The role of the rehabilitation professional in corporate disability management.

There are about 23 million people with disabilities in the United States, with nearly one-half of them experiencing severe disabilities (Eckenhoff, 1984). Each year, about one-half of one percent of employed persons in the U.S. must stay off their jobs for at least five months because of a disabling injury or illness (Hester & Decelles, 1985). These empployees present a multifaceted problem to employers. Their absences contribute to losses in productivity, lead to complications in reassigning work or in replacing them and place a financial burden on the company to support them.

In the past, employers traditionally did not become involved in the problems of workers with disabilities because there was little business advantage to doing so. In recent years, however, a number of economic and social changes have occurred which have had a profound effect on the way employers run their business and the benefits they provide their employees. These changes include: rising medical costs associated with disability; the aging of the workforce; and intensified competition from foreign businesses which has driven down the profit margin. As a result, some employers are becoming more active in managing the disabilities experienced by their employees. Their challenge is to get more workers with disabilities back in a job, thereby returning them to a productive status in society.

The irony of the situation is that in spite of these changes and increasing costs, many companies still invest nothing to maintain their employees' health or to intervene with help when an injury or illness strikes. This may be due to any of the following reasons: 1) employees with disabilities are not a "visible" group in the everyday operation of a business; 2) wage replacement programs (in the past) may have been only a minor aspect (financial) of a larger health/benefits program (Rickard, 1985); 3) a failure to realize the long-term benefits from up-front costs of a rehabilitation (Parham, 1984); 4) skepticism about the payoff from in investment in rehabilitation services (Carpenter, 1985); 5) an unawareness of available options and programs or how to implement them (Parham, 1984); or 6) due to "traditional ways of doing business," corporations have accepted writing off employees with disabilities and compensation claims as legitimate costs of business (Eckenhoff, 1984). Today, none of these reasons has a sound business foundation.

The rehabilitation community is a natural resource to help employers face this challenge because of its ability to assist in establishing and maintaining disability management programs. Yet, there is little information to guide rehabilitation professionals in the areas with which employers seem most to need assistance. To help meet this need, the Research and Training Institute at Human Resources Center, Albertson, New York, completed a nationwide survey of how companies of varying sizes handle employees who experience a disabling injury or illness. The goals of the study were to ascertain why companies establish disability management programs, and to identify areas in which rehabilitation professionals can respond most appropriately to meet employer needs. Concerns affecting the start-up of disability management programs and their day-to-day implementation have previously been discussed to acquaint employers with basic policy, organizational and operational issues that need to be addressed prior to creating a program (Gottlieb, 1988; Gottlieb, Vandergoot, & Smart, 1987). Previous research has also provided some much needed general information about disability policies and practices among large employers nationwide (Institute for Rehabilitation and Disability Management, 1986). Information, however, about how medium and small businesses approach the problem of disability is scarce (Galvin, Tate & Schwartz, 1986). Furthermore, the gathering and reporting of programmatic information for rehabilitation professionals has been lacking. There is a need for guidelines to show rehabilitation professionals (and employers) how to collaborate in implementing disability management programs. Rehabilitation professionals, as well as employers, need such information to help control costs and to facilitate retention of the growing population of individuals with disabilites who want to remain productive.

Information of this type could go a long way toward the development of more comprehensive disability management programs in the future.

Method

Subjects

Corporations and employing organizations of the Industry-Labor Council (ILC) and/or the New York Business Group on Health (NYBGH) were surveyed in 1986 on their policies, programs and practices designed to minimize the impact of disability on their employees and on the corporation itself. The ILC, based at Human Resources Center, is a group of national corporations and labor unions which have a commitment to employing individuals with disabilities. Corporate members represent virtually all industries found in Fortune 1000 companies. The NYBGH is a nonprofit group of New York area businesses, healthcare providers, labor organizations and governmental agencies concerned about the quality of health care services and the impact of disability on employee well-being and productivity.

At the time of sample selection, there were 103 corporate members of the ILC and 267 member organizations in the NYBGH. An overlap of seventeen (17) companies, which were members of both organizations, reduced the initial population size from 370 to 353 companies. Although the sample was not representative or randomly selected, in that it originated from organizations whose members may have had more access to disability-related information and/or inclination to provide disability-related services, it did provide access to employers in a wide range of sizes, industries, and services. Access to small and medium-sized companies was considered especially important, as information about corporate disability management practices (e.g. Washington Business Group on Health, 1986) has focused predominantly on large, national corporations.

