Accommodations for Epilepsy in the Workplace

1. Accommodations for Epilepsy • in the Workplace Daniel Tucker, M. S. Consultant, Cognitive / Neurological Team Melanie Whetzel, M. A. Senior Consultant, Cognitive / Neurological Team

2. Epilepsy, also called a seizure disorder, is a chronic neurological condition characterized by recurrent seizures. A seizure happens when abnormal electrical activity in the brain causes an involuntary change in body movement or function, sensation, awareness, or behavior.

3. People diagnosed with epilepsy have had at least two seizures and may have had more than one type of seizure. The severity of epilepsy and the type of seizure vary from person to person. Accommodation needs will also vary from person to person.

4. Daily Accommodation Servings • About 2.3 million people in the United States have some form of epilepsy • About 150,000 new cases of seizure disorders and epilepsy are diagnosed each year • 1 in 10 adults will have a seizure sometime during their lifetime

5. ADAAA and Epilepsy Substantially limiting: • Neurological functions • Speaking • Hearing • Communicating/interacting with others

6. Cognitive Limitations: • Memory • Time Management • Stress Management

7. Motor Limitations: • Driving • Balancing/climbing • Fatigue • Ensuring Safety

8. Sensory Limitations: • Photosensitivity • Seeing • Hearing • Communicating

9. Other: • Attendance/Absenteeism • Personal Care

10. Disclosure

11. Why Disclose? • To ask for job accommodations • To receive benefits or privileges of employment • To explain an unusual circumstance

12. How to Disclose? • The individual must let the employer know: • An adjustment or change at work is needed for a reason related to a medical condition • To request accommodation, an individual: • May use “plain English” • Need not mention the ADA • Need not use the phrase “reasonable accommodation”

13. Who to Disclose to? • Verbally or in writing, tell the… • Employer • Supervisor • HR representative, or • Other appropriate person

14. Job Accommodations

15. Accommodation Ideas for Cognitive Impairments • Associated with Epilepsy

16. Situation: A receptionist in a large office had difficulty remembering names/faces and keeping track of the in/out status of the various case managers on staff.

17. Accommodation Issues: Memory • Provide written or pictorial instructions or prompt with verbal cues • Offer training refreshers • Use a chart to describe steps to complicated tasks • Maintain, safely and securely, paper lists of crucial information such as passwords • Use voice recordings of verbal instructions

18. Accommodation Issues: Memory (cont.) • Provide the employee directory with pictures • Use nametags and door/cubicle name markers • Provide a building directory or employee directory by name, floor, unit, etc. • Label items on the employee’s desk (in-box, this week’s videos, etc.) • Use auto-dial phone features to connect quickly to used numbers

19. Solution: A Velcro in/out board was provided with the photo and name of each case manager. When entering or leaving the office, staff members would prompt the receptionist as to their status and he would then move their photo from the “in” to the “out” column, or vice versa, thereby allowing him to keep track of case managers and better serve clients who were trying to contact them.

20. Situation: An administrative assistant asked for accommodations to help her with time management and prioritization of tasks due to some cognitive difficulties related to seizure medication.

21. Accommodation Issues: Time Management • Divide large assignments into several small tasks • Set a timer to make an alarm • Provide a checklist of assignments • Supply an electronic or handheld organizer and train on how to use effectively • Use a wall calendar to emphasize due dates

22. Solution: She was accommodated with a basic list of job priorities and strategies on how to plug in unexpected tasks, and a WatchMinder to assist with time management.

23. Situation: A call center employee was having difficulty managing her stress during times of heavy call volume. She asked for an accommodation of fewer calls and more breaks.

24. Accommodation Issues: Stress management • Provide praise and positive reinforcement • Refer to employee assistance programs • Allow the employee to make telephone calls to doctors (and others) for support • Provide sensitivity training • Modify work schedule

25. Solution: Because her employer does not have to reduce a performance standard, they agreed to give her two added 15 minute breaks – one in the morning and one in the afternoon daily. To make up the time, the employee agreed to come into work 30 minutes early daily.

26. Accommodation Ideas for • Motor Impairments • Associated with Epilepsy

27. Situation: An IT specialist who cannot drive because of recent seizures had been riding to work daily with his wife. Her job location changed, taking her in another direction and she was unable to take him to work. They live in a rural area with no public transportation. The employee has asked for the accommodation of telework.

28. Accommodation Issues: Driving: • Pair the employee with a co-worker who can drive to meetings or events • Allow telework or work from home • Transfer the employee to a position that does not require driving • Adjust schedule so the employee can access public transportation • Help facilitate a carpool with co-workers for transportation to/from work

29. Solution: The employer allows the employee to telework for the next several months, but reserved the right to withdraw that accommodation if the work situation changes or if the need for the accommodation is extended. The employer specified this in writing. Based on state law, if the employee were to have another seizure, the timeline for the revocation of his license would have to be extended.

