Work and Arthritis.

Last updated Thursday, January 06, 2005

Arthritis on the job

Educate yourself

Some people with arthritis and other rheumatic diseases have difficulty on the job because of their condition.

It is important to know about:

• your legal rights
• ways to get the support you need from your employer and co-workers
• ideas for making your work easier

People with arthritis have rights

The Americans with Disabilities Act

The Americans with Disabilities Act (ADA), passed by Congress in 1990, is the most extensive legal bill of rights for people with disabilities. It bans discrimination against people with disabilities in many areas, including hiring and employment. At the same time, it protects employers from having to make changes that are unreasonable or expensive.

While the ADA gives people with disabilities specific rights, the exact meaning of many of its terms such as unreasonable, undue, or essential probably will be decided by the courts.

The ADA and employment

The ADA applies to companies employing 15 or more people. It bans discrimination against qualified individuals with disabilities by private employers, state and local governments, employment agencies, and labor unions. It applies to all aspects of employment, including hiring, job assignments, training, promotion, pay, benefits, and company-sponsored social events.

For you to be considered an individual with a disability, arthritis must "substantially limit" a major life activity such as walking, performing manual tasks, or working. To be considered qualified you must:

• have the education, skills, and experience the employer requires.
• be able to perform the essential functions of the job--those that might be listed in an advertised job description - with or without reasonable accommodation.

Reasonable accommodation means any changes in a job or work place needed to enable an individual to:

• apply for a job
• perform the essential functions of the job
• enjoy all the benefits and privileges of employment.

Examples of reasonable accommodation include:

• part-time or adjusted work schedules
• job restructuring--for example, changing your job to cut out non-essential activities that you have trouble doing
• providing assistive equipment or devices
• providing an access ramp or making the work place more accessible
• changing the height of a desk

Changes that would put undue hardship, defined as significant difficulty or expense, on an employer are not considered reasonable accommodations. If accommodations are needed, the employer cannot ask you to pay for them, and he or she cannot pay you less to cover the cost of the accommodations. If the cost of the accommodation is an undue hardship for the employer, he or she must give you the choice of providing it for yourself or of sharing in the cost. Keep in mind that an employer is not required to place you in a particular job if he or she believes that doing so would put you or others at increased risk.

Health insurance

Your employer must offer you the same health insurance benefits offerred other employees. For this reason, he or she can offer health insurance policies that do not cover pre-existing conditions like arthritis. He or she does not have to offer you extra benefits to cover your particular medical condition.

Does the ADA help me get around?

The ADA says that state and local government services and "public accommodations" must be accessible to, or easily entered and used by, people with disabilities. Public accommodations include places like restaurants, doctors' offices, and private schools and colleges.

Public bus and train systems also must be made accessible to people with disabilities, and so must private bus and van companies.

How can I make the ADA work for me?

The ADA and the legal rights it creates give you the tools to be an effective advocate for yourself and to work with your employer for your mutual benefit.

If you still feel you have not been treated fairly, the ADA allows you to file complaints with the Equal Employment Opportunity Commission (EEOC) and other federal agencies. However, the ADA also encourages other ways of settling disagreements, such as negotiation, mediation, mini-trials, and arbitration. This makes good sense, since litigation may be time consuming and costly and may not achieve your goal.

If you wish to file a formal complaint, you should contact the field office of the EEOC within 180 days of the time the incident happened. Ask your employer to give you a copy of all letters and reports regarding your situation. Keep them together in a safe place so that it will be easier for you to prove your case, if necessary. If your complaint is upheld, you are entitled to a remedy that will place you in the position you would have been in if the discrimination had never occurred. You may be entitled to hiring, promotion, reinstatement, back pay, or reasonable accommodation, including reassignment to a different job. You may also be entitled to attorney's fees.

The Rehabilitation Act of 1973

The Rehabilitation Act of 1973 was the model for the ADA and contains many of the same protections for people with disabilities. It applies to the federal government and all its agencies, to companies that do business with the federal government, and to institutions that receive federal financial assistance.

The Americans with Disabilities Act and the Rehabilitation Act ban discrimination against people with disabilities in hiring, promotion, and other aspects of employment.

The Family and Medical Leave Act

The Family and Medical Leave Act (FMLA), which went into effect in August 1993, includes a provision that allows employees to take up to three months unpaid medical leave per year if they are unable to work because of a serious health condition. You can take FMLA leave all at one time, intermittently (at different periods), or by working part-time. For example, you could use FMLA leave to receive "continuing treatment", such as physical therapy, from a health care provider.

