Arthritis and work
The importance of work
The presence of arthritis does not mean a person can not lead a productive and interesting life, although it may require changes in lifestyle and employment.
It is important to understand how arthritis affects your work, what types of jobs are compatible with your limitations, and to have confidence in your skills and abilities. Vocational rehabilitation is available to help you achieve your employment goals.
This article was assembled for people disabled by arthritis who may:
- Be unable to locate or maintain employment
- Need retraining for a new job
- Need financial assistance for retraining or educational programs
- Be school-age and planning to enter the job market or higher education after graduation.
Most of us work because of financial necessity or a desire to be financially independent. In addition to providing an income, work is one way Americans "connect" with each other. The relationships enjoyed through work help us to be vital giving members of the community.
People with arthritis often have difficulty in finding or keeping employment. Individuals need to judge for themselves whether arthritis is affecting their ability to be employed.
Consider if any of the following are interfering with your ability to work:
- Frequent days missed from work. Have you missed more days this year than last year? Are you and your doctor concerned?
- Need more assistance from co-workers. Sometimes even without knowing it your co-workers may help lift items carry things or pitch in to help on "bad days."
- Decreased level of performance due to arthritis.
- Lost employment opportunities because of inability to meet job demands.
- Assistance required from family for daily living skills (dressing cleaning cooking driving) in order to conserve energy for work. Does all your energy have to go into your job? Are weekends spent resting up for the work week?
- Need for flexibility at work site: rest periods work-site modifications or sharing responsibilities.
If several of these factors are preventing you from becoming employed or remaining productive within your current job it may be time to consider vocational rehabilitation.
About vocational rehabilitation (VR)
Finding work for people with disabilities
Federal and state governments work in partnership to fund vocational rehabilitation (VR) programs.
The VR agency assists people with disabilities to find and keep employment. To achieve this goal VR provides a variety of services that help clients market and use their interests skills and abilities within the present work force. These services include work evaluation job retraining and educational expenses.
Vocational rehabilitation is not a "make work" or entitlement program. You are not automatically eligible just because you have arthritis and are unemployed or because you are at risk of losing your job. It must be shown that the disability directly affects your ability to obtain or maintain employment.
Every state is required to have a VR program and the services are financed by federal and state funding. However, the range of services number of clients served and money available will vary between states.
Each state has a central office that administers the VR program and district offices that actually provide the services. District offices are located throughout the state and serve a specific geographic area.
The Division of Vocational Rehabilitation for the State of Washington is in the Department of Social and Health Services OB 21 C Olympia Washington 98504 (206) 753-2544. For other states contact the Arthritis Foundation or the state government offices.
How to qualify for VR
Eligibility for rehabilitation services is determined on the basis of three criteria:
- You must have a physical or mental disability.
- Your disability must create or cause a substantial handicap to employment or cause you to perform the job below your potential.
- There is a reasonable expectation that the provision of VR services will help you obtain employment.
The relationship between these three criteria is very important as shown in the examples given below:
1. An unemployed school counselor with osteoarthritis in the knees would probably not be eligible for services. This is because the disability does not prevent the person from counseling and the individual already has the skills necessary to perform the work.
2. An unemployed construction worker with rheumatoid arthritis would most likely benefit from VR services. The arthritis may present a handicap to employment. The provision of services such as job restraining would enable the person to enter a field of work that better suits his or her limitations.
A state rehabilitation counselor will decide if a person qualifies for VR services based on the federal definitions of "physical and mental disability, Substantial handicap to employment," and "employability." The counselor will also consider medical and work evaluations and the effects of the disability on the person's job performance.
There are several factors that should not affect a person's application:
- Race, sex, color, creed, or national origin.
- Whether or not the person is a resident of the state.
- Age: clients should be at an employable age. However, services are available to younger students in preparation for future work or higher education. Older adults are also served but many states often set priorities based on age groups and funding limits.
Three outcomes are possible when you apply for VR services:
- You may be determined to be not eligible for services. This decision can be appealed (see "Appeal Rights").
- You may be determined to be eligible for services. (Application and preliminary diagnostic studies meet guidelines.)
- You may be given an extended evaluation period. If there is a question about employability the extended evaluation looks at all client information in depth. Services will be provided on a trial basis for up to 18 months to determine if the person's employability will improve. During this time a decision will be made to continue or terminate services. Again the denial can be appealed.
