The JAN Team focuses on technology – new and old – and its possible applications in accommodating people with disabilities in the workplace.
Lyssa Rowan, New Media Assistant
One of the most talked-about trends with today’s technology is wearables – technological devices that you wear as part of your clothing or accessories. One example of these is Google Glass. JAN has had a chance to take a look at Glass to see how it could be used as a type of assistive technology (AT). While it’s a newer product and is in active development, we’ve seen apps that include voice recognition for real-time captioning of conversations, heads-up GPS navigation, timers, presentation assistance, and many more – there’s a lot of potential here. Look for more tidbits coming soon!
Melanie Whetzel, Senior Consultant, Cognitive/Neurological Team
Trying to keep up with all of the new apps is virtually impossible. There are apps for just about anything these days, and knowing which ones are worthwhile can be quite difficult. Listed below are a few apps that individuals with mental health impairments may find beneficial:
Bipolar Disorder Connect helps individuals with bipolar disorder to stay connected with a large growing community of people living with the same diagnosis. It’s the place to discuss treatments, start conversations, and learn from others.
CBT Calm helps assess stress levels, provides relaxation skills, and contains links to online resources for stress and anxiety.
DBT Diary Card and Skills Coach is a resource of self-help skills, reminders of therapy principles, and coaching tools for coping.
Operation Reach Out is a free intervention tool that helps people who are having suicidal thoughts to reassess their thinking and get help. Also helps those who are concerned about the safety of others.
WhatsMyM3 provides a reliable gauge to determine if users exhibit symptoms of various mental health impairments, then monitors moods and tracks mental health over time.
Linda Batiste, Principal Consultant
I recently read about a new technology for runners that also can help people with vision impairments navigate their environment. The product is from a company called Lechal and is basically a Bluetooth-enabled shoe or insole with haptic feedback vibrations that tell you which direction to go. For those of you who aren’t tech-savvy, haptic feedback just means that the device provides some kind of physical sensation to tell you something, like vibrating a certain way to tell you to turn right. According to an article in Boston Magazine, “the shoes and insoles—customers can choose between the two—rely on Bluetooth technology to connect to a person’s smartphone, and can map out the route to their destination, guiding them with the buzzing feelings on their feet along the way.”
The best thing about this product and the people who designed it is that they plan to help people with vision impairments get the shoes. One of the inventors told Boston Magazine that “for every pair of shoes that someone that isn’t visually impaired buys, another pair would be subsidized for a person that’s blind. Because that is the people who we started this for.”
This product might also help people with cognitive impairments who have difficulty getting around independently. Pretty cool!
Beth Loy, Principal Consultant
Lily Born, an 11-year old granddaughter, designed something called the Kangaroo Cup for her grandfather who has Parkinson’s Disease. Lily wanted to help her grandfather, who had trouble drinking from other cups, keep from spilling his drinks. The three-legs of the cup help stabilize it to make it harder to knock over. Individuals with Parkinson’s disease can have fine motor limitations such as tremors and a loss of strength in their hands. Check out the JAN Website for more accommodation ideas for individuals with Parkinson’s disease.
Lisa Dorinzi, Consultant, Motor/Mobility Team
I learned about Telorion Vox at the 2014 Annual International Technology and Persons with Disabilities Conference (CSUN). Telorion Vox makes select smart phones accessible to low vision and blind users. The device comes with software that features voice recognition, screen reading and optical character recognition (OCR) capabilities, and talking GPS. There are built- in features such as a color detector and light sensors as well.
The software is integrated with the phone’s platform, but it also comes with accessible applications such as alarms, an agenda, weather information, and voice memos.
Along with the software, it comes with a removable keypad overlay that gives the user points of reference on the screen. The overlay also serves as a key guard, which could be beneficial for users with tremors.
Elisabeth Simpson, Senior Consultant, Sensory Team
AT in higher education is often a vital part of a student with a disability’s success in the classroom. Technology advancements have brought about AT equipment that is portable, user-friendly, and multifunctional. For students with a vision impairment, deciphering text on handouts or other print material distributed during class can be difficult. Professors and instructors may modify lecture slides as the class progresses, write notes on a whiteboard or Smart board, or reference a video as part of the instruction. Without AT, students with a vision impairment could be missing information necessary for class participation activities and exams.
Optical Character Recognition (OCR) technology and video magnification are two types of AT that a student with a vision impairment may benefit from using in the classroom. OCR allows people with a vision impairment to scan printed text and receive a synthetic speech output or save it to a computer.
Optical Character Recognition (OCR) has three factors: scanning, recognition, and reading text. First a camera scans the printed document. Next, OCR software converts the image into recognizable characters/words. Then the user can store the information in electronic form to a computer or the OCR system itself. Video magnifiers vary in size, as well as magnification level, and use a camera to project a magnified image onto a computer monitor, television monitor, or other type of video monitor.
Some AT devices, such as the MagniLink S and the SmartView Graduate combine OCR and video magnification. With this, one AT can be used in a class for both reading printed material and for distance viewing. In addition to the camera scanning printed text, the student can tilt the camera head to the appropriate position for viewing a whiteboard or smart board. The images on the board are then displayed on the student’s laptop where color, contrast, and magnification settings can be adjusted.
It is important to note that each individual’s needs are different and what works for one student with a vision impairment may not work for another. Accommodations should be determined on a case-by-case basis. For more information about accommodations related to a vision impairment, check out JAN’s Website.
Sheryl Grossman, Consultant, Motor/Mobility Team
I have two technologies I’d like to highlight for Blog readers.
The first is an oldy but goody — the Logitech T-CD2-6F TrackMan Stationary Mouse. For those with very little arm/hand movement, this stationary trackball can be fixed to a specific location and allow for angled use of the selection part without changing the hand/finger position again.
A technology less often discussed — for those who have a private office and need a quick getaway to a private restroom, having a built-in, concealable commode that fits in with the office décor can make a huge difference for some individuals with disabilities. Check out the following Websites for more information: http://www.whitehallmfg.com/patient-care-units and http://www.metcraftindustries.com/Catalog/Hospitals/Swing-a-Way.pdf.
