Supporting employees back into work following a stroke can be both complex and challenging. A supportive and collaborative approach is likely to be key to identifying what reasonable adjustments can be made. Importantly, the leadership that occupational health can provide will be invaluable, argues Laura Barlow.
Strokes are very common, with one in six people suffering a stroke in their lifetime. Around 100,000 people have strokes in the UK each year, and the incidence of stroke in the working population is increasing, with around 25% occurring in people of working age, and almost half of those (12%) in people under age 45.
Stroke can cause a number of significant long-lasting problems for survivors, including physical disability, cognitive problems, issues with communication, fatigue, and difficulty managing emotions.
Although stroke has devastating effects for some individuals, many stroke survivors are able to return to work and can make a valuable contribution in doing so.
Duty on employers
The Equality Act 2010 places a duty on employers to make reasonable adjustments for employees with disabilities. ‘Disability’ is defined as a physical and or mental impairment that has a substantial and long-term effect on a person’s ability to carry out daily activities. A ‘reasonable adjustment’ is an alteration to the workplace or the way a disabled person does their job in order to allow them to work. Consequently, the vast majority of people returning to work following a stroke will have a right to reasonable adjustments, and it’s important that the employer takes their duty towards their employee seriously.
The adjustments that can reasonably be made will depend on the resources of the organisation, but adjustments don’t need to be costly or complicated. There is no set formula as to what constitutes a reasonable adjustment; no two stroke survivors are the same and the important thing is to tailor adjustments to the individual’s specific needs.
Stroke and the workplace
A good starting point is to ask the stroke survivor about their needs, because this may also help to identify ‘hidden’ disabilities. The process of working out an employee’s exact needs may take some time, partly because they might not be aware of all of their needs until they start working and/or they may struggle to talk about their difficulties.
Employers might not be able to provide adjustments for everything, but a supportive and collaborative approach is likely to identify the reasonable adjustments that can be made. Reviewing and adapting any adjustments as employment continues is just as important as making adjustments ahead of the return to work, as an employee’s needs are likely to change as their recovery continues.
What might ‘reasonable adjustments’ look like?
For physical problems following a stroke, such as weakness or loss of movement in limbs or down one side of the body, reasonable adjustments could include specialist equipment, for example a one-handed keyboard or a supportive chair. The employee might benefit from spending more time working from home to avoid a challenging commute.
Cognitive issues can be particularly challenging for stroke survivors when returning to the workplace. Concentration, memory and problem-solving can all be affected, as can planning and organisational skills.”
Cognitive issues can be particularly challenging for stroke survivors when returning to the workplace. Concentration, memory and problem-solving can all be affected, as can planning and organisational skills. Written instructions for carrying out certain tasks might be helpful. Strategies such as having an appointed ‘buddy’ for support, allowing extra time for completing work, and ensuring a calm working environment may also be helpful in working around cognitive issues.
Communication problems are very common following a stroke and are not simply limited to difficulties with speaking – they often also include problems with understanding what other people are saying, and difficulty with reading, writing and recalling words. Assistive technology might be an option, and allowing extra time to consider and respond to verbal and/or written communications may also help.
Fatigue is a hugely common after-effect of suffering a stroke. Post-stroke fatigue is not ‘tiredness’ as it isn’t always directly related to how busy or active a survivor has been. A later start time, regular breaks, shorter or fewer days and a private place to rest are all examples of adjustments that could help manage fatigue.
Emotional problems following a stroke can often be overlooked, but they are just as important to consider as the other issues listed above. Stroke survivors can experience a range of emotional problems including anxiety, frustration, anger, grief and guilt. Regular, honest discussions about how an employee is coping can be useful, and more formal counselling or emotional support might also need to be considered, either at work if available or externally.
Four other questions for employers
When should an employee return to work following a stroke?
Stroke survivors often want to get back to ‘normal’, so it can be tempting to rush back to work, but this can lead to problems further down the line. Conversely, too much delay can affect confidence. Staying in touch and having open discussions with employees and their doctors and/or therapists will assist in good timing of the return.
How will their return to work be managed?
Staying in touch with the employee and their treating team will assist with creating an individualised plan for returning to work. A phased return, allowing an employee to gradually build up their working hours can often be a good strategy which allows time to see what’s working and assess whether any changes are needed.
What do they want their colleagues to know?
Employees have a right to privacy so it’s important to find out what they would like other colleagues to know, and for any disclosure about their condition to be communicated in an agreed way.
What’s going on outside of work?
Stroke survivors returning to work are likely to continue having medical and health appointments after their return. They may also have problems outside of work, such as struggling with childcare responsibilities or relationship difficulties. Being aware of what is happening outside of work can help employers support stroke survivors in their workplace.
With good planning, collaboration and continued open communication – with occupational health practitioners very much able to provide the lead in all these areas – employers will have the best chance of supporting stroke survivor employees to succeed following a return to work.