The services of vocational rehabilitation are designed to help people from all walks of life who are disabled match their skills with current job opportunities. These may include professional jobs, self-employment, family or farm work, industrial or technical work, sheltered or home-bound employment, or any other gainful work.
The specific type and number of services you might need are determined through an evaluation process. Two examples are given below:
1. A surgical nurse with severe osteoarthritis in the feet may only need work evaluation studies to determine what other types of hospital work he or she can perform.
2. A truck driver with progressive ankylosing spondylitis might require a number of services and a complete change of career.
Examples of VR services
To help you achieve your employment goals VR may provide the following services:
- Medical and psychological examination. You may be asked to see a rheumatologist physical and/or occupational therapist or psychologist
- Evaluation of interests, skills, and ability for future work
- Counseling guidance and referral to other necessary services
- Physical or mental restoration programs and services that could include surgery, hospitalization, or physical therapy
- Expenses for training or education in universities, colleges, technical schools, apprenticeship programs, or on-the job
- Expenses for purchasing books, tools, licenses, or other equipment
- Basic living expenses
- Transportation costs
- Medical equipment necessary for employment (Wheelchairs, prosthetics, glasses, self-help devices)
- Job placement
- Follow-up after employment
VR services for teens
For young people with arthritis, the change or transition from school to working life involves many choices and decisions regarding employment or higher education. Vocational rehabilitation and the Department of Education will work together to help teens make a successful transition from student to independent adult. The two agencies coordinate and offer services that begin in high school and continue into the early adult years.
Parents and students need to actively pursue this coordination. They should check with the school counselor and local VR office about transition programs. Early planning will make the transition smoother and success more likely.
Payment for VR services
Not all vocational rehabilitation services are provided free of charge. You will be asked to submit information about your income and expenses to determine how much you can contribute to the cost of your VR program. In some cases VR does pay for all expenses when the person has very limited funds.
You will not be asked to pay for services that involve medical psychological or vocational evaluation counseling referral and job placement. However financial need must be proven for all other services.
Individuals who are entering an educational program beyond high school (college, university, technical school) must apply for federal student financial aid. Once you apply the VR counselor will work with the financial aid officer to determine how your educational expenses will be met. Usually financial aid pays for educational costs and VR covers disability-related expenses.
As discussed earlier, each state sets its own budget for rehabilitation programs. The amount of money available for VR in your state will directly affect the range of services and number of clients served.
In addition, each state agency receives its funds for a 12-month period (fiscal years). The fiscal year may begin on January 1 or another date and this may vary from state to state. That means there will be more money available at the beginning of the fiscal year than at the end. These factors: budget, number of clients served, and timing in relation to the fiscal year may affect your ability to receive needed services even though you qualify. Therefore, it is advisable to apply early in the fiscal year. Contact the local VR office with specific questions.
Applying for VR services
Application for services should be made at your local VR office. For individuals who can not visit their local office, counselors will interview clients in the home.
There are several ways to contact vocational rehabilitation:
- Individuals who receive Disability Insurance Benefits (DIB) from Social Security (also called Social Security Disability Insurance or SSDI) may be referred to VR by the Social Security Administration.
- Self-referral by phone, letter, or a visit to the local office.
- Referral by a physician, other health care professional, or health agency such as the Arthritis Foundation.
After your application is received a VR counselor will be assigned. A general medical examination is required (paid for by VR). The counselor may request additional information such as school records, work history, Social Security data, and current medical reports. Your medical history is very important and should be complete and updated. All of the above information helps the counselor determine whether you qualify for VR and what type of services are needed. The reports you share with the counselor are kept confidential.
When an application for rehabilitation is approved, the counselor and client develop an Individualized Written Rehabilitation Plan (IWRP). The plan describes in detail the person's employment goals and the services VR will provide. Your IWRP spells out how VR will assist you and what you are expected to accomplish. Regular reviews are made of your plan. If your condition changes the IWRP will be revised accordingly.
The IWRP contains the following information:
- Reasons why you are eligible for VR services
- Long range employment goals
- Intermediate plans to accomplish goals
- Services provided by VR
- Starting and ending dates for services
- Estimated cost of services
- How and when the plan will be reviewed
- A statement of your responsibilities including payment of some services if necessary
- A statement that you understand and approve the program and have been informed of rights and appeal process
- Criteria for deciding when you are rehabilitated
- Any plans for providing services after you are employed
The IWRP is very important. It becomes the written plan of action between the client and the state agency. Individuals need to work closely with the counselor to make certain that the plan accurately and fully describes a program which will help them reach their vocational goals. It is also a good idea for clients to share the IWRP with their physician and physical and occupational therapist. These professionals can determine if the activities are appropriate and will benefit the client.