30. Situation: An inspector employed in a manufacturing plant used a catwalk for about half of his daily duties. Because of a new epilepsy diagnosis, his doctor determined that it wasn’t safe for him to use the catwalk at all. The employee disclosed his disability and asked for an interactive meeting to discuss his options.

31. Accommodation Issues: Balancing/Climbing: • Cushion a fall by using rubber matting on floor and by adding padded edging to corners and edges • Install machine guarding • Use rolling safety ladders with handrails and locking casters • Provide head protection • Provide eye protection • Use fall protection

32. Solution: Because no accommodations could be found that would keep the employee safe on the catwalk, the employer reviewed open positions for a reassignment. Out of three open positions, they were able to find one that best matched the employee’s skills and didn’t require climbing or being at heights.

33. Situation: A cashier experienced fatigue in the afternoons on days when she had longer shifts. She asked for accommodations to help her with this.

34. Accommodation Issues: Fatigue: • Use anti-fatigue matting on the floor • Provide flexible start or ending times • Adjust workweek • Provide private or secure rest area during breaks

35. Solution: Her employer met with her to discuss what might be the best options. Together they came up with using an anti-fatigue mat at her station, a stool during slower periods, and a change in schedule from working 3-4 longer shifts a week to 5-6 shorter shifts.

36. Situation: An employee with epilepsy and a vagus nerve stimulator has asked co-workers to run a hand-held magnet over his chest when he has a seizure in order to shorten its duration. His coworkers are nervous about performing this health-related procedure.

37. Accommodation Issues: Ensuring Safety in the Workplace: • Designate a person to respond to emergencies • Keep aisles clear of clutter • Provide a quick, unobstructed exit • Post clearly marked directions for exits, fire doors, etc. • Know when to (or not to) call 9-1-1 • Consult employee’s plan of action to determine how to respond/react when employee has a seizure on the job

38. Solution: The employer asked for medical documentation from a neurologist to substantiate the need for the accommodation. The doctor provides information that states the employee is in no danger from having the seizure but simply prefers to have it end earlier, and holding the magnet over the chest too long or too close can cause the device to stop. The employer denied this request, but was willing to look at alternative effective accommodations. The ADA does not require employers to provide health-related procedures as accommodations

39. Accommodation Ideas for • Sensory Impairments • Associated with Epilepsy

40. Situation: A clerk who worked in a large factory area with fluorescent lighting asked that the lighting be switched out with full-spectrum bulbs.

41. Photosensitivity: • Use a flicker-free monitor (LCD display, flat screen) • Use a monitor glare guard • Use a cubicle shield • Use fluorescent light tube covers • Allow frequent breaks from tasks involving computer

42. Photosensitivity (cont.): • Provide alternative light sources: • Replace fluorescent lights with full spectrum lighting • Use natural lighting source (window) instead of electric light

43. Solution: Due to the size of the factory and the extent of the lighting, it was not feasible for the employer to change all of the lighting in the factory. The clerk was accommodated by the use of bulb jackets to cover the fluorescent bulbs within a radius of his workstation, and provided a cube shield to help further block the lighting from his area.

44. Situation: An employee who works in a semi-secluded area asks for a policy modification so that he can use his cell phone to notify a co-worker when he has had a seizure. The employer has a policy forbidding the use of cell phones in the workplace.

45. Accommodation Issues: Seeing/Hearing/Communicating: • Allow the employee time to recuperate from seizure • Identify hand signals or other universal signals that the employee might use to communicate with another person • Use PECS (picture exchange communication system) to communicate • Use paging systems to communicate with coworkers • Provide 2-way radios with texting options

46. Solution: The employer considers the request and determines that allowing the use of a cell phone in this case would be more effective than purchasing two-way radios to serve the same purpose. They modify the policy so that this employee can use his cell phone to call the designated persons when he has had a seizure.

47. Other Accommodations

48. Situation: A new federal employee had missed 17 days the first month of work, and the current month’s attendance was following the same pattern. The employee had missed several days due to seizures, but the majority of the days missed were for reasons that were unrelated to her epilepsy. Because she was a new employee, she had not accrued any leave, and the employer had forwarded her the maximum amount of leave possible.

49. Attendance/Absenteeism: • Allow employee to remain on the job after a seizure when possible • Provide flexible schedule • Modify an attendance policy • Provide leave while the employee is adjusting to medications • Work a straight shift instead of rotating shifts

50. Solution: The employer accommodated the employee by modifying the attendance policy in order to count the epilepsy/seizure absences as one occurrence, but was firm about holding this employee to the attendance policy as it related to all other absences.