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HBNS: The Prepared Patient, Volume 1, Issue 12, Sick at Work

 

Sick at Work

 

Most people don’t have the luxury of letting work slip, even when serious illness strikes.  Everyday bills keep coming and new health care expenses pile up.  For many, the workplace is the main source of health insurance and provides social support that can help through stressful times.

Workplaces can vary dramatically in how they treat illness.  Remember that policy manuals might not tell the whole story and you may need to know about general protections like the Family Medical Leave Act.  To gauge how you can expect to be treated, observe how your employer has treated others’ illnesses.

When Rick Daniel suffered an acute brain hemorrhage in December 2005, wheels were turning in his Dallas workplace even as he lay in a coma.  Coworkers donated vacation leave to the 49-year-old applications engineer, the human resources director helped his wife fill out disability papers and supervisors reassigned his workload.

For Christine Cook, 26, a music teacher in Calvert County, MD, illness came on less suddenly.  In January 2006, she learned that she had Crohn’s disease, a chronic and debilitating digestive condition.  She wasn’t sure how much to reveal at work or if she could function during exacerbations.

Cook only took time off for medical appointments she couldn’t schedule outside of work: “I don’t think I’ve ever taken off a day for the disease, because you never know if it’s going to be even worse in a week.”

As a young, untenured teacher with little sick leave built up, Cook was anxious to protect her livelihood.

Is Your Job At Risk?

Could you lose your job if you became ill?  Much of the research in this area focuses on women with breast cancer.  Two large studies found that about 80 percent to 90 percent of breast cancer survivors keep their jobs and most of those who leave say it was their choice.

However, reality could be harsher for people with blue-collar or nonprofessional jobs, noted psychologist Leslie Schover of the University of Texas M. D. Anderson Cancer Center, in a 2004 editorial.

Jackie Lynn Jeter is president of the Amalgamated Transit Union, Local 689, which represents workers for the Washington Metropolitan Area Transit Authority.  The WMATA employs bus and train operators, station managers, maintenance workers, electricians, mechanics, communications professionals and custodial staff, among others.
 
“In some ways, we are blessed with good benefits,” Jeter says, “but when it comes to getting sick people back to work, this employer tends to put obstacles in their way.  They’re hardnosed when it comes to blatantly disqualifying workers,” preventing some from returning to work.

If illness or injury prevents someone from working, they have three years to find another position within the Metro transit authority, Jeter says.  But a worker might find that there’s no replacement job waiting.

“Usually it’s a less-skilled job; if you’re a custodian, it’s hard to find something else you could do. Chances are slim,” Jeter says.  “A station manager might have to go down to custodian. Say you’re a mechanic with some skills, you could enter a retraining program.”

In certain cases, if “a person is disqualified and their illness or injury should not really disqualify them, we will step in and take it to arbitration and see if the Authority overstepped its bounds,” Jeter says.

Know Your Rights…and Responsibilities

For a newly diagnosed person unfamiliar with the world of work benefits, “the information is overwhelming,” says Theresa (Terry) Perry, the managing principal with Pink Slip, a San Francisco-based benefits and retirement consultancy.  “You can still seek out your benefits, even if you don’t say what the illness is,” she says.  

“There may be a lot of information online, if the company has an intranet,” she adds. “Also, pull out that enrollment booklet that you never read when you were hired.”

Seek out other sources of information, she advises.  “Insurance vendors can tell you about add-on benefits” such as coverage for disease management and pharmacy costs.

At the WMATA, if somebody develops a serious illness, “their first recourse is to call their division or station location,” Jeter says.  “We — the union — advise people to tell supervisors their symptoms if they’re not comfortable giving their illness.  Once you call in sick, bring in your first doctor’s certificate and take it straight to WMATA to medical unit.”

Bypassing paperwork is not an option, Jeter says.

Workers “could lose their job if they don’t have medical coverage — a doctor’s note from the time they went out to the day they return to work, or if they don’t come back when a doctor releases them from care.”

Asked about reduced duty, for instance for a transit worker on chemotherapy, Jeter says, “No, we don’t have light duty; it’s one of the things we’re lacking.”

Larry Kessler, Sc.D., is the director of the Office of Science and Engineering Laboratories in the Center for Devices and Radiologic Health of the Food and Drug Administration.  

Being too closemouthed could put your job in jeopardy, Kessler says: “Recognize that if you are ill and nobody knows (and your work is slacking) people will want to know why the boss is not disciplining or firing you.”

“At first, I didn’t want people to know, other than my music department colleagues,” Cook recalls.  But her students knew something was wrong.

