I keep getting reminded how fuzzy words can be — and how much clarity matters to those of us who work across traditional boundaries between specialties, disciplines, or sectors of society.
We just submitted in a paper that will be presented at the McCrery-Pomeroy SSDI Solutions Conference on August 4 and then published later this year. During the peer review process, it became clear that we, the authors, were confusing readers by using terms differently than they do: “disability,” “early intervention,” and “recovery” . So in our new and improved version of the paper, we began by making three key distinctions. I offer them to YOU, in case they are useful.
Disability vs. Work Disability
According to the ADA, disabilities are impairments affecting major life functions (such as work). In the world of employment and commercial insurance, work disability is absence from or lack of work attributed to a health condition. Having a “disability” need not result in “work disability”, a core concept embodied in the Americans with Disabilities Act. Similarly, having a health problem need not (and usually does not) result in work disability.
What this might mean for you: Train yourself to add a modifier in front of the word “disability”, especially when you are working with someone in another organization or discipline. I try to say “work disability” or “impairment disability”– because even if I define how I’m using the word “disability,” people LISTEN their habitual way.
Medical Recovery vs. Functional Restoration
Medical recovery refers to the resolution (disappearance or remission) of the underlying pathological process. Functional restoration refers to re-establishing the usual rhythm of participation in everyday life. That means the ability to go about one’s regular daily business: performing necessary tasks and enjoyable activities at home and work, and participating fully in society. Functional restoration does not necessarily require medical recovery. It may include figuring out new ways to accomplish the stuff one needs or wants to do. So function can be restored through rehabilitation (broadly defined), and can even include the successful use of assistive technology, adaptive equipment, and/or reasonable accommodation in the workplace.
What this might mean for you: Remember to consider these two issues separately in every case. In order for the affected individual to end up with an optimal outcome, especially when there’s not much to offer on the medical side, paying specific attention to functional restoration is important.
Early Intervention vs. Immediate Response
Our opportunity to influence the occupational outcome of an injury or illness episode DOESN’T really start the day a problem is reported, or the day YOU first get involved. The opportunity clock DOES start on the first day an affected individual stays home from work or admits to having difficulty working – because that is when the period of life disruption and uncertainty starts. A pro-active work disability prevention program involves immediate response which begins within the first few days and no later than 6 or 8 weeks after onset. This triggering event (and timeline) is different from the so-called early intervention used in many programs. In general, those programs start from an administrative date: claim notification, date of referral or application for benefits, etc. It is PATHETIC to see how LATE most referrals for early intervention are ACTUALLY made: typically 6 or 9 months. Naturally, the intervener WANTS to look responsive to the paying customer so they hop on the case promptly, within 48 or 72 hours. But hey: Life moves at the speed of life, you guys, not administrative procedures.
What this might mean for you: It is inappropriate to let anyone get away with counting from administrative dates — unless you are content with LOOKING responsive rather than BEING helpful. On EVERY chart or file, keep an on-going record (at every visit or update) of how many days have elapsed since the episode began. Also include data about how many days it typically takes someone with that particular condition to get back to work. It will keep your and your collaborators’ feet to the fire.
Personally, when I’m doing my physician version of case management, I use MDGuidelines.com to keep track of how long the episode SHOULD last, and a website called timeanddate.com to calculate elapsed time to date. I put those numbers at the top of my reports. This keeps me and my customer REALLY aware of the passage of time, because otherwise, the days just keep slipping away — along with the individual’s chances of EVER going back to work.