Accommodation in Action
experience has shown that job accommodation can be a very cost-effective
alternative to long-term disability payments (Job Accommodation
Network, 1997) for both the employee with a disability and for the
employer. Investment in accommodations usually costs only a small
fraction of the hundreds of thousands of dollars that would otherwise
be paid out in cash benefits. The practice of job accommodation,
however, continues to be uncharted territory for business managers
who have historically approached the issue of work disability purely
through payment of disability benefits. An understanding of job
accommodation techniques can help managers through this process
to achieve real company savings while offering the best possible
rehabilitative care to employees with disabilities.
job accommodation includes the active involvement of the individual
with the disability, as well as the supervisor and coworkers. The
job accommodation process must start as early as possible in the
course of a disability, while the individual's connections with
the workplace are still strong and before the employee begins to
see him/herself as more of a patient than an employee. The first
course in exploring the possibilities for return to work should
be the worker's former job, where personal ties and work skills
are strongest. It is here that the worker can be the most helpful
in planning a course for job accommodation.
Americans with Disabilities Act (ADA) states that an employer has
the right to expect a worker with a disability to be able to perform
the "essential functions" of a job. Identifying these
essential functions is not easy when job descriptions are incomplete
or obsolete. Rarely do job descriptions include the information
needed to identify areas where job accommodation might be needed
for rehabilitation planning. At the same time, available clinical
information may not readily show whether the worker can perform
these essential functions. In this situation, physicians commonly
withhold clearance to return to work until recovery is complete.
If it becomes evident that the employee will not be able to return
to his/her former job, return to work efforts stall. Before any
return to work planning can begin, the impact of the worker's limitations
on job performance must be clear.
A Sample Job Analysis Process
excellent approach to job analysis was developed with the support
of the World Health Organization to the ERTOMIS Foundation in the
1970's, to conduct research into methods for vocational integration
of people with disabilities. The resulting Ertomis Assessment Method
(EAM) correlates individuals' functional capabilities with function
EAM consists of two graphic forms (Jochheim & Scheid, 1989).
One, a profile of the worker's abilities to be completed by the
attending physician, and the other a profile of job requirements,
to be completed at the worksite. Direct comparison of these two
profiles allows immediate identification of any mismatch between
job requirements and worker abilities (Jochheim & Scheid, 1989).
1995, J.L. Mueller, Inc. adapted the Ertomis approach for a corporate
client's Medical and Human Resources staff to share information
among all those involved in the accommodation process without compromise
of confidential medical or business information.
a check for objectivity, the client's case manager often asked the
disabled employee, as well as attending physicians, to complete
the "Physician's Statement of
Ability to Work". "The
Employer's Description of Job Requirements" was often completed
by the worker, as well as the supervisor and/or coworkers. Side-by-side
comparison of these two forms clearly defined any mismatches between
job requirements and worker abilities. These mismatches became the
targets of job accommodation efforts.
accommodation planning begins with identification of mismatches
between the requirements of the job and the abilities of the worker.
Accommodation planning must be coordinated through one individual,
whether an internal or consulting job accommodation specialist or
occupational health professional. In 1982, J.L. Mueller, Inc. assisted
AT&T in establishing its internal team of Job Accommodation
Specialists (JAS), and in 1991 assisted MetLife in creating its
MetLife Accommodation Coordinator (MAC) Network. In 1995, Lucent
Technologies also adopted AT&T's Job Accommodation Specialist
should be involved in the job accommodation process, and what role
does each play? Who decides what is "reasonable"? What
steps should be included in the accommodation process? These are
questions the accommodation coordinator must answer in facilitating
a successful return to work and job accommodations, if they become
the Individual with the Disability
the center of the job accommodation process must be the individual
with the disability. No one has more experience in living with the
limitations the accommodation is intended to address. As self-evident
as this seems, it is frequently overlooked. Passive, "patient"
behavior, a common byproduct of the medical treatment process, must
be reversed for the individual to take an active part in their return
to work. In the hurry to resolve problems, or to avoid confronting
difficult issues, supervisors sometimes neglect to involve the individual
in identifying needs or solutions to accommodation issues. This
usually results in wasted effort and expense, exacerbation of disability,
or even legal action.
should be noted that the law doesn't require that the employer provide
the most expensive accommodation possible, nor even the accommodation
most preferred by the individual with the disability, only that
the decision is made with that individual's input.
very resources needed for effective job accommodation are usually
within the organization. Union representatives and human resources
staff can help resolve issues of job task restructuring. Facility
managers can suggest and implement environmental modifications.
