From the desks of Melanie Whetzel, M.A., CBIS, Lead Consultant – Cognitive/Neurological Team and Teresa Goddard, M.S., Lead Consultant – Sensory Team
In 2013, 44.7 million Americans were aged 65 or older. They represented 14.1% of the U.S. population, about one in every seven Americans. By 2060, there will be about 98 million older persons, more than twice their number in 2013 (U.S. Administration on Aging, n.d.).
Older workers remain a vital segment of today’s workforce. Some individuals have retired from one form of work and chosen to switch careers or work part-time to earn extra money and maintain insurance benefits, keep active, learn new skills, or socialize. With the aging of the baby boom generation, the average age for workers will increase, and the likelihood that more employees will be managing a disability increases.
Age-related limitations can involve a wide range of conditions, including depression and anxiety, addiction, repetitive strain, and other cognitive, sensory, and physical limitations. Due to these limitations, older workers may need accommodations related to activities of daily living, the psychological aspects of aging, and job performance. Limitations may be from aging, returning to work after an injury, the occurrence of a primary disability, the exacerbation of a long-term impairment, and/or prevention of a secondary impairment. Many older workers, however, will continue to work at full production with no limitations and no need for accommodations.
Keep in mind that aging, by itself, is not an impairment, but a person who has a medical condition (such as hearing loss, osteoporosis, or arthritis) often associated with age has an impairment on the basis of the medical condition. If that impairment substantially limits a major life activity, the person may be entitled to accommodations under the ADA.
The following are examples of some of the accommodations that might be useful for age-related limitations. For more information on aging employees, see JAN’s A to Z: Aging.
For aging employees with cognitive-related impairments, limitations may affect the ability to remember, concentrate, stay organized, manage time, complete tasks, and manage stress and emotions.
- Deficits in memory impact the ability to recall information that is seen and/or heard. This may result in the inability to recall facts, names, passwords, procedures, and telephone numbers. To accommodate memory deficits, an employer might: allow the use of a job coach or provide a workplace mentor; use auditory or written cues and reminders as needed; allow additional training time; provide written checklists; or use a color coding scheme to prioritize tasks, remembering to use the same sequence of colors for quicker and more consistent recognition. The use of notebooks, planners, sticky notes, and apps to record information can be effective reminders, as long as the employee doesn’t use too many of them and they become ineffective. Employers can also provide labels and use bulletin boards to assist in locating items. Providing minutes of meetings and trainings is an accommodation that can assist all employees.
- Decreased ability to concentrate may be common in aging workers. To accommodate concentration deficits, an employer might: reduce distractions in the work area by providing space enclosures, sound absorption panels, a private office, white noise machines, music players, environmental sound machines, or even a fan. These options can help reduce background noise that can be distracting. Uninterrupted “off” work time where an employee can concentrate on work tasks without answering the phone or responding to e-mails can be helpful as well. Desk organizers come in a variety of styles and can help reduce clutter. It can also help to increase natural lighting or provide full spectrum lighting to improve productivity and alertness. Employers can also divide large assignments into smaller tasks and goals, use auditory or written cues as appropriate, and restructure the job to include only essential functions to allow for more time and energy for the completion of those. Memory aids such as schedulers, calendars, email add-ons, or apps can aid in concentration, but make sure the employee knows how to use them.
- Difficulties with organization can be the result of an inability to retain information, and/or the inability to transfer or apply skills in different work environments. To accommodate deficits in organization, an employer might: allow the use of daily, weekly, and monthly task lists, as well as calendars with automated reminders to highlight meetings and deadlines; divide large assignments into smaller more manageable tasks and goals; or use a color coding scheme to prioritize tasks. Color coding can be as simple as using colored folders, paper clips, or hi-lighters. The use of electronic organizers or mobile devices and apps can aid in organization as well, just remember that training in the apps and devices too may be necessary.
