Job Accommodation Network

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. JAN can be reached at (800)526-7234 (V/TTY).

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 Bleeding Disorders

What are bleeding disorders?

Bleeding disorders are a group of conditions that result in poor blood clotting and extended bleeding time. People with bleeding disorders do not bleed more quickly than other people, just for a longer period of time.

How prevalent are bleeding disorders?

Some bleeding disorders are present at birth and are caused by rare inherited disorders. Others develop during certain illnesses such as vitamin K deficiency and severe liver disease, or during treatments such as with the use of anticoagulant drugs or prolonged use of antibiotics (National Hemophilia Foundation, 2006a). Von Willebrand disease and hemophilia are the most common hereditary bleeding disorders. Von Willebrand disease affects at least 1% of the population (MedlinePlus, 2006). About 1 out of every 10,000 people is born with hemophilia A, and around 1 out of 50,000 people is born with hemophilia B (World Federation of Hemophilia, 2006). About 17,000 Americans have hemophilia (National Hemophilia Foundation, 2006b).

What are symptoms or complications of bleeding disorders?

Generally, bleeding disorders make it difficult to stop bleeding when an injury occurs. With von Willebrand disease, excessive bleeding may occur with minor cuts or during dental work (National Hemophilia Foundation, 2006c). With hemophilia, internal bleeding into the joints is more common, especially into the knees, elbows, and ankles. This can cause stiffness and decreased range of motion and strength in the extremities and may ultimately cause chronic joint deformities. Some individuals who have joint deformities may undergo joint replacement operations (World Federation of Hemophilia, 2006).

How are bleeding disorders treated?

There are many plasma proteins called factors that are involved in the blood coagulation process, and if one or more are missing or deficient the blood clotting process is affected. Treatment may consist of replacing the missing factors by an injection or nasal spray of desmopressin acetate (DDAVP). Other individuals may need infusions of blood clotting factors before a scheduled surgery. In emergency situations, cryoprecipitate may be used, and although screening techniques for viruses have greatly improved, this method still carries a risk of hepatitis and HIV infection (National Hemophilia Foundation, 2006).

Bleeding Disorders and the Americans with Disabilities Act

Are bleeding disorders disabilities 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 bleeding disorders 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 Bleeding Disorders

(Note: People with bleeding disorders 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 bleeding disorders 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 a bleeding disorder 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 a bleeding disorder been consulted regarding possible accommodations?

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

7. Do supervisory personnel and employees need training regarding bleeding disorders?

Accommodation Ideas:

Gross Motor Impairment:

Modify the work-site to make it accessible
Provide parking close to the work-site
Install automatic door openers
Provide an accessible restroom and break room
Provide an accessible route of travel to other work areas used by the employee
Adjust desk height if wheelchair or scooter is used
Move workstation close to other work areas, break rooms and restrooms

Fine Motor Impairment:

Implement ergonomic workstation design
Provide alternative computer input devices and telephone access

Fatigue/Weakness:

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

Recurrent Need for Medical Intervention or Transfusions

Permit flexible scheduling
Provide time off for medical appointments
Allow periodic rest breaks
Consider permitting work from home
Allow additional unpaid leave if employee exhausts accrued time off

Promote an Inclusive Workplace:

Provide general disability awareness to coworkers while keeping the individual and his/her condition confidential
Provide sensitivity training to coworkers and supervisors
Offer peer counseling to the individual with the bleeding disorder, allow telephone calls to emotional supports, negotiate time for accommodations and time off for counseling or therapy
Institute an "open-door policy" so employees with disabilities may approach their supervisors candidly

Plan of Action:

Employers who have an individual with a bleeding disorder on staff may want to become educated about bleeding disorders and have a plan set up in the event that a bleed occurs. Employers and coworkers may want to be able to recognize the signs and symptoms of a bleed. These can include an employee complaining of tingling, bubbling, or stiffness in a joint, visible swelling in a body part, bruising, nose bleeds, or bleeding of the gums (National Hemophilia Foundation, 2006).

Employees with bleeding disorders may want to have a letter at their place of work written in advance to take to the emergency room with them describing their disorder and treatment. They should also let their employers know if they have an emergency supply of factor that needs to go to the emergency room with them. Employees with bleeding disorders may wear a medical alert necklace or bracelet. If basic first aid is needed for small surface cuts, caregivers should maintain Universal Precautions at all times, including the use of latex gloves. Additional first aid treatment information should be obtained from qualified healthcare providers.

Situations and Solutions:

A mental health employee with hemophilia was restricted by her physician from repetitive bending and twisting at the waist. JAN suggested the employee use a reacher to pick up lighter objects to prevent bending.

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

An office worker with a bleeding disorder was limited in the amount of time she could work at a keyboard. JAN suggested using speech recognition software to decrease keyboarding time and suggested implementing an ergonomic workstation.

An insurance clerk 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 of the employment provisions (title I) of the Americans with disabilities act. Retrieved January 4, 2006, from http://www.jan.wvu.edu/links/ADAtam1.htm

MedlinePlus (2006). Medical encyclopedia: Von Willebrand's disease. Retrieved January 4, 2006, from http://www.nlm.nih.gov/medlineplus/ency/article/000544.htm

National Hemophilia Foundation. (2006a). What is a bleeding disorder? Retrieved January 23, 2006, from http://www.hemophilia.org/bleeding_disorders/what_is_bleeding_disorder.htm

National Hemophilia Foundation. (2006b). Hemophilia a (factor VIII deficiency). Retrieved January 4, 2006, from http://www.hemophilia.org/bleeding_disorders/types.htm

National Hemophilia Foundation. (2006c). Von Willebrand disease. Retrieved January 23, 2006, from http://www.hemophilia.org/bleeding_disorders/vwd.htm

World Federation of Hemophilia. (2006). Frequently asked questions about hemophilia. Retrieved January 4, 2006, from http://www.wfh.org/index.asp?lang=EN