Disability Accommodation & Prevention

Job Accommodation in Action

Overview

Industry experience has shown that job accommodation can be a very cost-effective alternative to long-term disability payments (Job Accommodation Network, 1997) for both the employee with a disability and for the employer. Investment in accommodations usually costs only a small fraction of the hundreds of thousands of dollars that would otherwise be paid out in cash benefits. The practice of job accommodation, however, continues to be uncharted territory for business managers who have historically approached the issue of work disability purely through payment of disability benefits. An understanding of job accommodation techniques can help managers through this process to achieve real company savings while offering the best possible rehabilitative care to employees with disabilities.

Start Right Away

Successful job accommodation includes the active involvement of the individual with the disability, as well as the supervisor and coworkers. The job accommodation process must start as early as possible in the course of a disability, while the individual's connections with the workplace are still strong and before the employee begins to see him/herself as more of a patient than an employee. The first course in exploring the possibilities for return to work should be the worker's former job, where personal ties and work skills are strongest. It is here that the worker can be the most helpful in planning a course for job accommodation.

Gathering Information

The Americans with Disabilities Act (ADA) states that an employer has the right to expect a worker with a disability to be able to perform the "essential functions" of a job. Identifying these essential functions is not easy when job descriptions are incomplete or obsolete. Rarely do job descriptions include the information needed to identify areas where job accommodation might be needed for rehabilitation planning. At the same time, available clinical information may not readily show whether the worker can perform these essential functions. In this situation, physicians commonly withhold clearance to return to work until recovery is complete. If it becomes evident that the employee will not be able to return to his/her former job, return to work efforts stall. Before any return to work planning can begin, the impact of the worker's limitations on job performance must be clear.

A Sample Job Analysis Process

An excellent approach to job analysis was developed with the support of the World Health Organization to the ERTOMIS Foundation in the 1970's, to conduct research into methods for vocational integration of people with disabilities. The resulting Ertomis Assessment Method (EAM) correlates individuals' functional capabilities with function job demands.

The EAM consists of two graphic forms (Jochheim & Scheid, 1989). One, a profile of the worker's abilities to be completed by the attending physician, and the other a profile of job requirements, to be completed at the worksite. Direct comparison of these two profiles allows immediate identification of any mismatch between job requirements and worker abilities (Jochheim & Scheid, 1989).

In 1995, J.L. Mueller, Inc. adapted the Ertomis approach for a corporate client's Medical and Human Resources staff to share information among all those involved in the accommodation process without compromise of confidential medical or business information.

As a check for objectivity, the client's case manager often asked the disabled employee, as well as attending physicians, to complete the "Physician's Statement of Ability to Work". "The Employer's Description of Job Requirements" was often completed by the worker, as well as the supervisor and/or coworkers. Side-by-side comparison of these two forms clearly defined any mismatches between job requirements and worker abilities. These mismatches became the targets of job accommodation efforts.

Coordination of Resources

Job accommodation planning begins with identification of mismatches between the requirements of the job and the abilities of the worker. Accommodation planning must be coordinated through one individual, whether an internal or consulting job accommodation specialist or occupational health professional. In 1982, J.L. Mueller, Inc. assisted AT&T in establishing its internal team of Job Accommodation Specialists (JAS), and in 1991 assisted MetLife in creating its MetLife Accommodation Coordinator (MAC) Network. In 1995, Lucent Technologies also adopted AT&T's Job Accommodation Specialist approach.

Who should be involved in the job accommodation process, and what role does each play? Who decides what is "reasonable"? What steps should be included in the accommodation process? These are questions the accommodation coordinator must answer in facilitating a successful return to work and job accommodations, if they become necessary.

Involving the Individual with the Disability

At the center of the job accommodation process must be the individual with the disability. No one has more experience in living with the limitations the accommodation is intended to address. As self-evident as this seems, it is frequently overlooked. Passive, "patient" behavior, a common byproduct of the medical treatment process, must be reversed for the individual to take an active part in their return to work. In the hurry to resolve problems, or to avoid confronting difficult issues, supervisors sometimes neglect to involve the individual in identifying needs or solutions to accommodation issues. This usually results in wasted effort and expense, exacerbation of disability, or even legal action.

It should be noted that the law doesn't require that the employer provide the most expensive accommodation possible, nor even the accommodation most preferred by the individual with the disability, only that the decision is made with that individual's input.