Kim Cordingly, Lead Consultant, Self-Employment Team
In working with individuals with disabilities interested in self-employment and small business development, where and how to market a new product frequently comes up in our conversations. This led me to locating a product Website called The Grommet. The site helps launch new and innovative products – some with very practical applications and others just for fun.
Recently, one product in particular caught my eye – the AirPhysics Hands-Free Hair Dryer. This hair dryer is not shaped in the traditional “gun” design, but has a more “ergo friendly” shape — sits straight up and down and can rest on a counter.
Jeffrey the inventor who is a hairstylist himself writes, “This hands-free hair dryer was created in order to prevent the painful wrist, shoulder, and neck injuries that have been attributed to traditional gun-type hair dryers. We originally created this hands-free method of drying for use in our own salon, and we’re thrilled to be able to offer it to all of you for use in your own home.”
I was talking to the hairstylist I use about fatigue and repetitive strain issues, and he said most professional stylists reach a point in their career when they’ll no longer be able to do their jobs due to the repeated motions of cutting, pulling, styling, grasping, and so on. He said for those stylists who are self-employed, your income is based on how many clients you are able to serve each day, so the impetus is to see as many clients as possible – hence, more repetition and risk of injury.
The potential applications for this dryer are numerous not only for those contemplating a career as a hair stylist who may need this type of accommodation, but also for those veterans in the field who may be able to extend their careers by reducing strain. This dryer can also serve as an accommodation for home use.
You can read more about The Grommet and view their interesting product selection on their Website.
Beth Loy – Principal Consultant
I recently read Laura L. Hayes’ article How to Stop Violence: Mentally ill people aren’t killers. Angry people are.
In this Slate.com article, Hayes discusses examples of individuals who were characterized as “mentally ill” by society, but who acted out of anger to commit crimes. These individuals, she argues, were controlled by that behavior and committed violent acts on someone else because of anger, not a mental health condition. Citing examples and statistics that show most violent crimes are committed by individuals who do not have a mental health condition, Hayes goes on to discuss research studies, media speculation, biological responses, gun regulation, and references in the Diagnostic and Statistical Manual of Mental Disorders. Hayes argues that violent crimes committed by people with a mental health diagnosis get a lot of attention from the media, but are extremely rare. And, Hayes writes, anger fuels violence, not a mental health diagnosis.
Linda Batiste – Principal Consultant
After receiving several questions in a row about whether the ADA applies to foreign employment, I decided to read up on the subject. I found several publications on the Equal Employment Opportunity Commission’s Website, including:
Employee Rights When Working for Multinational Employers-Fact Sheet
The Equal Employment Opportunity Responsibilities of Multinational Employers – Fact Sheet
Enforcement Guidance on Application of Title VII and the Americans with Disabilities Act to Conduct Overseas and to Foreign Employers Discriminating in the United States
After reading these publications, I decided to write up a summary for the JAN Website to serve as a quick reference on this subject:
Consultants’ Corner: Does the ADA Apply to Foreign Employment?
I hope you find the summary useful!
Anne Hirsh – JAN Co-Director
I am reading any and all articles that I can find on the new regulations for Section 503 of the Rehabilitation Act that went into effect on March 24, 2014. Employers are hungry for information on how to effectively implement self-identification of disability within their company as well as how to find qualified talent. They are also either creating or reviewing existing company reasonable accommodation policies including reasonable accommodation for onboarding. OFFCP continues to update its Website and FAQs.
This article on Job Application/Interview Stage Dos and Don’ts may be of interest.
Here is a JAN article on incorporating reasonable accommodation into a company onboarding procedure.
JAN’s archived Federal Contractor Webcast series may also be of interest
Sheryl Grossman – Consultant, Motor Team
Since recently returning from the Jewish Women Entrepreneurs Annual Conference, I’m really excited to pick up an often referenced book by Deborah Gallant entitled Shine Online. According to Ms. Gallant, “Shine Online is a 100-page book that answers every question you have about what to do…and in what order…,” regarding the Internet marketing of your business. For more tips on building a successful business, see her Website.
Daniel Tucker – Consultant, Cognitive/Neurological Team
I recently read an article in Rehabilitation Counseling Bulletin entitled Shame-Focused Attitudes toward Mental Health Problems: The Role of Gender and Culture (2014) by Nan Zhang Hampton and Seneca E. Sharp. The purpose of this study was to determine whether there were differences based on gender and three ethnicities (Asian, Latino, and Caucasian American) concerning internal attitudes toward one’s own mental health impairment. Previous research suggested that women feel more shame than men, however, this study concluded there was no significant difference between genders across the three ethnicities. The results of the study did suggest there was a significant difference in attitudes across ethnicities, with Asians reporting the least amount of Internal Shame (IS), and Latinos reporting they would feel the most shame as compared to Asians and Caucasian Americans. The authors attributed these findings to cultural values, particularly Latino cultures tending to place high value on family honor and the stigmatization of mental illness being seen as a dishonor to the family.
In conclusion, the authors pointed out the implications for rehabilitation counselors. Due to the shame associated with mental health impairments among Latinos, they may be less likely to seek rehabilitation services. As a result, the authors suggest rehabilitation counselors should put more focus on encouraging Latinos to “get facts” by developing educational workshops and providing materials to service providers who would have contact with individuals from this population.
It is probable that these findings and suggestions would be applicable in the workplace as well. Given the diversity of today’s workforce, employers may benefit from looking at ways to effectively communicate disability awareness with the goal of reducing stigma and helping all employees to feel they can approach their employers about reasonable accommodations. Most accommodations, especially those for mental health impairments, cost nothing, while the process of replacing an otherwise qualified employee can be costly.
Hampton, N.Z., & Sharp, S.E. (2013). Shame-Focused Attitudes toward Mental Health Problems: The Role of Gender and Culture. Rehabilitation Counseling Bulletin, 57 (3), 170-181.
