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Addressing the Physical, Psychological and Psychosocial Needs of Older Workers

When an employee becomes injured on the job, it is essential to consider the needs of the whole person — physical, psychological and psychosocial — in order to facilitate a successful return to work. Although much of the emphasis in a workers’ compensation case is placed on the physical body, issues ranging from depression and fear of reinjury to a lack of support systems cannot be overlooked.

With an older employee, psychological and psychosocial issues may be more imperative. Fears surrounding losing one’s job (even if unfounded) and feeling a loss of control in one’s life can become real impediments that keep older workers from returning to work and successfully staying on the job.

“There are specific issues when older workers are out on workers’ compensation,” says Thomas Emerick, president of Emerick Consulting LLC of Fayetteville, Ark. “Older workers in this situation have special concerns such as fear of being able to return to work, combined with worries over seeing their careers suddenly being limited.”

For case managers handling workers’ compensation cases, being attuned to the red flags and warning signals can ensure that psychological and psychosocial issues are addressed along with clinical and rehabilitative aspects of care.

The Aging of the Workforce

Demographic changes in the workforce heighten the need for case managers to understand this important segment of the population and the labor pool. According to U.S. government statistics, there are some 77 million baby boomers (those born between 1946 and 1964) in the United States, representing about 37 percent of the total population aged 16 and older.

While much attention has focused on the expected waves of retirees from the baby boomer generation, social and economic trends — including the impact of a stock market crash on retirement savings and a desire to stay active longer — are keeping many older workers on the job. According to data from the Bureau of Labor Statistics, the percentage of older workers has been increasing since the late 1990s, particularly among those aged 65 and older. This compares with labor force participation rates for this age group that had been at historic lows in the 1980s and early 1990s.

Looking ahead, workers aged 55 to 64 are expected to see a 36.5 percent jump in workforce participation. By 2016, workers aged 65 and older are expected to account for 6.1 percent of the total workforce, compared to 3.6 percent in 2006.

According to an April 2008 survey by AARP, one in five people between the ages of 55-64 and one in four between 45-54 planned to delay retirement due to the economic downturn. Declining home values, shrinking 401(k) balances and investment portfolios, and more people borrowing from their 401(k) plans were cited as factors contributing to the decision to keep working.

For employers, older workers bring many benefits, including experience, skills, knowledge and motivation. Employers often describe these employees as being loyal and having a good work ethic. Older workers can act as mentors to younger employees, and usually have high communication skills and decision-making abilities. All of these factors — coupled with a projected labor shortage in the future — showcase reasons to encourage older workers to remain productive.

But what about the health issues associated with older workers, particularly as they relate to workers’ compensation cases? According to industry data, older workers have fewer incidents of on-the-job injuries than younger employees. However, once injured, older workers typically take longer to recover and return to work than their younger colleagues.

Recovery times for older workers can also be impacted by health issues, including obesity, hypertension, high cholesterol, heart disease and smoking. Importantly, these risk factors are not exclusive to workers aged 55 and older, but are associated with the general population and contribute broadly to rising health care costs. Therefore, employers should promote health and wellness programs for all employees, including older workers. Health fairs and wellness programs at work, such as cholesterol checks and blood pressure screening, can also raise awareness and provide information on intervention and self-care.

Among the types of workers’ compensation injuries that affect older workers, soft-tissue injuries are among the most frequently reported. Contributing factors that lead to these types of injuries include visual and hearing impairment and loss of muscle dexterity and balance. When an older worker is injured, in a slip-and-fall incident at work, for example, the employer faces direct and indirect costs, including hiring a replacement worker, lost productivity or both. There are also medical and indemnity costs associated with a workers’ compensation case.

Containing those costs is an imperative for employers. Many companies have return-to-work programs to help employees who are recovering from a workplace illness or injury resume productivity as soon as possible. If the individual has medical restrictions, modified duties and transitional assignments can help the person resume working in a limited capacity.

Injuries Are More Than Physical

Case managers who handle workers’ compensation cases — whether working for insurance companies, third-party providers, or employers — know that a workplace injury has more than a physical impact on employees. In play are psychosocial factors, which, if unaddressed, can extend the duration of a workers’ compensation case.

For the older worker in particular, the human impact of an injury or a temporarily disabling condition can be significant. One is the loss of income, since workers’ compensation typically pays two-thirds of a person’s average weekly salary. Beyond the financial, there are other issues, including a loss of self-esteem and a sense of being severed from the workplace, which is an important source of identity and social connection for many older workers. For someone aged 55 or older who has worked 30-plus years, the inability to work because of an occupational illness or injury can lead to depression.

Consider John, who at 63 had no plans to retire from the company where he had worked for 31 years. When he suffered a back injury on the job, John suddenly was on the sidelines, with a prognosis that he could be off work for a minimum of 12 weeks. John’s life, which had revolved largely around his work, was completely disrupted. Normally energetic and positive, John became increasingly irritable and withdrawn; he complained of escalating pain and difficulty sleeping.