The FMLA applies to companies that employ 50 or more workers within a 75-mile radius. To be eligible for family leave, you must have worked for your employer for 1,250 hours in the previous 12 months. Whenever possible, you should provide advance leave notice and medical certification.

Your employer must allow you to take unpaid leave to care for:

• a newborn, adopted, or foster child
• a spouse, child, or parent who has a serious health condition
• your own serious health condition

You may take "intermittent leave" or work a reduced leave schedule (fewer hours per day) with employer approval. When you return to work (except in certain cases), you must be restored to your original or equivalent positions with equivalent pay, benefits, and other terms of employment. Your medical insurance benefits must be continued on the same terms.

It is against the law for your employer to interfere with or deny rights granted under the FMLA. All employers are required to post notices of rights under the FMLA.

Handling work relationships

In spite of the protection offered by the ADA, many people are reluctant to mention their arthritis for fear they will be denied promotions or other opportunities. However, if arthritis begins to interfere with your work, you will have to decide whether and how to tell your employer and co-workers about it.

Co-workers who don't know about your arthritis can become resentful if they feel you are not pulling your share of the load. They may get annoyed if they are often asked to help out or to make up for you on days missed if they do not know the reason. Even people who do know about your arthritis may think of it as "just aches and pains." They may feel you are making a fuss about nothing and getting special treatment you don't deserve. These attitudes can trigger anger on both sides.

You, on the other hand, may worry that you will be treated differently or denied opportunities for promotion if people know that you have arthritis. You may be tempted to ignore your body's warnings. In fact, you may work extra hard to cover up the fact that you have arthritis.

Talking about your arthritis

If you decide to disclose your arthritis, plan carefully how and when to discuss the subject of arthritis with your co-workers or supervisors. Research carefully all the changes that could be made to make your work as productive as possible.

Schedule a meeting with your supervisor at a time when neither one of you is under pressure. It may also be helpful to find an opportunity to talk informally with your co-workers or a personnel officer about ways to make things go more smoothly.

In the meetings, describe as simply as possible the ways arthritis may affect your work. Make it plain that you are not looking for sympathy, but for ways to resolve the problem that will benefit both the company (or your coworkers) and yourself. The goal of these meetings should be to generate a supportive atmosphere in which everyone works together as part of a team.

Be prepared to help your employer. You are the expert on what you need to work efficiently. Offer suggestions for changes that could be made, based on the research you have done before the meeting. Chances are any changes you may need will not cost much.

It is a good idea to be as well informed as possible about the ADA, assistive devices you may need and their cost, and resources to help employers. In fact, there may be tax deductions and/or tax credits available to certain employers who provide accommodations and/or jobs for people with disabilities.

Here is an example of how such a situation could be handled.

Jan worked as an office clerk for a small company and had arthritis in her wrists, hands, and shoulders. Whenever she typed for long periods, the pain became worse. She had difficulty completing her work and often called in sick because of the pain. Co-workers often were asked to complete her work, and they had become resentful of her.

Although Jan had learned about special devices and self-care activities, she was afraid to discuss these with her supervisor. When Jan's supervisor finally spoke to her about her poor work performance and absenteeism, she realized she had to tell her about her arthritis.

They discussed the special devices that would help Jan. Her supervisor agreed to purchase a computer armrest, thick-handled pens, an electric stapler, and a desk chair with armrests. In addition, Jan would be allowed to take a 15-minute rest break every morning and afternoon. If, however, Jan's work did not improve in 60 days, her employer would have to re-evaluate the situation.

The devices and rest breaks helped Jan. She began to feel better at work and performed her job well. As her work improved, her supervisor and co-workers became more supportive of her. Jan realized that if she had not asked for the special devices she needed, she might have lost her job due to poor performance.

When her co-workers commented on these devices, Jan used the opportunity to explain briefly why she needed them and to get in a little public education about arthritis.

However, realize that subtle discrimination in some companies may still exist, especially when it comes to promotions. Also, some unions may have a problem with allowing workers with disabilities to take jobs that traditionally have been reserved as rewards for workers with seniority. To prevent problems, your company's personnel manager may ask the union's help in working out a solution when an accommodation such as a job change or job restructuring is needed.

You and your employer can work together to make changes or accommodations in your job to help you remain as productive as possible. Be prepared to give your employer the information he or she needs to make the necessary changes.

Continuing to work

There are times when, in spite of all your doctor's efforts and in spite of all your own efforts, arthritis makes it impossible for you to continue in your present job.

This does not mean you will have to stop working altogether. With the help of the ADA and vocational rehabilitation services, you may be able to continue working for many years. However, you may have to change jobs, work fewer hours, or consider self-employment.

