Effective Strategies for Employing and Accommodating Individuals with Chronic Health Conditions

1. Effective Strategies for Employing and Accommodating Individuals with Chronic Health Conditions • USBLN Conference 2012

2. Speakers • Anne Hirsh, MS, JAN CoDirector (moderator) • Mike Moses, ARM, CPDM, ADA Case Manager, Integrated Disability Management, Kaiser Permanente Northwest Region • Melanie Whetzel, MA, JAN Senior Consultant • Teresa Goddard, MS, ATACP, JAN Senior Consultant

3. Chronic Health Conditions • Overview • Set the stage • KP experience • Accommodations examples

4. Chronic Health Conditions • Definition • can be slow in progression • long in duration • no spontaneous resolution • often limits function • Arthritis, asthma, bipolar disorder, diabetes, epilepsy, heart disease, HIV infection, multiple sclerosis, traumatic brain injury, etc.

5. Chronic Health Conditions • Prevalence • 2005 – 133 million, almost 50% of all adults had at least one chronic illness • 2020 estimate - ½ of U.S. population will have at least one chronic condition and ¼ will have multiple conditions • Institute or Medicine (IOM) 2012

6. Chronic Health Conditions • Research • Retain employees • NO or low cost • Accommodations effective The study results consistently showed that the benefits employers receive from making workplace accommodations far outweigh the low cost.

7. Integrated Disability Managment Kaiser Permanente NW Mike Moses ADA Case Manager

8. Overview • Kaiser Permanente • Transitional Work Program • ARX2 – Tool for physicians • ADAAA – Interactive process • Accommodations • Case Study

9. Kaiser Permanente • Kaiser Permanente • 180,000 employees • 8 regions nationally • Kaiser Foundation Health Plan (KFHP) recently ranked highest in the J.D. Power and Associates 2011 U.S. Employer Health Insurance Plan Study. • KPNW – One of eight regions • 9800 employees • Two state jurisdiction – OR and WA • One hospital – multiple medical/dental/vision clinics • 600,000 + members

10. Transitional Work • Philosophy – Return to work/Stay at Work • Transitional work • Occupational • Non-Occupational • ADA accommodation • Case Manager role

11. Transitional work process • How does an employee access transitional work • Note from physician • How long is the program – 90 days • How is the program managed • Home department – 80% stay within home department • Outside placement – other department 20 % placed elsewhere • Challenges to transitional work • Employees • Supervisors

12. IDM Case Manger Role • Communication with stakeholders • Employee • Supervisor/Manager • Physician • Union • Third party administrator • Labor relations consultant • Legal • Safety/Employee health • EAP

13. Activity RX2 – Physician tool • What is the ARX2 • Tool for physicians to manage absences and return to work • Designed for all types of leaves • Work • FMLA • Jury Duty • School • Caregiver • DMV reports • Designed for doctors to use during patient visit. • MDA durational guidelines embedded in our Health connect system.

15. Benefits of Activity RX2 • Uses evidence based medicine • Improves work flow • Lends itself toward best practice • Provides guidance to physicians on appropriate time away from work • Provides improved work restrictions for employers

16. ADAAA • ADAAA – • Change of definition of disability • Refocus on the original intent • Touches other state and federal programs • FMLA • State leave laws • State Workers Compensation • Company benefits – PTO, STD, LTD

17. ADAAA • ADAAA Overview • What changed – Definition of disability was expanded • Interactive Process – Is now critical for employers to document. • Essential functions of the Job • Reasonable accommodations

18. The Interactive Process • What is the Interactive Process? • A dialogue with an employee • Why is it important? • EEOC – Looking at employers response - • EEOC - Ligation costs are rising • When does the Interactive Process Start? • Employee makes a request • Supervisor needs to respond • Our internal interactive process • The role of the ADA Case Manager • The importance of documentation.

19. ADA Interactive Process • Who are the stakeholders • Employee • Physician • Manager • Union • Labor relations consultant • Legal may be consulted

20. Accommodation Challenges • I need a ‘Bossectomy’ • An employees perspective • Accommodations are not forever • When accommodations need to change • Handshake accommodations • Making accommodations without interactive process • “You don’t look so good” – the dangers of paternalism • Employers overreaching their role.

21. Case Study • Employee – Work in billing department • MVA • Leave of absence – 1 yr. • Returned in transitional work • Premature RTW • Referred to Head Injury Program – 8 weeks • Employee requested to return to work

22. Progressive RTW plan • Stakeholders • Employee • Manager • Co-workers • Union • ADA case manager • Labor relations • Head Injury job coach

23. Plan Outcome • Employee was motivated • Supervisor and staff supportive • Job coach worked employee daily • Monthly progress reports • Progress was slow – 8 months • What was the outcome?