Instrument

A six (6) page written survey was divided into three content areas: 1) company background, which included information about size, industry and unionization; 2) program characteristics, which included questions about activities, achievements, administrative structure, procedures for initiating and maintaining contact with employees, types of costs and cost-effective measures, use of outside resources and problem areas; and 3) questions for companies which did not have a disability management program, asking why they did not have a program and what benefits they perceived could result if a program was initiated. There were 25 items to answer if a disability management program existed. They consisted of checklists and some open-ended questions. There were 7 items to answer if no program existed.

The survey was designed to be completed by the corporate representative in charge of the company's disability management activities or whoever was most familiar with the company's policies and practices related to disability. A cover page included instructions, a definition of disability management, and assurances of confidentiality. It was intended for the survey to take about twenty (20) minutes of the respondent's time.

Analyses

Descriptive statistics were obtained on all questions. Background information was used to form groups of companies which were then compared regarding characteristics of their disability management programs by using chi-squares, t-tests, or analyses of variance, depending on the measurement characteristics of the variables tested. Non-parametic tests were used when the distribution of data was markedly skewed and cell sizes were small.

Results

One hundred fourteen companies (31%) of differing sizes, industries and union status responded to the survey (See Table 1).

Results of the survey results suggest several areas in which the rehabilitation community can become involved in corporate disability management. They are:

* Providing overall information about the value of disability management;

* Suggesting ideas about what specialized activities/services to offer as part of a disability management program;

* Conducting training on how to implement a case management approach; and

* Providing case management and evaluation services.

                        Table 1
                Respondent Characteristics
Characteristic                         % companies (N=114)
Primary industry/service
  Business services                               37(41)(a)
  Manufacturing                                     21(23)
  Finance/insurance                                 21(23)
  Transportation/public utilities                   12(13)
  Wholesale/retail trade                              7(8)
  Other                                               3(3)
Size (# employees)
  100 or less                                       23(23)
  101 to 1000                                       23(23)
  1001 to 10,000                                    25(25)
  10,001 to 50,000                                  21(21)
  50,001 to 100,000                                   5(5)
  Greater than 100,000                                5(5)
Unionization
  Unionized                                         48(49)
  Non-unionized                                     52(54)
Location (state)
  New York                                          66(75)
  New Jersey                                          8(9)
  Illinois                                            6(7)
  Connecticut                                         5(6)
  Pennsylvania                                        4(5)
  Other                                             11(12)
  Note: Percentages in some categories may not total 100% due to
rounding of figures.
  (a) Numbers of responses are in parentheses.

Providing Overall Information About the

Value of Disability Management

In the survey, 62 percent of the responding companies indicated they had set up a disability management program. A little over one-third, therefore, reported having no disability management program or set of procedures to control disability in their workforces. Of these companies without programs, almost 60 percent felt they could benefit from having one, and 42 percent indicated they would like to start one. Most indicated no particular reason for not starting one. Others gave such reasons as small size, budget restraints, administrative burdens, and a feeling that they needed additional evidence of the effectiveness of such programs.

These results suggest that not only are employers interested in the advantages of actively managing disability experienced by their employees, many have initiated specific or full-fledged formal disability management programs. Private rehabilitation vendors, insurance carriers and others have also begun to provide services to these companies to help return employees to the workforce as soon as possible after the onset of the disability. The market for such services, therefore, is significant and growing.

Many companies are now beginning to realize that they must be concerned with HOW to implement a disability management program, not WHETHER to implement one. Many are being convinced that simply allowing people to drop out of the workforce is no solution because retirement medical benefits and disability benefits are major costs that eventually must be borne. Considerable gaps in information remain, however, especially about the role of the rehabilitation community in helping to reduce costs and to maintain a productive work force. A clear opening exists for rehabilitation professionals to take an active stance in this education process.

