In the United States, 60% of adults have at least one chronic health condition: illnesses or conditions like chronic pain and fatigue that last at least one year and require ongoing management or restrict an individual’s activities. These numbers don’t include Covid-19 “long-haulers,” or the 10% of those who experience lingering symptoms, such as difficulties with memory and thinking (“brain fog”), fatigue, racing heartbeat, gastrointestinal problems, or chest pain for weeks, months, or longer after contracting the virus.
Chronic health conditions present several challenges for employees. Although the numbers of affected workers are staggering, there is surprisingly little written about how to support and manage employees with chronic health conditions. Supporting them isn’t just the right thing to do — it will help you retain them, and it will convey the message that you value your employees as people.
The Challenges of Chronic Health Conditions at Work
In our recent research, my colleagues and I found that conflicts between work and health management are common for workers with chronic health conditions. For example, it can be difficult for an individual working with a chronic health condition to maintain attendance requirements while also going to medical appointments and managing symptoms.
We studied four samples of workers with chronic health conditions in various occupations and found two main categories of conflicts: time conflicts (where time spent working interferes with the time a person needs to manage their health condition) and energy conflicts (where energy allocated to work takes away from the energy a person needs to manage their health condition).
We found that high levels of time and energy conflicts were consistently related to worker burnout across the samples. Energy conflict was also related to both withdrawal from work (not putting in one’s best effort) and perceived work ability (perceptions of a person’s ability to continue working in their current job).
We concluded that high levels of work-health management interference signal a need for intervention — individually, through coaching or job accommodations, and/or organizationally, through supervisor training and flexible work policies.
Dealing with symptoms at work can also be challenging. In another study, my colleague and I asked 86 workers with chronic pain who interact with customers as part of their jobs to complete surveys twice per day for five consecutive workdays, at the middle and end of each day. We found that workers’ perceptions of pain interfering with their work at midday predicted emotional exhaustion at the end of the workday, beyond their reported somatic experiences of pain. In other words, it’s not only the experience of pain that’s problematic for workers with chronic pain — it’s more so the interpretation of the pain experience as affecting work. Results again point to intervention as important to helping workers with chronic pain maintain work ability and avoid burnout.
What We Know Works
In supporting workers with long-haul Covid and other chronic health conditions, there are important roles for leaders at all organizational levels.
Formal policies and informal arrangements. Organizations should have formal policies in place to accommodate workers with chronic health conditions. These may include opportunities for reduced work hours or “reduced-load work,” job task modifications, and sick leave — all of which should be made available without the risk of the employee losing their health care benefits.
The Family and Medical Leave Act (FMLA) provides unpaid leave and covers health conditions that require continuing treatment and interfere with job functions. FMLA regulations stipulate employee eligibility and employer implementation. For example, employees are not eligible until 12 months of employment with an organization, and private organizations with fewer than 50 employees are exempt. However, FMLA is a minimum standard to which organizations are legally bound, and they can and should have additional policies for leave that expand eligibility and allow for continued pay.
For example, one participant in a recent study I conducted had multiple sclerosis, and they occasionally experienced fatigue and mental fog that interfered with their work. They said that being able to use their personal paid time off, as well as their company’s specific policies on extended leave, were critical to being able to continue working in that job.
While formal policies are important, managers should also be given some flexibility to meet their employees’ needs. Health conditions manifest differently, and rarely will a one-size-fits-all approach be effective. For example, reduced-load work, which involves a reduction of both work hours and workload with a relative pay cut, is helpful for some workers with chronic health conditions. This can be incorporated into formal organizational policies, but research finds that reduced-load arrangements are often implemented “under the radar” by individual managers.
Managers can creatively address their employees’ needs in other ways as well. For example, another study participant had generalized anxiety disorder, which included panic attacks that would happen at work. Their supervisor was able to implement a creative solution to support them in managing their anxiety-related work challenges: “After a particularly bad patch, my employer assigned me part-time assistants from other departments who were looking for extra hours. They’re essentially on call, and I can use them to make sure tasks are taken care of if they involve things that are likely to provoke my anxiety.”
