Managing chronic or terminally ill staff

Team leading / 10 January 2011

How do you balance compassion with business needs when an employee becomes severely ill, asks Pepi Sappal

There’s nothing more sobering than hearing that a member of your team or a close member of their family has been diagnosed with a terminal or debilitating illness. After the initial shock of the news, managers have to grapple with the practical and emotional challenges of managing a terminally or chronically ill employee. Should other team members be told of the situation and when, how much time off is allowed, and what adjustments can and should be made if the employee wants to continue to work in between treatments? It's a delicate subject that requires sensitivity and compassion on the part of the manager. But trying to balance the needs of an individual with those of the business can be tricky.

When people are diagnosed with a terminal or debilitating illness, some may want to stay at work for as long as possible. This could be to prolong a sense of normality, be near friends and social networks, or maximise their income to help their family. “Terminal illnesses have an uncertain trajectory, as people don’t know when it will end,” says Kevin Friery, the clinical director of Right Corecare. “According to Macmillan, life expectancy following diagnosis of a terminal cancer is usually between four and eight years.” For those with other debilitating illnesses, such as MS, or less aggressive forms of cancer, there can be several more years of active workplace life.

If an employee wants to work around their treatments, it’s important to make any adjustments if and where possible so they can continue to work. “Although many companies have rules in place regarding compassionate leave, policies that deal with terminal/debilitating illnesses can be vague because every case is different, and time off/flexibility is often at the discretion of a manager,” says Sally Duff, managing consultant Europe, at organisational development consultancy Caliper.

Talk support

Schedule a conversation with the employee to discuss any future plans and needs, and to assess whether the employer can provide these or any other forms of support. The levels of support and assistance available will vary depending on the size of an organisation, and the nature of the job.

Although many companies have rules in place regarding compassionate leave, policies that deal with terminal/debilitating illnesses can be vague because every case is different, and time off/flexibility is often at the discretion of a manager.

Sally Duff, managing consultant Europe, Caliper

Marie*, who works in admin at a UK university, developed breast cancer two years ago, yet she chose to continue to work around her treatments and surgery. “I could have taken six months off, but I chose to come in as a way of hanging on to some normality. The treatment started with blocks of chemotherapy every three weeks for the first few months. I worked up until every treatment, but then needed to take four or five days off after every session. After a few months of chemo, I had surgery and took three months off to recuperate, but I then returned to work around my treatments again. Because of the side effects I could only work part-time and times were agreed between myself and my manager on a weekly basis, so I could attend appointments.”

Needs can often change over time. In Marie’s case, her manager arranged for her to work flexibly and part-time, and practicalities were organised with the help of HR and occupational health, including a replacement for when she took three months off and adjustments to her role because of her shorter working day. “Also, because I couldn’t walk for long periods, my manager organised a disability badge for workplace parking, which was a life saver, as not only could I park nearer the building, but on days that I came in later I was guaranteed a parking place. My return to work full time was phased in gradually from three hours a day in early 2009 to back to full time last September,” she says.

Luckily for Marie, she worked in an organisation where her manager was able to make adjustments with the help of HR and occupational health. Of course, this is not always possible in every firm, especially in smaller companies where such resources are simply not available.

Taking time off

Some illnesses can be so debilitating that no amount of adjustments will help an individual do their job, and that can be a difficult message to deliver to an employee. “I was recently involved with a case of debilitating cancer, where an employee was so disabled that she couldn’t do her job any more,” says Friery. “The managers' biggest fear was that this employee and other team members would think badly of her. Our role was to help the manager deliver that difficult message by exploring all the options available, which meant assessing what duties existed which the employee could complete, and one by one we crossed off every one, as no more adjustments could be made. The workplace can’t be care and community. But managers are entrusted to make compassionate business decisions.” That means exploring all the options with an employee and making adjustments where possible.

Another tough issue is confidentiality. “On the one hand, employees have a right to confidentiality and privacy, but on the other, an employer also needs to know whether an employee has the ability to do their job,” says Friery. “Then there are questions such as who else needs to know, who will be affected and how do you share the news with them. All this depends to a certain extent on the wishes of the employee. If an employee wants complete confidentiality, then you must respect it, but there may come a time when others in the business will need to know.”

Initially, Marie also insisted on complete confidentiality: “But the treatment took its toll pretty quickly, and close members of my team noticed I was very unwell, so I had no choice but to tell them eventually.”

Where the physical effects of illness are becoming more apparent, managers may need to broach the subject of sharing the news with colleagues to the employee, says Friery. “If an employee is taking a lot of time off, or there are apparent physical changes like weight or hair loss, and team members are noticing, another conversation between manager and employee, along the lines of: ‘I know you want to keep it confidential, but everyone can clearly see something is wrong and it’s now impacting on the workplace, so we need to agree how best to share it with others,’ will be necessary,” he says. “However, if an employee still insists on confidentiality, it’s acceptable to respond to other team members with ‘I won’t and can’t share, because I’m looking after employee confidentiality’.”

A family matter

If it is an employee’s relative or partner that is suffering from an illness, it is easier to keep things under wraps. That was the case for Karen* who works for a small firm. Her partner, who was just in his forties, was diagnosed with a terminal form of cancer a year ago. “Initially, I worked normally, taking the odd morning/afternoon off to accompany my partner on appointments, without attracting any attention from others. But when things got worse, my partner was admitted to a hospice. I chose to keep it quiet, until towards the end, where I had to take time off to be with my partner,” says Karen. “But before I came back to work after the funeral, I asked my boss to inform people about what happened, which made things easier for me, as I did not have to answer too many questions about my absence on my return.”

It’s vital to support employees who are supporting a family member through an illness. “Those going through difficult circumstances like this are under an enormous amount of strain and pressure, so it’s vital not to add to it,” says Duff. “You have to be empathetic and compassionate, yet practical.”

“Don’t hide behind the rules,” warns Friery. “In cases of terminal illness, there’s usually an element of flexibility, as every case will be different, but it will require an element of compromise from both sides.”

A useful resource can be found in the form of an employee assistance programme (EAP), if your organisation offers one. “But, as recent court cases like the Intel and Daw (2007), demonstrate, no amount of counselling/EAPs will make up for bad management,” adds Friery.

So be consistent. “Think, if it happens to someone else, would I do the same for them – it’s a very delicate balancing act,” says Duff. “Talk to someone in HR, as they will be able to advise you of previous solutions for similar situations. This way you’ll avoid giving more preferential treatment to one employee over another, and also avoid future legal problems.”

*Names have been changed to protect confidentiality