Engaging Internal Resources

The very resources needed for effective job accommodation are usually within the organization. Union representatives and human resources staff can help resolve issues of job task restructuring. Facility managers can suggest and implement environmental modifications. Coworkers can suggest alternate ways of completing tasks that can work for everyone. Technical staff can help create tools to help make workers safer and more productive. Before enlisting outside technical assistance, each of these potential resources should be explored. If it becomes necessary to contract with external resources, this exploration can help to clearly identify what needs to be done.

Evaluating Accommodation Alternatives

Job accommodation planning should include a variety of alternative solutions, so that comparisons can be made in cost, complexity, time needed, and other factors impacting the business. Weighing several alternatives helps to engage all the players in the process of accommodation, so that each will have a stake in the success of the process.

Especially when litigation is involved or feared, the meaning of the term "reasonable accommodation" arises. Who determines when accommodation is "reasonable"? Although this question is sometimes referred to an outside consultant for an objective opinion, the ultimate decision rests with the employer. The law requires that the decision be based on issues such as the effectiveness, cost, and impact of the accommodation on the business - issues that the employer is best able to judge. Though accommodation is nearly always inexpensive, it usually involves some cost, in time and effort, if not also in the purchase of equipment. The employer must weigh these costs against the potential benefits of retaining a skilled worker, saving the costs of long-term disability benefits, and promoting a positive attitude among employees toward their jobs.

Planning, Implementing, and Following-Along

Successful accommodation is the result of teamwork, not the singular, heroic effort of one individual. Once a plan for accommodation is set, the coordinator of the process must be sure that each individual involved clearly understands what will be done, when it will be done, and what each individual's responsibilities are. When technology is installed, job modifications are made and other accommodations are complete, a plan for follow-up is essential. Changes in work load, staffing changes, work flow interruptions, and new contracts can require adjustment in accommodations as well. Any foreseen changes in these factors should be considered in the follow-up plan. Identifying the need for changes in accommodation and intervening as early as possible prevents minor problems from becoming critical.

Evaluating Success

Savings in disability benefits and insurance costs through job accommodation nearly always outweighs the cost of accommodation. Most job accommodations are very simple and involve minimal cost. But this doesn't mean that inexpensive accommodations are reasonable and expensive accommodations are not. The most successful accommodations are those that are:

1. Effective: The solution enables the individual with the disability to do his/her job productively and safely. An effective accommodation does not substitute for the individual but enables the individual to use his/her own abilities.

2. Transparent: The solution either has no effect on coworkers, customers, and other aspects of the business, or has a positive effect in improving productivity and/or safety.

3. Timely: The solution can be implemented within a reasonable time frame.

4. Durable: The solution is useful and flexible enough to remain effective throughout the employee's service. Maintenance, as well as modifications necessary due to business or technology changes, can be readily accomplished.

Reasonable workplace accommodations are likely to be a compromise among these criteria. For example, it may be less expensive for a business to relocate an employee who uses a wheelchair to a ground-floor office than to invest in an elevator to the usual workplace. Or it may be less disruptive to coworkers to invest in a document scanner than to restructure jobs so that a coworker can read documents to a blind employee. Each employer must select from a number of accommodation alternatives that solution which best suits the needs of the individual and the business.

Reasonable Expectations about Job Accommodation

Each job accommodation situation, like each worker and each job, is unique. In pursuing the most reasonable course for job accommodation, occupational health professionals must appreciate the concerns of managers who in turn must consider the needs of co-workers, the needs of the business, and the needs of the worker with the disability. The most reasonable accommodation may well be a compromise among these needs. The Americans with Disabilities Act acknowledges that this compromise is possible without violating the rights of the individual with the disability.

It must also be acknowledged that not all successful accommodations result in the employee with the disability returning to work. Sometimes an employee leaves the job despite effective resolution of the accommodation issue. Personal motivation, co-worker relationships, family factors, and job satisfaction influence job success for workers both with disabilities, just as they do for workers without disabilities.

When Accommodation = Prevention

When job accommodation involves cooperation among workers and supervisors, the resulting accommodations usually benefit coworkers with and without disabilities, as well. On-site job analysis often reveals risks of re-injury to the returning disabled worker that are also hazards to other employees. Accommodations planned with this in mind bring employers the double benefit of accommodating the limitations of a qualified worker with a disability, but also reducing the risk of disability among co-workers. Employers experiencing these benefits commonly ask, "Why didn't we do this in the first place?" Employees formerly seen as "different" due to their disabilities suddenly are seen as effective templates for improvements in job and workplace design.

Reference:
Mueller, J. (1999). "Returning to Work Through Job Accommodation". Journal of the American Association of Occupational Health Nurses, 47(3), 120-129.