If you have an employee who has told you they have either Crohn's disease or ulcerative colitis (they may also have used the term inflammatory bowel disease (IBD)), you may be wondering what the condition is and the impact it might have on the job and the person working for you.
Understanding the condition is the first step in ensuring that you can support and get the best out of the working relationship with your employee.
Most people with inflammatory bowel disease (IBD) lead productive lives and work full-time. However, as with any chronic condition, understanding and making necessary adjustments to take into account health needs can really help.
This guide will help you to
- Understand what inflammatory bowel disease is.
- Understand how the condition may affect your employee.
- Understand how it can be possible, sometimes with minimal changes, for people with Crohn's and colitis to work successfully and to fulfil their potential.
- Understand what you can do to help and how you can work together.
Crohn's disease and ulcerative colitis are the two most common types of inflammatory bowel disease (IBD). These conditions cause inflammation, swelling and ulceration in the intestines.
There are over 40,000 people living with IBD in Ireland.
The majority of people with this condition are of working age when diagnosed and are likely to be concerned about their job and employment prospects.
However, many people with Crohn's and colitis want to and are able to work successfully and fulfil their potential. Studies have shown that people with IBD give high priority to maintaining their attendance and performance at work.
There is no cure for IBD at present. However, with appropriate support from their employer and healthcare team, combined with proactive management, most people with IBD find that problems in the workplace can be successfully managed so that they remain in their jobs.
The only difference between people with IBD and those without the condition is that without their medication, their gastrointestinal tract doesn't work quite as well. In all other respects, they are the same as everybody else and deserve to be treated in the same manner as others in the workplace. They want empathy, not sympathy.
Inflammatory Bowel Disease
Inflammatory Bowel Disease (IBD) encompasses at least two separate disorders that cause inflammation (redness and swelling) and ulcerations of the small and large intestines, namely Crohn's disease and ulcerative colitis.
Ulcerative colitis typically affects the innermost lining of the large intestine (colon) and rectum and occurs through continuous stretches of the digestive tract.
Crohn's disease can occur anywhere in the digestive tract from the mouth to the back passage. Diseased sections of the bowel are often interspersed with healthy ones.
Crohn's and colitis are treated with various classes of drugs or, if drug therapy fails, surgery.
What are the symptoms of IBD?
IBD is a chronic or lifelong illness, but the way in which it affects each person with the condition is highly individual. Many people with Crohn's and colitis will have long periods when they have few or no symptoms, but the disease can flare up unpredictably.
The most common symptoms are:
- Diarrhoea sometimes with blood)
- Urgent and/or frequent need to go to the toilet
- Severe abdominal pain
- Extreme tiredness
- Lack of appetite and weight loss
Some people with IBD may also suffer from painful joints, eye problems, mouth ulcers, and skin rashes.
What IBD is not
- IBD is not the same as Irritable Bowel Syndrome (IBS).
- IBD is not contagious.
What causes IBD?
The cause or causes of IBD are not yet known. Most researchers believe the condition may be caused by an abnormal reaction of the immune system to intestinal bacteria, combined with genetic factors and environmental triggers.
What is the treatment?
Crohn's and colitis generally require lifelong treatment, and this can include taking medication which may have unpleasant side effects. However, if taken as prescribed, most medicines will help to control flare-ups so a person can get on with normal life.
Some treatments require the person with IBD to attend hospital regularly and it is helpful in these situations if there is flexibility at work.
Sometimes, surgery is needed to treat the symptoms of IBD
Does Crohn's/colitis affect a person's ability to do their job?
That is broadly dependent on the individual with IBD, their condition and the type of job they have. A UK employment survey found that people with IBD who were feeling well had a total work productivity score higher than that of the general healthy population. More than half reported putting in more effort at work to make up for any shortcomings that might result from their IBD
Key factors that helped their success included:
- Flexibility in working arrangements
- A knowledgeable and supportive social environment at work
- Team working
- Adequate accessible toilet facilities
Your Legal Obligations
The legislation in Ireland is very narrow and from an employment/equality perspective, relates only to disability as opposed to chronic illness. However, all employees are protected by general employment law principles relating to maximum working hours and daily rest breaks etc. For further information on your obligations as an employer under employment law, contact your local Citizens Information Centre.
All employees (except casual employees) are entitled to sick leave if they suffer a personal illness or injury. However there may be times when people with IBD need to be away from work for longer periods of time, possibly due to a severe flare-up of symptoms or surgery.
An ISCC survey has found that 71 per cent of people with IBD feel stressed or pressured about taking sick time from work, college or school.
It is at your discretion as an employer to decide your own policy on sick pay and sick leave. This must include the terms or conditions relating to incapacity for work due to sickness.
An employer cannot require an employee to take annual leave for a certified period of illness. Workers in Ireland are now allowed to accumulate statutory annual leave entitlement during a period of certified sick leave.
How can you as an employer help to support your employee?
Understanding IBD and the effect it may have on your employee and discussing the situation with your employee will help you both find the best way to move forward.
If your employee feels supported and understood, they are more likely to feel positive about coming to work and feel a responsibility for their job and work colleagues.
