Employers’ Response to Workers With Progressive Cognitive Impairment: A Systematic Literature Review

An aging workforce increases the risk of workers experiencing cognitive decline that may lead to a diagnosis of mild cognitive impairment or early onset dementia (MCI|EOD) while still employed. This systematic review explores the use of technologies (defined as any methods, processes, software, hardware or equipment) deployed by employers to accommodate, or build sustainable workspaces for, workers diagnosed with MCI|EOD. After screening 3,860 titles/abstracts and 67 full text reviews, we identified and analyzed eight articles that met our inclusion criteria. We found that: 1) The existing literature almost exclusively focuses on employees’ perspectives on the quality of work life when diagnosed with MCI|EOD, 2) Negative workspace culture toward employees’ cognitive decline, and the variability of disease onset and progression, may account for low employer awareness, 3) Employer responses focus on mitigation of risk associated with workers’ impairment. While this review demonstrates there is scant research exploring employers’ perspectives on employees diagnosed with MCI|EOD, there is even less that explores technologies designed to specifically address employers’ needs and challenges. Technology will increasingly facilitate early identification of progressive neuro-cognitive disorders, and tools to help employers respond to an employee’s MCI|EOD disclosure as a disability accommodation rather than a terminal performance management challenge. Empathic research, that engages organizations in the process of understanding the value of affordable, employer-side technologies that help build diverse, sustainable, productive workspaces is critical to a foundational understanding of our aging workforce and accommodating workers who develop MCI|EOD while still employed.

Non-Burdensome Process: An Argument in Support of Reframing What Constitutes Necessary Disability Documentation

Institutions of higher education and their respective disability offices have been challenged with determining how to apply the 2008 Americans with Disabilities Act Amendments Act (ADAAA) in our present-day work settings. Prior to the amendments, third-party documentation was considered essential almost to the point of being non-negotiable in need for most disability offices to facilitate accommodations for disabled students (The authors have made an intentional choice to utilize identity-first language to challenge negative connotations associated with the term disability and highlight the role that inaccessible systems and environments play in disabling people). The ADAAA questioned this mindset. Students with disabilities often found (and still find) themselves burdened financially and procedurally by disability offices requiring documentation to the point where students may not receive the access they truly need. Furthermore, college campuses are increasingly focusing on the limitations of the environment and not the person. As a result of this evolution, the Association on Higher Education and Disability (AHEAD) offered a new framework in 2012 describing how to define documentation. For professionals in the higher education disability field and for those invested in this work, it is critical to grasp the evolving understanding of what constitutes documentation and necessary information to make disability accommodation decisions. Otherwise, disabiled students may be further excluded from higher education access.

Diamond in the rough? An “empty review” of research into “neurodiversity” and a road map for developing the inclusion agenda

PurposeThe aims of the paper were to highlight the dearth of applied practitioner research concerning the expression of neurodiversity at work and develop an epistemological framework for a future research agenda.Design/methodology/approachA systematic empty review protocol was employed, with three a priori research questions, inquiring as to the extent of neurodiversity research within mainstream work psychology, psychology in general and lastly within cross-disciplinary academic research. The results of the final search were quality checked and categorized to illustrate where studies relevant to practice are currently located.FindingsThe academic literature was found to be lacking in contextualized, practical advice for employers or employees. The location and foci of extracted studies highlighted a growing science-practitioner gap.Research limitations/implicationsThe research focused on common neurominority conditions such as autism and dyslexia; it is acknowledged that the neurodiversity definition itself is broader and more anthropological in nature. A need for a comprehensive research agenda is articulated, and research questions and frameworks are proposed.Practical implicationsGuidance is given on applying disability accommodation to both individual and organizational targets.Social implicationsThe disability employment gap is unchanged since legislation was introduced. The neurodiversity concept is no longer new, and it is time for multi-disciplinary collaborations across science and practice to address the questions raised in this paper.Originality/valueThis paper offers an original analysis of the neurodiversity paradox, combining systematic inquiry with a narrative synthesis of the extant literature. The conceptual clarification offers clear directions for researchers and practitioners.

Can disability accommodation needs stored in electronic health records help providers prepare for patient visits? A qualitative study

Background Embedding patient accommodation need in the electronic health record (EHR) has been proposed as one means to improve health care delivery to patients with disabilities. Accommodation need is not a standard field in commercial EHR software. However, some medical practices ask about accommodation need and store it in the EHR. Little is known about how the information is used, or barriers to its use. This exploratory-descriptive study examines whether and how information about patients’ disability-related accommodation needs stored in patient records is used in a primary health care center to plan for care. Methods Four focus groups (n = 35) were conducted with staff of a Federally Qualified Health Center that asks four accommodation questions at intake for the EHR. Respondents were asked how they learned about patient accommodation need, whether and how they used the information in the EHR, barriers to its use, and recommendations for where accommodation information should reside. A brief semi-structured interview was conducted with patients who had indicated an accommodation need (n = 12) to learn their experience at their most recent appointment. The qualitative data were coded using structural coding and themes extracted. Results Five themes were identified from the focus groups: (1) staff often do not know accommodation needs before the patient’s arrival; (2) electronic patient information systems offer helpful information, but their structure creates challenges and information gaps; (3) accommodations for a patient’s disability occur, but are developed at the time of visit; (4) provider knowledge of a regular patient is often the basis for accommodation preparation; and (5) staff recognize benefits to advance knowledge of accommodation needs and are supportive of methods to enable it. Most patients did not recall indicating accommodation need on the intake form. However, they expected to be accommodated based upon the medical practice’s knowledge of them. Conclusions Patient accommodation information in the EHR can be useful for visit planning. However, the structure must enable transfer of information between scheduling and direct care and be updatable as needs change. Flexibility to record a variety of needs, visibility to differentiate accommodation need from other alerts, and staff education about needs were recommended.

Disability Barriers in Academia: An Analysis of Disability Accommodation Policies for Faculty at Canadian Universities

This article examines disability accommodation policies for faculty at 42 Canadian universities. Although universities in Canada are legally required to accommodate disabled employees, fewer than half of all universities have a written disability accommodation policy available. The search for disability accommodation policies revealed that there is a lack of consistency in policy implementation as well as language and content. The analysis revealed that disability accommodation policies contain overtly medical language and provisions that work to isolate disabled faculty by reinforcing the notion of competency as able-bodiedness and emphasizing the entanglement between disability, health and medicine. This article encourages universities to acknowledge their role in establishing accessible and inclusive workplaces and concludes with recommendations aimed at addressing some of the gaps and inconsistencies in disability accommodation policies.