Asynchrony and the Art of Caregiving: COVID-19, Caregiving and the Economy

Our economy cannot recover without addressing the needs of caregivers

By Alexandra Drane and Lisa Suennen

The word “asynchronous” first appeared in print in 1748, according to Merriam Webster’s Dictionary.  A quick Google search suggests that the word was rarely used until the 1950’s, but its usage has gone up, hockey stick style, since that time.

Why?  Are we just all that much more asynchronous?  What does that even mean?

There are several definitions of the word “asynchronous”– but it’s the one from the Oxford Dictionary as it relates to the field of astronomy that’s particularly resonating right now:

“…(of a satellite) revolving around the parent planet at a different rate from that at which the planet rotates.”

Note that 1748 is also the first year that the term “red flag” appears in print.

You know what’s a big fat red flag?  The asynchronicity we are about to experience as COVID-19 enters the “return to work” phase of its ravaging journey through the American landscape.

There’s an out-of-body experience aspect to asynchronicity – it’s like watching something unfold that you know doesn’t feel right, but you can’t explain why.  Until you slam into it.

And that interplanetary force we are about to slam into is this:  the disconnect between what our country needs to actually get back to normal vs. the typically uncompensated, always underappreciated role of caregivers and how essential these individuals are to the normal functioning of our country.  And if there were 44 million Americans who fit the description of unpaid caregiver before the coronavirus entered our orbit, the number has increased exponentially since.  Estimates are that the numbers have more than doubled since the start of the pandemic. In other words, more than a quarter of the U.S. population is acting in a caregiving role today.  An easier question to ask might even be, “Who’s NOT a caregiver right now?”

In the past week, have you found yourself stressed about the health risk of a loved one?  The 44 million of us who were unpaid caregivers before know the routine – make sure our loved ones have (and are taking) their medications, are seeing their doctors, are getting the care they need, are letting us know when they aren’t doing their best. It’s not an easy job – but there’s no option, and it’s usually done with a whole love of love.  Caregivers rarely complain and those that assume these roles by choice do this despite knowing there is no upward career path and no financial payout at the end. Unpaid caregivers often forfeit their own opportunities to play this role. And all of them are a vital part of keeping this economy functioning.

Since the advent of COVID-19, a key part of the caregiver job description is keeping those they care for out of a medical system where the risk of infection goes up, and the need for reserving beds and resources for COVID19 patients is a priority. As the understanding of who’s ‘at risk’ for COVID keeps expanding, so does the population of unpaid caregivers.  This challenge is particularly acute for the 42% of GenXers who may be caring for aging parents and kids at the same time, often under one roof and while trying to do their day job from home.  Their day is filled with efforts to apply for new jobs or work professionally from home while their children run amok in the background; all the while they are parallel-processing to get food safely into the hands of an isolated senior living across town, across the country, or maybe just in the other room.

Caregivers of all types are suddenly finding themselves in a familiar role where the rules have become fundamentally unfamiliar, and dramatically so.  Long-time family caregivers might have a leg-up on the new COVID-19 caregiver population because at least they’re familiar with the stress and complexity of the role, not that it makes it any easier.  But few caregivers – new or existing – have the resources or experience to succeed in this new world order and very few have had to contend with caring for, home-schooling and guarding the health of young children while also doing the same for older adults.  The National Alliance for Caregiving has written eloquently about this challenge.

Here’s where the asynchronicity comes in.  Cities and states across the country are thinking about how to re-open workplaces.  Companies whose workers were a little less ‘essential’ will soon be encouraged and expected to leave their homes and re-enter the economy.  And yet, it appears that school openings may lag workplace openings by many months.  In a world where childcare is already difficult to find, it is expected that as many as 20% of daycare and other childcare programs may never return, according to Kinside.  And even if childcare is available in theory, the cost may make it prohibitive in today’s reality.

At the same time, nursing homes and assisted living facilities, where many older adults have lived, are now finding themselves without clientele as families move their beloved aging parents back home to escape the spreading scourge that has particularly plagued senior living sites.  Some nursing homes and long-term care facilities have themselves sent clients away in order to make space for those with more serious illnesses or because they are worried about the further spread of the coronavirus.   The result has been major displacement for seniors, many of whom have had no place to go other than their own children’s homes.  It is possible that some of these senior living and long term care facilities will never fully recover and that many older adults may end up residing for the long term with their adult children, most of whom did not expect to find themselves with this daily responsibility, particularly if they must head back into the workforce.  If they also have school-aged children, it will be a profound dilemma for these parents to let their children come and go from school given the risk of bringing the virus home to their vulnerable grandparents.   Heading back into the workforce has never been so fraught with risks for caregivers of all kinds.

