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Osteoarthritis, the progressively more painful form of arthritis that afflicts the knee, hip, back, hand, and joints of millions of workers, will become much more common over the next decade, posing major challenges for employees and their employers.
That was the unanimous opinion of medical, disability, aging and work, and human resources experts interviewed in August by BNA.
In 2010, some 27 million Americans had the so-far incurable degenerative condition, roughly half under age 65, according to the National Institutes of Health. NIH projects that in 2030, osteoarthritis will affect 60 million Americans.
Osteoarthritis is the most common form of arthritis. According to the Arthritis Foundation, beyond a very small number of children, teens, and young adults with the condition, it has historically begun to affect people when they reach 45 to 55 years of age.
Osteoarthritis is certain to be a bigger workplace challenge in the next decade for two reasons: the entire baby boom generation reaching their 50s, 60s, and 70s, and the enormous increase in obesity over the last 35 years, Marcie Pitt-Catsouphes, director of the Sloan Center on Work and Aging at Boston College, told BNA.
Obesity is a major risk factor for osteoarthritis, noted Glenn Pransky, director of Liberty Mutual's Center for Disability Research, part of the workers' comp insurer's Research Institute for Safety. Every pound of additional weight effectively puts four pounds of additional weight on peoples' knees and hips, increasing the risk of osteoarthritis, Pransky said.
The adult obesity rate has rocketed up from 15 percent in 1975 to 36 percent in 2010, according to the Centers for Disease Control and Prevention.
Meanwhile, by 2020, 37 percent of the labor force will be age 55 or older, up from 25 percent in 2010, according to projections published in the January 2012 issue of the Bureau of Labor Statistics' Monthly Labor Review. One out of every 10 workers will be 65 or older in 2020, up from one in 17 today, according to the article by BLS economist Mitra Toossi.
With the combined factors of age and weight, the looming workplace impact is hard to overstate, Pransky warned.
Employers can do a number of things to help reduce the incidence of osteoarthritis and help affected employees remain productive.
Russell D. Robbins, senior clinical consultant for Mercer Health and Benefits, suggested that good employer practices include:
• ensuring that jobs and work tasks are designed ergonomically;
• encouraging good fitness and weight management;
• working with arthritic employees to modify their jobs to accommodate their pain;
• offering prescription benefit plans covering drugs that relieve the progressively worsening pain of osteoarthritis; and
• using technologies that reduce or relieve employees of the need to use arthritic joints.
Advances in pain medication have made a dramatic difference for many people with osteoarthritis in terms of their ability to continue to work, Pitt-Catsouphes said.
On technology, Robbins noted that speech recognition software can sharply reduce the number of keystrokes and mouse clicks needed to create documents or manage computer applications.
Scissor lifts that make it very easy to elevate objects from floor to waist height are very helpful to employees working in store room, warehouse, and other commercial and industrial jobs, Pransky said. He added that scissor lifts are very cost effective, with prices beginning at well under $1,000.
Accommodation is usually very inexpensive compared to the costs of long-term disability and medical costs, Pransky said.
To keep them connected to employment, employees suffering a period of unusually high osteoarthritis pain should be offered a temporary, very light-duty job rather than ordered to recover at home, Pransky suggested. Each additional day a disabled worker is off work increases the risk that he or she will not return to work, Pransky said. “There is a straight line between the number of workdays lost and total medical costs,” he asserted.
Also effective, Pitt-Catsouphes said, are having one or more co-workers handle ancillary job tasks that are difficult for an employee with advancing arthritis, or moving an affected employee to a job that is easier for him or her to perform. She also suggested part-time work and/or telecommuting.
When employees suffer work performance challenges related to osteoarthritis, self-disclosure of their condition to management greatly simplifies initiating employee-employer discussions that can lead to successful job accommodations, observed Atlanta-based human resources consultant Carol Hacker.
Pransky said that in most cases, employees will self-report to their employer when arthritis is interfering with their ability to do a job. The likelihood of self-reporting is highest in workplaces in which employees are confident their disclosure will not be used against them, Pransky added.
Wellness programs that lead people to improve their health and fitness and maintain it will reduce the incidence of osteoarthritis and help people with the condition feel better and stay productive much longer, according to NIH and the Arthritis Foundation.
But inducing most employees to adopt healthy behaviors is not easy.
Pitt-Catsouphes and Pransky each pointed to unusual workplace wellness programs that they said have had good results.
Among other wellness practices, walking meetings, in which groups of employees walk and talk together instead of meeting around a table, have been a success at GlaxoSmithKline, Pitt-Catsouphes said.
Pransky suggested a two-prong approach that he said is working in Europe.
One prong: the employer replaces unhealthy food and beverages in cafeterias and canteens with healthy--and subsidized--alternatives.
The other prong: the employer modifies elevator service in such a way that employees must walk up and down stairs much of the time.
The two-prong system “has yet to take root in the United States,” Pransky lamented.
In such environments, managers can ask individual employees, “how's this job working out for you?” and receive an open and honest reply, Pransky said. He added that in a trusting work culture, employees with osteoarthritis can remain productive for many years, even decades, provided they practice good self-care.
An employer might feel obligated to intercede with an employee who appears to be in pain and struggling to accomplish what had been a regular work task.
However, employers seeking to help such an employee need to proceed with care to avoid possible liability under the Americans With Disabilities Act, noted Washington, D.C.-based attorney Kenneth M. Willner, a partner in the employment law section of Paul, Hastings, Janofsky & Walker LLP.
A manager who suggested to an employee that arthritis was slowing his or her typing down, prior to the employee disclosing it, would open the door to an ADA lawsuit charging that the employer regarded the employee as having a disability, Willner said.
Instead, the manager should approach the employee without mentioning any potential cause of his or her difficulty, Willner said. He suggested that the manager ask, “Are you having trouble with the keyboard?”
Hopefully that will lead to the employee self-reporting and the start of interactive discussions. If it does not, the manager could say, “We don't want to pry. You might want to contact the employee assistance program,” or suggest that the employee contact the company's ergonomics consultant, Willner said. Such steps will hopefully lead to the employee disclosing his or her osteoarthritis to the manager, beginning the interactive process.
In health care settings, where patient wellbeing is at risk, Willner said stronger action can be taken. For example, the employer can suspend the surgery privileges of a surgeon who cannot hold a scalpel steady, and require the surgeon to undergo a medical evaluation. Nonetheless, declaring the possible medical cause of the shaking hand before the medical evaluation could expose the employer to an ADA claim, he said.
When an employee with a disability and an employer begin discussing possible accommodations, the employer needs to avoid saying that the condition makes it impossible for the employee to do a broad class of jobs, Willner said. However, he said employers may determine that an employee's disability makes it impossible for him or her to do one job, without violating the ADA.
Employer-sponsored health assessments can be effective in helping employees adopt healthy behaviors that can help prevent osteoarthritis and help manage the condition when it is present, said Pitt-Catsouphes. She said the assessments are broadly effective when done in settings that provide strong follow-up. Hospitals have had notable success in using health assessments to trigger real change in employees' eating and exercise choices, she said.
Willner said health assessments can be ADA compliant--if they are completely voluntary for employees and if doctors disclose nothing about employees' health status to the employer.
Employers may instruct medical personnel to refer employees with osteoarthritis to an EAP, Willner said. Hopefully, he said, the employee will subsequently self-report to the employer, beginning the interactive process that can lead to an accommodation
By Jeff Day
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