Suggesting Program Activities/Services

Survey results suggest these are three components of a comprehensive disability management effort. The first, and basic component, offered by virtually all companies in the survey, is financial support. It includes the provision of and assistance with short and long-term disability benefits as well as workers' compensation benefits. A second component centers around primary prevention activities, which include services that minimize the risk of acquiring a disability. These can include wellness and safety programs, formal employee assistance programs and other counseling support systems. These types of activities were present in about two-thirds of the responding companies. The third component involves secondary prevention activities which provide post-disability services. It includes various early medical and rehabilitation approaches with an emphasis on a speedy return to work. About a third of the companies offered such services as part of a more comprehensive approach to disability management.

Two-thirds (66%) of the companies offered services and activities from all three components. Another quarter (23%) offered a combination of basic benefits and primary prevention services. Eleven percent provided the basic financial support alone. These results illustrate that there is a range of activities that business personnel consider to be legitimate "disability management." There seems to be significant room for rehabilitation professionals to suggest and assist with program services on prevention and intervention levels.

Most company programs served all types of disabilities, including physical, psychiatric and substance abuse cases. A majority (70%), however, did not provide alternative procedures or services for specific disabilities, although some companies (15%) did have separate programs for employees with alcohol or controlled substance abuse problems. The rehabilitation community can provide a needed service to employers by more fully exploring the advantages of having non-discriminatory policies and procedures that are applicable to all individuals regardless of disability vs. having specialized policies and procedures for individuals with selected disabilities. The degree to which tailored practices meet specific needs for a particular disabling condition would be crucial to the success of such programs, and the rehabilitation community with its specialized knowledge could provide such a vital service to business.

                        Table 2
   Reasons For Companies to Start Disability Management
                       Programs
Reason                                 % companies (n=71)
Internal factors
Concern with employee welfare                         77
Increased use of benefits                             54
Loss of productivity                                  39
Loss of experienced workers                           24
External factors
Increases in insurance premiums                       52
Changes in covered services                           10
Changes in reimbursement provisions                    7
Union pressure                                         3
Other factors
Response to statutory requirements                     1
General cost management                                1
Orientation of organization                            1
Part of total benefits package                         3
To provide competitive benefits                        1
Good medical practice                                  1
  Note: Data are reported only for companies having a program.  Percentages
do not total 100% due to companies having multiple
reasons.  The "internal" and "external" factors were listed on the
survey.  The "other" factors were offered by respondents.

Conducting Training

A large proportion of the companies in the survey indicated that they developed and operated their programs because of their concern for employee welfare (Table 2). They also cited the increased use of disability-related benefits by employees and increased costs associated with insurance premiums. These companies were also positive about the value of their programs, feeling that they improved employee welfare, increased productivity, helped to retain experienced workers, increased safety consciousness and controlled costs.

In spite of these positive concerns and beliefs about achievements of program activities, it was surprising to find that about half (35) of the companies with programs indicated that they informed new employees about the disability management program only when they were hired. Thirteen percent (9) waited to inform employees at the time of injury. While an additional 32% (23) of the companies reported informing employees at both times, this still indicates that fewer than half of the companies made an effort to tell injured or ill workers about the disability management program at the time the disability occurred. A lack of information at this point could retard delivery of rehabilitation services and minimize chances for eventual success. Rehabilitation programs must emphasize to employers the need to inform workers and prepare them to participate in return-to-work activities as soon as possible after illness or injury.

Furthermore, only about 40% of the companies reported the existence of procedures for effectively identifying likely long-term disability cases from short-term cases--not as high as might be expected considering the importance placed on early identification and intervention in the literature as an integral component of disability management (e.g., Galvin, 1986). Slightly under one-half of responding companies also indicated they did not follow-up with employees after their cases are closed--either when the employee retires, returns to work, or becomes "permanently disabled." This lack of desire or ability by some employers to provide information on a timely basis, to identify employees who may unnecessarily experience long-term problems, or to follow through with those individuals who have experienced a disability points to the urgent need for information and/or training in these areas. The rehabilitation community might well focus on developing practical "how-to" guidelines on the importance of case management services and training corporate providers in how to implement a total case management program, including the potential for cost savings, retraining workers and minimizing residual disability-related problems.

Return-to-Work Alternatives

As the rehabilitation community is aware return-to-work options are a vital component of an overall rehabilitation strategy. Table 3 highlights these options as reported by responding companies. The most frequent types of approaches provided different work or reduced work requirements.