24. Types of Accommodations • Migraines • Chronic Depression • ADHD/ADD • Hearing impairments • Cognitive impairment (other than head injury) • Diabetes

25. Chronic Health Conditions JAN’s Sensory Team takes calls on chronic health conditions such as: • HIV • Asthma • Diabetes • Allergies/MCS • Blindness/Low vision • Deaf/Hard of Hearing • Communication disorders

26. Chronic Health Conditions Typical accommodation ideas include: • Telework • Flexible leave • Modified Policies • Modified schedules • Assistive technology • Modified workstations • Allowing service animals • Alternate communication • Allowing personal use items

27. Chronic Health Conditions Situation • A secretary with HIV could only go to the HIV clinic during work hours. 

28. Chronic Health Conditions Solution The employer provided the employee with a flexible work schedule, so that she could go to the clinic for medical attention and counseling.  The employee made up the hours throughout the week by staying later and by coming in early.

29. Chronic Health Conditions Situation A long-term city employee had diabetes and needed to use a wheelchair due to foot ulcers. She was having difficulty accessing her workstation.

30. Chronic Health Conditions Solution Her employer opened up her work area and made it more accessible, lowered the files she needed to use, and located a refrigerator closer to her workstation. At a cost of $100, the employer retained a good employee and sent a message to other employees that the employer treats employees well.

31. Chronic Health Conditions Situation A pharmacist with HIV was having difficulties standing for eight hours a day on atile floor.  This employee was responsible for filling prescriptions for medication.

32. Chronic Health Conditions Solution The work area was carpeted using extra padding, which assisted in reducing fatigue and a sit/stand/lean stool was purchased to assist employee when standing.  Employee was also permitted to take frequent rest breaks throughout the day.  This was possible since the employee cut his lunch hour down to 30 minutes, which provided him with 30 minutes that could be used at other times of the day whenever a break was needed.

33. Chronic Health Conditions Situation A newly hired federal employee requested to bring her service dog into the workplace. After starting, a co-worker informed the employer of a severe allergy to animals.

34. Chronic Health Conditions Solution The employer moved one employee’s workstation, provided an air purifier for the employee with the allergy, established separate routes of travel, maintained a regular cleaning schedule, and allowed the employees to communicate in alternative ways such as email and phone, in place of face-to-face communication

36. Chronic Health Conditions JAN’s Cognitive / Neurological Team takes calls on chronic health conditions such as: • Alzheimer’s • Brain Injury • Epilepsy • Mental Health Impairments • Sleep Disorders • Stroke

37. Chronic Health Conditions Typical accommodation ideas include: • Modified Schedules and Policies • Telework • Leave • Assistive Tech • Service Animals • Written directions, checklists, flow charts • Prioritization of tasks • Extended time for training, retraining • Job Coach • Reassignment

38. Chronic Health Conditions • A federal employee with major depression has been teleworking two days a week. Due to the depression, the three to four hour round trip commute to the office is too much for the employee.

39. Chronic Health Conditions • The employer suggested that the employee work four days from home and come into the office once a week, but the medical documentation the employee submitted explained that he would need to be in a work environment where personal interaction with coworkers occurs on a daily basis. Working from home more than two days a week would be too isolating. The employer then suggested an accommodation to move the employee’s workspace to a facility closer to his home. The employer agreed to call the alternate worksite to see if there was room there to relocate the employee.

40. Chronic Health Conditions • An employee is returning to work after a leave to get her meds adjusted after she is diagnosed with epilepsy. She returns to work with no restrictions. Her job entails traveling once a quarter to a location within the state to evaluate program effectiveness and provide training. The employee feels a little nervous about driving out on the highway, and has asked for the task of traveling and training be taken from her.

41. Chronic Health Conditions • Since training the other offices is an essential function of the job and offices are located throughout the state, the employee will need to travel. In the past the employer was very strict about when and where the employee should go to do the training every quarter. With the request from the employee about the nervousness involved in traveling, the employer made a change in the travel. In order to accommodate the employee and her fear of driving, the employer has allowed the employee to decide where and when she will travel each quarter, permitting the employee to plan ahead and have a co-worker, family member, or bus take her to the work location.

42. Chronic Health Conditions • A retail employee with bipolar often forgot the closing and cash-out procedures, which resulted in missed printouts of daily sale reports.

43. Chronic Health Conditions • The employer created a numbered checklist that identified each step for proper closing procedures and identified which reports to run from the cash registers. This accommodation benefited all employees. 

44. Chronic Health Conditions • A telemarketer with OCD had extreme thirst caused by medication taken to help with the impairment. The employee worked in a call center answering phones. The call center had a policy that prohibited the use of drinks at the workstation. She requested the accommodations of the use of a water bottle at her workstation, and the ability to get up more frequently to use the restroom.

45. Chronic Health Conditions The employer was rather leery at first, but agreed to move her workstation closer to the restrooms so that she wouldn’t have as far to go, and also provided a wireless headset so that she would be able to get calls quicker when traveling to and from her desk. The “no drink” policy was modified for this employee to allow her the access to sips of water.

46. Chronic Health Conditions • Contact • (800)526-7234 (V) & (877)781-9403 (TTY) • AskJAN.org & jan@askjan.org