How Can We Help Workers with Medical Conditions Stay Employed?
Each year, more than two million workers leave the labor force, at least temporarily, because of an injury or illness that prevents them from working. The absence from work takes a toll on workers and their families, their employers, and the government programs they often rely on for income and other supports.
Some research suggests that if government programs could identify and assist workers early— ideally when they are still in their jobs—the employees would be more likely to stay at work or return to work after a short absence.
On this week’s episode of On the Evidence, we take a deep dive into the topic of interventions for workers who have begun to miss work because of an injury or illness and are at risk of prolonged or even permanent exit from the labor force. Specifically, we discuss the need for providing assistance early—within the first several weeks of missing work—before the employee’s absence from work has become normalized. Our guests include the following:
- Annette Bourbonniere, a research associate at the University of Rhode Island’s department of environmental and natural resource economics, who also owns a consulting business that helps companies hire, accommodate, and retain employees with disabilities.
- Jennifer Christian, the cofounder, president, and chief medical officer of the Webility Corporation, a firm focused on speeding the recuperation of ill and injured employees and supporting the continued employability of those who are aging, chronically ill, or functionally impaired. Dr. Christian is also a physician who is board certified in occupational medicine.
- Yoni Ben-Shalom, a labor economist and senior researcher at Mathematica who specializes in policies and programs related to the employment and income of people with disabilities.
Click here to listen to the full conversation. You can also read an abridged version of the conversation in the following edited Q&A.
Why are workers who leave work because of injury or illness a priority for policymakers, and what’s at stake when people develop health problems that keep them away from work?
Ben-Shalom: The most immediate effect is for individual workers and their livelihoods. They are at risk of losing their main source of income, and if they leave their jobs around age 45 or 50, they could be losing a flow of income for themselves and their families for 20 years.
From a public perspective, if the workers end up entering a federal program, such as the Social Security Disability Insurance Program, and are on the program for 20 years, that will be quite a large expense over time. They would also receive health insurance benefits from Medicare, which obviously incurs additional costs.
Bourbonniere: Besides losing the paycheck and the economic stability that comes with employment, the person that goes out on disability loses their whole social context. All their social contacts are with their employer. All their scheduling is related to work. Their whole lives become disrupted, and it is a very serious cause of depression.
Why is it important to identify people at risk of leaving work and provide interventions as early as possible?
Christian: When they develop a medical problem that interferes with their work, people may start changing their sense of who they are and what the future looks like. We want to catch them while the situation is fluid and they are still influenceable. Once people have made a decision about how they see something, they tend to collect evidence to support that point of view, and they tend to not be interested in evidence that points the other way. Once somebody has decided, “I’m too disabled to work, I’ll never work again,” we now are working uphill. If we can get to them while they’re still trying to sort out what’s possible, then we can have a better shot at making a difference.
What have researchers found with regard to programs or services that might help those workers?
Bourbonniere: In a study of Rhode Island’s mandatory short-term disability insurance program, we found that people who received partial return-to-work benefits that allow the transition back to normal employment also were more likely to return to work and had the shortest disability durations.
Christian: The Washington State workers’ compensation system uses a form called the Activity Prescription. The doctor is paid to counsel the patient about activity and complete the form, which is much more thorough than the usual note you get back from the doctor. If the employer is not sure what the Activity Prescription means, a health care service coordinator (who serves as a translator between the doctor’s office and the workplace) can ask the doctor, who is also paid for time it takes to answer questions. Having that person in the middle to clarify what the work capacity is and clarify what kind of protections the worker might need is really very helpful.
Ben-Shalom: And, according to an evaluation, Washington State’s approach improved the number of people who were employed at the end of the year by 20 percent.
What questions do you hope future research will answer about this group of workers and programs designed to help them?
Ben-Shalom: The federal government has rolled out a program called the RETAIN demonstration. RETAIN stands for Retaining Employment and Talent after Injury/Illness Network. It is a collaboration between the U.S. Department of Labor (DOL) and the Social Security Administration (SSA). DOL is providing grants to states to test their own version of the Washington model, and SSA is funding an independent evaluation of each state’s program. In full disclosure, Mathematica is the contractor for the independent evaluation, and I’m on that team.
I think we’re going to learn a lot from that program about what works from a public policy perspective. There are many challenges to overcome. Even if something worked in Washington State inside its workers’ compensation system, it’s a big question if that same approach will work in another state, on another target population, in a setting outside of workers’ compensation. So there are a lot of questions we hope to answer through the RETAIN demonstration.
More information on research related to stay-at-work and return-to-work programs and policies is available in the following journal articles, book chapters, and issue briefs:
Ben-Shalom, Yonatan. “Steps States Can Take to Help Workers Keep Their Jobs After Injury, Illness, or Disability.” Washington, DC: Mathematica Policy Research, September 2016.
Ben-Shalom, Yonatan, Steve Bruns, Kara Contreary, and David Stapleton. “Stay-at-Work/Return-to-Work: Key Facts, Critical Information Gaps, and Current Practices and Proposals.” Washington, DC: Mathematica Policy Research, February 2017.
Ben-Shalom, Y., and J. Schimmel Hyde. “Opportunities for Early Intervention to Avoid Prolonged Work Disability: Introduction to the Special Section.” Journal of Occupational Rehabilitation, vol. 28, no. 4, December 2018, pp. 569–573.
Ben-Shalom, Yonatan, and Steve Bruns. “DI Applicants’ Characteristics and the Implications for Efforts to Help Them Remain in the Labor Force.” Washington, DC: Mathematica Policy Research, December 2018.
Ben-Shalom, Yonatan, Jennifer Christian, and David Stapleton. “Reducing Job Loss Among Workers with New Health Problems.” In Investing in America’s Workforce: Improving Outcomes for Workers and Employers, edited by Stuart Andreason, Todd Greene, Heath Prince, and Carl E. Van Horn. Kalamazoo, MI: W.E. Upjohn Institute for Employment Research, 2018.
Bourbonniere, A.M., and D.R. Mann. “Benefit Duration and Return to Work Outcomes in Short Term Disability Insurance Programs: Evidence from Rhode Island’s Temporary Disability Insurance Program.” Journal of Occupational Rehabilitation, vol. 28, no. 4, December 2018, pp. 597–609.
Contreary, Kara, Yonatan Ben-Shalom, and Brian Gifford. “Worth the Wait? Improving Predictions of Prolonged Work Disability.” Washington, DC: Mathematica Policy Research, July 2018.
Stapleton, David, and Jennifer Christian. “Helping Workers Who Develop Medical Problems Stay Employed: Expanding Washington’s COHE Program Beyond Workers’ Compensation.” Washington, DC: Mathematica Policy Research, September 2016.