By knowing, using and educating others about ADA and FMLA, you are also bringing about awareness of people with chronic illnesses and their rights.
We hope that as practice owners and managers you are making reasonable accommodations at your practice and adhering to the Americans with Disabilities Act (ADA) and the Family and Medical Leave Act (FMLA). By knowing these laws you can assist patients and employees by pointing them in the right direction toward the appropriate federal resources.
While most Americans have heard of or are at least familiar with ADA, let's review the purpose of the act to ensure clarity. The purpose of ADA is "to establish a clear and comprehensive prohibition of discrimination on the basis of disability."1 In section 2 of the document, titled "Findings and Purposes," the eighth bullet point has this to say: "The nation's proper goals regarding individuals with disabilities are to assure equality of opportunity, full participation, independent living and economic self-sufficiency for such individuals."1 Audiologists should be familiar with the communications-related accommodations that the ADA calls for, but should consider people with other kinds of disabilities and illnesses for whom they would need to make accommodations.
To make equal opportunities and reasonable accommodations, audiologists, employees and patients all must understand the definition of disability — taking into account visible and invisible illnesses — and who is eligible before someone makes any requests for accommodations.
"Definitions are good because they help us clearly understand the possible scope of disability and that helps people start to broaden how they think of disability," said Kathy Foltner, AuD, practice management consultant and owner of Foltner Consulting LLC, in Chicago, and the CEO of AuDNet Inc. Most likely, people think of total disability at first, but that is not always the case. ADA is not just for those in wheelchairs and those with canes.
Perhaps some of the confusion of what disability is stems from the various definitions that government and private organizations use. The U.S. Equal Employment Opportunity Commission (EEOC) should be a primary source for information on disability laws and regulations, however. The organization's Web site clearly states that "an individual with a disability is a person who:
is regarded as having such an impairment."2
Nearly half of the population, about 125 million Americans, is currently living with one chronic illness, reported a study from The Partnership for Solutions, led by Johns Hopkins University, in Baltimore, and The Robert Wood Johnson Foundation, in Princeton, NJ.3 Even though this is an issue for approximately one in three Americans, people with such disabilities and illnesses are still living in the minority and being excluded and discriminated against on a daily basis.
Audiologists, Take Heed
Audiologists need to consider how invisible illness can impact an employee's or patient's life. Take the story of Jan B. Curran, for example. Curran, a former reporter and public relations representative, has lupus and had cancer. As a result of both illnesses, she now has hearing loss and also experiences cognitive dysfunction commonly called "chemo-brain."4 Caused by chemotherapy (chemo), it is characterized by short-term memory loss and confusion on many levels, though a number of cancer survivors find that their cognitive function comes back anywhere from six months to two years after chemo is completed.4
All of this is important information for an audiologist taking a case history to consider, because lupus and chemo use can affect hearing. (Curran's audiologist, whom she met through Starkey president Bill Austin, knew she was undergoing chemo treatments and checked for changes in her hearing once or twice a month. Today, Curran wears a hearing aid.)
To ensure that entrepreneurial audiologists are up to speed on ADA rules and know how to properly and effectively treat and accommodate people with invisible illness like Curran, Dr. Foltner shared with ADVANCE readers the highlights of the law, federal regulations for people with illnesses and disabilities, and her experiences with the ADA.
The Tenets of ADA
She points to Title I of ADA, in particular. It "applies to any employer who has 15 or more workers,"1 and is very important, she said.
While the vast majority of audiologists probably have fewer than 15 employees, Dr. Foltner noted that a growing number of audiologists are opening multiple offices and can easily employ 15 or more people. "Once you hit that mark, there are laws that you must follow," she explained. (There are additional laws for people employing more than 25 employees to follow.1) It's not a guideline or a suggestion; audiologists must follow the regulations under ADA accordingly.
Dr. Foltner and Wayne R. Connell, founder and president of The Invisible Disabilities Advocate (IDA), both said one of the first sources of disability information with which any audiologist should be familiar is ADA policies pertaining to reasonable accommodations. "The ADA has classes and great resources available for any size business, as well as their online resources at www.ada.gov and www.adaportal.org," said Connell. [Editor's Note: For a comprehensive list of resources, go to page 52.]
