Alzheimer’s disease/dementia in the workplace
An HRinfodesk subscriber recently sent us the following comment so we could provide some input on the topic. He wrote:
An HR colleague of mine and I were recently having a discussion about Alzheimer’s disease. The topic came up because one of our subsidiary companies (we are a financial services company) had an issue with a client that had developed Alzheimer’s/dementia, and this got people thinking about the implications of age-related illnesses and conditions such as this from an HR perspective, given our aging workforce and people seeming to be deferring retirement more and more (although early onset of these conditions is certainly possible). I’m not sure that much has been written on this topic before in terms of HR, so I thought I might offer it as a suggestion for future topics.
Well, the suggestion piqued my curiosity and I did some research.
What is Alzheimer’s disease/dementia?
Alzheimer’s disease was first identified by Dr. Alois Alzheimer in 1906.
According to the Alzheimer’s Association (in the United States), Alzheimer’s disease is the most common form of dementia, which is a progressive and fatal brain disease that currently has no cure. Dementia causes problems with memory, thinking and behaviour. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks. Specifically, in its early stages, memory loss is mild, but with late-stage Alzheimer’s, individuals lose the ability to carry on a conversation and respond to their environment.
Alzheimer’s disease accounts for 50 to 70 percent of dementia cases. While Alzheimer’s is not a normal aging ailment, age is the greatest risk factor for the disease.
In a recent article, Alexandra Dillon, associate director of the Great Plains (US) Chapter of the Alzheimer’s Association stated that Alzheimer’s/dementia is becoming a nationwide (talking about the United States) epidemic and impacting the workforce more and more every day.
Alzheimer’s not only touches more and more lives every day but also impacts the workplace, especially as older people are postponing retirement and continuing to work into their 70s.
Alzheimer’s not only impacts the older worker, who may have to work out of economic necessity, but a spouse who has been impacted by the disease, creating additional pressure to work to supplement their income while taking care of a spouse suffering from Alzheimer’s.
36.5 billion business dollars are associated with Alzheimer’s disease due to lost productivity, related to employees providing care for individuals with Alzheimer’s or other dementias.
US statistics indicate that one in six women and one in ten men age 55 and older can expect to develop Alzheimer’s disease. (Figures for women are higher largely because women live longer than men.)
So what about Canada?
In a report from the Canadian Alzheimer’s Society, Rising Tide: The Impact of Dementia on Canadian Society, we learn that:
- Half a million Canadians have Alzheimer’s disease or a related dementia. Approximately 71,000 of them are under age 65. This means that 1 in 11 Canadians over the age of 65 currently has Alzheimer’s disease or a related dementia.
- In 2008, more than 103,000 Canadians developed dementia. This is equivalent to one person every five minutes. By 2038, this will become one person every two minutes, or more than 257,000 people per year.
- If nothing changes, the number of people living with Alzheimer’s disease or a related dementia is expected to more than double, reaching 1.1 million Canadians within 25 years.
- Women represent 72 percent of all cases of Alzheimer’s disease. In the context of overall dementia, women represent 62 percent of cases.
- The hours of care delivered by unpaid family members are expected to more than triple, increasing from 231 million hours in 2008, to 756 million hours by 2038.
- Dementia costs Canadians $15 billion a year, a figure expected to grow ten times to $153 billion by 2038.
Experts say the incidence of Alzheimer’s in the workplace will only increase with more people trying to work longer.
Recently, in the media, the son of former president Ronald Reagan, Ron Reagan claims that his father experienced the onset of Alzheimer’s while in office. If this claim is true, being afflicted with a serious impairment that disrupts memory and mental function, Ronald Reagan having knowledge of this affliction should have resigned his office. At 69, Regean was the oldest man ever elected to the White House.
According to some research, jobs with higher mental demands require skills that might enhance an individual’s ability to perform well on the tests used to diagnose Alzheimer’s. If this is the case, then the disease may go undetected in these people until the disease is much farther along than in those whose jobs pose lower mental demands.
Although it is clear that Alzheimer’s affects one’s ability to hold a job or volunteer position, fulfil domestic responsibilities, and maintain social relationships, there is no set parameter for how employers should respond to someone who exhibits Alzheimer’s/dementia-related symptoms in the workplace.
Knowing that the workforce is aging, employers need to be sensitive to the disease and able to spot the warning signs of Alzheimer’s/dementia.
According to John C. Morris, M.D., the director of the Alzheimer’s Disease Research Center at Washington University in St. Louis, the warning signs may differ depending on one’s profession, but a common denominator that affects executives, doctors, lawyers and construction workers alike is an overall decline in job performance.
“People just can’t do their job as well as before,” Dr. Morris says. “These changes or declines in mental ability are subtle, so co-workers will cover up at first and make excuses such as ‘Well, Fred is getting over the loss of his brother’ or ‘We just got a new computer system.’ Gradually, their level of responsibility has to keep getting reduced so the person is either let go or kept on in a largely ceremonial role.”
Simply stated, we tend to rationalize the symptoms away.
What does early Alzheimer’s look like on the job?
Short-term memory loss is an early symptom of Alzheimer’s. Initially, memory problems may show up as forgetting appointments, repeating anecdotes, confusion, misplacing things and trouble finding the right word in conversation. Eventually people tend to get an official diagnosis when the impairment is to the point where no one can ignore it anymore. The forgetfulness has gone beyond names and phone numbers to include meetings, key decisions and reiterating and rehashing decisions that have already been made.
However, memory loss isn’t the only warning sign. Others include difficulty with technology and new tasks, and personality changes such as becoming more withdrawn and less talkative. In some cases, people may become irritable or agitated, or may start to behave inappropriately.