In most cases, disagreements over a person's rehabilitation services or plan can be settled between the counselor and client. However, any decision or action that a client is not satisfied with can be appealed.
The steps in appealing decisions of the VR counselor are:
- Personally check with the counselor to make certain his or her decision is final.
- Ask the counselor's supervisor to review the decision.
- Meet with the counselor and supervisor. The supervisor will make a decision within ten days of the meeting.
- If dissatisfied with the supervisor's decision, ask for a review by the VR District Supervisor. This is called an Administrative Review.
- If dissatisfied with the District Supervisor's decision, request a Fair Hearing. This is a formal meeting before the State Director of VR or his/her representative.
- If dissatisfied with the Fair Hearing decision, ask for a review by the U.S. Secretary of Education in Washington D.C. This is the last step and final decision of an appeal.
Arthritis can often present a confusing picture especially when the illness involves "good days and bad days". One counselor's evaluation may not reflect all the problems a client is having with arthritis. It is important to pursue the steps in the appeal process to be sure you get the services and programs for which you are eligible.
Each state is required to have a Client Assistance Program (CAP). This agency helps clients work out any problems they may have with their counselor or program that they have been unable to correct themselves. Assistance from CAP is especially important when:
- the client and counselor have major disagreements over the IWRP or
- the client is considering an appeal.
Independent living centers
Independent Living Centers (ILC) are funded by federal and state government. They coordinate the services that enable people with disabilities to remain independent within the community. The centers also provide assistance in understanding and obtaining the rights and benefits of programs like VR. They will serve as an advocate when problems arise.
To locate the ILC that serves your area look in the telephone book under "Independent Living Center" or call your local Arthritis Foundation chapter or VR office.
How VR affects other benefits
Disability Insurance Benefits (DIB) and Supplemental Security Income (SSI) will continue when you enter a rehabilitation program. However there are two instances when benefits could be discontinued:
- If an individual refuses rehabilitation services without good cause.
- If Social Security determines an individual has medically improved and is no longer disabled under the Social Security guidelines. All people who receive disability benefits are periodically reviewed.
There are a number of work incentives offered by Social Security for people with disabilities who return to work. These incentives protect the person financially until the individual can pay his or her own way and obtain other health insurance. Some of these incentives include:
- Trial work period
- Continuation of benefits (DIB and/or SSI)
- Continuation of health insurance (Medicare and/or Medicaid).
Federal regulations may change from year to year so check with the local Social Security or VR office for the current rules regarding disability benefits VR services and work incentive programs.
How to make VR work for you
Facts about VR
If you decide to apply for rehabilitation services there are some important facts you should keep in mind.
- Vocational rehabilitation is not a "make work" program. It helps people with disabilities find and keep employment.
- The agency serves all types of disabilities.
- Counselors often handle more than 100 clients at any one time.
- Arthritis is not well understood by many counselors and other VR personnel.
You are responsible for making sure that the rehabilitation plan developed by you and your counselor meets your needs.
- Discuss with your physician the extent and future outlook of your arthritis.
- Discuss with your physician and a physical and occupational therapist how arthritis affects your ability to work.
- If presently employed talk to your employer about modifying the work situation to meet your needs. An occupational nurse in your work site may be helpful in documenting problems you are having with arthritis.
- Discuss with your family how VR services may temporarily change family lifestyle.
- Initial contact to VR is made by you or someone you know. The agency will not seek you out (Unless Social Security contacts you).
- Complete paperwork on time and provide all the necessary information. Make certain physicians and other health professionals do the same.
- Provide specific information regarding how long you can stand and sit, how far you can walk, your need for self-help devices, and your overall strength and endurance.
- Set realistic career or employment goals. Consider how arthritis honestly affects your ability to work.
- Provide the counselor with information about arthritis if necessary. Arthritis Foundation pamphlets are a good resource.
- Keep the counselor informed of any changes that may affect your IWRP (health financial progress in school or training programs
- Meet financial commitments.
- Meet deadlines and scheduled meetings with your counselor.
- Understand your IWRP.
- Understand your rights.
- Resolve small problems before they become major concerns.
- Ask questions. You need to be the coordinator of your program!
Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK contact the National Helpline: (800) 283-7800.
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