Supporting employees with health conditions

Apr 17, 2012

Supporting employees with health conditionsWith Canada’s aging workforce and a now delayed retirement in all of our futures, says research scientist Monique Gignac, watch for greater effort to prevent work loss due to pre-existing health conditions.

People with chronic or episodic conditions may experience a number of challenges when working. At a March 12 plenary session hosted by the Institute for Work & Health, Dr. Gignac shared findings from recent studies of individuals with inflammatory arthritis and osteoarthritis. She also discussed the need for workplace interventions to target work-related and psychosocial issues that could encourage or undermine employment. Dr. Gignac, a senior scientist at the University Health Network’s Toronto Western Research Institute and co-director of the Canadian Arthritis Network, is joining the scientific staff at the Institute for Work & Health.

A list of steps that employers can take to help employees remain productive contributors to the workplace appears below (see “10 proactive opportunities”). But first, learn more about the effect of conditions like arthritis on employees and the workplace.

By prevalence, the top five chronic diseases among people who have been in Canada for at least 15 years are

  • back pain
  • high blood pressure
  • arthritis
  • migraine
  • mood and anxiety disorders

“If we want to start factoring in disability or problems with everyday activities,” said Dr. Gignac, “the most disabling conditions are

  • arthritis
  • back and spine MSDs (musculoskeletal disorders)
  • upper and lower limb MSDs
  • heart conditions
  • other disorders of the nervous system.”

Arthritis is also among the most costly to the Canadian economy. “The estimated cost of arthritis in 2000, and this is best data we have, is $6.4 billion. If you extrapolate that to 2008, you get $7.7 billion.”

These figures don’t include such indirect costs as

  • absenteeism
  • lost productivity/presenteeism
  • underemployment (“We see a lot of this with arthritis, particularly people moving to part-time employment.”)
  • retention and retraining

As a researcher, said Dr. Gignac, arthritis is interesting from a psychosocial perspective in terms of stress and coping. For example: “It’s not usually life threatening, you have good days and bad days (with a focus on the good), and no one knows you have it — it’s invisible… If no one in the workplace knows, then you may avoid potential problems around discrimination.

“So for all of these reasons,” said Dr. Gignac, “arthritis is not seen as stressful. But if you talk to people with arthritis, it’s exactly these same three reasons that create stress from living with the disease. It’s not usually life threatening… but there’s no cure. You live with pain and disability for the rest of your life. And while we tend to think of arthritis as a disease of aging, which it is in that it increases in prevalence as people get older, 3 of 5 Canadians with arthritis are under the age of 65. Among those who are aged 25 to 44, 25% are not working, and if you look at arthritis disability — people who are reporting problems with the disease — about 50% of those individuals are not working.”

For those who are, the prospect of a long working life is stressful. “You have good days and bad. It’s an episodic disability with unpredictable symptoms… Taking care of yourself doesn’t guarantee that you’re not going to have a flare or an episode. So now you have all this unpredictability in your work life. Will you be able to do a good job? Can you keep up with this pace of work? Should you apply for a promotion? Can you travel to meetings? These are the kinds of things that people worry about a great deal.”

Among the most stressful decisions some people have to make, says Dr. Gignac, is whether to tell their employer and co-workers about their disease, and if so when. “Are they waiting too long? Will it create problems with others at work? Will they lose their job or promotion opportunities? Even though there is legislation preventing discrimination, is their condition something that will be used against them? ‘So perhaps I will apply for a promotion but people with think I won’t be able to do the job and I’m not going to get it.’”

Living and working with an episodic illness

“Pain, stiffness, and fatigue, which are very common with arthritis, can affect daily tasks, activities, and mobility,” says Dr. Gignac. “What we hear a lot from people is that energy and concentration are affected in the workplace, and these things often make people feel moody and exhausted.

“If you don’t tell someone that you have arthritis, there seems to be potential for workplace misunderstandings. People tell us that others think they’re malingering. ‘Yesterday you were carrying boxes everywhere and walking all around the workplace, and today you tell me you can’t do this. I don’t know why. You look fine to me.’”

These symptoms and their effects are not exclusive to arthritis. “You hear these same kinds of issues with people who have migraines, mental health conditions, low back pain, lupus, multiple sclerosis…”

In her research, Dr. Gignac has also explored how people self-manage or accommodate their disease in the workplace. “Our findings from previous studies show that people do much less outside of work than they do at work.1 So the typical kind of thing you hear from people is, ‘I don’t tell anyone at work. I go home and go to bed because I need to get my rest so I can sustain my energy at work. I’ve stopped all my hobby and leisure activities… All my coping efforts are at home so that when I come to work no one knows that I have any kind of problem.’

