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By MATTHEW BRODSKY, senior editor/Web editor of Risk & Insurance®

Death is not a favorite topic in American culture. Perhaps if we don't talk about it, it won't happen to us or our loved ones. But death, like birth, happens to us. Death is just a little more unpredictable. Likewise for serious illness or a catastrophic injury. Chances are, you, me, or someone we know and love will eventually succumb sooner than later.

As do their workers, employers tend to shy away from these numbers. Sure, most employers offer healthcare benefits and some form of disability coverage to help employees cope financially should something bad happen.

A small but growing number of employers, however, are also offering a different kind of benefit to help employees deal with end-of-life and caregiver issues.

Stamford, Conn.-based Pitney Bowes is an employer on the forefront of this issue. Dr. J. Brent Pawlecki, the corporate medical director for the global communications service and product provider, recounts how the interest end-of-life management in his company got started. The company did an internal survey of employers and found that one-third of respondents who were caregivers were under the age of 40. About one in five caregivers were actually considering leaving the workplace to become full-time caregivers.

"That's a huge brain drain out the door," Pawlecki said.

And the revelations made him and others at the company realize that no one was considering this state of affairs as "normal," when "dying is a normal part of life," the doctor explained. The realization was that end-of-life discussions and decisions happen too late or not at all. The company needed to begin talking to its employees in this context.

That said, Pitney Bowes now includes end-of-life and caregiver benefits in its wellness offering, with the idea that it wants to help employees consider planning for such terrible scenarios, like they would plan for their children's college tuition or for their own retirement.

For instance, the employer offers end-of-life learning courses to employees and gives incentives to complete them. The company provides workbooks that employees can fill out and use as a reference tool should something terrible happen. Think blank spots where employees can note to family members what bills to pay and to whom, where savings and bank accounts are located, where the family's insurance policies and agent are located, and such.

According to Pawlecki, Pitney Bowes also looked at its existing benefits services, like legal, employee assistance programs (EAP) and financial consultations the company had offered to employees, then it talked with the vendors about ways to augment and shape them to be useful for end-of-life issues.

Of course, it needs not be repeated that death and disability are touchy subjects for most anyone. An employer pressing the issue with its workers could come off as pushy, creepy or downright Orwellian if end-of-life matters are not approached with care and sensitivity.

"You have to be very cautious about it," Pawlecki said.

When Pitney Bowes put together its materials and benefits, for example, it approached many stakeholders to make sure any of it didn't offend. Pawlecki recounted how the company even approached clergy from many different religions to review employee materials.

"Overwhelmingly, people were very supportive of our efforts in this," he reported.

Nor are Pawlecki and Pitney Bowes alone in pursuing it either. Pawlecki heads a working group on the subject within the National Business Group on Health. The 10 organizations involved represent more than 1 million employees.

Still, Pawlecki conceded that there's a long way to go. Pitney Bowes has a ton of work to do on end-of-life issues, the chief medical officer said, and unfortunately the company is ahead of most everybody else.

"We're just putting our toe in the water," he put it, comparing where employers are at now with end-of-life issues with where they were at dealing with obesity seven or eight years ago.

"Frankly, I think it's pretty rare," said Nathan Kottkamp, a Richmond, Va.-based healthcare attorney and partner at law firm McGuireWoods LLP, regarding employers providing end-of-life tools and benefits.

Not that Kottkamp isn't doing his part to spread the word. Besides his law practice and his expertise in medical ethics, he is the founder of the National Healthcare Decision Day, April 16, which encourages Americans to talk about their future healthcare decisions and to complete an advance directive.

Advance directives come in two forms, generally speaking. There's one that allows an individual to name a decision-maker should he or she become incapacitated and unable to make or voice his or her own medical decisions. The other advance directive is the so-called living will--written instructions on specific wishes regarding healthcare treatment, involving treatments such as life support, antibiotics, and dialysis.

As with the National Healthcare Decision Day, Kottkamp advises employers interested in helping employees with these issues to start talking. Again, like Pawlecki, he recommended care and caution when doing so. It's not about telling employees what to do; instead, suggest they think about these issues and provide resources to help them along, Kottkamp said. It's less on the "push side," he explained, as it is on the "it's just out there" side.

For instance, employers could reach out to a local healthcare lawyer to set up a brownbag lunch discussion for interested workers. Another way would be to include an advance directive form and helpful information in the employee benefits packet usually handed out during benefits open enrollment.

"People are already thinking about their health at that point," he said. "It's a great time to capture that."

Advance directive forms are available for free on state Web sites, and the NHDD site also contains links to useful resources. Pawlecki recommended the Caring Connection Web site, where employers can find a step-by-step guide for putting together a workbook.

According to Pawlecki, employers ready to step up to the plate should start by recognizing and calculating the extent to which this issue is already affecting their workforce and their bottom line, whether it's through workers simply dying, through increased absenteeism or healthcare losses, or through troubles recruiting or retaining talent. Then, Pawlecki advised, employers should encourage employees to plan ahead for the unforeseen health event, to create a will, to draft an advance directive. The next step would be to review and revise existing bereavement and caregiver policies, and the benefits such as EAP. Consider offering new services like grief counseling or the identification of quality hospice or assisted living centers in the area.

And though we talk about end-of-life decisions, we are not necessarily talking about death or the elderly. As Pawlecki realized at Pitney Bowes, many of his caregivers were under 40. And as Kottkamp admonished, strokes, car accidents and other acute events do not happen solely to gray hairs.

"You're definitely going to die," Pawlecki said. So all of us might as well do something about it now.

June 1, 2010

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