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Accommodation and Compliance Series:
Employees with Arthritis
By Beth Loy, Ph.D.

Preface

Introduction

JAN's Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.

The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee's individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.

For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar.

Information about Arthritis

How prevalent is arthritis?

Arthritis affects 70 million Americans, or one in three people (National Arthritis Foundation, 2003b). Arthritis is second only to heart disease as a cause of work disability (National Arthritis Foundation, 2004a). Arthritis typically affects more women than men, is one of the most prevalent chronic health problems, and is the nation's leading cause of disability among Americans over age 15 (National Arthritis Foundation, 2004a).

What is arthritis?

Arthritis includes approximately 100 inflammatory and noninflammatory diseases that affect the body's joints, connective tissue, and other supporting tissues such as tendons, cartilage, blood vessels, and internal organs. There are more than 100 different types of arthritis and the cause of most types is unknown (National Arthritis Foundation, 2004a).

What are the symptoms of arthritis?

Swelling in one or more joints, early morning stiffness, recurring pain or tenderness in any joint, obvious redness and warmth in a joint, unexplained weight loss, fever, or weakness combined with joint pain that last more than two weeks are typical symptoms of arthritis. Skin, joint, kidney, lung, heart, nervous system, and blood cell infections may accompany fatigue and difficulty in sleeping. Evaluating arthritis requires an assessment of past history, current symptoms, blood tests, biopsies, and x-rays (National Arthritis Foundation, 2003a).

What causes arthritis?

Researchers have identified several risk factors for developing arthritis. For example, osteoarthritis is often blamed on genes that cause weakness in the cartilage. However, excessive physical stress and repeated injuries may also play a role. Genetic factors have been implicated in other disorders such as lupus, rheumatoid arthritis and scleroderma. Another factor involved in certain kinds of arthritis is gender. Lupus, rheumatoid arthritis scleroderma, and fibromyalgia are found to be more common in women. This suggests that hormones may have a role in the development of these conditions (Missouri Arthritis Rehabilitation Research and Training Center, n.d.).

How is arthritis treated?

Treatments for arthritis vary; exercising, medication, natural remedies, nutrition, and surgery may be helpful. There is no best treatment for everyone who has a particular type of arthritis, as each individual may respond differently to different treatments; emphasis is on improving function of joints and relieving pain (National Arthritis Foundation, 2004b).

Arthritis and the Americans with Disabilities Act

Is arthritis a disability under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). Therefore, some people with arthritis will have a disability under the ADA and some will not.

A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment (EEOC, 1992). For more information about how to determine whether a person has a disability under the ADA, visit http://www.jan.wvu.edu/corner/vol02iss04.htm.

Accommodating Employees with Arthritis

(Note: People with arthritis may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with arthritis will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.)

Questions to Consider:

1. What limitations is the employee with arthritis experiencing?

2. How do these limitations affect the employee and the employee's job performance?

3. What specific job tasks are problematic as a result of these limitations?

4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?

5. Has the employee with arthritis been consulted regarding possible accommodations?

6. Once accommodations are in place, would it be useful to meet with the employee with arthritis to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?

7. Do supervisory personnel and employees need training regarding arthritis?

Accommodation Ideas:

Large Blue Triangle Bullet Activities of Daily Living:

Small Triangle Blue Bullet Allow use of a personal attendant at work
Small Triangle Blue Bullet Allow use of a service animal at work
Small Triangle Blue Bullet Make sure the facility is accessible
Small Triangle Blue Bullet Move workstation closer to the restroom
Small Triangle Blue Bullet Allow longer breaks
Small Triangle Blue Bullet Refer to appropriate community services
Small Triangle Blue Bullet Allow access to a refrigerator

Large Blue Triangle Bullet Fatigue/Weakness:

Small Triangle Blue Bullet Reduce or eliminate physical exertion and workplace stress
Small Triangle Blue Bullet Schedule periodic rest breaks away from the workstation
Small Triangle Blue Bullet Allow a flexible work schedule, flexible use of leave time, and work from home
Small Triangle Blue Bullet Implement ergonomic workstation design
Small Triangle Blue Bullet Provide a scooter or other mobility aid if walking cannot be reduced

Large Blue Triangle Bullet Fine Motor Impairment:

Small Triangle Blue Bullet Implement ergonomic workstation design
Small Triangle Blue Bullet Provide alternative computer access
Small Triangle Blue Bullet Provide alternative telephone access
Small Triangle Blue Bullet Provide arm supports
Small Triangle Blue Bullet Provide writing and grip aids
Small Triangle Blue Bullet Provide a page turner and a book holder
Small Triangle Blue Bullet Provide a note taker

Large Blue Triangle Bullet Gross Motor Impairment:

Small Triangle Blue Bullet Modify the work-site to make it accessible
Small Triangle Blue Bullet Provide parking close to the work-site
Small Triangle Blue Bullet Provide an accessible entrance
Small Triangle Blue Bullet Install automatic door openers
Small Triangle Blue Bullet Provide an accessible restroom and break room
Small Triangle Blue Bullet Provide an accessible route of travel to other work areas used by the employee
Small Triangle Blue Bullet Modify the workstation to make it accessible
Small Triangle Blue Bullet Adjust desk height if wheelchair or scooter is used
Small Triangle Blue Bullet Make sure materials and equipment are within reach range
Small Triangle Blue Bullet Move workstation close to other work areas, office equipment, and break rooms