Some were permanent while others were intended to be temporary. Some provided a transition to full-time, regular work. It is important to note that almost two-thirds (35) of the companies provided physical accommodations which can be used to overcome functional limitations associated with disability. The number of return-to-work alternatives ranged from one to nine, with a mediam of four per company. There was quite a range, therefore, in company policies which provide ways to encourage a worker to return to the workforce.

                        Table 3
     Return to Work Alternatives Offered by Companies
Alternative                            % companies (n=55)
Light duty                                        80(44)(a)
Other jobs in company                               75(41)
Flexible/shorter hours                              73(40)
Physical accommodations                             64(35)
Transitional jobs                                   45(25)
Trial work                                          35(19)
Out-placement                                       33(18)
Telecommuting/home-based work                        15(8)
Others (e.g. transportation to/from work)             4(2)
  Note: Data are reported only for companies offering return to work
alternatives of any kind.  Percentages do not total 100% due to
companies offering multiple alternatives.  Companies offering return
to work alternatives included 78% (55) of respondents with
programs.
  (a) Numbers of responses are in parentheses.
    Table 4
  Services Supplied by External Resources for Companies'
              Disability Management Programs
Resource                               % companies (n=71)
Evaluation services (69%)
Rehabilitation vendor                                 28
Consultant                                            31
Contractor                                             7
Insurance company                                     39
Other                                                  3
Case management services (59%)
Rehabilitation vendor                                 24
Consultant                                            14
Contractor                                             7
Insurance company                                     39
Other                                                  3
Training services (25%)
Rehabilitation vendor                                 13
Consultant                                            11
Contractor                                             3
Insurance company                                      4
Other                                                  0
Other services
Rehabilitation vendor                                  3
Consultant                                             4
Contractor                                             1
Insurance company                                      7
Other                                                  3
Any of the above resources                            17
Any of the above services
Rehabilitation vendor                                 34
Consultant                                            39
Contractor                                             8
Insurance company                                     55
Other                                                  6
Note: Data are reported only for companies having a
program.  Percentages
do not total 100% due to companies utilizing multiple
resources and services (59%).

It was disturbing to find that nearly one-quarter (16) of the respondents reported that no return-to-work alternatives were offered by their companies. This reported absence of options might be due to a lack of information about practices which may occur informally between workers and their supervisors or department heads; or it may truly reflect formal company policy that such alternatives are not allowed nor viewed as essential components of a disability management effort. In either case, rehabilitation professionals could address this gap in information or perceived lack of need by training company personnel to ensure all practices are coordinated and implemented in the best interests of the company and its workers.

Providing Services

Companies in our survey purchased three classes of services through external resources to support their disability management programs (Table 4). These included: evaluation services; case management services; and training services.

Evaluation services were reportedly purchased most frequently, with case management services following closely. Training services were purchased through external resources in only 25 percent of the programs. Companies indicated they purchased these services most frequently through insurance companies and rehabilitation vendors, although other types of contractors and consultants were also used. These findings suggest that most companies use a variety of vendors to provide services, which may be due to a fear of becoming too dependent on one provider or may reflect a constant search for better providers. Perhaps no single third-party vendor provides the full scope of services needed, and a company must therefore rely on several outside resources.

Fulfilling this need for external experts is precisely what the rehabilitation community can offer. Mutually beneficial relationships can be built if rehabilitation professionals market themselves to answer this need by tailoring services specifically for company programs. Providing disability management services through these partnerships can also open doors for the hiring of other people with disabilities referred by the rehabilitation program. Competition definitely exists, and the rehabilitation professional or organization wishing to enter this expanding market will need to have specific knowledge of the individual companies with which they wish to do business.

Conclusion

The efficacy of rehabilitation still needs to be proven to many in the business community, even though the goals of rehabilitation programs-- to save money, improve productivity, and improve morale--parallel that of business, and in spite of the increase in rehabilitation efforts by many other employers.

Implications for Rehabilitation Professionals

As suggested by the results of this survey, providing information, training, and hands-on services are all avenues through which the rehabilitation community can respond to the needs of businesses. The specific types of interaction and support, however, that will best meet an individual employer's needs and result in the establishment of a mutually beneficial relationship must be based on a careful assessment and understanding of the company and its workforce.