But head back into the workforce they must.  Given the coronavirus’ impact on the economy, few can afford to give up their jobs.  The problem is that many now have a second job that they hadn’t previously planned upon: caregiving.

This is the essence of asynchronicity.  The workforce may well re-open long before there are solutions to these care-giving challenges. For those who have no other solution to their caregiving challenges, returning to the workforce may be impossible since one cannot be in two places at the same time.  As Jennifer Olsen, Executive Director of the Rosalynn Carter Institute for Caregiving, said, “Caregiving is a form of work.  We wouldn’t double book someone from 9 to 2 at a restaurant and at another restaurant at the same time.  But we’d expect them to be doing their caregiving responsibilities and doing their work at the same time.” To paraphrase, no one can be at two jobs at the same time.

Work-from-home solutions are not realistic for many in the workforce – it is impossible to wait tables or drive busses from home – and a troubled economy makes it even harder to afford caregiving resources were they even available.  Without schools opening, parents are tied to their homes, which may be the direct route to unemployment.  As we know, this leads to a cascade of other problems, such as loss of insurance, and is a particular challenge for the 20 million single parent households in America.  Imagine, now, that you are the schoolteacher who is called back to work but who must leave school to be home with her/his own children or the nurse who must leave their hospital shift to care for his/her own parents.

It’s not much easier for two-parent households. According to the Pew Research Center, the share of two-parent households in which both parents work full time stood at 46 percent in 2015, up from 31 percent in 1970, a 50 percent increase in a 45-year time span. Meanwhile, the U.S. Bureau of Labor Statistics puts that estimate higher, stating that 63 percent of married couples with children have both parents employed.   But the loss of one of those two incomes can be catastrophic for the family and those for whom they provide support.  A major change in caregiver status can easily precipitate this situation.

Because it is often the women of the household that are expected to care for children when no alternative exists, it is likely we will see many women forced to leave the workforce to care for children or parents who have no other place to go and can’t be left alone.  As a result, it is reasonable to expect a roll-back of many of the advancements working women achieved before the virus sent them back to traditional roles.

It is also worth noting, however, that that 45% of unpaid caregivers are men and that more than 10 million unpaid caregivers are millennials; 47% of those millennial caregivers are men. Significantly, 38% of men have left a job over caregiver issues vs. 27% of women.

The bottom line:  this is not only a problem for women or those of middle age.  While middle-aged women are likely to feel the brunt of the caregiver burden, the truth is that this crisis affects people across the age spectrum, across genders and of all races.

Discussions of how to re-open the economy and ensure a rapid return to work are now dominating the news cycle.  With that must be a serious commitment to addressing caregiver issues in a way that we have not undertaken before.  Employers cannot expect employees to find their own solutions to caregiver challenges without serious and direct support of that effort, both organizational and financial.   The North East Business Group on Health (NEGBH) reports that 35% of companies have offered their employees paid leave to address childcare issues, but that time is likely to be used up before return to work even begins in earnest. An NEGBH survey found that more than three quarter of respondents believe caregiving will be an increasingly important issue over the next five years. At the same time, nearly a quarter of those employers view themselves as below or well below average in offering these benefits when compared to their peers.

Employers aren’t the only one with a stake in this situation.  Payers are well aware that medical costs are higher for those with caregiver responsibilities; they should consider ways of contributing to the solution, whether they are public or private insurers.  The federal and state governments, those who rely on the tax revenues created by the American workforce, must step in and lead the effort to find caregiving solutions or they, too, will suffer not only from lost revenues but rising medical costs, particularly in Medicare; caregivers may find it is easier to send seniors to the hospital when there is no one available to care for them at the home.

In fact, Jennifer Olsen also recently wrote in Ms. Magazine that, “While our public health system doesn’t consider the role of the family caregiver in its crisis planning, it is clear it would be even more crushed without their critical support.  Unpaid family caregivers are the backbone of the health care system in the United States, providing as much as 90 percent of all home health care for no pay and at personal risk.”

With return to work initiatives evolving as quickly as they are, it is important to keep our eyes on the asynchronous fact that these policies may be “revolving around the parent planet (aka caregivers) at a different rate from that at which the planet rotates.” To ensure that the economy gets back on its feet, it will be essential to find a way to simultaneously address the caregiver dilemma AND the back-to-work imperative in a far more comprehensive way than we have ever done before. Never has a flag been any redder.

This is the moment to reframe how we as a country support the unpaid caregivers who are a vital part of our economic backbone and essential to our ability to survive in normal times, let alone now.

Let’s take that red flag and wave it in support of caregivers everywhere to draw attention to their sacrifice, their plight, and their essential role in rebuilding our post-coronavirus economy.

 

Note to Readers: great sources of information for caregivers can be found at:

Archangels

Family Caregiver Alliance

AARP

Rosalyn Carter Institute for Caregiving