the crisis as they've been navigating diagnoses a little bit, but then certainly as they come out on the other side and post-hospitalization or dealing with a mound of insurance bills and trying to navigate what needs to be paid or what needs to be recoded. And so, we've been able to support families throughout the life cycle of the crisis and it's been encouraging to see employers really tune in to the topic of family care and complex care for the first time in a much more significant way.

Fuller: Well, Lindsay, thanks for sharing the story of Wellthy with us on the Managing the Future of Work podcast at a time when the types of services you're offering seems so profoundly relevant to all of us.

Jurist-Rosner: Joe, thank you so much, such a pleasure to be here with you. Thank you for inviting me on.

Fuller: Thank you for listening to this episode of the Managing the Future of Work podcast. To find out more about our project on the future of work visit our website at hbs.edu/managing-the-future-of-work. While you're there, sign up for our newsletter.