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 Lupus

How prevalent is lupus?

The Lupus Foundation of America estimates that approximately 1,500,000 Americans have a form of lupus (Lupus Foundation of America, n.d.). Despite the fact that lupus can affect men and women of all ages, it occurs 10 to 15 times more frequently in adult females than in adult males. Lupus develops most often between ages 15 and 44 and is two to three times more common among African Americans, Hispanics, Asians, and Native Americans (Lupus Foundation of America, n.d.).

What is lupus?

Lupus is a widespread and chronic autoimmune disease that, for unknown reasons, causes the immune system to attack the body's own tissue and organs, including the joints, kidneys, heart, lungs, brain, blood, or skin. The immune system normally protects the body against viruses, bacteria, and other foreign materials. In an autoimmune disease like lupus, the immune system loses its ability to tell the difference between foreign substances and its own cells and tissue. The immune system then makes antibodies directed against "self." There are several forms of lupus: discoid, systemic, drug-induced, and overlap syndrome or mixed connective tissue disease (Lupus Foundation of America, n.d.).

What are the symptoms of lupus?

Although lupus can affect any part of the body, the most common symptoms are achy joints, frequent fevers, arthritis, fatigue, skin rashes, kidney problems, chest pain with deep breathing, a butterfly-shaped rash across the cheek and nose, photosensitivity, impaired vision, Raynaud's phenomenon, and seizures. No single set of symptoms is uniformly specific to lupus and no laboratory test can prove lupus conclusively; symptoms may disappear for no apparent reason and remain in remission for weeks, months, or even years (Lupus Foundation of America, n.d.).

What causes lupus?

The cause of lupus is unknown, but researchers believe there is a genetic predisposition and environmental factors also play a role in triggering the disease. Some of the factors that may trigger lupus include infections, antibiotics, ultraviolet light, extreme stress, certain drugs, and hormones (Lupus Foundation of America, n.d.).

How is lupus treated?

Treatment approaches vary depending on the symptoms of each person. Because the characteristics and course of lupus may vary significantly among individuals, a thorough medical evaluation and ongoing medical supervision are essential to ensure proper diagnosis and treatment. Medications are often prescribed for people with lupus, depending on which organs are involved, and the severity of involvement (Lupus Foundation of America, n.d.).

Lupus and the Americans with Disabilities Act

Is lupus 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 lupus 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 Lupus

Note: People with lupus 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 lupus 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 lupus 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 lupus been consulted regarding possible accommodations?

 

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

 

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

Accommodation Ideas:

Activities of Daily Living:

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

Cognitive Impairment:

• Provide written job instructions when possible
• Prioritize job assignments
• Allow flexible work hours
• Allow periodic rest periods to reorient
• Provide memory aids, such as schedulers or organizers
• Minimize distractions
• Allow a self-paced workload
• Reduce job stress
• Provide more structure

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

Fine Motor Impairment:

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

Gross Motor Impairment:

• Modify the work-site to make it accessible
• Provide parking close to the work-site
• Provide an accessible entrance
• 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
• Modify the workstation to make it accessible
• Adjust desk height if wheelchair or scooter is used
• Make sure materials and equipment are within reach range
• Move workstation close to other work areas, office equipment, and break rooms

Photosensitivity:

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

Respiratory Difficulties:

• Provide adjustable ventilation
• Keep work environment free from dust, smoke, odor, and fumes
• Implement a "fragrance-free" workplace policy and a “smoke free” building policy
• Avoid temperature extremes
• Use fan/air-conditioner or heater at the workstation
• Redirect air conditioning and heating vents
• Provide adequate exhaust systems to remove fumes from office machines
• Allow individual to wear a respirator mask
• Allow work from home

Seizure Activity:

• Eliminate the need to use sharp objects
• Eliminate blinking and flickering lights
• Replace fluorescent lighting with full spectrum or natural lighting
• Use computer monitor glare guards, adjust monitor intensity and color, and decrease the cursor speed of the mouse
• Provide protective clothing/equipment
• Modify job tasks requiring fine finger dexterity
• Allow flexible work hours
• Allow periodic rest breaks
• Allow work from home

Skin Irritations:

• Avoid infectious agents and chemicals
• Avoid invasive procedures
• Provide protective clothing

Stress Intolerance:

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

Temperature Sensitivity (including Raynaud’s Phenomenon):

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

Vision Impairment:

• Magnify written material using hand/stand optical magnifiers
• Provide large print material, screen reading software, and large-size high resolution monitor
• Control glare by adding a glare screen to the computer
• Install proper office lighting
• Allow frequent rest breaks

Situations and Solutions:

A teacher with lupus was restricted from extended periods of typing.  She was having difficulty creating lesson plans. She was accommodated with speech recognition software, an alternative keyboard, and a trackball.

A corporate trainer with lupus had difficulty standing and walking when giving presentations.  The individual was accommodated with a scooter for getting around the work-site and a stand/lean stool to support her weight when standing.

A claims representative with lupus was sensitive to fluorescent light in his office and to the radiation emitted from his computer monitor.  The overhead lights were changed from fluorescent to broad spectrum by using a special filter that fit onto the existing light fixture.  The individual was also accommodated with a glare guard and flicker-free monitor. 

An engineer with lupus was having difficulty completing all of his work in the office due to fatigue.  The individual was accommodated with frequent rest breaks, a flexible schedule, and work from home on a part-time basis. 

An executive secretary with lupus had severe back pain due to arthritis.  The individual was accommodated with an adjustable height workstation to alternate between sitting and standing, an adjustable keyboard and mouse tray, and an ergonomic chair with lumbar support.

A health care worker with lupus had low vision.  She was having difficulty viewing her computer screen and paper copies.  The individual was accommodated with a large monitor, screen magnification software, hand/stand magnifier for paper copies, and a closed circuit television system. 

A systems analyst with lupus had migraine headaches.  The individual was moved from a cubicle office to a separate workspace away from distractions and noise. She was then able to use task lighting instead of overhead fluorescent lighting and adjust the temperature control when necessary.

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 September 5, 2008, from http://www.jan.wvu.edu/links/ADAtam1.html

Lupus Foundation of America, Inc. (n.d.). Lupus fact sheet. Retrieved September 5, 2008, from http://www.lupus.org/webmodules/webarticlesnet/templates/new_empty.aspx?articleid=351&zoneid=76

Updated 09/05/08