Culture. While policies are important, employees need to feel free to use them and to ask for help when needed. Actively cultivating a supportive culture that prioritizes work-life balance and employee well-being is critical. This goes beyond just saying that worker well-being is important. One way leaders can signal that it’s okay to prioritize health is to be open about their own health challenges and use the company’s benefits, policies, or accommodations when needed.
Flexible work arrangements. In a recent study, my students and I asked participants what their employers do to help them continue working with a chronic health condition. Flexibility was a common answer among those who felt supported and wanted to stay in their current jobs. One participant said, “My boss is really understanding, and if there’s nothing pressing, he allows me to work from home when I can, like working on some coding.” Another said, “I don’t have a problem with testing blood-sugar levels or eating at certain times of the day; I’m able to do that right at my desk… My supervisor has been incredibly helpful in this regard, stating that if I need to take time off for doctor’s appointments, that I should do so. Her exact words were, ‘Your health is more important than any job.’ I feel very supported here.”
Supportive programs. In conjunction with more formal policies, organizations should make supportive programs available to help empower workers with chronic health conditions to navigate their challenges. My colleagues and I found that a 12-week, six-session, one-on-one coaching program (conducted over the phone) for workers with chronic health conditions helped them manage work challenges. In a randomized trial, we found that coaching led to improvements in work ability, resilience, and well-being, along with reductions in exhaustion. Importantly, this coaching was not about changing specific health behaviors, like quitting smoking or eating a healthier diet, which is already common. It was about empowering, strategizing, and problem-solving to improve participants’ work ability in the face of the challenges their health conditions posed at work.
In a follow-up study, a colleague and I found that coaching helped participants integrate needed health-related changes into their lives to maintain employment — for example, adopting assistive devices and accommodations they had previously resisted — through building confidence. Coaching also helped them learn ways to manage their professional identities through effective communication about their conditions. As one participant said, “[A main benefit was] developing a capacity to know when and what I need to be able to tell somebody about my chronic illness… Now I’ve got it that I don’t need to disclose what the actual disease is. That is where I always got hung up. We talked about in certain situations providing less information, and in other situations providing more.”
The Importance of Manager Support
Many of these examples highlight the general importance of support from managers. But it’s hard to know what to say or how to react when an employee discloses their health issues or exhibits symptoms at work that interfere with performance. It’s critical to train managers on supporting employees with chronic health conditions by communicating empathetically about sensitive topics, looking for behavioral warnings, and providing accommodations. In addition to that more formal training, here are some do’s and don’ts for managers navigating health-related conversations with their employees:
- Do work on building trust with employees from day one. This will help provide a foundation for them to feel comfortable approaching you with a health-related issue later if the need arises.
- If a worker discloses a health condition, do display empathy and compassion — but don’t violate their boundaries. Disclosing their condition to you is likely anxiety-inducing for them, so pay attention and react with the level of gravity the situation deserves. Say something kind, but do not ask for details about their diagnosis, symptoms, or course of illness.
- Don’t be tempted to reveal your own personal issues in response to an employee’s health disclosure — keep the focus on them in that moment.
- Don’t catastrophize or jump to a worst-case scenario, despite what you know or think you know about their particular health issue.
- Do listen carefully and ask what they need in order to continue doing their job to their (and your) expectations. Express empathy, but also keep the focus on the job.
- Don’t be afraid to draw a boundary. You don’t need to commit to a course of action in that moment. Talk with Human Resources if needed, and come up with a thoughtful solution that helps your employee manage their health condition while also meeting necessary work targets.
- Do tell your employee that the conversation does not need to end there. Open the door for them to come to you in the future if things change.
- Do point your employee to available employer-sponsored resources (EAPs, disability and return-to-work programs, etc.). Make a list of these in advance that you can easily access when needed.
Covid-19 long-haul syndrome has highlighted existing challenges many employees with chronic health conditions have been facing in the workplace. Organizational leaders who support those workers by implementing formal but flexible policies, providing coaching, and training managers to have sensitive conversations will send a signal that they value their employees and care about retaining them. But more importantly, it’s the right thing to do.
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