If your job involves physical labor, it may be helpful to have your doctor refer you to an occupational or physical therapist or a state vocational rehabilitation agency for a physical work performance evaluation or functional capacity evaluation. Such a test will determine exactly how much you can lift, carry, push, pull, and perform fine motor skills.

There are three ways to continue working if arthritis prevents you from doing your present job. They are: reasonable accommodations, vocational rehabilitation, or working from home.

Reasonable accommodations

The ADA says your employer must make reasonable job accommodations to assist you. These might include:

• restructuring (changing the duties of) your job to cut out tasks you have difficulty doing
• allowing you to work on a flexible schedule or part-time
• placing you in a different job.

Vocational rehabilitation

Vocational rehabilitation (VR) is another road to employment if the ADA can't help you. The goal of VR is to help people with disabilities develop job skills and find and keep employment. It has been found to have a 50-percent success rate in helping people with arthritis find employment. Vocational rehabilitation services vary from state to state, but usually include:

• counseling and guidance about possible careers
• help in getting transportation and assistive devices such as wheelchairs
• tools, equipment, supplies, and licenses needed to help you work
• job training and job placement services
• personal assistance services

Working from home

You may work from home by starting your own business or by working at home for an employer. If you are independent, self-disciplined, and like to plan your own hours, then a home business may be right for you.

Before you begin, however, consider the following questions:

• Do you have the self-discipline you need to focus on work?
• Will you miss socializing with others?
• Will you miss getting out?
• Will you be able to successfully develop and run a business?

If you feel confident that you can deal with these issues, contact the Small Business Administration Office (SBA) in your area. The SBA's Handicapped Assistance Loan (HAL-2) program provides direct loans and loan guarantees to qualified individuals with disabilities to set up their own businesses. The agency also provides individual guidance and a variety of classes for people starting out in their own business. Many college and community adult education programs offer similar classes.

Some companies will allow you to work for them out of your home. They often provide you with the equipment you will need. Jobs that can be done largely on computers or by telephone are best suited for this arrangement. To find such companies, check with your local chamber of commerce, businesses in your area, classified ads, vocational rehabilitation agencies, and friends.

Work disability

If you become disabled because of arthritis and are unable to return to work, you may be eligible for Social Security disability benefits. The Social Security Administration considers you disabled if you are unable to do any kind of work for which you are suited, if your inability to work is expected to last at least one year or to result in death.

There are two kinds of benefits: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both offer specific incentives to encourage people receiving these benefits to return to work.

If you have bought private disability insurance, your benefits will be governed by the terms of the policy.

The Social Security Administration offers work incentives to enable people receiving disability benefits to continue to work.

Be creative and flexible

You cannot expect to work successfully if you don't have good medical management of your disease. This includes care from an experienced doctor, proper medication, and exercise prescribed by a physical or occupational therapist.

Combined with good medical care, being flexible, creative, and a problem-solver can help you balance your work and the demands of arthritis. By figuring out your energy patterns during the day and what kind of activities hurt or help you, you can arrange your work schedule to keep arthritis under control.

Some ways of doing this include:

• Create an efficient work environment. Arrange things around you to limit the amount of lifting, reaching, carrying, holding, or walking you must do.
• Set priorities and pace yourself. List the things you must do in order of importance, and do the most important ones while you feel strongest and most energetic.
• Vary activities from time to time so you do not sit too long in one position.
• Keep a diary of your good days and bad days to help you predict the causes and events that may tend to trigger flares.
• Maintain a positive attitude. Having a positive attitude and belief in your abilities can make you more effective at work. Paying attention to your appearance can also boost your self-esteem and help you maintain a professional image. Keeping a sense of humor will help you over the rough spots.
• Maintain a schedule. To avoid fatigue at work, get to bed at a regular time and get enough rest to carry you through the day. Include exercise, therapy, and regular medical check-ups in your schedule.

Other tips on managing your arthritis in the workplace:

• Sit in a chair that can be easily adjusted.
• Use a footrest.
• Keep files and supplies within easy reach.
• Use vertical files on your desk for current work.
• Install work assist arms or wrist rests at your keyboard.
• Use a glare screen and paper holder on your monitor.
• Use lateral file cabinets for easier access.

Protecting joints

Finding ways to cut out or cut down on activities that hurt your joints can prevent disability and help you remain active in the work force longer. Ways of doing this include:

• using your joints wisely
• exercise
• relaxation techniques
• learning to save your energy
• making travel to and from work easier

Credits

Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK, contact the National Helpline: (800) 283-7800.

This material was originally prepared for the Arthritis Foundation and is protected by copyright.