Accommodating for Episodic Disabilities

Employees with episodic disabilities face unique challenges that may make it more difficult for employers to accommodate them in the workplace. Chronic mental and physical disabilities that are considered episodic are characterized by intermittent periods of good health with severe symptoms that come and go. They are often unpredictable or invisible, and many employees choose not to disclose their conditions at all, relying instead on benefits that are available to all, such as sick time. Some conditions that are episodic include depression, anxiety, multiple sclerosis, Chron’s, colitis, diabetes, HIV/AIDS, migraines, chronic fatigue syndrome, and epilepsy. When creating accommodation processes, employers should consider strategies to help employees manage episodic illnesses before larger workplace problems arise.

Challenges in Managing Episodic Disabilities

Episodic disabilities are difficult to manage in the workplace as the worker will have fluctuating symptoms that may not be present from one day to the next. It is challenging for employers and disability management specialists to use a standard accommodation or medical leave process for workers with episodic disabilities due to:

• Unpredictability of presence and duration of symptom aggravation
• Ongoing and changing health care requirements
• Invisibility to others
• Reluctance from employees to disclose requirements for accommodation

Employees may not disclose their conditions due to privacy concerns, stigma, belief that they can get through their chronic episodes alone, or denial of their disability altogether. But a lack of communication about the health condition can have serious effects in the workplace. When new episodes occur, they can cause harm to workplace relationships and perception of work performance. Monique Gignac, lead investigator of the partnership project Accommodating and Communicating about Episodic Disabilities (ACED), says that disabilities are often managed as “a performance or disciplinary issue instead of a health-related challenge that can be accommodated,” (Institute for Work and Health, 2019).

Accommodation Strategies for Managing Episodic Disabilities

It may be challenging to accommodate for episodic disabilities, but it is not impossible. No accommodation is “one-size fits all.” This is especially important for accommodating for episodic disabilities. Usually, it is the individual that best knows what they need. The first step is to ask what changes to their work, schedule, or environment might best support them. Sometimes, they may not know and may require further assistance to determine the best accommodations for their unique situation. In this case, it would be best to contact an Occupational Therapist to conduct an accommodation assessment to bridge the gap between work and health.

Accommodation Assessments

During the assessment, the Occupational Therapist will do a thorough review of the work (job demands), workplace (environmental conditions and work culture), and worker (employee abilities and limitations).

Here are some examples of what the Occupational Therapist may assess during an accommodation assessment:

WORK:

• What are the cognitive demands of the role?
• What are the physical demands of the role?
• What are the emotional demands?
• What are the deadline requirements and workload demands?
• What are the work hours and schedule?
• When are breaks provided?
• Is it independent work or are there group task assignments?
• Flexible work arrangements?

WORKPLACE:

• Physical set up of the workstation – chair, desk, screens, location of workstation
• Lighting and noise conditions
• Open office, private office, or remote?
• Location within the office
• Culture of the workplace – workload considerations and ability to take breaks, openness to receive support
• Available benefits or EAP programs

WORKER:

• What triggers the employee’s symptoms?
• What work tasks are challenging to complete?
• What is their tolerance for sitting, keying, mousing?
• Objective assessment of physical, emotional, and cognitive abilities related to the job demands
• What are their symptom management strategies?
• What are they doing on a regular basis to manage or treat their medical condition?
• Do they have adequate health care support?

Potential Accommodations

The following are a list of potential accommodations that may be helpful for employees with episodic disabilities. Remember that each circumstance will require an individualized solution:

WORK:

• Flexible schedules to attend medical appointments or manage bouts of symptom aggravation
• Allow for additional breaks in work to pace out the day, give a break from screen time, or to engage in helpful symptom management strategies
• Developing contingency plans for meetings the employee may not be able to attend/lead
• Assistive technology to reduce demands of typing or reading

WORKPLACE:

• Adjustment to physical setup – ergonomic chair, adjustments of display settings on monitor, adaptive keyboards or mice
• Addressing glare or changing the lighting conditions
• Reinforce scent-free environments
• Provide noise cancelling headsets or move employee to low traffic area
• Provide access to a private room so the employee can take breaks, control lighting, manage symptoms effectively
• Move workstation closer to bathroom if there are side effects to medications
• Consider remote working to allow better control of environment
• Ensure employee has appropriate benefits and knowledge to access them when needed

WORKER:

• Job coaching to lessen cognitive work demands – providing cognitive compensation strategies
• OT intervention to teach energy conservation, symptom management, and assertive communication skills
• Stress management skills and applications to manage stress/mood
• Ensure appropriate health care is accessed to manage condition

What Can Employers Do?

In addition to engaging an Occupational Therapist and implementing individualized accommodation strategies, here are some other helpful tips for managing accommodations for employees with episodic disabilities:

1. Education: Provide education to all employees on the accommodation process, how to request accommodation, and episodic disabilities.
2. Resources: Obtain a list of resources that an employee with episodic disabilities may be able to access including benefits, EAP, or community supports.
3. Communication: Never request specific medical information including diagnosis or treatment. Always keep open communication with the employee and confirm your commitment to supporting them to be successful. Always use inclusive language when communicating (e.g., “people first” language).

Gowan Consulting has Occupational Therapists across Canada to support objective assessment of an employee’s functional needs and requirements for reasonable accommodation in the workplace. Contact us at [email protected] to learn more or make a referral today.

Works Cited

“IWH researchers help MPs examine episodic disabilities and work issues,” Institute for Work and Health, November 2019, https://www.iwh.on.ca/impact-case-studies/iwh-researchers-help-mps-examine-episodic-disabilities-and-work-issues