Melanie Whetzel – Senior Consultant, Cognitive/Neurological Team
I am reading The Essential Brain Injury Guide, a publication of the Brain Injury Association of America. With the number of questions and often complex requests for assistance we receive on the cognitive/neurological team in the area of brain injuries, it makes sense to expand my knowledge as much as possible. The guide contains eight chapters ranging from understanding the brain and brain injury, to understanding and treating functional impacts, to family, legal, and ethical issues. I will be reading and learning from this guide for quite some time to come.
Tracie DeFreitas – Lead Consultant, ADA Specialist
JAN Consultants must be familiar with many different workplace laws that impact the employment of people with all types of medical impairments. In particular, we offer in-depth technical assistance on the employment provisions of the Americans with Disabilities Act (ADA) and use a number of enforcement guidance documents issued by the Equal Employment Opportunity Commission (EEOC) to explain employers’ obligations and employees’ rights under the statute. I read and share many of these documents daily and so can you by going to JAN’s AskJAN.org ADA Library under EEOC Guidances.
Another law JAN Consultants frequently receive questions about is the Family and Medical Leave Act (FMLA). FMLA often poses unique challenges for employers and so in-order to stay up-to-date on the latest trends and issues, I’ve been following a Blog entitled FMLA Insights. This informative Blog is authored by Jeff Nowak, who is co-chair of the labor and employment practice at Franczek Radelet where he represents employers in all aspects of employment law. The Blog addresses practical FMLA topics of interest to employers, highlights important court decisions, and provides updates on U.S. Department of Labor enforcement practices and initiatives – among many other FMLA and state family leave law issues. To learn more, you can go to the Website and sign-up to receive e-mail notices about new entries.
Kim Cordingly – Lead Consultant, Self-Employment Team
I’m currently reading the 2nd edition of Making Self-Employment Work for People with Disabilities (2014) by Cary Griffin, David Hammis, Beth Keeton and Molly Sullivan. The 1st edition has been a vital resource for JAN customers pursuing self-employment, so we’re thrilled to be referring individuals to this new edition.
I’ve also recently read the Office of Disability Employment Policy report on Self-Employment for People with Disabilities (2013). It discusses the experiences and outcomes of ODEP’s Start-Up USA grant projects, which sought to “…develop research-based policy and provide technical assistance to organizations geared toward achieving sustainable self-employment outcomes for individuals with disabilities.”
These are both indispensable reading for anyone interested in advancing self-employment opportunities for people with disabilities.
Also, I recently attended a conference on Women and Economic Security at the University of Michigan, which prompted me to read the following article related to women with disabilities and poverty:
Income Poverty and Material Hardship among U.S. Women with Disabilities (2009) by Susan Parish, Roderick Rose, and Megan Andrews – Social Service Review.
It includes data that suggest, “…women with disabilities experience such hardships as food insecurity, housing instability, inadequate health care, and loss of phone service at rates that are higher than those among nondisabled women. Rates of hardship remain higher even after adjusting for a host of individual characteristics, including marital status, age, race, and education.”
Much discussed at the conference was The Shriver Report – A Woman’s Nation Pushes Back from the Brink (2014), which is next on my reading list.
Teresa Goddard – Senior Consultant, Sensory Team
I am planning a vacation, so am reading Walt Disney World with Disabilities by Stephen Ashley. It was published in 2008, but still has detailed information on many rides and attractions. Next on my list is PassPorter’s Open Mouse for Walt Disney World and the Disney Cruise Line: Easy Access Vacations for Travelers with Extra Challenges by Deb Wills and Debra Martin Koma.
Earlier this month while making vacation plans, I picked up a copy of Walt Disney World with Disabilities by Stephen Ashley. Although the information was a bit dated due to changes both in the attractions at Walt Disney World and in the park’s system for providing accommodations since 2008, I found the book’s detailed descriptions of rides, restaurants, and events such as fireworks to be helpful as my party and I decided which parks to visit and how to make the most of our FastPass ride reservations; this is a system that allows one to reserve a place in a faster moving line for a small number of attractions each day. What impressed me most about this book was the attention to details of interest to those with hidden impairments such as fragrance sensitivity. In fact, the information on lighting and on rides with fragrances helped two members of our party avoid potentially problematic situations and allowed them to plan ahead about how to self-accommodate in some areas of the park. I would like to see this resource updated to reflect current park conditions and practices. Ideally, I would also prefer to have an accessible digital copy. The book is very large — too large in fact to fit in the bag that I wanted to carry to the park, so I memorized all pertinent details in advance. Also, while the book was large the print was small.
If you are looking for information on navigating Walt Disney World as a person with a disability, this book is only one of many resources that you may wish to explore.
The Walt Disney World Website also contains a wealth of information.
Elisabeth Simpson – Senior Consultant, Mobility/Sensory Team
I recently read an article in Counseling Today magazine on the role of school counselors in transition planning titled Focusing on ability, not disability by Amy Cook, Laura Hayden and Felicia Wilczenski. The article discusses how school counselors can be advocates for students with intellectual disabilities (ID) as they transition into post-secondary education. They highlight programs where school students with ID work with educational coaches and can audit or enroll in college courses for credit. The article states, “… educational institutions have increased postsecondary educational options for individuals with ID, including offering greater access to higher education through concurrent enrollment between high schools and universities. Such programs provide students with ID the opportunity to attend college and enroll in college classes, participate in college-based activities (for example, clubs, intramural sports and extracurricular activities) and, in some cases, reside on campus.”
By: Kim Cordingly, Lead Consultant
JAN is fortunate to have many thriving collaborations with organizations throughout the U.S. seeking to advance employment opportunities for individuals with disabilities. One of our strongest alliances is with the National Multiple Sclerosis Society (NMSS) – a national organization that seeks to improve the lives of individuals living with multiple sclerosis (MS) while searching for a cure.
What is MS?
According to the NMSS Web site, “…in multiple sclerosis (MS), damage to the myelin coating around the nerve fibers in the central nervous system (CNS) and to the nerve fibers themselves interferes with the transmission of nerve signals between the brain, spinal cord and the rest of the body. Disrupted nerve signals cause the symptoms of MS, which vary from one person to another and over time for any given individual, depending on where the damage occurs.” Functional limitations may include neuro-cognitive changes, fatigue, mobility impairments, vision loss, and chronic pain.