The case manager working with John recognized the red flags: John was suffering psychologically, as well as physically, from the injury. Although he never used the words “depression” or “feeling depressed,” the case manager was attuned to his complaints of feeling pain that appeared elevated compared to the level of injury. Suspecting that John was having difficulty coping with being off work and had anxiety over whether he would be able to return to his job, the case manager honed in on his psychological needs.

Accompanying John to one of his doctor’s appointments, the case manager engaged him in conversation about how he felt being off work. “They’ll never take me back now,” John said. “I’m no use to them anymore.”

John’s statements were not true, but that didn’t minimize the fact that he believed them. His fears — being unable to work and certain that he would lose his job — escalated to the point that they affected his health. In John’s case, a simple remedy could have averted a great deal of his concern: contact with his employer. Phone calls, emails, cards and notes from supervisors, managers and co-workers can help an injured or ill employee feel connected to the workplace.

“Absolutely the best thing an employer can do is keep in touch with the person on disability leave in a personal way,” says Emerick, a former vice president of benefit design for Wal-Mart Stores Inc. who has experience managing health, medical and disability programs. “Calls from the boss or the department head — or better yet an in-person visit — can do wonders for the psychological well-being of folks who have been injured.”

In John’s case, hearing from his supervisor helped allay his fears of not being wanted any more and imminently threatened to lose his job. The simple message — “We want you back, John. Get well soon.” — improved his mood and, with it, his ability to cope with pain.

Employers and co-workers may be reticent to contact an injured worker out of concern of saying the wrong thing, which the employee might use against them if the person decides to sue the employer. However, practical experience bears out the fact that employees who are contacted by the employer and who feel appreciated by their supervisors and colleagues are less apt to litigate a case.

Addressing Psychosocial Needs

Case managers handling workers’ compensation cases, whether telephonically or in-person, also need to be on alert for the psychosocial needs of the ill or injured person. The Commission for Case Manager Certification (CCMC) has identified key areas, or domains, of case management practice — among them psychosocial and support systems. This domain covers specific interventions, family and cultural issues, and resources that must be integrated into case management practice. These case management criteria address the need to engage in interpersonal communication with individuals, as well as with their place of employment.

Case managers must deal with factors like family dynamics, mental illness, chronic illness, mental health and disabilities, as well as the need for community resources and support. An injured worker, for example, may need transportation to and from doctors’ offices for follow-up visits. The case manager may also coordinate tests, MRIs and lab work, as well as treatments from epidural injections for pain management to physical therapy.

Dealing with psychological and psychosocial issues extends beyond recuperation. For example, if an employee’s fears of re-injury are impeding return to work, the case manager with whom the person has established rapport may be the first to hear of it.

These concerns can be allayed by communicating with the doctor regarding medical restrictions, and also communicating with the workplace. The case manager may obtain a modified-duty job description from the employer to discuss with the physician and with the injured worker. Once the doctor signs off on the job description, which stipulates what the person can and cannot do, that document is then returned to the employer.

The days and weeks after a worker is back on the job are critical to a successful return to work. The case manager should follow up with the individual to find out how he is doing, whether or not the person is able to do the specified work, and if he is experiencing any pain, fatigue or other symptoms.

After one employee, whom we’ll call Mary, returned to work, she reported to the case manager that her supervisor was not adhering to the doctor’s prescribed protocols for transitional duty. Mary was prohibited to lift more than 15 pounds. However, she felt the supervisor was pressuring her to lift more than the weight limit set by her doctor. If she didn’t comply, Mary feared she would be fired. Her concerns were escalated by the fact that she was over 50 and considered herself vulnerable to being let go if she couldn’t, as she described, “work as hard as a younger person.”

Hearing Mary’s concerns, the case manager followed up with the employer to stress that the physician’s orders for modified duties needed to be followed. Soon thereafter, Mary’s complaints ceased. As she continued to heal and gain strength, Mary was able to safely increase the amount of weight she could lift until the modifications no longer became necessary.

In Conclusion

Whenever an employee becomes ill or injured on the job, a host of issues are raised, from concern over loss of income to how and when the person can return to work. For the older worker, these issues are often intensified by fears surrounding the ability to remain productive and engage in meaningful work.
With the growing number of older employees in the workforce, case managers who work with these individuals need to be aware of the psychological and psychosocial issues involved in workers’ compensation cases.

Being aware of the potential for depression, loss of self-esteem, and a feeling of disconnectedness from the workplace will help case managers address the needs of the whole person and not just the physical injury.

As advocates for employees, case managers can see to it that a treatment care plan addresses all aspects of the person’s needs — while helping an experienced and valuable employee resume productivity as quickly and as efficiently as possible.

Dorothy Consonery-Fairnot, BS, MSHA, RN, CCM, CLNC, is a Commissioner of the Commission for Case Manager Certification (CCMC), a nationally accredited organization that certifies case managers (www.ccmcertification.org). She has 36 years of diversified nursing experience, including 15 in managed care. She is also the Southeast Area Manager for MedInsights Inc., a workers’ compensation managed care organization. [ This e-mail address is being protected from spambots. You need JavaScript enabled to view it ]