Long Term Care Consultants



A Method for Assessing the Extent of Family Caregivers in the Workplace and their Financial Impact

by David J Levy, JD CCE
reprinted with permission

One of the great social enigmas of the past 10-15 year has been the recognition that tens of millions of working Americans are family caregivers however, there has been no way to effectively identify their true number in the workplace.

This failure to self-identify and the desire to remain “invisible” is the need to protect their jobs, retirement and essential well-being due to their fear that asking for help will typecast them as a worker who doesn’t give the company 100%.
Family caregivers are showing up for work, “perfect attendance”, but they are dealing with their family caregiver/health issues on the employer’s time - presenteeism.

While absenteeism can show much of the direct costs of caregiving (sick time, time off, reduced work hours, early retirement), presenteeism shows the indirect costs and they are a multiple of absenteeism costs totaling in the $100’s of billions.

The overall stress of family caregiving causes a unique cluster of five symptoms and illnesses. Those top five illnesses match the top five found in workers participating in the American Productivity Audit - a major, ongoing investigation of productivity and presenteeism in the workplace.
This correlation by illness allows a better ability to identify and assess the true extent of family caregivers in the workplace.
Due to the enormous financial impact caregiver presenteeism places on the bottom line, this is an issue that needs recognition at every level of corporate management.

To stem workplace presenteeism, the corporate culture and existing eldercare programs must be critically reevaluated and replaced with a more caregiver tolerant corporate mind set and supportive programs that are meaningful and effective.



  • Tens of millions of working Americas are family caregivers but have remained invisible in the workplace.

  • The working family caregiver leaves home every workday but they do not leave their caregiving issues at home. They come to work preoccupied with family caregiving and health issues. They secretly deal with those issues at work.

  • This resulting loss to productivity from employees who show up for work, but are preoccupied is called – presenteeism. Presenteeism results in employers losing as much as 10 times the workplace productivity as it does from absenteeism.

  • Presenteeism productivity losses are based on; indirect costs of workers managing daily caregiving tasks from their desk, lack of initiative due to redundant caregiving problems and a failure to focus on, and successfully perform, workplace tasks due to chronic, low level, caregiver-related illnesses.

  • Traditionally, workplace caregiver studies have been done by questionnaire and telephonic polling using <2000 self-identified caregivers who retrospectively assess their long term workplace impact from caregiving. The results are adjusted for the broader marketplace (margins of error and ethnic and gender balancing). This methodology typically aggregates direct costs associated with identifiable lost time and observable absenteeism. Its major flaw is in accurately identifying all caregivers, as many remain hidden due to fear of exposure and categorization as workers who don’t give 100% and with potential loss of promotions, salary bonuses and/or their jobs.

  • The American Productivity Audit (APA), an ongoing study focused on workplace productivity/presenteeism, uses a pool of >29,000 participants, a portion of whom are polled bi-weekly. The Audit never asks participants if they are family caregivers. Their research reveals that the top five health conditions for worker presenteeism are: headache/back pain, cold/flu, fatigue/depression, digestive problems and arthritis.

  • The APA reveals that a majority of lost productivity time based on these health conditions is invisible to employers because it occurs "on the job." - time missed at work; not time missed from work!

  • Extensive family caregiver health studies over the past 20 years have continually reported depression/fatigue, chronic stress, anxiety, head and backaches and stomach/intestinal disorders as their top five disorders. The reported illnesses for both groups are virtually identical. These illnesses are underreported in the workplace as they are neither readily seen in claims data audits nor typical of conditions targeted by disease management programs.

  • Using these illnesses may be a more inclusive measurement for the true extent of caregivers in the workplace and a more accurate basis for assessment of their indirect costs.

  • Family caregiving is typically a 3-5 year event and as high as 10+. It is rarely crisis management. Rather, it is a serious, long term, day-to-day effort that is counterintuitive, complex and confusing. No prior experience is adequate preparation for the extent of family caregiving or emblematic of the depth of problematic and ethical issues being raised. The illnesses shown are typical of the physical reactions to the unending task family caregiving presents.

  • The California Public Employees' Retirement System (CalPERS) reported more than a third of the State of California workforce reported physical and emotional strain created by family caregiving responsibilities.

  • A major driver of family caregiving is chronic illness. Presently 125 million Americans have at least one chronic illness; 60 million two or more. By 2020, the 125 million will grow by 25% to157 million. Conservative estimates project family caregiver totals in the range of 35-40 million and rapidly rising.

  • The July 2006, NAC/MetLife Study estimated close to 16 million full time caregivers in the workplace. There approach was to poll for self-identified caregivers and was based on absenteeism/partial absenteeism estimation. Using the illness approach, the extent of caregiving based on national chronicity statistics, it would be reasonable to estimate that there are 25-30 million family caregivers in the workplace.

  • The APA revealed an average annual loss per U.S. worker of 115 productive hours due to presenteeism at a cost to employers of $180+ billion per year. Failure to calculate the costs of presenteeism is a major disconnect in evaluating the real cost of caregiving to a company’s bottom line. 

  • Workplace eldercare programs are patient-focused, clinical services for the patient. These include care assessments, referrals to facilities and geriatric care managers etc. It also makes the issue one of eldercare only. Chronic illness requiring caregiving responsibility occurs at any age from early childhood through the boomers. The programs do not directly support family caregiver issues - problem solving, advocacy, emotional support, ethical caregiving, long term planning and expectation management. It is usually in the form of crisis management. Family Caregivers need to first be engaged by a live, caregiver trained, non-judgmental human to establish a "competent authority relationship" and understand what they are really asking. Data based referrals or websites and blogs with lists of lists and articles rarely related to a caregiver’s specific needs and often cause more confusion then they help solve.

  • Both the existing workplace "caregiver culture" and the "programs" offered need to be substantially revamped to allow working family caregiver to self- identify, seek help and begin to mitigate the enormous hidden costs of caregiver presenteeism on the employer.

  • To read David Levy's paper,  Presenteeism: The Hidden Cost of Doing Business in its entireity, right click on the link and download.