Missed opportunities in disability management

‘Significant’ gaps in policies, practices: Report
By Sarah Dobson
|Canadian HR Reporter|Last Updated: 11/19/2013

More than one-half (55 per cent) of employees with access to stay-at-work programs — such as part-time work, a modified work schedule or a different job — were able to avoid a health-related leave of absence because of a workplace program or resource available to them.

But only 21 per cent of those who took a leave of absence were offered such resources when they first experienced health issues, according to a Conference Board report based on a survey of 2,004 workers, including 727 managers.

“Many employees would be medically able to work part-time during their recovery period, but are not currently doing so because this option either is not available or is not offered to them. This is a missed opportunity for employers not only to gain productivity in the shorter term but also to maintain an important connection with employees who may otherwise be slow to return to work,” wrote Karla Thorpe and Louise Chénier, authors of Disability Management: Opportunities for Employer Action, the third report in a series looking at absenteeism and disability management.

While employers may have the best of intentions when it comes to disability management, significant gaps still exist when it comes to employer policies and practices and the treatment of employees who are struggling with mental health issues, said the report.

“There is a tremendous opportunity for employers to invest in disability management and attendance support programs. Employers can avoid the significant long-term costs associated with absenteeism by focusing on prevention, health promotion, wellness, early treatment and stay-at-work/return-to-work programs.”

The most common stay-at-work resources offered are workplace accommodations, assistance to receive medical treatment, extended health benefit plans and a structured stay-at-work program, found the survey. Also popular are flex hours, telework and modified duties.

The paucity of stay-at-work programs is surprising but not much has been done in the workplace or with insurance programs to orient people this way and look for different strategies, such as telecommuting, said Annette Gibbs, vice-president of North American work health strategies at Sun Life Financial in Toronto.

“I worry that what has mired us in the whole disability business… is that we have spent a lot of our time on restrictions and limitations and not enough time on capability.”

Getting right treatment, accommodation

More than three-quarters of employees take a leave of absence due to a physical health issue while 15 per cent take one because of a mental health issue — and eight per cent take one for both, found the survey.

But one-quarter of those who go on a health-related leave of absence have difficulties getting the right medical treatment, such as timely appointments with a medical specialist or accessing the right medication.

And one-half of those with physical and mental health issues said access to the right treatment could have made a big difference, said Thorpe, director of workplace health and wellness research at the Conference Board of Canada, speaking at its conference in Toronto on Oct. 28.

“Fifty per cent of people, if they’d had the right treatment, the right diagnosis, the right plan in place from the beginning, could have actually prevented a leave of absence.”

Employers can be frustrated by the health-care community but most doctors don’t want to be involved in the decision around whether someone can or cannot do their job because of an illness or injury, said Adam Kelly, vice-president, business development, occupational health solutions, at Morneau Shepell in Toronto, who was also at the conference.

“Most of them perceive that their role is to support the diagnosis and treatment of their patients, not to determine the disability. But physicians play a critical role in helping us understand what employees can and cannot do.”

There’s also a need for common language in disability management among the many players — case managers, HR, insurance and actuarial people — as terms are often used incorrectly, said David McDougall, senior medical consultant at Centric Health, speaking at the conference.

“They don’t speak the same language and yet we’re also supposed to be (working) to this common theme of helping Bob get back to work,” he said. “It just creates a mess.”

Mental health concerns

One-half (54 per cent) of employees said proper accommodations exist in the workplace for those with physical health issues, found the Conference Board, but only 32 per cent said the same for those with mental health issues.

“Employees with physical health issues actually have shorter absences than those that have mental health issues or those that have both physical and mental health absences,” said Thorpe.

“And we know that it’s actually more challenging to return someone to work if they’ve been off for a longer period of time, so if you were to look at where employers should actually be investing their efforts around return-to-work, it should be more around mental health issues.”

It’s about focusing on prevention and investing in resources at the front-end to keep employees healthy, said Thorpe. That includes analyzing the data and looking at predominant health-risk factors at the organization.

“Intervention at the first possible stage is just so critical, even on day one of an absence. It’s never too soon to intervene, to reach out, to make sure that that support is offered, to make sure the employees knows you’re thinking about them, you care about them, you want them to get better and you want them to come back to work.”

We need systems and structures in place to identify a problem far before it occurs, especially in the case of mental health, said Kelly.

“These things don’t happen in an isolated moment of time — they take time to build, they take time to evolve.”

The best way to impact costs around disability is to reduce the incidents or reduce the duration, said Kelly.

“Really good return-to-work programs help us reduce the duration of the disability. And that translates directly to the bottom line,” he said.

“Our ability to identify that risk as to whether it’s a workplace issue or evolving mental health-based issue or a colleague relationship issue, something that’s going on in the whole life of that individual are contributors that impact that absence experience. And our ability to identify that earlier ultimately has a significant impact in reducing the incidents of disability.”

Role of managers

Two-thirds of the managers surveyed said they have received support to more effectively manage employees with health issues, but they were less likely to have information on the role and responsibilities of other parties, such as case managers and medical professionals, while an employee is away on leave, found the Conference Board. This is important information as these individuals are often the main point of contact while an employee is off work.

“Engaging supervisors to address attendance concerns is another common challenge, particularly for those incidental absences, when really the most effective strategy is proactive intervention, which is management sitting down with someone (to talk),” said Thorpe.

All the stakeholders need to be involved, and trust is essential, said McDougall.

“If you don’t have trust in your programs, nobody will participate. If they hate you and you hate them, everyone’s suspicious; it’s not going to work.”

Organizations need to have an atmosphere of fairness and collaboration, said Gibbs, who also spoke at the conference.

“The more we can do where we can train managers to work collaboratively, to create an atmosphere of trust, we will break down some of the barriers with regards to people saying, ‘Hey, I need help.’”

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