Employment and MS
Because of the complexity of the progression of MS and its unpredictable nature, each person may be affected very differently in their work life. For some, their career course may be unaffected for many years, while for others, an initial exacerbation of symptoms may lead to leaving employment — often prematurely. Access to, or continuation in, meaningful employment plays a critical role in the health and well-being of adults with MS, consequently the NMSS has made this a priority in the work they do.
Steve Nissen – Senior Director, Employment and Community Programs, NMSS – National Capital Chapter
Since 1998, Steve’s work with the NMSS at both chapter and national levels has focused on the importance of cultivating employment opportunities and supports for individuals with MS. Steve is a co-author of the book Employment Issues and Multiple Sclerosis 2nd Edition (2008) and directs numerous employment-related training and policy initiatives.
In my conversation with Steve, we wanted to highlight some new and updated resources available through NMSS (nationally) that focus on employment. In addition, Steve pointed out that the NMSS Web site has undergone a major facelift — adding resources and enhancing navigation. For those already familiar with the site, and for newbies as well, it will be worthwhile for you to visit the new online face of NMSS.
The employment portal of the Web site offers a wide range of resources for individuals with MS, employers, service providers, family members, and chapter trainers. Collaboration with JAN, particularly in the area of workplace accommodations, is evident throughout the site – including a photograph showing an individual viewing JAN’s Website as a resource. Steve highlighted a new resource on their site called Employment Matters: Managing MS in the Workplace. This training tool offers a video series as well as a written toolkit on how to “…navigate the complexities of managing work and MS.” Topics covered in the video include thinking proactively about employment, recent changes to the Americans with Disabilities Act (ADA), disclosure in the workplace; managing fatigue in the workplace; managing cognitive challenges in the workplace; and assistive technology and the workplace. The toolkit covers developing your skill set; job search strategies; writing a good resume; Social Security disability benefits and work incentives; disclosure issues; accommodation information; and components of the Americans with Disabilities Act (ADA). As a bonus, Employment Matters was designed to be implemented by local NMSS chapter staff and volunteers to address these important employment topics.
Other excellent employment resources available on the NMSS Web site include:
Career Crossroads – A six part video series on employment and MS.
Health Insurance Resources – One of the best sites for providing an overview of all the options, particularly the Affordable Care Act (ACA).
The Win-Win Approach to Reasonable Accommodation: Employment Issues – Discusses the employment provisions of the ADA; implementing reasonable accommodations; and taking a “win-win” approach to this process. NMSS has additional employment related brochures available on their Web site.
Find Services in Your Area – Find a NMSS chapter near you for one-on-one assistance.
An Information for Employers brochure is available.
The video MS Learn Online- Employment and MS features Steve responding to employment related questions.
Steve pointed out that making relevant employment information available to individuals with MS is a priority of the organization. JAN has been a participant in this effort through information sharing and reciprocal consulting, as well as partnering in various training and presentations.
I asked Steve what he thought were some of the biggest challenges for individuals with MS in the workplace. Without hesitation, he shared with me the following:
1. Leaving the workforce prematurely – Research on MS and employment shows that many individuals leave their jobs prematurely when the first exacerbation of symptoms occurs. Well-meaning family members, physicians, and others may be concerned that work is too stressful and support leaving. While each individual situation is unique, research shows with appropriate accommodations and support, many employees with MS can continue to work successfully in their positions. Accommodation consultation and suggestions from NMSS and JAN can provide individualized assistance with these questions.
2. Disclosure – Because symptoms of MS may not be visible, or come and go – the issue of disclosure is a challenge for many. NMSS and JAN can discuss these issues and respond to your specific questions and concerns.
3. Managing symptoms in the workplace – Steve pointed out that often individuals who contact them are not sure how to manage particular impairments in the workplace. An example might be someone who has lost some vision and can no longer view the text on a computer. NMSS and JAN can address these types of accommodation questions, which can empower employees with MS to stay on the job.
4. Being proactive and not waiting until there’s a crisis – Steve shared that too often NMSS and JAN get contacted about a workplace issue when it’s already turned into a “crisis.” He emphasizes to individuals who contact NMSS that “knowledge is power,” so learn as much as possible so you can advocate for yourself and know what resources and services are out there to support you in this process. Be proactive!
Steve is an invaluable employment advocate for individuals with MS around the country and friend to JAN. We thank him and the NMSS for all of their important work on behalf of individuals with MS.
National Multiple Sclerosis Society – Main Web Site
Toll Free: 1-800-344-4867
National Capital Chapter: National Multiple Sclerosis Society
1800 M Street, NW, Suite 750 South
Washington, DC 20036
Toll Free: 1-800-344-4867
“The National MS Society helps each person affected by MS in our area address the challenges of living with MS. We help by raising funds for cutting-edge research, driving change through advocacy, facilitating professional education and providing programs and services that empower people with MS and their families to move their lives forward.”
JAN – Accommodation Ideas for Multiple Sclerosis
Includes various accommodation examples for individuals with MS in the workplace.
Employment Issues and Multiple Sclerosis (2nd Edition) by Phillip Rumrill, Mary Hennessey, and Steve Nissen
“Employment Issues and Multiple Sclerosis, 2nd Edition is a must read for any person with MS that has a question regarding employment and disability. Chapters cover everything from vocational rehabilitation to job placement, and the laws covering employment.”
By: Burr Corley
Consultant, Motor Team
April is National Donate Life Month focusing attention on the importance of organ and tissue donation in much needed medical transplants. Donate Life America and its partnering organizations feature activities throughout the month of April to bring awareness to the needs of those awaiting transplants, and how individuals can become involved in this issue.