The first step is to provide a supportive environment in which an employee with IBD feels able to disclose their condition to you. A survey carried out by CCI found that only 30 per cent of people with IBD are comfortable sharing their experiences of their condition with their boss and even less (27 per cent) feel comfortable discussing the issue with their co-workers.
It is not uncommon for people to feel embarrassed talking about their condition and they can find it difficult to explain their symptoms.
It may be a relief for an employee with IBD to talk to you about their condition as it can be a strain for them to hide their symptoms. Once you are aware of an employee's needs, you can work together to make reasonable adjustments to support them.
Finding the best way to help your employee should be a two-way process. Allocate a time to sit down together to discuss the best way forward. Ask your employee if they would like someone with them such as someone from occupational health or human resources.
It is important that employees are assured of confidentiality and respect, especially around whether and how much they wish others to know about their IBD.
What are the needs of a person with Crohn's and colitis likely to be?
Each person is unique and their needs are very different. There is no 'one size fits all' solution.
Helpful adjustments may include:
Flexible working hours
Flexible working hours, particularly a later start, can help, especially when your employee is going through a flare. There may also be times during flare-ups of their illness when shorter working hours, or where possible, working from home would be useful.
Additional meal or snack breaks can be of use as many people with IBD have difficulty eating a normal-sized meal and may need to eat small amounts more often. Breaks would also be helpful if somebody has to take prescribed medication at particular times of the day.
Accessible and adequate toilet facilities
One of the main fears for many people with IBD is not getting to the toilet on time when there is an urgent need.
Many workplaces provide a wheelchair-accessible toilet facility and it would be helpful if employees with IBD were permitted to use these facilities also.
Frequent toilet breaks
Many people with Crohn's and colitis feel embarrassed and stressed about the need for frequent toilet breaks when going through a flare and worry about the consequences if they are not able to go whenever they need to.
Those in jobs with fixed breaks may need support from co-workers to offer cover.
Travel and parking
Travel is a major issue for many people with IBD. Due to frequency and urgency, they may find it difficult to take public transport and prefer to drive to work or meetings. Allowances for car travel and the provision of a parking space may be helpful in these cases.
Employers in Ireland are not obliged by law to make adjustments to the work environment of a worker with a chronic condition. Increasingly, though, employers are tailoring the workplace to their employees' needs through small but significant changes.
Most adjustments needed by people with IBD are inexpensive or may not cost anything at all, and/or cause little disruption.
The sort of adjustments which may be considered reasonable will depend on the individual situation.
Examples of reasonable adjustments for people with Crohn's and colitis:
- Allowing time off for medical appointments or treatment
- Offering shorter, different or flexible working hours
- Offering another place of work or the option of working from home
- Adjusting performance targets to take into account the effect of sick leave or fatigue
- If your company has an Occupational Health service, it would be helpful for them to link in with employees who have a chronic illness like IBD
Supporting employee's return to work after sickness absence
There may be times when some people with Crohn's or colitis are off work longer than the average. This may be due to a severe flare-up or occasionally due to surgery for their IBD.
It is common for people to lose confidence about being able to return to work, even after a relatively short time out on sick leave, and keeping in touch with an employee can help with this.
It may be helpful to set up an agreed procedure about how you and your employee could maintain contact when they are absent.
At times, it may be appropriate to appoint a family member as a point of contact. The employee may prefer contact from a co-worker, close colleague, union representative or occupational health worker.
It is also a good idea to establish what type of contact they would prefer, whether by telephone, email, letter or in person.
It is important not to pressure an employee into returning to work too soon before they are well
Return to work after sickness absence
Employees should always be involved in planning their return to work.
This gives them the opportunity to voice any concerns they may have or to request adjustments. They may need a phased return if they have been off work for a considerable period, and do not feel able to work a full day at first.
For example, they may want to start by working fewer hours and gradually building up to their usual working pattern. Having a reduced workload, to begin with, could also be helpful.
If the employee has to remain away from work until reasonable adjustments are in place that would enable them to return to work, this should not be recorded as 'sick leave' and they should receive full pay.
Ongoing support and regular reviews
IBD is an unpredictable disease and your employee's condition and specific needs may change over time, for better or worse. It is helpful to have periodic reviews with your employee. Their situation may change and they may wish to vary any adjustments to make it easier for them to continue working.
What happens if it's not working out?
There may be some rare occasions when you have made reasonable workplace adjustments but your employee feels their condition makes it difficult to continue their job or to accept an alternative job. In these circumstances, you may have no alternative but to consider terminating their employment on grounds of incapability.
There are certain procedures you need to follow before taking this step. For example, you will need to consult with the employee, obtain medical evidence and consider whether alternative employment or training has been offered. (Please note that termination of a contract is a legal issue and this information does not constitute legal advice).
Support if an employee is unable to work
Your employee may be entitled to claim a social welfare benefit or support such as Illness Benefit or Invalidity Pension if they are unable to continue working due to illness. This can depend on their social insurance record, their means and their circumstances.
The Department of Social Protection (DSP) publishes detailed information about each payment as well as general booklets. The most useful of these booklets are the 'Guide to Social Welfare Services' and 'Rates of Payment!
Information booklets and claim forms are available at local social welfare