By Carrie Clawson, OTR/L, ATP, and John Noiseux, MS, ATP
Approximately 32 million working-age Americans (18.7% of the population age 15 to 64) have a disability.1 The rate of unemployment among those with nonsevere disabilities is approximately 5% higher than persons without disabilities (25.1% and 17.9%, respectively); the unemployment rate for persons with severe disabilities is more than three times the rate of persons without disabilities (73.9% compared to 17.9%). One of the ways that the Americans with Disabilities Act (ADA) has helped reduce barriers to employment is by mandating reasonable accommodation for qualifying persons with disabilities who request it. The cost and difficulty of workplace accommodations are frequently overestimated. In fact, the Job Accommodation Network (JAN) reports that 19% of the accommodations reported by businesses that used JAN cost nothing, and nearly 80% of the accommodations cost under $500. Many of these low-cost accommodations consist of rearranging of equipment (lowering shelves, moving furniture out of the way to provide access), the provision of inexpensive tools (electric staplers, electric screwdrivers), and job restructuring. According to JAN: "For every dollar an employer spends for a disability-related job accommodation, the company saves $34, eg, workers’ compensation and other insurance savings, training of new employees, and increased productivity."2 For individuals with severe disabilities or complex needs, it may be difficult for an employer or employee to identify what accommodations are needed. In these cases, a workplace accommodation evaluation by an experienced interdisciplinary team is helpful. The team may include an occupational therapist, rehabilitation engineer, and vocational rehabilitation specialist. From the Beginning When an evaluation is requested, typically the team obtains detailed background information from the employee including diagnosis, prognosis, medical complications, transportation issues, and employee concerns. The employer/supervisor assists in identifying the essential job functions of the position, past modifications, and any concerns regarding the employee and the position. Finding out about goals the employee and employer may have for future employment responsibilities is also beneficial. In order to ensure that modifications and adaptations fit the individual needs of the worker, it is important to know the objective abilities and limitations of the worker. Gross and fine motor skills, sensation, visual skills, and cognitive skills should be evaluated by an occupational therapist to identify potential problems in performing essential job functions. Next, the employee is observed while performing each of these functions. Problem solving is begun for each task that presents difficulty for the employee. Minor adaptations and modifications can be made during the evaluation such as moving a computer monitor or rearranging a desk. Adaptive techniques and equipment are reviewed, and both the employee and employer can be trained on basics like how to adjust a keyboard tray or an office chair. A detailed assessment of the work area is also completed to determine any architectural barriers. Areas such as restrooms, break areas, dining areas, conference areas, parking, and entrances/exits are included in this assessment. The next step in the process is the formulation of recommendations for each problem encountered during the evaluation. These recommendations, along with any product and vendor information that may be applicable, any diagrams that aid in clarifying the recommendations, as well as any other pertinent information, are incorporated into a report designed to facilitate the adoption of the workplace accommodations. Other items that may be discussed in the report include recommendations for training, job restructuring, and the need for follow-up. The employer usually discusses the information with the employee, and a plan is created for implementing the recommendations. The employer or agency funding the modifications will decide on contractors used, as well as which and how recommendations will be followed. After the modifications have been completed, it is important to review the accommodations to ensure they are indeed enhancing the employee’s ability to perform the essential job functions. Essential Job Functions and Job Restructuring The essential job functions are typically outlined in the employee’s job description, provided by the employer/supervisor. At times this information is vague and does not adequately describe what is expected of the employee. These issues are clarified with the supervisor, and a new job description may be generated as a result. The vocational rehabilitation specialist may assist the employer in revising the job descriptions to produce one that is accurate and clear. In some cases, an employee may be able to perform the essential job functions if the job is restructured. For example, if an employee gets too fatigued to deliver mail or perform filing tasks for two continuous hours, the task could be broken up into shorter periods, perhaps an hour in the morning and an hour in the afternoon. Another example would be trading some of the job functions with another employee in a similar position. If an employee with a disability is unable to carry stacks of paper and photocopy them one morning each week, this task could be switched to another employee, and telephone support and data entry could be covered by the employee with a disability in return. These kinds of arrangements should be used only when alternatives like environmental modifications, use of adaptive techniques, and adaptive equipment are not reasonable. Adaptations Changing how an employee performs a particular task, or use of an adaptive aid to enhance performance, is useful to compensate for limitations secondary to a disability. Such alterations can be inexpensive and improve the worker’s efficiency. A common commercially available accommodation for people having difficulty holding a telephone handset is a headset. Reaching higher elevator buttons from a seated position can be accomplished by using a dowel with nonslip material on the end, a much simpler and inexpensive alternative to lowering the entire elevator keypad. Training an employee to use the heel of the hand or one of the knuckles to press larger copy machine buttons can compensate for poor hand strength. Often, adaptations are useful to all employees in a similar position, such as using templates or macros stored on word processors to avoid retyping frequently used blocks of text. However, not all adaptations are inexpensive: computer upgrades, alternative and modified machine controls, voice dictation software with training, better office seating, and even desks shaped or sized to better match an employee’s needs can be more costly, but can make a tremendous difference in an employee’s ability to work. Environmental Modifications Modifications that are done to accommodate persons using wheelchairs and scooters include curb cuts, access ramps, various types of lifts, widened doorways, and the inclusion of maneuvering room in areas such as bathrooms. Many of these modifications benefit others as well (people pushing baby carriages or handcarts). Environmental modifications can also include powered door openers, raised and lowered work surfaces, enhanced lighting, air filters, space heaters, and lowered control panels. Making an entrance accessible (ramps, powered doors, lever door handles), providing access to a restroom (accessible entrance, accessible toilet stall, lowered soap and towel dispensers, accessible waste can), and adapting the workstation or stations themselves are the main areas where structural modifications are typically made. The employee can often identify the areas of difficulty, such as a door that is too heavy to open, the lack of a wheelchair ramp, or the lack of a reachable soap dispenser and paper towels in the restroom. Sometimes, however, the evaluation team can help identify barriers that the employee may not have perceived. Conclusion In very few cases, an employee is unable to perform essential job functions, even after considering adaptive equipment and techniques, removal of architectural barriers, and attempts at job restructuring. In these cases, the employer may be able to offer a different position that better matches the employee’s strengths and limitations. The workplace accommodation team can assist the employer by making recommendations on types of activities the employee is best suited to perform. More frequently, employees can be successfully accommodated. A successful accommodation will maximize an employee’s ability to perform his or her job, while simultaneously accommodating his or her endurance, increasing comfort, and reducing the risk of aggravating symptoms or exacerbating the underlying condition, and will consider long-term prognosis and sound ergonomics. The accommodation process does not end with the production of a report and the purchasing of equipment. The provision of training and follow-up is often the key to producing a positive outcome. Carrie Clawson, OTR/L, ATP, is a staff occupational therapist and John Noiseux, MS, ATP, is an assistive technology practitioner at National Rehabilitation Hospital, Washington, DC. References
