Effective Strategies for Employing and
Accommodating Individuals with
Chronic Health Conditions
USBLN Conference 2012
JAN is a service of the U.S. Department of Labor’s
Office of Disability Employment Policy.
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
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Chronic Health Conditions
Overview
 Set the stage
 KP experience
 Accommodations examples
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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.
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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
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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.
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Integrated Disability Managment
Kaiser Permanente NW
Mike Moses ADA Case Manager
Overview
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Kaiser Permanente
Transitional Work Program
ARX2 – Tool for physicians
ADAAA – Interactive process
Accommodations
Case Study
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
Transitional Work
• Philosophy – Return to work/Stay at Work
• Transitional work
 Occupational
• Non-Occupational
• ADA accommodation
• Case Manager role
Transitional work process
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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
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Challenges to transitional work
• Employees
• Supervisors
IDM Case Manger Role
Communication with stakeholders
 Employee
 Supervisor/Manager
 Physician
 Union
 Third party administrator
 Labor relations consultant
 Legal
 Safety/Employee health
 EAP
Activity RX2 – Physician tool
What is the ARX2
Tool for physicians to manage absences and return to work
Designed for all types of leaves
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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.
Benefits of Activity RX2
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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
ADAAA
ADAAA –
• Change of definition of disability
• Refocus on the original intent
Touches other state and federal programs
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FMLA
State leave laws
State Workers Compensation
Company benefits – PTO, STD, LTD
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
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?
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Employee makes a request
Supervisor needs to respond
Our internal interactive process
The role of the ADA Case Manager
The importance of documentation.
ADA Interactive Process
Who are the stakeholders
 Employee
 Physician
 Manager
 Union
 Labor relations consultant
 Legal may be consulted
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.
Case Study
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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
Progressive RTW plan
Stakeholders
 Employee
 Manager
 Co-workers
 Union
 ADA case manager
 Labor relations
 Head Injury job coach
Plan Outcome
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Employee was motivated
Supervisor and staff supportive
Job coach worked employee daily
Monthly progress reports
Progress was slow – 8 months
What was the outcome?
Types of Accommodations
Migraines
Chronic Depression
ADHD/ADD
Hearing impairments
Cognitive impairment (other than head
injury)
• Diabetes
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Chronic Health Conditions
JAN’s Sensory Team takes calls on
chronic health conditions such as:
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HIV
Asthma
Diabetes
Allergies/MCS
Blindness/Low vision
Deaf/Hard of Hearing
Communication disorders
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Chronic Health Conditions
Typical accommodation ideas include:
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Telework
Flexible leave
Modified Policies
Modified schedules
Assistive technology
Modified workstations
Allowing service animals
Alternate communication
Allowing personal use items
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Chronic Health Conditions
Situation
A secretary with HIV could only go to the HIV clinic
during work hours.
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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.
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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.
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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.
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Chronic Health Conditions
Situation
A pharmacist with HIV was having difficulties standing
for eight hours a day on a tile floor. This employee was
responsible for filling prescriptions for medication.
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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.
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Chronic Health Conditions
Situation
A newly hired federal employee requested to bring her
service dog into the workplace. After starting, a coworker informed the employer of a severe allergy to
animals.
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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
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Chronic Health Conditions
JAN’s Cognitive / Neurological Team takes
calls on chronic health conditions such as:
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Alzheimer’s
Brain Injury
Epilepsy
Mental Health Impairments
Sleep Disorders
Stroke
Chronic Health Conditions
Typical accommodation ideas include:
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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
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.
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.
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.
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.
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.
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.
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.
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.
Chronic Health Conditions
Contact
 (800)526-7234 (V) & (877)781-9403 (TTY)
 AskJAN.org & jan@askjan.org
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