The rehabilitation community must educate itself in how to work with companies, as well as with individuals, in their rehabilitation efforts. Graduate programs in rehabilitation need to incorporate into their curricula the concept that businesses as well as individuals are consumers of their services (Habeck & Ellien, 1986). In-service training programs for practitioners already in the field need to provide information and materials about how to market and publicize their services to employers. Administrators need to provide the guidance and time to do so. Just as individual consumers have varying needs, so do businesses: services need to be tailored for employer disability management programs based on an assessment of their individual situations.

It is also likely that state and federal governments will become increasingly concerned about the impact of disability, especially as costs continue to rise. Employers need to anticipate this realistic concern and be prepared to address it. This preparation should include a strong base of information on which to frame both legislative and corporate policies. The rehabilitation community can provide a real service by working with the business community to help prepare this information.

Finally, as companies experiment with disability management approaches, rehabilitation professionals could work with them to implement a management information system that carefully monitors the characteristics of those using the system, the services they receive, and the costs and benefits associated with the program. Rehabilitation professionals who are experienced with database development and with the types of information that would be relevant could help set up such systems. The knowledge extracted from these information systems would be valuable in helping to make policy and program decisions about how to implement a disability management system, and would serve as a monitoring mechanism to evaluate the effectiveness of program activities. It could also be shared with medical and rehabilitation service providers so that continued improvements can be made to the programs and to the rehabilitation services provided.

Further Study

There is an underlying assumption of a disability management program that the employee who participates in prevention or intervention activities offered by the company will benefit from the program, which turns back into an advantage for the employer. Active and timely management of the worker's case, with its associated medical, vocational, personal, financial, legal, and other problems is believed to assure the worker that his/her difficulties will be minimized and that services offered will optimize a return to a productive status. In short, this support structure is believed to be mutually beneficial to the employer and employee.

To date, however, the experiences and benefits of employees as perceived by them have not been systematically documented. Opinions and experiences of individuals participating in such programs and interventions are not known. The potential information available from them, as consumers, has not been collected. Such information could be vital to improving the "track record" of disability management activities within a particular company or across companies.

It is also true that evidence to date for the cost effectiveness of such programs is not overwhelming. Most of the rationale for disability management is theoretical and often based on common sense. There is the belief that disability management is the proper, humane approach which is in everybody's best interests. Data such as that collected in the current survey, are validating this current rationale.

References

Carpenter, E. (1985). Roadblocks to rehabilitation. Business & Health, 2, 22-24.

Eckenhoff, E. (1984). Medical rehabilitation for disabled employees. Business & Health, 1 (6), 29-31.

Galvin, D.E. (1986). Employer-based disability management and rehabilitation programs. In E.L. Pan (Ed.), Annual review of rehabilitation (pp. 173-215). New York: Springer.

Galvin, D.E., Tate, D.G., & Schwartz, G. (1986). Disability management research: Current status, needs and implications for policy. The Journal of Applied Rehabilitation Counseling, 17 (3), 43-48.

Gottlieb, A. (1988). Employment trends: Disability management. Wolklife, 1 (2), 33-34.

Gottlieb, A., Vandergoot, D. & Smart, L. (1987). Managing disability in the workplace, Discussion Paper, Vol. 7 Supplement No. 1. New York: New York Business Group on Health.

Habeck, R. & Ellien, V. (1986). Implications of worksite practice for rehabilitation counselor education and training. The Journal of Applied Rehabilitation Counseling, 17 (3), 49-54.

Hester, E.J. & Decelles, P.G. (1985). The worker who becomes physically disabled: A handbook of incidence and outcomes. Topeka, KS: The Menninger Foundation.

Institute for Rehabilitation and Disability Management, 1986. State of the Art: Corporate behavior in disability management results. Washington, DC. Author.

Parham, J. (1984). Rehabilitating disabled workers. Dun's Business Month, 123 (6), 80-82.

Rickard, W.H. (1985). The rehabilitation of long term disability claimants. Monograph. (Other information unavailable).

AMY GOTTLIEB, Research and Training Institute, National Center on Employment and Disability, Human Resources Center, Albertson, New York 11507-1599.