HIV and rehabilitation management.
Having had this experience, as an employer who has dealt with the reality of HIV in the workplace, I feel a special obligation to contribute, in every way possible, to the improvement of services available to people with HIV.
Because good management always sets the direction and tone for delivering services in any agency, rehabilitation agency administrators and program managers should take the lead in developing a comprehensive and informed response to HIV. A definitive agency policy on HIV along with the provision of appropriate staff training should be at the core of such a response and would signal management's commitment to serving eligible people with HIV.
Educating consumers and others about eligibility for rehabilitation services is one of management's perennial tasks. As most readers of this journal know, basic vocational rehabilitation services provided under the Rehabilitation Act can only be offered to people with a physical or mental disability which is an impediment to employment. VR services must be required to achieve an employment outcome. Further, each eligibility decision must be made on an individual basis, not for groups of people with a given disability. Unfortunately, advocates often mistakenly assume that a person who has a certain severe disability is automatically eligible for vocational rehabilitation services. This assumption is not true. Advocates frequently confuse eligibility for vocational rehabilitation with entitlement to programs such as special education for youth. VR can offer needed services only to those HIV infected persons who are eligible for VR services. We need to take the lead in helping these clients become eligible. An educational process needs to be initiated to assure that advocates of persons with HIV understand the VR eligibility criteria and service delivery potential. People with HIV and their advocates need to be educated on the following basic VR eligibility criteria:
* there must be a physical or mental disability;
* this disability must be an impediment to employment for the individual; and
* the individual must require VR services to achieve an employment outcome. Where employment is not a goal, agencies should not overlook the use of independent living resources.
Rehabilitation managers have numerous considerations when developing a policy in response to HIV. This could take the form of an umbrella policy on life-threatening illnesses in general or an HIV-specific policy. The policy would spell out when such individuals might be eligible for traditional rehabilitation services, facilities, programs, or independent living services. The agency policy might address such issues as:
* availability of comparable services and benefits;
* extent of agency medical payments;
* prohibition on purchase of experimental drugs and treatment;
* providing equipment and services for people who may not be medically stable;
* using independent living services as a resource; and
* establishing categories of risk classification for staff in all routine and reasonably anticipated job-related tasks (including identifying those tasks which might expose staff or clients to body fluids, such as daily living skills instruction in cooking or instruction in insulin injection for blind clients).
Developing standard operating procedures (SOP's) for work tasks which might cause exposure to body fluids may be considered. These could include mandatory work practices and use of protective equipment. Unfortunately, this may well be an issue of employer liability and could even creep into future union contracts.
Foremost in any policy should be respect for the individual and his/her rights. Confidentiality of all health records must be maintained. People with HIV, whether clients or staff, may be physically disabled and are therefore protected by Section 504 of the Rehabilitation Act with regard to employment. They are also protected by the Americans with Disabilities Act (ADA).
Marketing this Service
VR, which has been a traditional resource to employers, can take a leading role in disseminating information to break down barriers to employment for individuals with HIV. Agencies can establish employer advisory groups and offer technical assistance or educational programs at the worksite to help educate employees about co-workers with HIV. This effort could assist employers and their work force to be more receptive to working with these individuals. However, the VR agency or facility needs a clear policy on how it will treat employees with HIV in order to give confidence and credibility to agency staff making such educational presentations to the public.
Agency Educational Programs
An education program for all employees is advised and would help implement an agency's policy. The rapid spread of HIV to all segments of society necessitates that all employees learn and practice appropriate infection-control procedures to assure workplace safety.
Education programs would accomplish several objectives:
* provide employees with the information they need to make informed choices to reduce their risk of exposure;
* share information and skills training for infection control and prevention; and
* promote a nondiscriminatory, compassionate response to co-workers and clients with HIV.
In addition, management can ensure that agency medical consultants and the state disability determination unit are also educated on this critical issue. VR agencies may wish to offer their training to other rehabilitation facilities, Client Assistance Projects (CAP's), private rehabilitation providers, independent living centers/programs, and other sources of rehabilitation services in the state.
Rehabilitation managers can greatly improve their services to eligible people with HIV by working with other organizations and service providers. Developing cooperative agreements and initiatives with these groups--which should include state health departments and organizations formed specifically to assist people with HIV is important. Since many people with HIV might benefit from independent living services, agreements with these service providers should be made in advance of referral. Outreach procedures could be developed to encourage referral of potentially eligible clients.
Rehabilitation managers can demonstrate a commitment to serving those with HIV in many ways. They can develop a case coding for tracking when HIV is a factor in eligibility determination. They can direct outreach efforts to encourage people with disabilities and HIV to apply for services. They can be creative in identifying possible sources of rehabilitation services. As an example, VR professionals should consider using independent living programs to provide services. VR agencies serving blind people frequently have people with HIV referred to them who need training in alternative techniques of performing everyday household activities. Many of these agencies have used independent living services to maximize their clients' abilities to live at home with dignity.
It is important for rehabilitation managers to monitor caseload assignments to prevent overloading staff who have a high rate of success or who volunteer or specialize in serving persons with HIV. "Burnout" is reportedly a real problem for staff confronted with caseloads of people with HIV. The appropriateness of such specialized caseloads should be dictated by the incidence of HIV in a specific geographic area, agency size, state population, and the need to develop highly trained liaisons with other public and private service providers.
Some staff, overly concerned about "unsuccessful closures," may tend to avoid serving clients who have HIV. Even worse, some employees may refuse to work with co-workers or clients who have HIV; counseling and perhaps disciplinary measures may be needed to remedy these situations.
To stay current with developments in services to people with HIV staff also require ongoing training. Additionally, training in coping with issues of death and dying could be offered to direct service providers.
It is also important for rehabilitation managers to consistently evaluate the rewards and recognition they provide to all their staff, to ensure that service providers' needs are met with the same care as are the needs of the people they serve. Because people with HIV can benefit from VR services, they should be offered the same opportunities to work that our society endeavors to make available to people with other disabilities.
Yet, we also need to be aware of the possibility that eventually some people with HIV may become too ill to contribute effectively. I have seen a good counselor eventually became too ill to perform his duties and I have seen how his co-workers were required to carry too much of his workload. At such a point, VR managers may have to intervene, so that everyone concerned will be able to deal with this highly emotionally-charged situation.
I know that my experience is not unique. Many rehabilitation agencies, facilities, and independent living centers have had employees with HIV and have served clients with HIV as a primary or secondary disability. Unfortunately, it appears that state agencies and facilities will continue to be confronted with the issue of HIV in future years. It is therefore imperative that management address this issue promptly and explicitly.
Mr. Young is Administrator of the Oregon Commission for the Blind and Past President of the Council of State Administrators of Vocational Rehabilitation (CSAVR).
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|Author:||Young, Charles E.|
|Date:||Sep 22, 1993|
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