Monday, March 24, 2014

Memory And Work Comp

After Dad died my siblings and I made arrangements for Mom at the best memory care facility we could find.

My eldest sister has worked in the elder care industry for years and has extensive education, training and experience in the field. Fortunately she knows who the players are, what their reputations are, who the owners are, care policies etc.

Placing your parent into a memory care facility is a bit alarming - as my brother observed, first visit is a scene right out of One Flew Over the Cuckoo's Nest; people wandering about with various emotions expressed on their faces clearly indicative of cognitive impairment.

Mom has moderate to advanced dementia.

I can't say that I ever really appreciated what dementia was until Mom was at the moderate stage.

For years Dad would complain about Mom's behavior - that he would have to coach her in the simplest of activities; walking for example. As her disease progressed I noticed that even eating was not simple - there was this sort of vacant look to her eyes as she tried to make the fork find her mouth.

Mom's standard response when asked to recite something of recent history would be "I don't recall" and she would complain that "my brain doesn't work like it used to."

But she could regal us in stories of the past, often several iterations in a single sitting (she would remember the past event, but forget that she already told the story ... three times already).

And she always seemed happy. If she didn't recall who you were she would at least carry on like she did, and smile.

Always smiling.

Always smiling.

At last weeks California Workers' Compensation Institute's annual meeting Terry Bogyo (pronounced "Bo-show"), an independent researcher who formerly was the Director of Corporate Planning and research for WorkSafeBC (the Workers' Compensation Board of British Columbia) gave a presentation mostly comparing California work comp to Canadian work comp.

A big part of Bogyo's talk was about demographics, and how changes to the population affect the work force and, ergo, what impact that has on work comp.

I was surprised to hear from Bogyo that Alzheimer's Disease, a subset of dementia, was the third leading cause of death.

I didn't know that any form of dementia was a direct cause of death.

The Alzheimer's Association says however that 500,000 people in America each year die directly from the disease and that it is the 6th leading cause of death, 5th if over age 65 is accounted for and the only cause of death in the top ten that can not be cured, prevented or slowed.

According to the National Institute on Aging, over 5 million people in America have Alzheimer's. The disease disproportionately affects women, though men are not impervious; and typically the disease is not apparent until after age 60, though it can begin as early as age 30.

Bogyo brought this up because the age of the work force is changing. There are more people over age 60 who continue to work past retirement age, and in surveys a majority of people say they will continue to work past retirement age regardless for various reasons.

And, I suspect, the health care industry, representing trillions of dollars in the American economy, will be disproportionately represented in the workers' compensation statistics.

For instance, according to the Alzheimer's Association, caregivers to Alzheimer's patients rack up about $9.3 billion in additional health care costs on their own in 2013 due to the physical and emotional burden of taking care of the patients. They say that caregivers rate the emotional stress as high or very high and more than one-third report symptoms of depression.

The facility where Mom lives has a very high proportion of caretakers to patients, and residents are highly engaged - Mom is woken at 7:15 every morning and typically keeps moving until bed time around 8 or 9 (in the past she would sleep in until as late as 11...).

But her facility is atypical. It costs a lot because it provides a lot. Most facilities have a much lower ratio of caretakers to patients putting additional pressure and stress on that work force.

I would expect that the facility where Mom is at does not experience the same level of changes to employee count or work place accidents as other facilities.

Nevertheless, this is just a small example of changes the economy is undergoing. More obvious are the changes we have seen in the shift from manufacturing to information.

I can't say that I fully comprehend what all these changes mean to workers' compensation, or frankly whether they are even relevant to what we all do day in and day out. Clearly the risks are different, and how we deal with those risks may take on different tones.

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