Why This Matters and to Whom
Spiraling health care costs, the recent financial crisis and recession, and a health care industry talent shortage seem to have created the perfect storm, threatening the viability of health care organizations and the patients and families who depend on them. PER programs may offer one solution that begins to address these challenges. The proposed PER program for family caregivers provides a practical plan for getting family caregivers back on their feet. Consistent with the tenor of health care reform, it could begin to address the talent shortage by targeting, training, and connecting a large and new influx of diverse talent, thereby helping to stabilize the workforce. Additionally, the program could begin to address the relationship between illness and poverty by building human capital and promoting economic resilience among at-risk individuals, ultimately improving their prospects for steady employment above the minimum wage. Figure 1 depicts an integrated schematic of our proposed PER program.
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Figure 1.
Program schematic. PER = path toward economic resilience.
As an example of the program in action, consider a family caregiver from a low-income family. For 2 years, this hypothetical caregiver has been providing care to her mother, who had cancer and just passed away. While caring for her mother, the caregiver has not worked; accordingly, she has taken out loans to pay for her mother's medical bills. Prior to her mother's illness, she worked in a school cafeteria at minimum wage. After her mother's passing, the caregiver could possibly reapply for her job in the same cafeteria. However, she has now gained new caregiving skills that—with a reasonable amount of relatively low-cost supplemental training through the PER program—could allow her to obtain certification. This certificate, in turn, could enable her to apply for a medical assistant or other caregiver position. We believe that, after a sufficient amount of grief closure, this caregiver and others like her might prefer the opportunities afforded by a PER program. If so, the health care industry would benefit from a new and experienced set of employees.
As this example suggests, the proposed PER program is grounded on the basic economic principle that individuals will generally pursue the path that maximizes their utility, broadly defined. Avoiding economic deprivation and achieving economic resilience are inherently beneficial for families suffering the fallout from an illness. The PER program is not a curative remedy; it applies only after considerable economic damage has been incurred—and often becomes feasible only after a family caregiver's duties are relieved. Additionally, it would not help those who are not interested in or qualified for health care work. Some who forgo opportunities in order to care for their loved one may have better paths to recovery. Some who provide end-of-life care may find the emotional toll too high or the responsibilities too demanding so soon after bereavement. That said, we believe that many people would find gainful employment and the opportunity to assist others, an important part of the economic and emotional recovery process.
Some clarifications and caveats should be noted. As stated, not all caregivers are eligible or want to gain employment after caring for their loved one. Rather, some are patients who, themselves, need health care support. Although this could decrease the impact of the PER program, it is also important to note another consideration that could increase its impact: the economic challenges of illness often extend to people with insurance. The vast majority of people with health insurance in the United States remain vulnerable to economic deprivation as a result of the multiple dimensions of the cost associated with illness. For example, health insurance rarely covers lost wages or foregone educational opportunities. Additionally, the current move in national policy toward preemptive versus reactive health care strategies (e.g., the Patient Protection and Affordable Care Act) makes it increasingly important to target those who are likely to lose significant financial ground as a result of illness (e.g., the underinsured).
For these reasons, we believe that the PER program for family caregivers offers a step in the right direction. Having presented the basic outlines of a PER program, substantial future effort would be required to see our proposal to fruition. For example, future data collection on the feasibility of the PER program for caregivers from various communities around the United States, especially from distinct cultures and socioeconomic positions, would enhance the empirical evidence presented here. Likewise, in-depth, qualitative interviews with leaders from multiple health care industry sectors (e.g., hospice, health care insurance, medical centers) as well as the public sector would help to demonstrate PER feasibility from a programmatic perspective. Similarly, the input of education and training sector leaders is needed to understand the logistical and content-related requirements for a PER program. Once this information is collected and analyzed, pilot testing of different types of PER programs is needed before undertaking any full-scale implementation.
In summary, we recognize that additional research and program development is required. Nevertheless, we believe that the rationale and preliminary evidence presented here suggest that the proposed PER program could appeal to both family caregivers and the health care industry, thereby promoting economic resilience and helping to mitigate the health care talent shortage. Given the tectonic shifts currently shaking the U.S. health care system, we strongly encourage further discussion, debate, and dialogue on the development of PER programs as a step toward the future.