Employers' Guide
Working is very important to many people
who have kidney failure, also known as end stage renal disease (ESRD).
It can help them to have a feeling of value to their families,
to society and to themselves. As an employer, you probably have
many questions about how hiring or continuing to employ someone
with kidney failure could affect you and your business.
What is end stage renal disease?
End stage renal disease is now a fairly
common problem in the U.S. population, with about 200,000
patients undergoing treatment. It means that the kidneys have
lost about 85 to 90 percent of their ability to function. The
kidneys' job is to filter toxic wastes from the blood. These
wastes can build up in the body and cause death if not removed
by treatment.
How is end stage renal disease treated?
Two types of treatment are available for
end stage renal disease ¾ dialysis and transplantation. Dialysis
is a method of cleaning the blood by removing the fluid and
toxic wastes that the kidneys normally get rid of. Two types of
dialysis can be done. The most common is haemodialysis, which
involves cleaning the blood by pumping it through a machine that
has a special filter called a dialyzer. Hemodialysis can be done
at a dialysis center or at home.
The second type of dialysis is called
peritoneal dialysis. In this method, a plastic tube called a
catheter is implanted in the abdominal wall by a small
operation. To do the treatment, the patient places a cleansing
solution into his or her abdominal cavity through this catheter.
The lining of the cavity acts as a natural filter, and wastes
accumulate in the cleansing fluid, which is drained after four
to six hours and discarded. While the cleansing fluid is in the
patient's abdominal cavities, he or she can go about normal
daily activities. Some patients are able to do another form of
peritoneal dialysis that can be done during the night while
sleeping.
Another form of treatment is a kidney
transplant. Kidney transplants can come from living donors who
are usually close relatives of the patient or from people who
died recently (non-living donors). The success rates of both
types of transplants are good.
How do ESRD and treatment affect a
person's ability to work?
With medical advances, the treatments and
medicines available today help many ESRD patients to feel
stronger and have more energy. There may be some fatigue at the
beginning while patients are getting used to dialysis
treatments. However, this should decrease in time. Studies have
shown that most ESRD patients have good attendance records. So
employers should rest assured that having an employee who has
ESRD does not necessarily mean that the individual will be
missing a lot of days. Many people with ESRD are conscientious
and valued employees who make a contribution to their place of
business.
Dialysis
Patients who choose dialysis may need a temporary reduction of
hours to help them ease into their new routine. Those who choose
in-center haemodialysis need to go for treatments about three
times a week for three to four hours. Many dialysis centres have
flexible schedules to accommodate working people, and the
employee with ESRD may be able to arrange dialysis treatments in
the evenings. If this is not possible, the employee may need to
arrange "flex-time" a few days a week, perhaps coming in earlier
to make up for leaving early for treatments. Patients who choose
home haemodialysis can do their treatments at their convenience
so they will not interfere with their work schedule. Patients
who do continuous ambulatory peritoneal dialysis (CAPD) will be
able to work regular hours, but will need to have a clean,
private area in the workplace to do their exchanges (removing
the old cleansing fluid and adding fresh fluid). This process
takes about a half hour and must be done three to five times
every 24 hours. Those who choose continuous cycling peritoneal
dialysis (CCPD) can plan to do their treatments at times that
will not interfere with their work schedule.
Transplant
Employees who are candidates for a kidney transplant will need
time off for the surgery (one to three weeks) plus some
additional time at home before they are ready to return to work.
If they expect to get their kidney transplant from a living
donor, surgery can be scheduled to meet their needs. If they are
on a waiting list for a non-living donor kidney, however, they
may need to take time off on short notice, when a kidney becomes
available for them. After regaining their strength and returning
to work, most transplant patients should be able to resume their
regular work schedule.
Will the employee need to be switched to
another job?
In some cases, yes. Medical circumstances
may limit an employee's ability to do a particular task. For
example, if the job involves heavy physical labour, it might be
necessary to restructure the job so the employee is using other
skills. This will vary according to the individual and the type
of job.
How can businesses accommodate people
with ESRD?
Employers can do many things to assist
individuals to re-enter or stay in the workplace. Following are
some of the ways employers can help:
- making the workplace readily accessible
- restructuring the job if needed
- creating part-time positions
- reassigning individuals to vacant
positions with different job requirements
- creating positions that allow job
sharing.
The job description should be clear so
both employer and employee understand what is to be performed.
Who pays for ESRD treatment?
Treatment for ESRD is expensive, but the
federal government, through Medicare, helps to pay for much of
the cost. Often, private insurance or state programs pay for the
balance not covered by Medicare. Most dialysis and kidney
transplant patients are eligible for Medicare regardless of
their age. Home or self-care dialysis patients are eligible for
Medicare the first month of dialysis. Patients who receive
dialysis at a facility are not eligible for Medicare until the
fourth month of treatment; during the waiting period, they must
rely on the coverage they had before starting dialysis. Someone
who has a transplant before going on dialysis generally is
eligible for Medicare coverage starting the month the transplant
is done.
If your group insurance plan covers kidney
disease and its treatments, the plan may be responsible for some
of the employee's bills. The employer group insurance plan would
be the primary payer for the first 18 months after the patient
becomes eligible for Medicare.
Are any benefits available to employers
of someone with ESRD?
In addition to the satisfaction that comes
from helping someone, other benefits can come from employing
someone with ESRD. For example, if the individual has been
working for you for a while, by continuing to employ this
person, you will avoid losing someone who is experienced and
productive at his or her job. In addition, you will save
expenses involved in recruiting, hiring and training a new
worker. Tax credits may also be available to companies that hire
someone who is certified as medically handicapped by the State
Employment Office. (The government considers kidney failure a
"handicap.") Tax credits may also be available to employers who
make workplace changes to accommodate a handicapped employee.
Are there any laws concerning employment
of people with ESRD?
Yes. The Americans With Disabilities Act,
a federal law passed in 1990, makes it unlawful to discriminate
in employment against qualified individuals with disabilities
and requires most employers to make "reasonable accommodations"
to remove obstacles to continued employment. ESRD qualifies as a
disability under the Act. This law is in effect for businesses
that employ more than 15 people.
The Family Medical Leave Act, passed in
1993, allows people emergency time off to care for dependents or
themselves if they are too ill to do their work. The individual
may return to the same job or one that is comparable to it. This
law affects not only those being treated for ESRD but can also
be applied to those who decide to donate a kidney to a loved
one.
Employers should be informed of such laws
and make their employees aware of them. Employers are less
likely to be challenged if their employees know their rights.
Why would someone with ESRD want to work
if he or she can qualify for disability?
While ESRD patients may be eligible for
Social Security Disability, many of them express a strong desire
to continue their jobs if they are working, or to get back to a
job if they have been temporarily unemployed. In many cases, the
disability payments will be less than the person's former
salary. Someone who was the "breadwinner" of the family may feel
a loss of purpose and accomplishment. In addition to earning
money, work is a way of enhancing a person's self-esteem. Work
also gives people a chance to practice skills and abilities and
to socialize with others.
Would other people who work for me be at
risk of catching kidney disease?
No. Kidney diseases are not contagious,
and there is absolutely no risk to your other employees.
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See also in this A-Z guide:
- Working With Kidney Disease:
Rehabilitation and Employment
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