The aging of the older generation poses one of the greatest challenges facing single-family offices (SFO) today.
There are 56 million Americans ages 65 and over, which represents 17% of the population, per the U.S. Census. In seven short years, by 2030, that number is expected to increase to 73 million, with 70% of those needing some type of short- or long-term care.
The National Institutes of Health stated in 2021 that the number of caregivers would decrease uniformly over the decades to come. What options will families have to hire skilled and experienced caregivers, and how can their SFOs help them when there is a nationwide shortage of nurses and caregivers?
A case study: William is an accomplished and respected CFO who has worked for SFOs for over 14 years. In 2017, he was courted by a self-made, ultra-high-net-worth entrepreneur born in the 1940s. Upon accepting the position, William knew he had both the opportunity of a lifetime and his hands full. The office team was full of drama fueled in part by the mercurial behavior of the patriarch and the extended family that revolved around him.
By March 2023, the patriarch was in his late 70s. He was newly widowed and spending the majority of his time in and out of hospitals or back and forth to doctors’ appointments. His estrangement from his two daughters meant the day-to-day management of his care fell to his executive assistants, the elder household staff and his handyman/driver.
Instinctively, William knew this was not sustainable. For months he had been fielding calls from the staff regarding the patriarch’s explosive temper and his capricious decisions when it came to following doctors’ orders. The staff often found him on the bathroom or kitchen floor or in the garage still inebriated from the night before, covered in vomit and human waste. They knew it was only a matter of time before something horrific happened.
When William contacted the patriarch’s daughters, their response shocked him.
They said: “We cannot force him to take better care of himself, he no longer listens to us, and we certainly cannot convince him to follow doctors’ orders or stop drinking. We cannot remove him from the board in the current situation. As our CFO, what are your suggestions for his personal care management, and how much will it cost?”
These are the basic options:
1. Contact a national or local caregiver staffing company to provide round-the-clock care providers. The hourly rate he can expect ranges from $25 to $150 or more, depending on skills and experience.
Pros:
- This option provides a quick “staff-up” solution to deliver round-the-clock care with a variety of skill levels.
Cons:
- The agency will send different care providers depending on who is available for each shift; there is no guarantee the same staff members will be used.
- The SFO loses control over team members; they work for the staffing company, not the family.
- The company may not have staff available for every care shift, leaving the family without a caregiver.
- The quality of staff needed for long-term care may be lacking.
- These temporary staff members may not be willing to work with a patient who has a difficult or problematic personality.
- These agencies have varying degrees of vetting practices for their staff; some caregivers may have personality defects, poor work habits or an attitude that is not suited to care providing.
- The SFO executive does not have control of the staffing teams being used by the agency.
- The staffing company may not offer a single point of contact for families.
- Caregivers provided by the company may not be willing to travel.
2. Hire a highly skilled personalized care team focused on the well-being of the family member.
Pros:
- The highest level of personalized in-home care with consistent care team employees
- The SFO controls the hiring process and compensation.
- This option provides a single point of contact for doctors, medical care, post-op, medications, digital follow-up and documentation.
- Caregivers are aware of unique needs of the job and are willing to work with patient complexities.
- Caregivers are able and willing to expand their roles to include assistant duties, driving, food prep, pet care, household chores, open communication with the SFO office and travel with patients when asked.
Cons:
- This option may exceed the cost of an outsourced care company.
3. Assess and find assisted-living residences that best meet the patriarch’s needs. The price of these facilities varies greatly depending on services, unit size, care levels and region.
Pros:
- Assisted-living residences offer flexible options for living spaces (small to large) with outdoor spaces and parking garages.
- Different levels of nursing and post-op care.
- Many offer dining rooms for three-plus meals a day.
- Assisted-living facilities provide personal-care services (hairdresser, physical therapy, yoga, etc.).
- Residents can participate in indoor and outdoor group activities.
- These senior communities offer a sense of connection to others.
Cons:
- There is no single point of contact for medical care.
- Communication with the SFO may be inconsistent.
- There is a rotation of staff with variable skill levels and experience.
- Residents may feel isolated from family.
- These facilities may have strict policies, violations of which may incur possible fines or charges.
- Assisted-living residences can be expensive with annual increases.
- Pet restrictions are common (no pets or only small pets).
- Assisted-living residences have multiple rules and restrictions.
- These residences may offer limited options related to nutrition and dining.
- Residents live in close proximity to their neighbors.
As families age, countless SFOs will face the same dilemma to provide optimal care options for their family members. In addition, these offices will be in competition with each other and other families for trusted and skilled caregivers. It is paramount that executives be prepared to provide clear choices that align with the family’s needs and offer the best care possible.