We here at JAN think this is a good opportunity to discuss accommodation ideas for people who have experienced an organ transplant. According to data on organ transplants featured on the Website WebMD, the most commonly transplanted organs are the kidneys, liver, heart, pancreas, lungs, and small intestine. For those individuals given a new lease on life with their new organs, they often face significant challenges during their recovery. This not only includes time spent recuperating from a surgical procedure, but often a lifetime of managing medications they must take to keep their bodies from rejecting the new organ. Some of these medications have significant side effects. Many individuals who have undergone an organ transplant anticipate returning to their career after a successful transplant. An effective accommodation can make this possible.
The definition of disability was expanded when the Americans with Disabilities Act (ADA) was amended in 2008 so the ADA now protects a lot more people. As a result, individuals in need of organ transplants are probably entitled to accommodation under the ADA if they work for covered employers. An employer with an employee who needs an organ transplant might want to be aware of accommodations the employee might need before, during, and after a transplant.
Before The Transplant
An organ transplant is a medical procedure to replace a failing organ with a new, healthy one. Many transplant candidates have been managing a chronic illness for years before being considered for a transplant. For example, candidates for receiving a heart transplant may be experiencing cardiomyopathy, which is characterized by an enlarged heart and the weakening of the heart muscle. Liver transplants are typically needed for individuals with severe liver diseases such as cirrhosis.
Many individuals may have already requested and received accommodations from their employer at this point. However, being a candidate for a transplant may require some additional accommodations. In particular, while on the list for a transplant, the patient will require medical examinations in preparation for the surgery. These exams may be done at treatment centers some distance away from where the employee lives and works. According to the Equal Employment Opportunity Commission (EEOC), allowing for a flexible schedule so the employee can attend treatment appointments and/or permitting flexible use of leave could be an effective accommodation. In some circumstances, allowing the employee to work in an alternate location could also be an accommodation option.
During and After the Transplant
A transplant patient is usually put on a list and must wait for a period of time before he or she can receive an organ. This is a process that can take years, so the timing of the transplant is often unpredictable. Employers will want to work out leave arrangements ahead of time so the employee can focus on his or her treatment and recovery. After the transplant, there will often be a recovery time during which the employee will not be able to work. The doctor may also restrict the employee from driving so the employer may want to look into accommodations for driving.
When the employee does return to work, the employer may want to be aware of some limitations that may require accommodation. First of all, individuals who have received an organ transplant often have extensive follow up appointments that they must attend so the transplant team can monitor how they are faring with their new organ. These appointments will be necessary for the rest of the employee’s life. Again, an employer should be aware it may be necessary to consider schedule modification and/ or flexible use of leave as an accommodation so the employee can attend these appointments. In addition, the individual who received the transplant is likely to be taking medications that lessen the risk of the patient’s body rejecting the transplanted organ by suppressing the immune system. These are called immunosuppressant medications. With a suppressed immune system, the employee may need accommodations to help avoid infections.
Here are some ideas for accommodating an individual with a suppressed immune system:
- Allow employee to avoid work around infectious agents
- Provide the employee a private office with a computer keyboard, mouse, and telephone keypad that can be sterilized
- Limit the employee’s exposure to situations in which there could be at risk of infection
- Allow the employee to work from home
- Allow for flexible leave time
A suppressed immune system and the side effects of anti-rejection medications from a transplant may not be the only limitations that need to be accommodated in the workplace.
Here are other side effects and health problems that may need to be accommodated depending on the particular type of transplant:
- Tremors – Some of the anti-rejection drugs can cause the transplant patient to have tremors. Although it covers a different impairment, JAN’s publication on Accommodations for Essential Tremors can be a good source for accommodation ideas.
- Increased risk of diabetes – One out of 10 patients who undergo an organ transplant develop Type 2 Diabetes. Here is a JAN publication on Accommodations for Employees with Diabetes.
- Increased risk of heart disease because of elevated cholesterol — Here is a publication from JAN with information about accommodations for employees with heart conditions.
- Increased risk of high blood pressure.
- Gastrointestinal problems – Here is a page from the JAN Website addressing accommodations for gastrointestinal issues.
- Patients may develop gout or have symptoms of gout worsened because of immunosuppressant medication.
- Anxiety and Depression – As with any major life changing event, undergoing a transplant procedure can contribute to symptoms of anxiety and depression. Here is a JAN publication on accommodating employees with mental health impairments.
With accommodations for individuals who have organ transplants, there is not a one size fits all solution. Not every transplant recipient is going to experience all of the limitations listed above. Over time, the transplant patient’s risk of rejection is lowered so the treatment team may reduce the level of medication he or she needs, and side effects will be reduced. As with any interactive accommodation process, a good source of information about what is needed is the employee who requested the accommodation. Medical documentation can also be useful from the employee’s treatment team. As always, you can contact JAN with your questions at (800)526-7234 (Voice), (877)781-9403 (TTY), or visit us on the Web at AskJAN.org.
Donate Life America
“Donate Life America is a 501(c)3 not-for-profit alliance of national organizations and state teams across the United States committed to increasing organ, eye and tissue donation. Donate Life America manages and promotes the national brand for donation, Donate Life, and assists Donate Life State Teams and national partners in facilitating high-performing donor registries; developing and executing effective multi-media donor education programs; and motivating the American public to register now as organ, eye and tissue donors.”
WebMD – Organ Transplant Overview
By: Lisa Dorinzi – Consultant on Motor/Mobility Team; Sheryl Grossman – Consultant on Motor/Mobility Team; and Kim Cordingly – Lead Consultant on Self-Employment Team
March 3-7 is Telework Week 2014 – a global initiative that strives to raise awareness of the many benefits arising when employers provide the option for their employees to telework. For many employees in the federal government, Telework Week began by working from home during another day of severe winter weather. This proved to be a timely illustration of the benefits of telework to keep a workforce productive even when they aren’t physically able to get to work.
According to the Telework Enhancement Act of 2010, the term ‘telework’ or ‘teleworking’ refers to a work flexibility arrangement under which an employee performs the duties and responsibilities of such employee’s position, and other authorized activities, from an approved worksite other than the location from which the employee would otherwise work. This legislation requires federal agencies to implement telework protocol and procedures, which could allow eligible employees the option to work remotely.
