Dementia rises in aging workforce
Dementia rises in aging workforce
Forgetfulness may be an early sign
The housekeeper had always done a thorough job cleaning patient rooms, but lately her work was haphazard. When a supervisor pointed out things she'd missed, she said, "Oh, I must have forgotten." Forgotten? How could you forget how to do a job you'd done every day for 30 years?
Memory loss is one early sign of dementia, and as it turned out, the employee was in the early stages of Alzheimer's Disease. It was, in some ways, a sign of the times. As the nation's workforce ages, mental impairment in the workplace is becoming a growing problem.
Hospitals increasingly are navigating concerns about their employees' well-being with the need to maintain patient safety and quality care. Deficits may seem to emerge at an earlier stage in people who have jobs that require a higher level of cognitive functioning, says Gabor Lantos, MD, PEng, MBA, an occupational medicine physician and president of Occupational Health Management Services in Toronto. "It becomes more apparent and critical," he says.
Typically, the performance issues that occur with early dementia are initially addressed with the usual disciplinary steps. It's up to frontline management to talk with the employee and consider contacting employee health, Lantos says.
"There's no harm in a supervisor sitting down with them and saying, 'I noticed you're working slower, you seem distracted, you're not your happy, usual self. Have you had a check-up lately?' It's all a question of how you approach it," he says.
Alzheimer's cases will skyrocket
That topic is more likely to arise than ever before. About 5.4 million Americans have Alzheimer's Disease, but that number is expected to increase to 16 million by 2050, according to the Alzheimer's Association. Two-thirds of those with Alzheimer's are women.
While Alzheimer's Disease risk rises with age, about 200,000 people under 65 have "young onset," the Alzheimer's Association says. Dementia-like symptoms also may arise after a stroke or from other illnesses.
The first signs may include forgetfulness, difficulty concentrating, or frustration with tasks. At Henry Ford Macomb Hospitals in Clinton, MI, when the work of a long-time environmental services worker began to slip, supervisors suspected a medical problem. Broaching the issue was delicate, particularly because of the limits of the HIPAA privacy rule.
In this case, the employee suggested contacting her daughter. "We started partnering with the family to keep our employee working," says Betty Kuschel-Rapaski, RN, BSN, COHN-S, clinical manager of Employee Health Services. "We are trying to be very, very sensitive to our employees and their physical needs, dignity and respect."
The employee completed re-training and now uses a checklist to make sure she remembers all her necessary job tasks, Kuschel-Rapaski says.
Follow your HR policy
It's important to have a human resources policy to follow whenever a person's job performance suddenly begins to change, says Curtis Chow, NP, PA-C, COHN-S, employee health coordinator at Mercy Medical Center in Redding, CA. Such changes could be due to stress, such as a divorce, or substance use, such as prescription drugs, he notes.
"There needs to be a strong, interactive process that includes the responsibilities of the manager, human resources and the employee," he says.
While the discussions may begin informally – with a supervisor simply asking, "Are you feeling okay?" – the usual disciplinary steps should be followed for job performance problems. At the same time, there may be an evaluation by employee health and/or a referral to an employee assistance program, Chow says. (For advice on accommodating early dementia, see box on p. 34.)
The Americans With Disabilities Act (ADA) requires employers to accommodate a "known disability." If an employee doesn't ask for an accommodation, there's no obligation to provide one "except where an individual's known disability impairs his or her ability to know of, or effectively communicate a need for, an accommodation that is obvious to the employer," according to the U.S. Equal Employment Opportunity Commission.1
"Raise the issue in a non-judgmental, non-discriminatory fashion, in a concerned fashion," advises Lantos.
Lantos recalls a case of a nurse who had been disciplined for deterioration in her job performance. After 30 years of exemplary work, she suddenly began making errors. A brain scan revealed that she had had lacunar infarcts – tiny strokes. Instead of being terminated for poor job performance, the nurse went on long-term disability.
Reference
1. U.S. Equal Employment Opportunity Commission. Americans With Disabilities Act: Questions and Answers. http://1.usa.gov/8jyopH. Updated on November 14, 2008. Accessed on January 15, 2012.
The housekeeper had always done a thorough job cleaning patient rooms, but lately her work was haphazard. When a supervisor pointed out things she'd missed, she said, "Oh, I must have forgotten." Forgotten? How could you forget how to do a job you'd done every day for 30 years?Subscribe Now for Access
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