Serious illness in the workplace raises complicated issues for employers, including right to privacy, concern of fellow workers, accommodation and productivity. Breast cancer is one of the most prevalent serious illnesses. The diagnosis, treatment and ongoing monitoring of breast cancer can produce varying patterns of absence, degrees of debilitation and needs for schedule and/or workload changes. Yet, as strong anecdotal evidence suggests, most women choose to continue to work as much as possible over their course of treatment and plan to work as usual once treatments have been completed. Employers must strike a balance in supporting the employee, sustaining business objectives and managing costs. These goals necessitate a framework for addressing the sensitive workplace issues that arise when an employee has a serious illness.
The intent of this survey is to document how employers assist seriously ill individuals as they navigate through treatment to recovery. Coping with Serious Illness in the Workplace: Working Women with Breast Cancer examines employer policies, practices and experience in dealing with serious illnesses, with a particular emphasis on breast cancer. This survey addressed employer accommodation issues and a planned followup survey will address employer leave policies and benefit issues.
Part I of the survey (15 questions) was administered by e-mail on June 14, 2005 to 1,082 benefit managers and human resource professionals who are members of the International Foundation and work in corporate settings. The target population was selected to ensure only one response per employer. A total of 123 responses were received, an 11% response rate. Fifty-five percent of those responding indicated that they have had to address workplace issues relating to breast cancer and one in four respondents are currently dealing with a breast cancer case in the workplace.*
Accommodation for the Ill Employee: Survey results indicate a strong willingnessamong employers to accommodate requests that would allow a seriously ill employee to continue working. Half of the responding employers indicate they made the requested accommodations “all of the time”; the other half indicate they made the requested accommodations “most of the time.”
Accommodation for the Spouse of the Ill Employee: 55% of responding employers indicate they go beyond caregiver leave requirements under FMLA to accommodate an employee who is the spouse or partner of a seriously ill employee by allowing flexible hours, telecommuting or a temporary shift in work assignments in order for them to care for the employee during the more difficult stages of treatment.
Work Schedule and Assignment Accommodations: Regardless of whether employers reported having addressed any incidences of breast cancer, employers indicate they provide a variety of work schedule accommodations for an employee with a serious illness, such as breast cancer. Those most commonly provided include:
Employers indicate they provide a variety of accommodations in work assignments for employees with serious illnesses, including:
Fifty-six percent of employers reporting incidences of breast cancer indicate there was a request by the employee for an accommodation to facilitate working while receiving treatment. Commonly requested types of accommodations include:
Less frequent types of accommodations requested include:
Co-Worker Support: Many employers offer a variety of opportunities for workers to support an employee with a serious illness, including volunteer efforts such as:
Note: This survey data on donation of vacation/sick days closely matches survey findings from a previous survey conducted by the International Foundation in the spring of 2005 using a different sample of corporate representatives in which 16% reported allowing donation of sick/vacation or paid-time-off days on behalf of an individual facing a medical situation.
However, more than half of employer respondents (53%) indicate that offering these kinds of opportunities is not the employer’s role. Employers who do not view offering these kinds of opportunities as the employer’s role differ from those that do in several other areas with respect to serious illness in the workplace. These differences are shown in Table 1.
EAPs: 88% of employers offer an employee assistance program (EAP) or similar benefit to provide counseling for the worker, her family and co-workers impacted the employee’s illness.
Human Resource Challenges: Addressing the privacy/confidentiality issues of breast cancer is among the top challenges as indicated by 57% of employers, followed by maintaining productivity (31%), dealing with perceived equity issues (23%), and dealing with overall morale (17%). At the other end of the spectrum, nearly one-quarter (24%) of respondents do not view addressing breast cancer in the workplace as a human resource challenge.
Employer Size: Both larger and smaller employers ranked the human resource challenges in the same order of importance, beginning with privacy/confidentiality, followed by productivity, perceived equity and overall morale.
Legal Regulatory Compliance: Over half (52%) of employers indicate they’ve experienced no particular legal/ regulatory challenges in addressing breast cancer in the workplace. For the remaining employers, 19% indicate the Family Medical and Leave Act (FMLA) and 19% indicate the Health Insurance Portability and Accountability Act (HIPAA) as legal challenges, followed by 17% indicating the Americans with Disabilities Act (ADA). The Consolidated Omnibus Budget Reconciliation Act (COBRA), indicated by 7% of employers, appears to be least challenging for employers from a legal perspective.
Responding employers range in size up to 65,000 employees. The average number of employees is 4,790. The employer size distribution is shown in Table 2.
*The incidence of breast cancer among working women reported in this survey are lower than breast cancer incidence rates for women (working and non-working) reported by the American Cancer Society by about one-third. Rate of incidence for this survey based on reported size of workforce, percent of female workers and number of incidences over last five years translate to .035% per 100,000 female workers. The American Cancer Society reports a current breast cancer incidence rate of .10% per 100,000 females.
** Both ethnicity and age are factors in the incidence of breast cancer. Statistics from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program show that White, Hawaiian and African-American women have the highest rates of invasive breast cancer in the United States. Korean, American Indian and Vietnamese women have the lowest rates of invasive breast cancer in the United States. The breast cancer incidence rate in the United States for White non-Hispanic women is four times the incidence rate of Korean women. Rates of incidence for breast cancer also increase with age. The chance of a woman being diagnosed with breast cancer by age 30 are 1 in 2,212. By age 40, the risk increases to 1 in 235; by age 50 to 1 in 54; by age 60 to 1 in 25; by age 70 to 1 in 14 and over one’s lifetime to 1 in 8. IFEBP survey demographics (shown below) for the female workforces represented by survey respondents closely reflect Bureau of Labor Statistics for December 2004 for age and race, except for Hispanics (who are slightly overrepresented in the IFEBP demographics) and younger workers (who are slightly underrepresented in the IFEBP demographics.)
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Statement of facts and opinions are those of the authors and do not necessarily represent a policy or position of the International Foundation nor are they intended to replace legal counsel or professional consulting advice.