As illustrated this week, the option of telework has benefits during bad weather or other emergencies. Additional advantages include saving money on office space and supplies, “going green” by eliminating the commute to and from work, and encouraging work/life balance for employees. These factors may make it easier to recruit and retain workers as well as advancing the goals and mission of the workplace.
Telework as a Reasonable Accommodation
Apart from the overall benefits of telework, it can also be an effective accommodation strategy for employees with disabilities. The Equal Employment Opportunity Commission (EEOC) offers guidance on how telework can be a reasonable accommodation under the Americans with Disabilities Act (ADA). For many people with disabilities, telework arrangements can provide years of additional productive work beyond what would have been possible in a standard work setting. In many instances, the essential functions of a job can still be performed from an alternate location and at more flexible times. And, telework has been made a more viable accommodation option by advancements in digital technologies making various forms of communication possible across long distances, even on a shared project. These advancements also serve to reduce previous fears that an accommodation of telework forces isolation from co-workers. When appropriate attention is paid to the effectiveness of an accommodation, win-win situations can emerge.
As a federal collaborator, the Computer/Electronic Accommodations Program (CAP) at the Department of Defense (DoD) supports telework by providing services and accommodations to eligible federal workers with disabilities and wounded Service members. CAP’s employment initiative describes telework as a form of reasonable accommodation by permitting an individual to perform his or her job remotely. CAP can provide training and consultation, assistive technology, computer hardware and software, and other office telecommunication equipment to allow a person to telework.
Telework can benefit individuals with various medical conditions and the limitations they may face in the workplace. Let’s take a closer look at a few real scenarios fielded by JAN consultants where telework was an effective accommodation option.
Accommodation Examples from JAN Customers
An editor with a vision impairment was not able to drive to work. He lived in a rural area so public transportation was not an option. The employer permitted the employee to work from home. The employee was able to conference call in for important meetings when necessary.
A registered nurse with hearing loss and mental health impairment was experiencing anxiety and sleep disturbances. Her job entailed monitoring home health clients though a computer system and telephone. Her employer allowed her to install the data secured equipment in her home thus enabling her to successfully perform her job tasks while minimizing her symptoms.
A loan officer experienced migraine headaches multiple times a month. The migraines would cause the employee to be fatigued and photosensitive. This was causing the employee to only be able to work for 4-5 hours in the office causing attendance concerns. To minimize absences, the employee was allowed to telework from home where she was able to take self-regulated breaks and work when she felt her best.
An accountant with chronic pain syndrome and a back impairment had a problem sitting at his desk for extended amounts of time. The employee was allowed to work from home a few times a week, which enabled him to alternate positions and build in periodic rest breaks for stretching.
A customer service representative had multiple chemical sensitivity. The various fragrances within the office space were exacerbating the employee’s symptoms. After other options proved unsuccessful – such as a fragrance free policy, air purifiers, and an isolated office — the employee and employer mutually decided telework was the best option.
A paralegal with gastrointestinal issues had flare ups about four times a year. During these flare ups the employee was permitted to work from home, which allowed the employee to use the restroom as needed, but still perform all work tasks.
An insurance agent with post-traumatic stress disorder (PTSD) would experience flashbacks and anxiety during the two hour commute to work. The employer granted telework as an accommodation, enabling the employee to give her full attention and energy to her work tasks.
For more information regarding the telework option, visit the JAN Website.
Mobile Work Exchange
2013 Status of Telework in the Federal Government – Report to Congress
Telework, Once a ‘Mom Perk,’ Keeps Government Humming During Snow Storms
By: Melanie Whetzel, Senior Consultant – Cognitive/Neurological Team
While our thoughts this month are focused on Valentine’s Day, the American Heart Association uses February each year to bring awareness to some pretty grave statistics. According to the Centers for Disease Control and Prevention (CDC):
- Every year, about 715,000 Americans have a heart attack
- Every year about 600,000 Americans die from heart disease
- 1 out of every 4 deaths is a result of heart disease
- Heart disease is the leading cause of death for both men and women.
The term “heart disease” refers to several types of heart conditions. The most common type in the United States is coronary heart disease (also called coronary artery disease). Coronary heart disease can cause heart attack, angina, heart failure, and arrhythmias.
The situation is alarming, but there is good news—heart disease is preventable and controllable. Log on to both the CDC and the American Heart Association Websites for healthy tips and information on how to improve your heart health.
If a heart condition is causing difficulties on the job, consider how job accommodations may be helpful. Job Accommodation Network (JAN) consultants can provide individualized assistance and can be accessed by phone, TTY, relay, e-mail, online chat, Skype, or various social networks. A JAN consultant can provide assistance to employees and employers alike regarding accommodations that might be helpful for various heart conditions that cause limitations in the workplace.
Below are examples of real life accommodation situations and solutions from JAN customers with heart conditions:
A maintenance technician, restricted from working in extreme temperatures, was accommodated with a modified schedule not requiring her to work outside in these conditions.
An individual, who delivered mail in a high-rise office building had high blood pressure and was limited to no lifting and pushing over 25 pounds. The employer provided the individual with a power cart and compact lifting devices to assist with moving materials.
An employee with a heart condition who was unable to walk up more than one flight of stairs asked to be accommodated with a ground floor office. The elevator on the premises was undependable and broke down frequently. This employee was to be accommodated with a ground floor office as soon as one became available. In the meantime, the employee was provided a temporary office space in a seldom used small ground-floor conference area.
See JAN’s Accommodation and Compliance Series: Employees with Heart Conditions, Searchable Online Accommodation Resource: Heart Conditions, Effective Accommodation Practice Series: Heart Conditions, and find valuable contact information from an Organizations list all linked on JAN’s Website.
By: Melanie Whetzel, Senior Consultant – Cognitive/Neurological Team
The American Heart Association reports that heart disease is the leading killer of women in the United States, claiming more lives than all forms of cancer combined. For more than 10 years, the American Heart Association has sponsored National Wear Red Day® to raise awareness of the fight against heart disease in women.