- Limitations in managing time and completing tasks can be caused by difficulty with self-initiating, marking time as it passes incrementally by minutes and hours, as well as the inability to gauge the proper amount of time to set aside for certain tasks. Individuals may find it difficult to prepare for, or to remember, work activities that occur later in the week, month, or year. To accommodate deficits in managing time and completing tasks, an employer might: arrange materials in the order of use, with a numerical or color-coded task list; provide a job coach or allow a workplace mentor to guide the employee; provide additional training or retraining as needed, while considering alternative format for the training when needed; provide verbal and written prompts and reminders as needed; or use a watch that can be set multiple times where the face will show what task needs to be performed at each given time. Organizational and reminder apps may also work successfully
- Difficulties managing stress and emotions may be result of the psychological effects of aging that can cause depression and anxiety. To accommodate deficits in managing stress and emotions, an employer might: modify environmental triggers such as sounds and smells; allow a flexible work environment, which may include flexible scheduling such as adjusting the beginning and ending times of the employee’s work day and / or modifying a break schedule; allow leave for counseling; or work from home or Flexi-place, on a part-time or even on a temporary basis. Referring the employee to counseling and/ or an Employee Assistance Programs can be helpful and appropriate, as can allowing telephone calls during work hours to doctors and others for needed support.
When considering accommodations for aging employees with motor related impairments, limitations may have an impact on gross motor functions, fine motor functions, or a combination of both. For an older worker with a limitation that impacts a gross motor function, such as lifting people or patients, there are a variety of accommodations that could be implemented. Products such as patient lifts or transfer sheets could enable a nurse or healthcare worker to lift a patient independently or lifting could be done with the assistance of others or as a team. Compact material handling devices can assist someone who has difficulty lifting or transporting items of various sizes.
Carrying heavy items is another type of job task that an older employee with gross motor limitations may have difficulty performing. This could be a problem with carrying heavy items either on the ground or upstairs. Of course, one accommodation that many people might have available is the use of a dolly or hand truck or a cart. Another option could be to use a motorized cart. If the job requires the employee to carry heavy items upstairs, a stair-climbing hand truck could be used.
Accommodations related to workplace accessibility may need to be considered for aging employees with gross motor limitations. For example, climbing up a set of stairs could be difficult for someone with a hip impairment. Some employers express concerns that accessibility-related accommodations require them to remodel a whole building. However, there are some lower-cost accommodations, such as relocating a work station, which could be implemented as alternatives to a remodel. Another option that would be less expensive than putting in an elevator would be a stair lift.
Aging employees working in healthcare settings may have gross motor impairments that prohibit them from pushing patients who are in a hospital bed or wheelchair. And facility or maintenance workers might have to push heavy pieces of equipment or carts from one worksite to another. There are a variety of motorized pushing or tugging devices for these situations, both for moving people and objects, which could be explored as accommodations.
Individuals that have a sitting restriction or have a sitting and standing restriction could use an adjustable work station, modifying their existing workstation, or have an ergonomic evaluation completed. For those working in manufacturing environments or in a retail environment and have trouble standing, a stand/lean stool could be an option. These stools allow a person to alternate between a leaning position and a sitting position and can be adjusted so that the employee can access an assembly station or retail counter.
Some aging employees experience fine motor limitations resulting from conditions such as carpal tunnel disorder or arthritis, and have difficulty performing tasks like keyboarding or using a mouse. Alternative input devices could be used to enable an employee to access information on a computer. Speech recognition software could also be a possible accommodation solution for those who are unable to use a keyboard or mouse. Writing aids, grip aids, typing/keyboard aids, or hands-free telephones are other options to explore. Employees working in manufacturing environments who have fine motor limitations might benefit from using vacuum pickup tools, extra grip gloves, anti-vibration gloves, or anti-vibration tool wraps.
Sensory impairments are very common among aging employees. In fact, the names of two common conditions — presbyopia, a type of vision loss in which one gradually develops difficulty focusing on nearby objects, and presbycusis, a type of hearing impairment in which one gradually develops a reduced sense of hearing in both ears — both come from the Greek word “presbys” (πρέσβυς), which can be translated as “old man.” So, accommodations have been around for a long time.
Additionally, according to the NIH, “Approximately one in three people in the United States between the ages of 65 and 74 has hearing loss, and nearly half of those older than 75 have difficulty hearing.” Additionally, anyone who is 35 or older is at risk for presbyopia, according to the NIH.
JAN’s Sensory Team also takes questions on the senses of smell and taste, which can become less sensitive as a natural part of the aging process or as a result of conditions such as cancer or stoke or because of medication side effects.
Many workers seek out assistive technology such as hearing aids and computer glasses on their own and never come to the attention of their employer. Fortunately, many accommodation options exist for individuals whose sensory limitations impact them at work. For this article, three of the most common sensory-related issues that we get questions about at JAN will be touched on: mobility, communication, and computer use.