Wading through the sea of governmental, statistical and organizational Web sites can be a daunting task, but it is necessary for practice owners to understand disability laws and chronic illnesses so this information can be applied to their interactions with patients and employees. Fortunately, just knowing where to look and having a multitude of disability and chronic illness resources in one place is half the battle for busy practitioners or those who are new managers, Dr. Foltner said.
ADA for Your Building
"You not only have to think about [ADA] from your patients' and employees' standpoint, you also have to think about ADA and disability laws [for] the physical building," stressed Dr. Foltner. You have to know the age of your building and then find the appropriate regulations on the ADA site to make specific modifications like ramps at front doors and handicap-accessible bathrooms. Facility modifications vary with each building and each individual's case and situation.
"If you are an audiologist who has been in business for a while and, let's say you don't have 15 employees, you immediately think, 'None of this is going to apply to me," said Dr. Foltner. However, she cautioned audiologists not to dismiss ADA regulations, because many components apply to them. For example, if you buy a building and want to modify it, there are certain rules to follow when making the modifications, she pointed out.
"I can remember when I bought a building I was going to convert into an office. I had to be very careful about what we modified because you have to make [a room or whole building] accessible from that point of change [all the way out to the entrance]. Say you are putting in a new bathroom, and you think, 'I'll just make the bathroom accessible and I'll work on [the rest of the office] later.' At that time, the law said you can't do that. If you make the bathroom accessible, you have to make access to that bathroom accessible [to people with disabilities]. I would have had to increase the size of the doors, the hallways, the entry ways, etc.," Dr. Foltner recalled.
As she was rebuilding and modifying one of her former offices, she wanted to add a ramp outside. She explained that going from the point of the modification — which in this case was the front door, then going outward from there — the only modifications she had to make, according to ADA regulations, were to add a ramp outside and widen the front door. That was very different in comparison to what would have been required if she had modified an internal room such as the bathroom, even though her building was an old one. "You need to be aware of the regulations for your individual building because they are very specific and can vary based on many [factors]," she said. Check out the "ADA Guide for Small Business" on the ADA Web site for explicit details and outlines of possible building modifications.
Careful Examination
Each employer has to examine every modification and accommodation carefully and assess what is in their best interests in accordance with the law, as well as in the best interests of employees and patients.
For example, Curran requested a headset and an amplified telephone from the newspaper for which she worked to be able to conduct phone interviews, which are essential to a reporter's job. Her former employer also provided an adjustable chair, a back pillow, a foot stool and an answering machine with a red light signal so she knew when someone had called her. These are just a sample of the inexpensive accommodations an employer can provide for someone with hearing loss and a chronic illness such as lupus.
Curran advised that when people approach their employers with a request for special tools to do a better job that they do it not with a "woe is me" attitude, but rather a "lucky for me" mindset that these devices and supplies are available to make life easier.
According to Rosalind Joffe, founder and principal of CIcoach.com, a Boston area firm, "If a manager or owner of a practice finds that an employee is living with a chronic illness, first ask if there is anything he or she needs to manage the job better. Your willingness to be as flexible as possible will earn loyalty and motivation. If this doesn't work, then you might suggest that he or she seek help from someone experienced with chronic illness and workplace issues."
Joffe coaches people with chronic illness to thrive in the workplace. She has lived with multiple sclerosis for 25 years and, about 12 years ago, was diagnosed with ulcerative colitis. "The best thing you can do is to be supportive, find out how the chronic illness impacts performance and what your employee needs in the office so this individual can do the job," she noted.
FMLA Guidelines
On Aug. 5, 1993, the FMLA became federal law. The FMLA guidelines give people with chronic illnesses the opportunity to take time off when they need it without fear of losing their employment.
"It provides certain employees with up to 12 work weeks of unpaid, job-protected leave a year, and requires that group health benefits be maintained during the leave," according to the American Federation of State, County and Municipal Employees, AFL-CIO's Web site.5 The U.S. Department of Labor has issued detailed regulations interpreting FMLA.
An employee is eligible for leave "if they have worked for their employer for at least 12 months and have worked for at least 1,250 hours over the previous 12 months, and work at a location where at least 50 employees are employed by the employer within 75 miles,"6 the FMLA guidelines state. The leave also can be intermittent throughout a 12-month work period.