Some of us have an abundance of red in our wardrobes. It is a great color. It stands out and draws attention. According to the American Heart Association, the color red can be a confidence booster and make us feel powerful. That may just be the reason they chose the color red to declare the fight against heart disease. It is also the color of our hearts.
2014 marks the 11th anniversary of the National Wear Red Day. Numerous improvements have been made in women’s heart health in the intervening years. They include:
- 21 percent fewer women dying from heart disease
- 23 percent more women aware that it’s their No. 1 health threat
- Publishing of gender-specific results, established differences in symptoms and responses to medications, and women-specific guidelines for prevention and treatment
- Legislation to help end gender disparities
For more information about heart disease and the National Wear Red Day, visit the American Heart Association Website.
Stay tuned for JAN’s next Blog on accommodation situations and solutions for individuals with heart conditions.
For information about JAN and job accommodations, visit our Website at AskJAN.org. For more specific information about accommodations for heart conditions and the Americans with Disabilities Act (ADA), visit Accommodation Ideas for Heart Conditions.
By: Elisabeth Simpson, Senior Consultant – Motor Team
What do tennis balls, a headlamp, and curtains all have in common? They can all be used as a reasonable accommodation in the workplace. But wait — how can that be? Aren’t all accommodations expensive and high tech? In actuality, many accommodation solutions can be considered “low tech,” and according to an ongoing study conducted by JAN since 2004, employers report that a 58 percent of accommodations cost absolutely nothing to make, while the rest typically cost only $500.
A common misconception about accommodations is that products and equipment that have been developed to assist individuals with disabilities with various activities, including those that are work related, are expensive, high-end electronics and technology. It is not uncommon for employers to ask about a high cost device before considering low cost/low tech options or simple modifications that work just as well.
It is important to note that some types of assistive technology (AT) that are more expensive may be necessary. The type of equipment, product, or AT that an employee with a disability needs (or has requested) will always be a case-by-case determination. But one thing for employers to consider is that, in some cases, something as simple as putting curtains up to reduce glare on a computer monitor for an employee with migraine headaches is much less complicated than searching for the best anti-glare computer monitor on the market.
Here are a few real-life JAN examples of low cost accommodation solutions:
A clerical worker who stamped paperwork for several hours a day was limited in pinching and gripping due to carpal tunnel syndrome. The individual was accommodated with adapted stamp handles. Anti-vibration wrap was placed around the stamp handles. In addition, tennis balls were cut and placed over the wrapped handles to eliminate fine motor pinching and gripping.
A production worker with intellectual or cognitive impairment and cerebral palsy had difficulty grasping a plastic bottle to accurately apply an adhesive label. JAN suggested making a wooden jig to hold the bottle while the employee applies the label. Approximate accommodation cost was under $50.
A grocery stock person with autism could not remember to wear all parts of his uniform. JAN suggested taking a picture of the employee in full uniform, giving him the picture, and allowing him to use the picture as reference when preparing for work. Approximate accommodation cost is $5.
A custodian with low vision in a public school setting was having difficulty viewing the carpeted area he was vacuuming. A lighting system was mounted on the custodian’s industrial vacuum cleaner, and the custodian was provided a headlamp.
As these examples show, often accommodations are low cost, low tech, and can be implemented fairly easily. Workspace modifications can be made at little to no cost and there are all kinds of inexpensive devices on the market. Accommodations might also include a specially designed or modified product, but customization doesn’t always translate into high cost. Removing the legs of a computer desk can be a very low cost custom modification for an individual of short stature.
JAN consultants can provide individualized case-by-case assistance regarding various accommodation options; information on products; organizational referrals; and locating specific vendors of a wide variety of low cost and low tech accommodations.
For onsite assistance, rehabilitation professionals and assistive technology specialists can be great resources for employers. These individuals have been specifically trained to perform assessments that identify the individual’s needs; strengths and abilities; environmental consideration; tasks that are problematic; and the tools necessary for success.
So remember, before jumping to the conclusion that an accommodation will break the bank, low cost accommodations do exist! If you are wanting to learn more about the JAN study and the various findings related to the costs and benefits of providing accommodations in the workplace, you can review the JAN Accommodation and Compliance Series Workplace Accommodations: Low Cost, High Impact.
By: Louis Orslene, JAN Co-Director
When I’m on the road presenting, I often get this question. Usually it is from a supervisor or hiring manager, but at times from a human resource (HR) specialist who is responsible for advising managers. Being a manager, I understand the dilemma. The manager’s role is to keep a team well informed on issues affecting the team with the ultimate goal of insuring team cohesiveness and productivity.
When asked about another employee’s accommodation, the manager can take the approach that this information is none of the business of co-workers or other employees. However, as many who have served in this role know, this may not be the most pragmatic approach. And, as David K. Fram, Esquire, Director of the ADA & EEO Services for the National Employment Law Institute (NELI) suggests “…employees – or unions – may insist on knowing why one employee gets to perform the job in a different manner.” Thus, this complicates the manager’s dilemma.
At times, when it comes to sharing information involving an employee accommodation, managers are caught between the proverbial rock and a hard place. As with much of managing, it is a balancing act. On one hand, the manager must protect the confidentiality of the accommodated employee which also serves to minimize risk for business. On the other hand, the manager needs to communicate changes in the team environment to insure team morale, motivation, and ultimately productivity.
For guidance on this issue, let’s look to two national authorities on the topic of disabilities in the workplace — the Equal Employment Opportunity Commission (EEOC), who enforces the employment provisions of the Americans with Disabilities Amendments Act (ADAAA), and NELI.
The EEOC offers:
“If employees ask questions about a coworker who has a disability, the employer must not disclose any medical information in response. An employer also may not tell employees whether it is providing a reasonable accommodation for a particular individual.”
Fram from NELI adds:
“Some disability advocates have argued that disclosing that someone is receiving an ADA reasonable accommodation essentially reveals that the individual has a disability.”
So as a manager, “What then can I say?” First, I would suggest for the manager or HR specialist to request assistance from their legal department. A response to this question may have already been developed and sanctioned by the legal staff. If not, the EEOC offers that a manager:
“…may explain that it is acting for legitimate business reasons or in compliance with federal law.”
