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Accommodation and Compliance Series:
Employees with Lupus

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Introduction

JAN's Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.

The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee's individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.

For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar.

Information about Lupus

How prevalent is lupus?

The Lupus Foundation of America estimates that approximately 1,500,000 Americans have a form of lupus (Lupus Foundation of America, n.d.). Although lupus can affect men and women of all ages, nine out of every 10 lupus cases are in females. Lupus develops most often between ages 15 and 44 and is two to three times more common among African Americans, Hispanics, Asians, and Native Americans (Lupus Foundation of America, 2014.).

What is lupus?

Lupus is a widespread and chronic autoimmune disease that, for unknown reasons, causes the immune system to attack the body's own tissue and organs, including the joints, kidneys, heart, lungs, brain, blood, or skin. The immune system normally protects the body against viruses, bacteria, and other foreign materials. In an autoimmune disease like lupus, the immune system loses its ability to tell the difference between foreign substances and its own cells and tissue. The immune system then makes antibodies directed against "self." There are several forms of lupus: cutaneous, systemic, drug-induced, neonatal, and overlap syndrome or mixed connective tissue disease (Lupus Foundation of America, 2014).

What are the symptoms of lupus?

Although lupus can affect any part of the body, the most common symptoms are achy joints, frequent fevers, arthritis, fatigue, skin rashes, kidney problems, chest pain with deep breathing, a butterfly-shaped rash across the cheek and nose, photosensitivity, impaired vision, Raynaud's phenomenon, and seizures. No single set of symptoms is uniformly specific to lupus and no laboratory test can prove lupus conclusively; symptoms may disappear for no apparent reason and remain in remission for weeks, months, or even years (Lupus Foundation of America, 2014).

What causes lupus?

The cause of lupus is unknown, but researchers believe there is a genetic predisposition and environmental factors also play a role in triggering the disease. Some of the factors that may trigger lupus include infections, antibiotics, ultraviolet light, extreme stress, certain drugs, and hormones (Lupus Foundation of America, 2014).

How is lupus treated?

Treatment approaches vary depending on the symptoms of each person. Because the characteristics and course of lupus may vary significantly among individuals, a thorough medical evaluation and ongoing medical supervision are essential to ensure proper diagnosis and treatment.  Medications are often prescribed for people with lupus, depending on which organs are involved, and the severity of involvement (Lupus Foundation of America, 2014).

Lupus and the Americans with Disabilities Act

Is lupus a disability under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC Regulations . . ., 2011). Therefore, some people with lupus will have a disability under the ADA and some will not.

A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment (EEOC Regulations . . . , 2011). For more information about how to determine whether a person has a disability under the ADA, visit http://AskJAN.org/corner/vol05iss04.htm.

Accommodating Employees with Lupus

(Note: People with lupus may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with lupus will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.)

Questions to Consider:

  1. What limitations is the employee with lupus experiencing?
  2. How do these limitations affect the employee and the employee's job performance?
  3. What specific job tasks are problematic as a result of these limitations?
  4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
  5. Has the employee with lupus been consulted regarding possible accommodations?
  6. Once accommodations are in place, would it be useful to meet with the employee with lupus to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
  7. Do supervisory personnel and employees need training regarding lupus?

Accommodation Ideas:

Activities of Daily Living:

Cognitive Impairment:

Fatigue/Weakness:

Fine Motor Impairment:

Gross Motor Impairment:

Photosensitivity:

Respiratory Difficulties:

Seizure Activity:

Skin Irritations:

Stress Intolerance:

Temperature Sensitivity (including Raynaud’s Phenomenon):

Vision Impairment:

Situations and Solutions:

A teacher with lupus was restricted from extended periods of typing.  She was having difficulty creating lesson plans. She was accommodated with speech recognition software, an alternative keyboard, and a trackball.

A corporate trainer with lupus had difficulty standing and walking when giving presentations.  The individual was accommodated with a scooter for getting around the work-site and a stand/lean stool to support her weight when standing.

A claims representative with lupus was sensitive to fluorescent light in his office and to the radiation emitted from his computer monitor.  The overhead lights were changed from fluorescent to broad spectrum by using a special filter that fit onto the existing light fixture.  The individual was also accommodated with a glare guard and flicker-free monitor. 

An engineer with lupus was having difficulty completing all of his work in the office due to fatigue.  The individual was accommodated with frequent rest breaks, a flexible schedule, and work from home on a part-time basis. 

An executive secretary with lupus had severe back pain due to arthritis.  The individual was accommodated with an adjustable height workstation to alternate between sitting and standing, an adjustable keyboard and mouse tray, and an ergonomic chair with lumbar support.

A health care worker with lupus had low vision.  She was having difficulty viewing her computer screen and paper copies.  The individual was accommodated with a large monitor, screen magnification software, hand/stand magnifier for paper copies, and a closed circuit television system. 

A systems analyst with lupus had migraine headaches.  The individual was moved from a cubicle office to a separate workspace away from distractions and noise. She was then able to use task lighting instead of overhead fluorescent lighting and adjust the temperature control when necessary.

Products:

There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.

Resources

References

EEOC Regulations To Implement the Equal Employment Provisions of the Americans With Disabilities Act, as Amended, 29 C.F.R. § 1630 (2011).

Lupus Foundation of America, Inc. (2014). Get answers. Retrieved May 30, 2014, from http://www.lupus.org/answers

Updated 5/30/14

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