Coping with Cognitive Declines at Work

Cognitive impairment is a sad reality that will likely become more common as the workforce ages. Communication and compassion are key to handling the issue with care.

By Carole Fleck Sep 3, 2015
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Something disturbing was happening to Michael Belleville. He first noticed it at work, when he started having difficulty completing tasks at a job he had held for 18 years.

“I found myself … asking people questions about things that I should’ve known because I had trained them,” says Belleville, a senior telecommunications technician at Verizon in Charlton, Mass. “I work with a good group of people, and they were kind about it. But they were scratching their heads, wondering ‘What’s going on with Mike?’ I was getting less and less done.”

His concerns grew after he got lost on his way home from work one evening. Other troubling episodes followed, prompting him to seek help. A battery of brain scans, neuropsychological tests and a spinal tap revealed a diagnosis within six months: At age 52, Belleville had early-onset Alzheimer’s disease.

“It was a shock,” says Belleville, who is now 54. “It was the last thing you expect to hear at my age.”

Studies on the aging labor force have largely focused on the skills gap left by retiring Baby Boomers, the so-called brain drain of institutional knowledge. But another kind of brain strain may also be confronting employers and HR managers as America’s labor force population ages and older adults increasingly opt to stay on the job longer.

While early-onset Alzheimer’s is rare, mild cognitive changes related to the normal aging process are fairly common, and they can begin as early as a person’s 30s or 40s. Subtle symptoms include forgetfulness or taking more time to process new information. In most instances, few managers or co-workers even notice.

Over time, though, as cognitive changes deepen or medical conditions develop, some employees may show more-detectable problems with memory or functioning. They may forget regularly scheduled meetings, have difficulty with problem-solving, or be unable to switch back and forth between tasks. Yet, even in these instances, many of these workers are still able to do their jobs—in some cases with the help of simple accommodations.

“The degree to which changes in cognitive function may impact workers’ job performance varies,” says Bradford Dickerson, a neurologist at Massachusetts General Hospital in Boston. “The biggest challenge is trying to figure out what’s part of the normal spectrum of aging and what’s the beginning of an illness” such as dementia or Alzheimer’s.

Not Just About Aging

To be sure, cognitive problems aren’t limited to older workers. In fact, some older workers out-perform younger peers, and many retain excellent cognitive function well into their 70s and 80s. Conversely, medical issues such as depression and hypothyroidism can bring about cognitive impairments at any age, although fortunately in those cases the problem is largely reversible.

Amy Shives was 35 when she started to notice cognitive changes, including trouble concentrating and understanding spatial relationships, such as judging a car length or how fast a car was coming. Some 17 years later, at age 52, she was diagnosed with early-onset Alzheimer’s. She took a sabbatical from her longtime job as a counselor at a Spokane, Wash., community college. She was never able to return.

“My memory was failing me, like what class goes with what curriculum. It’s the kind of thing that, after 25 years, you don’t look up,” she says. She had to ask her peers for help and eventually created cheat sheets of what she needed to do. “You adapt in your professional life. It works for a while.”

Common Forms of Cognitive Decline

When cognitive changes begin to interfere with daily routines and work performance, one or more factors may be involved:

Mild cognitive impairment (MCI) causes a slight but measurable decline in people’s memory, language, thinking and judgment. It’s not always clear if MCI is the earliest symptom of Alzheimer’s, which may not show up for years, or whether it’s part of the normal aging process.

An underlying health condition, such as a vitamin deficiency, hypothyroidism or depression, can sometimes manifest as cognitive decline. Treating the condition could lessen or reverse the cognitive deficits and return the worker to his or her previous functioning.

Alzheimer’s disease is the most common form of dementia in people age 65 or older. The cause is not well-understood, but typical early symptoms include memory loss and difficulty performing routine tasks.

Vascular dementia is caused by stroke and other blockages of blood flow to the brain. Early signs of this form of dementia often include poor judgment or difficulty with planning, organizing and making decisions.