The word “mobility” is often associated with conditions that impair movement, such as spinal cord injury, stroke, and arthritis. However, it can also be used in connection with conditions that impair vision. In fact, there is a special name for professionals who train people with visual disabilities in how to get around safely and independently. These professionals are called “orientation and mobility specialists.” Many people who acquire vision loss early in life or following a sudden-onset medical event such as a stroke receive referrals for orientation and mobility training and may be more likely to receive formal training in how to use a white cane. They are also more likely to be referred to organizations that match individuals who are blind or have low vision with service animals. In contrast, those who experience gradual vision loss may learn a few strategies and tips from professionals but also rely on their own experiences to come up with ways of getting around that work best for them.
Some simple steps that employers can take to make it easier for all workers to get around include providing small-group or individual tours of a facility at the time of employee orientation and after workplace changes such as moves or renovations; providing adequate lighting in entryways, parking areas, hallways, restrooms and common areas; and providing orientation tools such as maps and printed directions in a format that employees are able to see and use easily.
Some facilities have also found that use of high-contrast wallpaper borders to be useful in marking important pathways. A chair rail that is painted in a contrasting color can add a tactile element that is useful for those who find it helpful to touch a wall while navigating a hallway. If permanent changes to a wall are problematic, vinyl decals may be a useful alternative. Additionally, using signs with large high-contrast print and tactile letters and symbols or even Braille may help individuals to navigate independently and avoid embarrassing mix-ups in common areas and restrooms. There are also special light switches and programmable doorbells that can be used to give an auditory cue about the room that someone has entered or is about to enter.
Employees who are hard of hearing may benefit from accommodations to enhance communication, for example over the telephone or during meetings and trainings. Two of the most common strategies for improving telephone-related communication are amplification and captioned calls. If an employee already uses a hearing aid, it may also be possible to use specialized equipment such as a hearing aid-compatible headset or Bluetooth technology to connect the sound from a phone to the hearing aid. The treating audiologist may be able to make target recommendations about what technology would work best with a particular person’s hearing aids.
For those who do not have hearing aids or who prefer to take them out when using the phone, one option is considering whether an amplifier that the employee can adjust would meet the employee’s needs. Most people with hearing loss can hear some types of sounds or frequencies better than others. No telephone amplifier is as customizable or adjustable as a hearing aid fitted by a qualified audiologist. However, one example of a telephone amplifier with easily adjustable volume across multiple frequencies is the Speech Adjust-a-Tone from Hearsay. This particular device has six sliders, which can be used to adjust the volume of sounds ranging from bass, mid, to treble. Some individuals with hearing aids can also benefit from this product since it can be used with a neck loop. It can also be used with certain types of headsets as well as with a bone-conducting transducer. Because there are multiple models of this product, it may be helpful to consult the manufacturer or a vendor to see which might work best in your setting.
The principles of amplification and captioning can also be used to make meetings and trainings more accessible. There are many types of assistive listening devices that may be helpful in amplifying the voice of the main speaker. Some models also work with hearing aids to reduce the impact of background noise. The type of captioning most commonly provided in meetings and trainings is Communication Access Realtime Translation or CART services. Of course, for individuals who are deaf and fluent in American Sign Language (ASL), interpreter services may be a more appropriate option. Check with the individual to be sure what accommodations work well for them.
Employees who are hard of hearing may benefit from accommodations related to computer use. These days, many operating systems have a number of built-in accessibility features designed to make their devices easier for all to use. In many cases, a simple adjustment in a settings menu is all it takes to turn on basic screen reading or improve the contrast of print on the screen. To find out about the accessibility features in a particular computer operating system, you can explore settings on your own or with the help of an IT professional or go to the manufacturer’s website and search for information on accessibility.
In some cases, efficient use of built-in accessibility features may make all the difference. In other cases, assistive technology such as screen magnification software or office equipment such as larger monitors and cubicle shields to block glare from overhead lighting may provide additional benefits, improving productivity while reducing eyestrain.
Sometimes, it may be helpful to mix and match to meet a particular employee’s needs. Some individuals may choose to learn Braille as their vision loss progresses. Other may simply find it more efficient and less visually taxing to listen to the computer for some tasks using screen reading software.
There are many potential accommodation solutions that aging employees with impairments could benefit from in the workplace. Each situation should be evaluated on a case-by-case basis to determine options that work for both the employer and employee, and there may be some trial and error before an effective solution is found. Hopefully the types of limitations and possible accommodations discussed in this article will give you an idea of what is possible!