Chronic Health Conditions and Disability
Chronic health conditions, such as cancer, arthritis, and diabetes, tend to develop gradually and worsen over time. When chronic health conditions transition from an asymptomatic to a symptomatic stage, they can contribute to the onset of disability. Diabetes, for example, is a condition in which the body either does not produce insulin or does not use it effectively, leading to uncontrolled blood glucose (blood sugar). Managing diabetes requires constant attention to maintaining safe blood glucose levels through diet, exercise, and medication, which can impose substantial limitations on an individual’s daily activities. Alternatively, having a disability also increases the risk of developing a chronic illness, like diabetes. Individuals with a disability and a chronic health condition may require reasonable accommodations to attain and retain employment due to their health management needs. Reasonable accommodations benefit both employers and employees by reducing staff turnover and improving job productivity.
What Are Reasonable Accommodations?
Under Title I of the Americans with Disabilities Act (ADA), a reasonable accommodation is defined as a modification or adjustment to a job or work environment that enables qualified applicants to participate in the hiring process or supports employees in performing job duties to the same extent as people without disabilities. It is important to note that accommodations may vary from person to person – not everyone with a disability will require the same accommodation, and not all people with a chronic health condition will need accommodations to perform their job.
For people with diabetes, reasonable accommodations may include:
- Provide a private, non-restroom area to test blood glucose and administer insulin or other medications
- Allow breaks to check blood glucose levels, eat a snack, or take medications
- Provide storage for diabetes supplies, medications, and snacks
- Provide leave time, late arrivals, or early departures for medical appointments or illnesses
- Provide chairs and flexibility to sit or stand to perform job duties
- Provide large monitors or assistive technology, such as screen readers or magnification software
- Allow for cell phone use to check continuous glucose monitors (CGMs) and insulin pumps
- Allow telework
- Educate workers on emergencies, such as symptoms and procedures for low blood glucose
Process for Requesting a Reasonable Accommodation
To request a reasonable accommodation in the workplace, the applicant or employee must notify the employer that a modification is needed due to a medical condition – the applicant or employee does not have to explicitly mention the ADA or use the phrase “reasonable accommodation.” Though accommodation requests do not have to be in writing, it can be helpful to have a paper trail in case a dispute arises. Once the accommodation is requested, the employer and the individual requesting it should collaborate to identify the appropriate accommodation(s). Employers are required to provide reasonable accommodations if the accommodation would not impose an “undue hardship” on the business. An undue hardship refers to significant difficulty or expense. Inconvenience or nominal cost to the employer does not qualify as undue hardship.
Universal Benefit of Reasonable Accommodations
Accommodations should not be perceived as special or unfair treatment. Policy and facility modifications generate universal benefits by improving convenience and accessibility for all workers, not just those with disabilities. Building enhancements, such as private areas for testing blood glucose and administering insulin or other medications, also benefit new mothers who need a private space to pump breast milk after an infant’s birth; installing ramps and automatic-opening doors, intended for wheelchair users, also benefit people pushing strollers, luggage, and heavy items on carts; closed captions or subtitles designed for people who are deaf or have hearing loss improve clarity for everyone in loud environments.
Since the ADA was enacted in 1990, inclusion has become the expectation. Reasonable accommodations ensure that individuals with chronic health conditions and disabilities have the same rights and privileges in employment as those without disabilities. To learn more about workplace accommodations, visit the ADA National Network or call 1-800-949-4232.
References:
- American Diabetes Association (ADA). (n.d.) Common Reasonable Accommodations for Individuals with Diabetes. https://diabetes.org/advocacy/know-your-rights/common-reasonable-accommodations
- American Diabetes Association (ADA). (n.d.) Proving Diabetes is a Disability. https://diabetes.org/advocacy/attorney-resources/proving-diabetes-is-a-disability
- Bosma, A. R., Boot, C. R. L., Snippen, N. C., Schaafsma, F. G., & Anema, J. R. (2021). Supporting employees with chronic conditions to stay at work: perspectives of occupational health professionals and organizational representatives. BMC public health, 21(1), 592. https://doi.org/10.1186/s12889-021-10633-y
- Ihara, E. (n.d.). Workers affected by chronic conditions: How can workplace policies and programs help? Health Policy Institute, Georgetown University. https://hpi.georgetown.edu/workplace/
- Job Accommodation Network. (n.d.). A to Z of Disabilities and Accommodations. AskJAN.org. https://askjan.org/a-to-z.cfm
- Pilla S.J., Rooney M.R., McCoy R.G. (2024). Disability and Diabetes in Adults. Diabetes in America. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); 2023-. https://www.ncbi.nlm.nih.gov/books/NBK609951/
- U.S. Department of Labor, Office of Disability Employment Policy. (n.d.). Accommodations. U.S. Department of Labor. https://www.dol.gov/agencies/odep/program-areas/employers/accommodations
Author:
- Camilla Herndon, Rural Health and Nutrition, Greenville and Laurens Counties
Reviewed by:
- Michelle Altman, Extension Associate, Rural Health and Nutrition
- Melissa Bales, Extension Associate, Rural Health and Nutrition