After a few years, the workarounds she put into place to compensate for her memory lapses no longer worked. She struggled to come to terms with all she had to lose. “I had it all: the income, the family who supported me, the resources, the ability to have judgment about what should be happening,” she says.

Symptoms of cognitive impairment generally come on slowly and begin years before problems arise at work, says HR consultant Jim Johns, president of the Johns Group Inc. in Jacksonville, Fla

“Workers missing deadlines, not showing up for meetings or showing up late when the person was always on time, saying ‘I don’t remember you telling me to do that,’ or someone’s personality changing from congenial to insubordinate or angry—that’s how this manifests,” he says.

What to Do

As daunting as this issue may be, HR professionals can help by working closely with employees and taking the following steps.

Conduct a safety assessment. A decline in cognitive abilities could have particularly serious consequences when workers are in jobs that require safety protocols or rapid response, such as air traffic controllers, pilots, first responders or surgeons. Similarly, top executives given major decision-making authority may reveal poor judgment as a result of diminished capacity, putting their organization at financial risk.

In circumstances like these, managers must quickly assess the employee’s ability to make decisions and determine whether he or she can remain in that job, says Alan King, CEO of Workplace Options, which provides employee well-being and employee effectiveness services to companies.

The Alzheimer’s Association Early Detection Alliance offers tools that can educate employers and managers about how to spot possible early warning signs among employees. It also provides other resources.

Engage employees. While exhibiting a gentle demeanor, initiate a conversation and discuss specific problems that prevented the employee from meeting company standards, such as missed deadlines or botched tasks.

“A manager’s responsibility is to engage that employee,” King says. “If they’re making errors they never made before or they stopped showing up for meetings, something that goes on for a period of time that’s uncharacteristic—these are examples where there may be issues.” This is your opportunity to express concern for the individual and also to point out the impact of such mistakes on the organization.

“Usually the employee recognizes changes before an employer does,” King says. “It’s about having a conversation that’s not confrontational and not diagnostic. Clearly what you don’t say is, ‘I think you have early-onset Alzheimer’s.’ ”

Keep thorough records. Managers and HR should document performance problems and any actions that were taken to address the issue, such as meetings with the employee, agreements that may have been reached and so on.

“If someone in the last three to four months has missed appointments or deadlines, those are objectively measurable criteria for measuring workplace performance for all people in that position,” says F. Damon Kitchen, an employment lawyer and partner at Constangy, Brooks, Smith & Prophete in Jacksonville, Fla. “It doesn’t matter if they’re in their 20s or 70s.

“We don’t want to jump to the conclusion that someone’s performance problems are the result of some kind of cognitive deterioration or impairment,” he says. “We want to avoid making age-related or disability-related comments.”

Pat Wilson was a manager at a state agency in Wisconsin when she suspected that one of her direct reports was showing early signs of dementia. She followed her employer’s guidelines and documented each task that went undone, along with the date it was noticed, and the length of time the problems went on. She conferred with her HR managers to keep them informed of the situation and how she was handling it.

Wilson said of the employee: “She wasn’t paying attention, getting to meetings on time or completing work assignments. When we went through the performance evaluation, I went through every problem I was seeing.” The employee admitted that she was having trouble. “She said she was feeling blue and it was hard for her to get out of bed because of personal things that were going on in her life.”

Consider reasonable accommodations. It’s usually best to avoid making statements about someone’s health unless he or she freely discloses the information first. Under the federal Americans with Disabilities Act (ADA), employers are generally prohibited from asking certain questions or making statements about an employee’s physical or mental health unless they have a reasonable belief that a medical condition is interfering with work or posing a threat to the workforce. Some state and local laws, and even some union contracts, provide complementary employee protections.

However, if an employee discloses a cognitive or physical impairment to a manager, a new set of ADA protections kick in. Employers with 15 or more employees are required to explore whether reasonable accommodations can be provided to help the individual perform the essential functions of the job.

Asking the employee for input about what accommodations might be helpful is perhaps the most effective way to begin the process, says Linda Carter Batiste, a lawyer and principal consultant for the Job Accommodation Network, a free service that provides guidance on workplace accommodations for people with disabilities.