Coworkers can suggest alternate ways of completing tasks that can
work for everyone. Technical staff can help create tools to help
make workers safer and more productive. Before enlisting outside
technical assistance, each of these potential resources should be
explored. If it becomes necessary to contract with external resources,
this exploration can help to clearly identify what needs to be done.
Job accommodation planning should include a variety of alternative
solutions, so that comparisons can be made in cost, complexity,
time needed, and other factors impacting the business. Weighing
several alternatives helps to engage all the players in the process
of accommodation, so that each will have a stake in the success
of the process.
when litigation is involved or feared, the meaning of the term "reasonable
accommodation" arises. Who determines when accommodation is
"reasonable"? Although this question is sometimes referred
to an outside consultant for an objective opinion, the ultimate
decision rests with the employer. The law requires that the decision
be based on issues such as the effectiveness, cost, and impact of
the accommodation on the business - issues that the employer is
best able to judge. Though accommodation is nearly always inexpensive,
it usually involves some cost, in time and effort, if not also in
the purchase of equipment. The employer must weigh these costs against
the potential benefits of retaining a skilled worker, saving the
costs of long-term disability benefits, and promoting a positive
attitude among employees toward their jobs.
Implementing, and Following-Along
accommodation is the result of teamwork, not the singular, heroic
effort of one individual. Once a plan for accommodation is set,
the coordinator of the process must be sure that each individual
involved clearly understands what will be done, when it will be
done, and what each individual's responsibilities are. When technology
is installed, job modifications are made and other accommodations
are complete, a plan for follow-up is essential. Changes in work
load, staffing changes, work flow interruptions, and new contracts
can require adjustment in accommodations as well. Any foreseen changes
in these factors should be considered in the follow-up plan. Identifying
the need for changes in accommodation and intervening as early as
possible prevents minor problems from becoming critical.
in disability benefits and insurance costs through job accommodation
nearly always outweighs the cost of accommodation. Most job accommodations
are very simple and involve minimal cost. But this doesn't mean
that inexpensive accommodations are reasonable and expensive accommodations
are not. The most successful accommodations are those that are:
Effective: The solution enables the individual with the disability
to do his/her job productively and safely. An effective accommodation
does not substitute for the individual but enables the individual
to use his/her own abilities.
Transparent: The solution either has no effect on coworkers, customers,
and other aspects of the business, or has a positive effect in improving
productivity and/or safety.
Timely: The solution can be implemented within a reasonable time
Durable: The solution is useful and flexible enough to remain effective
throughout the employee's service. Maintenance, as well as modifications
necessary due to business or technology changes, can be readily
workplace accommodations are likely to be a compromise among these
criteria. For example, it may be less expensive for a business to
relocate an employee who uses a wheelchair to a ground-floor office
than to invest in an elevator to the usual workplace. Or it may
be less disruptive to coworkers to invest in a document scanner
than to restructure jobs so that a coworker can read documents to
a blind employee. Each employer must select from a number of accommodation
alternatives that solution which best suits the needs of the individual
and the business.
Expectations about Job Accommodation
job accommodation situation, like each worker and each job, is unique.
In pursuing the most reasonable course for job accommodation, occupational
health professionals must appreciate the concerns of managers who
in turn must consider the needs of co-workers, the needs of the
business, and the needs of the worker with the disability. The most
reasonable accommodation may well be a compromise among these needs.
The Americans with Disabilities Act acknowledges that this compromise
is possible without violating the rights of the individual with
must also be acknowledged that not all successful accommodations
result in the employee with the disability returning to work. Sometimes
an employee leaves the job despite effective resolution of the accommodation
issue. Personal motivation, co-worker relationships, family factors,
and job satisfaction influence job success for workers both with
disabilities, just as they do for workers without disabilities.
Accommodation = Prevention
job accommodation involves cooperation among workers and supervisors,
the resulting accommodations usually benefit coworkers with and
without disabilities, as well. On-site job analysis often reveals
risks of re-injury to the returning disabled worker that are also
hazards to other employees. Accommodations planned with this in
mind bring employers the double benefit of accommodating the limitations
of a qualified worker with a disability, but also reducing the risk
of disability among co-workers. Employers experiencing these benefits
commonly ask, "Why didn't we do this in the first place?"
Employees formerly seen as "different" due to their disabilities
suddenly are seen as effective templates for improvements in job
and workplace design.
Mueller, J. (1999). "Returning to Work Through Job Accommodation".
Journal of the American Association of Occupational Health Nurses,