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Accommodation and Compliance Series:
Employees with Lupus
By Linda Carter Batiste, J.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 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, 2001). 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, 2001).

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, 2001).

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, 2001).

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, 2001).

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, 2001).

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:

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 Provide access to a refrigerator

Large Blue Triangle Bullet Cognitive Impairment:

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

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 and flexible use of leave time
Small Triangle Blue Bullet Allow 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 sunblocks 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 Respiratory Difficulties:

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

Large Blue Triangle Bullet Seizure Activity:

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

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 Stress Intolerance:

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 (including Raynaud's Phenomenon):

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

Large Blue Triangle Bullet Vision Impairment:

Small Triangle Blue Bullet Magnify written material using hand/stand optical magnifiers
Small Triangle Blue Bullet Provide large print material, screen reading software, and large-size high resolution monitor
Small Triangle Blue Bullet Control glare by adding a glare screen to the computer
Small Triangle Blue Bullet Install proper office lighting
Small Triangle Blue Bullet 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 April 29, 2005, from http://www.jan.wvu.edu/links/ADAtam1.html

Lupus Foundation of America, Inc. (2001). Lupus fact sheet. Retrieved July 6, 2005, from http://www.lupus.org/education/factsheet.html

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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