Accommodations may involve changing a work schedule if a cognitive impairment is more pronounced in the afternoon, using software to keep an employee with memory impairment on schedule, restructuring certain job duties, or providing assistive technology to help with a variety of functions.

Being Accommodating

Employers considering whether they can provide reasonable accommodations to an employee with a disability should consider these questions:

  • How do the employee’s limitations affect job performance?
  • What specific tasks are problematic for the worker?
  • What accommodations are available to reduce or eliminate these problems?
  • Has the worker been asked about possible accommodations he or she believes may help?
  • Once accommodations are in place, how often should we meet with the employee to evaluate their effectiveness and determine whether additional support is needed?

“Reasonable accommodations could be very simple and not cost anything,” Kitchen says. “Maybe working with his or her physicians to find if there’s some kind of medication we can provide, or offer[ing] different working hours. Maybe he’s no longer fit to do this position but he can do that position.

“It’s really hard to find quality workers—if you have a good, qualified employee, it makes sense to hold on to that person rather than go through the process of interviewing for the job and training someone,” he says.

Play to people’s strengths. A worker experiencing a decline in cognitive function is not all that different from someone diagnosed with a serious illness. “Just because someone has stage 3 colon cancer doesn’t mean they can’t be in the workplace,” King says. “When AIDS first emerged, you had to educate people about concerns—and it’s about education here as well.”

Al Frazia, SHRM-SCP, director of talent management at Baker Tilly, a professional services firm in New York City, says his employer has provided physical accommodations for employees over the years, including longtime mailroom workers who began to have difficulty lifting packages.

“We altered the job to relate to the individuals’ strengths,” he says. “These individuals still wanted to work. They were loyal, attentive employees, so we shifted the more physical responsibilities to others and expanded less physical tasks to these individuals, and it seemed to work out OK.”

Handling Termination with Care

Sadly, there are some situations in which an employee can no longer perform the essential functions of his or her job and restructuring and reasonable accommodations don’t help. In these cases, managers and HR professionals may have no choice but to terminate the employee by following the company’s policies and guidelines. If a severance package is typically provided in the case of an involuntary termination, for example, it must also be given to a worker who is let go because of a disability.

“If, at the end of the day, we explored accommodations and they can’t be done, we want to document that the termination was done for business and no other reason,” Kitchen says. “All efforts to explore accommodations need to be documented.”

Finding the Right Words

What Not to Say

  • You’re missing meetings and forgetting tasks. Have you been checked by a doctor? Do you think you could have dementia?
  • You’re not as sharp as you used to be. Can you still perform the duties of this job at your age?
  • If you don’t figure out how to perform the way you used to, we may have to let you go.

What to Say Instead

  • I’m concerned about you. Most health insurance plans cover an annual physical and some mental wellness benefits.
  • Do you know about our employee assistance program? It allows employees to discuss issues confidentially and to seek help for situations or conditions that may be affecting their home and work life.
  • What can we do to help you be more productive?

Employees may be able to take advantage of their employers’ short- or long-term insurance coverage or to file a claim for Social Security Disability Insurance. In 2010, the Social Security Administration announced that it would fast-track applications for disability benefits by people who could no longer work due to early-onset Alzheimer’s, allowing for faster payment.

As for Belleville of Verizon, he went on short-term disability leave through his employer’s plan in March 2014. Nine months later, the insurance carrier denied his claim, saying it didn’t agree with the Alzheimer’s diagnosis because he was younger than most are when they are diagnosed with the disease. “I basically had no choice but to come back to work,” he says.

He has since hired an attorney to appeal that decision. In the meantime, he continues to work at Verizon in a scaled-down job. He says his manager has been helpful in partnering with him to figure out the optimal way for him to work.

“I used to have two computer monitors running side by side, with five or six windows open and bouncing back and forth between each,” he said. “Now I have one computer monitor in front of me. I can only focus on one thing at a time or I get confused.”

It’s a small adjustment, but it makes a difference. Sometimes the most powerful thing an employer can do is show understanding and compassion.

Carole Fleck is a senior editor with AARP Media.

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