Large Blue Triangle Bullet Photosensitivity:

Small Triangle Blue Bullet Minimize outdoor activities between the peak hours of 10:00 am and 4:00 pm
Small Triangle Blue Bullet Avoid reflective surfaces such as sand, snow, and concrete
Small Triangle Blue Bullet Provide clothing to block UV rays
Small Triangle Blue Bullet Provide "waterproof" sun-protective agents such as sun blocks or sunscreens
Small Triangle Blue Bullet Install low wattage overhead lights
Small Triangle Blue Bullet Provide task lighting
Small Triangle Blue Bullet Replace fluorescent lighting with full spectrum or natural lighting
Small Triangle Blue Bullet Eliminate blinking and flickering lights
Small Triangle Blue Bullet Install adjustable window blinds and light filters

Large Blue Triangle Bullet Skin Irritations:

Small Triangle Blue Bullet Avoid infectious agents and chemicals
Small Triangle Blue Bullet Avoid invasive procedures
Small Triangle Blue Bullet Provide protective clothing

Large Blue Triangle Bullet Sleep Disorder:

Small Triangle Blue Bullet Allow flexible work hours
Small Triangle Blue Bullet Allow frequent breaks
Small Triangle Blue Bullet Allow work from home

Large Blue Triangle Bullet Stress:

Small Triangle Blue Bullet Develop strategies to deal with work problems before they arise
Small Triangle Blue Bullet Provide sensitivity training to coworkers
Small Triangle Blue Bullet Allow telephone calls during work hours to doctors and others for support
Small Triangle Blue Bullet Provide information on counseling and employee assistance programs

Large Blue Triangle Bullet Temperature Sensitivity:

Small Triangle Blue Bullet Modify work-site temperature
Small Triangle Blue Bullet Modify dress code
Small Triangle Blue Bullet Use fan/air-conditioner or heater at the workstation
Small Triangle Blue Bullet Allow flexible scheduling and flexible use of leave time
Small Triangle Blue Bullet Allow work from home during extremely hot or cold weather
Small Triangle Blue Bullet Maintain the ventilation system
Small Triangle Blue Bullet Redirect air conditioning and heating vents
Small Triangle Blue Bullet Provide an office with separate temperature control

Situations and Solutions:

A machine operator with arthritis had difficulty turning control switches. The small tabs were replaced with larger cushioned knobs and he was given gloves with non-slip dot gripping. These modifications enabled him to grasp and turn the knobs more effectively and with less force.

A plant manager with arthritis was having difficulty moving throughout her plant to monitor assembly line workers. She was accommodated with a motorized scooter.

A drafter with arthritis in his knees was having difficulty accessing his work-site. He was accommodated with a reserved parking space close to the building, a first floor office, and push pad activated power doors.

A social worker with arthritis in her hands was having difficulty reading case summaries, manipulating paperwork, and taking notes. She was accommodated with a page turner, bookholder, writing aids, and the option to dictate reports to her clerical staff.

A receptionist with arthritis in his right hand due to an injury needed to input data into a computer. He was accommodated with a left-handed keyboard, an articulating keyboard tray, speech recognition software, a trackball, and office equipment for a workstation rearrangement.

A laborer in a warehouse was having difficulty standing for long periods due to ankylosing spondylitis. As an accommodation he was transferred to a position within the warehouse that allowed him flexibility to stand, walk, and sit, as he needed. The employer also purchased a heated cushion for his chair, gave him a stand/lean stool, and provided him with a cart.

A vice president with osteoarthritis had difficulty maintaining her stamina during the workday. To accommodate the fatigue, she was given a flexible schedule and allowed to come in later when necessary. Her employer also provided her with a recliner for her office so she could take additional rest breaks throughout the day.

A forklift driver with rheumatoid arthritis had difficulty grasping the steering wheel. The forklift was fitted with a spinner ball to eliminate the need for grasping.

A secretary with rheumatoid arthritis was limited in typing due to pain and stiffness in her hands due to cold temperatures. These symptoms were exacerbated in the winter months but occurred throughout the year due to the below average air temperature in her office. She was accommodated with a space heater, additional window insulation, and speech recognition software.

An insurance clerk with arthritis from systemic lupus erythematosus was experiencing pain in her back, neck, and hands from sitting for long periods of time doing computer work. She was accommodated with speech recognition software, an ergonomic chair, and an adjustable sit/stand workstation.

Products:

There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.

Resources

References

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act. Retrieved April 29, 2005, from http://www.jan.wvu.edu/links/ADAtam1.html

Missouri Arthritis Rehabilitation Research and Training Center (n.d.). General arthritis. Retrieved July 1, 2005, from http://marrtc.missouri.edu/conditions/general.html

National Arthritis Foundation. (2003a). Arthritis 101. Retrieved July 1, 2005, from http://www.arthritis.org.sg/101/101.html

National Arthritis Foundation. (2003b). Arthritis answers. Retrieved July 1, 2005, from http://www.arthritis.org/conditions/onlinebrochures/Arthritis_Answers_brochure.pdf

National Arthritis Foundation. (2004a). The facts about arthritis. Retrieved July 1, 2005, from http://www.arthritis.org/resources/gettingstarted/default.asp

National Arthritis Foundation. (2004b). Principles of arthritis management. Retrieved July 1, 2005, from http://www.arthritis.org/resources/gettingstarted/management.asp

If you have a question about accommodations and/or the employment provisions of the Americans with Disabilities Act (ADA), click here:
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