HIV and rehabilitation management

American Rehabilitation,  Autumn, 1993  by Charles E. Young

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One of life's more difficult experiences is having to stand by helplessly as an associate dies of a terminal illness. The situation becomes much more difficult to bear when this person is a friend, a colleague, and one of your favorite vocational rehabilitation (VR) counselors, a favorite because of his ability to relate to people: to clients, fellow staff members, and even to you, the state agency administrator. Watching such a friend and co-worker die of AIDS complications makes you more keenly aware of the issues associated with HIV. Likewise, personal involvement with HIV issues brings home the unique perspective of the individual affected, his family and friends, and for you, his employer.

Having had this experience, as an employer who has dealt with the reality of HIV in the workplace, I feel a special obligation to contribute, in every way possible, to the improvement of services available to people with HIV.

Because good management always sets the direction and tone for delivering services in any agency, rehabilitation agency administrators and program managers should take the lead in developing a comprehensive and informed response to HIV. A definitive agency policy on HIV along with the provision of appropriate staff training should be at the core of such a response and would signal management's commitment to serving eligible people with HIV.

Educating consumers and others about eligibility for rehabilitation services is one of management's perennial tasks. As most readers of this journal know, basic vocational rehabilitation services provided under the Rehabilitation Act can only be offered to people with a physical or mental disability which is an impediment to employment. VR services must be required to achieve an employment outcome. Further, each eligibility decision must be made on an individual basis, not for groups of people with a given disability. Unfortunately, advocates often mistakenly assume that a person who has a certain severe disability is automatically eligible for vocational rehabilitation services. This assumption is not true. Advocates frequently confuse eligibility for vocational rehabilitation with entitlement to programs such as special education for youth. VR can offer needed services only to those HIV infected persons who are eligible for VR services. We need to take the lead in helping these clients become eligible. An educational process needs to be initiated to assure that advocates of persons with HIV understand the VR eligibility criteria and service delivery potential. People with HIV and their advocates need to be educated on the following basic VR eligibility criteria:

* there must be a physical or mental disability;

* this disability must be an impediment to employment for the individual; and

* the individual must require VR services to achieve an employment outcome. Where employment is not a goal, agencies should not overlook the use of independent living resources.

Rehabilitation managers have numerous considerations when developing a policy in response to HIV. This could take the form of an umbrella policy on life-threatening illnesses in general or an HIV-specific policy. The policy would spell out when such individuals might be eligible for traditional rehabilitation services, facilities, programs, or independent living services. The agency policy might address such issues as:

* confidentiality;

* availability of comparable services and benefits;

* extent of agency medical payments;

* prohibition on purchase of experimental drugs and treatment;

* providing equipment and services for people who may not be medically stable;

* using independent living services as a resource; and

* establishing categories of risk classification for staff in all routine and reasonably anticipated job-related tasks (including identifying those tasks which might expose staff or clients to body fluids, such as daily living skills instruction in cooking or instruction in insulin injection for blind clients).

Developing standard operating procedures (SOP's) for work tasks which might cause exposure to body fluids may be considered. These could include mandatory work practices and use of protective equipment. Unfortunately, this may well be an issue of employer liability and could even creep into future union contracts.

Foremost in any policy should be respect for the individual and his/her rights. Confidentiality of all health records must be maintained. People with HIV, whether clients or staff, may be physically disabled and are therefore protected by Section 504 of the Rehabilitation Act with regard to employment. They are also protected by the Americans with Disabilities Act (ADA).

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VR, which has been a traditional resource to employers, can take a leading role in disseminating information to break down barriers to employment for individuals with HIV. Agencies can establish employer advisory groups and offer technical assistance or educational programs at the worksite to help educate employees about co-workers with HIV. This effort could assist employers and their work force to be more receptive to working with these individuals. However, the VR agency or facility needs a clear policy on how it will treat employees with HIV in order to give confidence and credibility to agency staff making such educational presentations to the public.