These signs often become noticeable in the workplace before anywhere else. However, employees can often manage their symptoms in the early stages of the disease. As the workforce ages, the number of people working with early symptoms of dementia is likely to grow.
Unfortunately, many supervisors lack the training to either recognize or compassionately respond to people who show signs of dementia.
Employers and their management staffs need to become sensitive and gain an understanding about early-onset Alzheimer’s/dementia. Applying a delicate balance, employers and supervisors need to be more alert to some of the early signs. Employers should try to avoid creating a stigma around the disease. They should try to create an environment of support for the employee and their family, like any other disease or illness.
Experts urge employers to train supervisors and offer education to the whole team to raise awareness on behalf of those who have the disease, their working caregivers and the workplace itself.
If you have a worker who you suspect may be showing signs of Alzheimer’s, sitting down with the person and expressing your concern in a non-judgmental fashion is the best way to deal with the possibility of the disease at first. Be specific about what you’ve observed. Ask if similar problems are happening at home. Do not accuse them of having the disease; ask them to see a doctor to obtain a medical evaluation and early detection from a specialist.
Expect the employee to be on the defensive. They may think you intend to fire them if they are diagnosed with Alzheimer’s/dementia.
Employers should remember their legal duty to accommodate and prevent workplace harassment and discrimination based on the grounds of disability and age.
Alzheimer’s/dementia are diseases that would fit the definition of disability under the law. Thus, as long as workers can continue to perform their work with “reasonable accommodation”, then they should not lose their jobs.
In addition, Alzheimer’s is not recognized as part of aging. However, most people associate Alzheimer’s with very old and frail seniors; this is called a stigma or a stereotype. The fact is the early-onset Alzheimer’s disease can strike a person in his or her mid-50s. Thus, discrimination and harassment based on age because a person has or is perceived to have Alzheimer’s/dementia is against the law.
Early diagnosis is the key for both the individual and the employer. According the Alzheimer Association, there is a period of time when employees with dementia will be able to transfer the knowledge they have to their successors, “rather than have them drop out of the workplace and take all the historical knowledge and skill sets.”
In addition, an early diagnosis will help families plan for the inevitable financial hit when the person does stop working. Moreover, says Nina Silverberg, assistant director for the Alzheimer’s disease center program at the National Institute on Aging, “The medications can be most effective at an earlier stage in the disease, scientists believe,” she says. “You want to protect the healthy neurons, and the more intact they are the better.” Medication may delay the disease’s progression in some patients.
If the diagnosis is early-onset Alzheimer’s or other dementia, determine whether the person’s condition presents safety problems for him- or herself or others. Depending on the job, some employees may need to stop work immediately; others will be able to continue working. If the symptoms are severe enough that they interfere with a person’s ability to hold a job, or function the way they used to, than a decision to terminate needs to be made but only after a medical evaluation and all relevant facts have been gathered, analyzed and discussed with the employee.
Once all the facts are established, employers with the employee’s participation, can better plan, manage and monitor the situation. The employer can also better support the employee and co-workers during this difficult time.
As the number of Alzheimer’s/dementia victims rises, so does the number of home caregivers. As Alzheimer’s progresses into the later stages, the primary caregiver may experience stress that affects their workplace productivity. They may have to put their job on hold—or give up their work and benefits altogether—to take care of an afflicted family member.
Statistics (see reports referred to above) show that caregiving is mostly undertaken by women since it is regarded as a feminine role and they live longer. The failure to recognize and accommodate caregiving responsibilities, because they are related to longstanding gender roles and assumptions, has an adverse impact on women (and in some cases men) and may be considered discrimination on the basis of sex, as an alternative or in addition to discrimination on the basis of family status.
Employers need to realize that caregiving responsibilities are physically, mentally and emotionally exhausting on employees. Persons who are providing care to family members are benefiting society as a whole, and should not face discrimination, exclusion or disadvantage as a result.
Even as employers are trying to manage the company’s daily operation while applying the rules, they should also recognize that employees are trying to balance their job responsibilities and caregiving obligations to their children, parents or other family members.
Employers should display flexibility in rules, policies and procedures so that employees who have to care for an ailing family member get a fair opportunity to succeed in the workplace. Such arrangements allow workers and employers to find creative solutions to balance workplace and family responsibilities.
Employees are entitled to reasonable accommodations, not absolute ones. In evaluating what’s reasonable, courts scrutinize not just the scheduling accommodation the employee requests but the caregiving arrangement the employee proposes to make. The solution must be mutually acceptable to both employer and employee.
Thus, as long as workers can continue to perform their work with “reasonable accommodation”, for their caregiving responsibilities, then they should not lose their jobs.
The impact of Alzheimer’s/dementia in the workplace is a relatively new but escalating phenomenon because more and more employees are deciding to continue working past the traditional retirement age of 65.
In addition, family caregiving is an issue that could impact any of us at any time. Supporting caregivers is becoming an increasingly pressing social issue. Companies are collectively spending billions replacing caregivers who leave the workplace or take a leave of absence, using temporary employment agencies and continuing health coverage for those on leave.
Based on all the information provided above, we can clearly see the implications for business are not just with the loss of workers who have Alzheimer’s/dementia but with the increasing numbers of caregivers still in employment.
One thing I know for sure, no matter the disability, employers who take an active interest in the health and well-being of their employees foster the notion that they are concerned about the whole person, not just the work. This can attract higher-quality applicants and retain current employees who are looking for humane employers who understand the importance of life balance.
First Reference Human Resources and Compliance Managing Editor