Fram writes that in the proceedings for Williams v. Astrue, 2007 EEOPUB LEXIS 4206 (EEOC 2007), the EEOC offered employers additional language to be considered.
Thus, a manager might also say:
“…it has a policy of assisting any employee who encounters difficulties in the workplace,” and that “…many of the workplace issues encountered by employees are personal, and that, in these circumstances, it is the employer’s policy to respect employee privacy.”
However, one of the most concise and informative answers to this question was articulated in a recent Employer Assistance and Resource Network (EARN) Webinar by speaker Susan W. Brecher, Esquire, of Cornell University. Susan suggests that managers say:
“…we look and treat employees individually and make considerations based upon good business reasons which allows for privacy of each individual.”
Of the responses I’ve heard to date, I think this is the best. It provides just enough information without speaking directly to the specifics of the individual being accommodated.
EEOC Enforcement Guidance on the Americans with Disabilities Act and Psychiatric Disabilities, EEOC NOTICE, Number 915.002 , Date 3-25-97, page 18.
NELI’s The Human Resource Guide to Answering ADA Workplace Questions (8th Edition), 31st Edition 9/2011, Page III-41-42.
EARN Webinar, The Interplay between FMLA and ADAAA Human Capital Development, Cornell University, ILR School. Thursday, September 27, 2012.
By: Teresa Goddard, Senior Consultant, Sensory Team
November was American Diabetes Month, so predictably JAN consultants received many inquiries about accommodations for employees with diabetes. JAN customers often ask about the most common type of accommodation for a particular condition. Anecdotally, I would say that a modified schedule, such as flexible start times and modified break schedules, is one of the most common types of accommodation we discuss during calls about diabetes. Other typical accommodation solutions include providing a space for the employee to store medication and food; policy modifications which allow an individual to eat at one’s desk; or procedural modifications related to travel reimbursement which may be needed to avoid passing extra costs related to food, and medication storage or other disability related travel expenses on to the employee. However, over the past few years, I’ve noticed the number of questions we receive about the use of service dogs by employees with diabetes seems to be increasing. I’ve also fielded numerous questions on this topic during presentations and trainings, as well as the day-to-day calls here at the office.
The number of calls we receive at JAN related to employees with diabetes who use service animals to assist with management of their condition continues to be relatively small in comparison to the total number of accommodation inquiries we receive about diabetes. However, we have seen a gradual increase since the passage of the ADA Amendments Act of 2008 (ADAAA). Because of the ADAAA, individuals with diabetes are more easily able to show they are covered under the ADA. One of the changes that occurred when the ADAAA went into effect is that major bodily functions now count as major life activities for purposes of determining whether or not someone meets the definition of disability under ADA. In addition, Equal Employment Opportunity Commission (EEOC) guidance on the ADAAA specifically mentions functions of the endocrine system as an example of a major bodily function that counts as a major life activity. This is important for individuals with diabetes because the pancreas, which produces insulin, is an important part of the endocrine system. While there is still no list of conditions that are always covered under the ADA, it is likely that most people with a diagnosis of diabetes will be able to show that they are substantially limited in the functions of their endocrine system.
The increased interest in service dogs as an accommodation for diabetes may have to do with their ability to alert individuals to blood sugar problems. Service dogs for individuals with diabetes are sometimes referred to as hypoglycemia alert dogs. In order to be considered a service animal as opposed to an emotional support animal, the dog has to be trained to perform some type of task. Hypoglycemia alert dogs are trained to prompt an individual with diabetes or episodes of hypoglycemia that their blood sugar levels may be dropping. The mechanism by which a hypoglycemia alert dog can detect a change in blood sugar is not fully understood. A recent study published in the journal Diabetes Care (Dehlinger et al., 2013) did not support the idea that dogs use their sense of smell to detect changes in blood sugar. However, the sample size was small. The study also did not rule out the possibility of dogs using behavioral cues rather than scent to detect changes in blood sugar. Many more studies will be needed before we can fully understand how hypoglycemia alert dogs detect changes in blood sugar and the circumstances under which they can do so reliably. It is my understanding that not all dogs are able to do so.
Although hypoglycemia alert dog is a term that is typically used to refer to a service dog used by an individual with diabetes, some of our callers have reported that their dogs can also alert to hyperglycemia. Hypoglycemia means low blood sugar whereas hyperglycemia means high blood sugar. Different treatments are required for each of these conditions. Those who are prone to episodes of both may need to test their blood sugar level when alerted by the dog in order to know what to do next.
Dogs may alert individuals with diabetes to a change in blood sugar in different ways, but one common method is to nudge the individual who is experiencing an episode, or to vocalize in a manner similar to a whine or a whimper. To an outside observer, this may appear similar to a dog asking to go outside or for food, but the meaning is clear to the individual with diabetes. Some dogs may be trained to perform more complex tasks such as retrieving glucose tablets.
One issue that comes up frequently during calls about hypoglycemia alert dogs in the workplace is the fact that training methods tend to be different from those of other service animals. It is not unusual among users of hypoglycemic alert dogs for a pet that is already part of the family of the person with diabetes to undergo service animal training. This is different from the training of many service animals whereby the animal is trained through a specialized program (often with participation of the future owner) and then placed into service. Sometimes the individual may train the animal on their own with the support of a diabetes-related medical provider or support organization. This may complicate the process of providing medical documentation to an employer, particularly if the training is done by the individual with a family pet.
Over the years, service animals have taken on an increasingly important role as an accommodation option for people with disabilities to succeed in the workplace. For individuals with diabetes, hypoglycemia alert dogs can help mediate a potentially serious health condition so that the employee can continue to be a productive part of the workforce.
For additional information see:
Service Animals in the Workplace
Accommodation Ideas for Employees with Diabetes
Dehlinger, K., Tarnowski, K., House, J. L., Los, E. L., Hanavan, K., Bustamante, B., Ahmann, A. J., & Ward, K. W. (2013). Can trained dogs detect a hypoglycemic scent in patients with type 1 diabetes? Diabetes Care, 36(7), e98-e99.