“This is why some people are going to their managers and saying, ‘I can’t do this any more. I’m out.’ And co-workers and managers are shocked because they had no idea there was a problem.”

Dr. Gignac warned that the take-away message is not, “‘Don’t hire someone with arthritis. They’re a bad risk.’ In fact, the data often show that they aren’t, but that they may have episodes where they’re going to have problems. What we need to do is identify those individuals early on and offer support before the condition becomes a problem.”

Helping workers remain productive

“Successful organizations,” says Andrew Harkness, a healthy workplace specialist with Workplace Safety & Prevention Services (WSPS), “think of employees as people, and recognize that people bring both strengths and challenges to the table. Whether people are bringing physical health issues, mental health issues or family challenges, these are all aspects of life that effective employers will accommodate so long as it doesn’t impose undue hardship. Conversely, an organizational culture that treats its employees like robots can never sustain true success.

“As for chronic or episodic health conditions, a conscientious employer would not treat this any differently than other health concerns. Whether I apply a physical demands analysis (PDA) because a workstation poses ergonomic issues or someone is returning to work following an injury, or someone else has an episodic illness, I would apply whatever tools are available to protect these workers’ health and ensure they can continue contributing to the workplace.”

To ensure people are suited to the jobs assigned to them, says Harkness, employers can use tools they already have at hand, such as physical demands analyses, functional abilities assessments, employee surveys, and workplace inspections and walk-throughs. “For instance, during a walk-through pay attention to what people are doing in their workstations. If a movement or positions looks awkward, it probably is. Also watch for accommodations that people may have made on their own. For instance, a layer of cloth wrapped around a tool may indicate concerns about vibration.

“Whatever the health and working conditions are, employers need to make sure employees can be as productive and effective as possible. This means recognizing employees as people, recognizing their skills, attributes and needs, and then asking, ‘How do I put this in play at an earlier stage than one where an employee announces, as Monique Gignac puts it, “I can’t do this any more. I’m out”?’

“Ultimately, it’s in the employers’ best interests. But it’s also the morally and ethically right thing to do.”

10 proactive opportunities

Appearing below is a list of ways in which employers can maximize workplace productivity resulting from chronic health conditions.

  1. Implement policies acknowledging the value of and commitment to accommodation, and prohibiting discrimination on any grounds.
  2. Review and adapt related features of your benefits plan, such as access to an employee assistance program and coverage of physiotherapy, massage therapy, chiropractic sessions and other support for employees facing health challenges. Communicate these features to all employees. “People often don’t realize what their plans cover,” says Harkness, “especially if they’re experiencing a health challenge for the first time.”
  3. Create a healthy environment for all employees. Determine essential duties of each job, conduct task analyses to understand what's required by the job, and explore ways to reduce the physical demands on any employee. For employees managing a health condition, explore how best to accommodate their specific requirements and promote better health.
  4. Promote healthy lifestyle choices among all employees. Offer voluntary programs or incentives to encourage healthy habits, such as smoking cessation, fitness, weight loss, stress management and others.
  5. Educate employees on the workplace implications of common chronic conditions.
  6. Create an environment of trust and confidentiality, so that employees can disclose and discuss their health conditions without risk of harassment, demotion or job loss.
  7. Train supervisors to recognize signs of employees who may be facing physical or mental health challenges. Supervisors who recognize early symptoms can have open and frank discussions with employees that reinforce their value to the company, encourage them to seek medical attention, and bring forward any limitations they may have.
  8. Allow employees to be problem solvers and self-managers. People with health conditions usually know their functional limitations, their pain threshold, and their energy peaks and valleys better than anyone. Self-management protects self-esteem, and by extension personal commitment to managing their health and productivity at work.
  9. Provide flexible work arrangements. They can help avoid or minimize lost productivity due to flare-ups, medical appointments and other consequences. Conversely, if a set schedule is best for the employee, let him/her keep one, even if shiftwork is involved. Other options include:
    • changing the order in which tasks are performed
    • self-scheduled breaks
    • parking close to the entrance
    • working from home
  10. Involve employees with health conditions in the decision-making process. Give them a say in how they're accommodated, and how the workplace can accommodate others.

How we can help

View available resources on the Health & Safety Ontario website.

1 Listen to a recent podcast, “Working with a chronic illness — Making work changes, coping, and disclosure of arthritis in the workplace,” presented at St.  Michael’s Hospital in Toronto.