“I lost 30 pounds because I had no appetite,” Cook said.  “I told the kids that I didn’t lose the weight because of some crazy diet, but because of my diagnosis.  Later, some parents came back and thanked me for doing that.”

She told the principals at both of her schools, and keeps them posted. “I’ve had conversations where I’ll say, ‘We haven’t found a happy balance of drugs. As we’re trying to find that balance, I can’t always get appointments at 4 p.m., after the school day.’

An Employer’s View

Kessler is sympathetic to the plights of sick workers: “If somebody is doing chemo and it’s making them frail, they get tired easily; you can take some of the workload off their plate, if they can give you a good two to three hours of work stretched over the work day.  It helps their self-esteem and the project moves ahead.”

But productivity is still the top priority. “[As the boss] you’re still responsible for getting it done,” Kessler says.

Sometimes the supervisor gets sick.  “If you have a team under you, say that you’re going to need some help,” Perry says.  “It’s time to delegate.”

The Long-Term Picture

Nearly three years after her diagnosis, Christine Cook reports that her school administration remains supportive.  Her middle school principal periodically asks, “How are you feeling?  Are you OK?  Is there anything we can do for you?”

Now her condition is relatively stable. When she has a flare-up in school, which happens every two months or so, she manages the severe abdominal cramps without students being aware. “When I feel it coming on, I’ll give the orchestra something to practice, and just sit down and watch rather than actively instruct.”

The outlook isn’t always so optimistic.

Theresa Perry recalls the case of a terminally ill person with a degenerative bone disease.  As the illness progressed, the employer “continued to let that person work at home, in the hospital, over the telephone. The person would just call in and that would count as time worked.”  Perry says.

“Typing was a huge part of that job role.  The company did a creative ADA-type of implementation with voice-recognition software.”  Eventually, “the company hired another person to help.”

Because the organization was large, it could make every effort to allow this person to keep working, Perry says.  “It’s expensive, but the respect it demonstrates boosts morale of all the workers; they feel the company cares.”

But people who’ve lived through the experience warn that employers’ patience with illness often changes over time.  Some will bend over backwards initially, but eventually, they have to get the work done and if you can’t do it, you might have to leave. 

“It’s extremely important to protect your job and income,” Perry says.  “If it’s overwhelming for you, pull in a friend, a trusted person” to help gather information and be your advocate.

See the “Resources for Sick Workers,” sidebar for possible sources of support within and outside the workplace.


Resources for Sick Workers

Employee Assistance Programs

Many companies and agencies offer EAPs.  If you work in a Federal agency, see the U.S. Office of Personnel Management Web site:
http://www.opm.gov/Employment_and_
Benefits/WorkLife/HealthWellness/EAP/
Family Medical Leave Act

“For an employee’s serious health condition, FMLA requires employers with 50 or more employees, both private and public, to provide eligible employees with 12 weeks of unpaid leave, continue health care benefits and provide job protection.” (Condensed from a 2007 report from The Society for Human Resource Management (SHRM)

Are you covered? Learn more:

Society of Human Resource Management:
DOL FMLA Report Summary


DOL Family and Medical Leave Act of 1993

Social Security Disability Insurance

The Social Security Administration program is for people who are unable to work for a year or more because of their disability.
http://www.ssa.gov/dibplan/index.htm

Human Resources

The HR department is a prime source of information on leave, accommodation and insurance issues. Past experiences with your employer and HR department can inform you on how much or little to reveal about your illness, and how much support to expect.

Unions/Associations
Professional associations and labor unions can provide guidance and assistance if you feel your employer is not treating you fairly.

Published by
Health Behavior News Service

Written by
Lisa Esposito, Editor

Designed by
Brandon Moore, IT/Comm Manager

The Health Behavior News Service, of The Center for the Advancement of Health, does not provide medical advice or consultation. The Prepared Patient is a new series intended to help people make informed choices about their health care.

© 2008, All Rights Reserved

 

PREPARED PATIENT ARCHIVE

Volume 1 1:
1: Do You Need a Yearly Checkup?

2: Chronic Conditions: When Do You Call the Doctor?
3: Effective Patienthood Begins With Good Communication

4: The “Handoff”: Your Roadmap to a New Doctor’s Care
5: Monitoring Your Child’s Development: Your Pediatrician Can Help
6: Don't Let Germs Hitch a Ride from your Doctors Office
7: When Getting to the Doctor Is Half the Battle

8: Giving Your Doctor the Pink Slip
9: Larger Patients: ISO Fewer Lectures, Better Health Care
10: Retail Clinics: What’s in Store for Health Care
11: Hospital Report Cards: Grading Facilities Near You

 

 
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