The law "only requires unpaid leave," as opposed to paid time off. However, it does permit an employee to elect, or the employer to require the employee, to use accrued paid leave (such as vacation or sick leave) for some or all of the FMLA leave period. When paid leave is substituted for unpaid FMLA leave, it may be counted against the 12-week FMLA leave entitlement if the employee is properly notified of the designation when the leave begins.6
FMLA and States
States may have their own family leave laws that can differ from the federal law in significant ways. For example, state laws may apply to smaller employers, meaning you may have to follow this law, even if the federal FMLA doesn't apply to you. Also, your state's law may allow employees to take longer periods of leave. To find out about your state's law, contact your state's labor department.7
According to a 2004 National Small Business Poll for the National Federation of Independent Business, small business owners grant virtually all requests for family and medical leave. Of those employer plans, most fall into one of two categories. The first type of policy is open-ended and allows employees to come back when they are ready, while the second policy accommodates leave, but imposes some sort of time limit.8
When developing a policy for your office, be sure to research information about disabilities and eligibility on the various government Web sites, such as the Department of Labor's portal. Also, be sure to seek legal counsel, said Connell. Know your rights and your patients' and employees' rights.
Promoting Chronic Invisible Illness Awareness Week also may help you to achieve the purpose of the ADA. You may want to start with a seminar in your office to educate your local community on accommodation laws and regulations. With more awareness, people with disabilities and chronic, invisible illnesses will one day be accepted everywhere.
Look to our Online Extras section for Jan Curran's full story and more information on invisible illness and making accommodations.
References
1. U.S. Dept. of Justice. Americans with Disabilities Act of 1990. Accessed at www.usdoj.gov/crt/ada/pubs/ada.txt on the Web.
2. U.S. Equal Employment Opportunity Commission (EEOC). Disability. Accessed at www.eeoc.gov on the Web.
3. Partnership for Solutions. Statistics and Research: Prevalence. Accessed at www.partnershipforsolutions.com/statistics/prevalence.cfm on the Web.
4. American Cancer Society®. Accessed at www.cancer.org/docroot/NWS/content/NWS_2_1x_Seeking_Solutions_to_Chemo-Brain.asp on the Web.
5. American Federation of State, County and Municipal Employees, AFL-CIO. Accessed at www.afscme.org/wrkplace/fmla.htm on the Web.
6. Department of Labor. Family and Medical Leave Act. Accessed at www.dol.gov/esa/whd/fmla/index.htm on the Web.
7. Yahoo Small Business. "Providing Family and Medical Leave."
Accessed at http://www.smallbusiness.yahoo.com/sharedresources/advanceforaud/resources/DownloadableResources/article.php?mcid=5&scid=51&aid=2540 on the Web.
8. The National Federation of Independent Business. "Small Business Weighs in on Effects of the Family and Medical Leave Act." Accessed at www.nfib.com/object/IO_23041.html on the Web.
For More Information
Rosalind Joffe, rosalind@cicoach.com via e-mail.
Jennifer Schestok is Assistant Editor of ADVANCE. Contact her at jschestok@merion.com via e-mail.
The Four Cs
If we know someone who has a disability or chronic health condition, how do we treat them? Jess Dancer, EdD, professor emeritus of audiology at the University of Arkansas at Little Rock, has his own golden rule for interacting with these people: "Treat others as we would want to be treated if we had that condition, or were in that condition."
The following are Dr. Dancer's four Cs to apply when communicating with people with chronic and invisible illnesses. He offered these as reminders for things that audiologists already do (though all people, not just audiologists, should think about them when communicating with people with chronic illnesses).
Courtesy — No matter what problem the person brings to us, we should be courteous to the person.
Concern — Show concern. "A lot of times, we are so busy as audiologists that time is often the enemy of being able to treat a person as we would want to."
Caring — Show patients and employees that you care.
Compassion — Show compassion toward your patients and employees with chronic health conditions.
"If we could apply those [Cs] to all the people that we see, audiologists will come out ahead. What we apply to others, we apply to ourselves," Dr. Dancer observed.
�Jennifer Schestok
Background on the Awareness Week
Sept. 12-18 is National Invisible Chronic Illness Awareness Week. The theme is "Choose to Thrive, Not Just Survive!" This public awareness campaign is sponsored by Rest Ministries, an organization that offers a supportive environment for those who live with chronic illness or pain.
Outreach during the week includes various events and activities, such as: