Working With Kidney Disease: Rehabilitation and Employment

Many people with chronic kidney disease (CKD) or kidney failure work full time or part time. Some go to school or take care of their homes and families. Others do volunteer work, have hobbies, or have regular exercise routines. If you have kidney disease or kidney failure, you may have questions about working.

Many people who start dialysis or have a transplant want to go back to work. Some people feel it helps them get their lives get back to normal. Others may take a little time off to get used to dialysis or recover from transplant surgery.

Some people continue to work full time as they begin treatment. Others switch to a part-time or flexible schedule. Some people ask for jobs that are less physically demanding.

You may need to work different hours to go to hemodialysis. Or you may need a clean, private area where you can do peritoneal dialysis.

You should feel free to talk to your employer about job changes that might make it easier for you to work. Remember, your employer probably won’t know what changes you might need if you don’t ask for them.

Your employer may not know much about kidney disease or how it may affect your abilities. There might be concerns about how much work you can do and how much time off you will need. There could also be concerns about how much your health benefits will cost the company. You may want to ask your doctor or another member of your healthcare team to talk with your employer about these. A little information about your illness, abilities, and limitations can do a lot to ease an employer’s concerns. Here are a few of the topics you and your employer may want to discuss:

• Changing your work schedule to allow for dialysis and healthcare visits
• Making up time taken off for medical reasons
• Physical limitations, if any
• What to do in case of an emergency

Employers may not know about tax credits they can get for making changes to the workplace.

The Civil Rights Act, the Rehabilitation Act, and the Americans with Disabilities Act all protect you from job discrimination. Examples of discrimination include being fired or being turned down for a job or a promotion because of an illness or condition that does not affect your ability to do your job. The Department of Labor handles complaints filed under the Rehabilitation Act.

If you work for a company with 15 or more employees, the Americans with Disabilities Act (ADA) requires your employer to make any “reasonable accommodations” that you might need in order to work. Examples include:

• Making parking lots, bathrooms, and work areas handicapped accessible
• Having flexible work schedules
• Reassigning you to a less strenuous job if you request one and one is available
• Assigning any of your non-essential tasks to other employees, at your request

The Equal Employment Opportunity Commission handles complaints under the ADA.

If you work at least 20 weeks of the year for an employer with 50 or more employees, you may qualify for the Family and Medical Leave Act (FMLA). The FMLA allows for 12 weeks of unpaid, job-protected leave for medical reasons.

If you had group health insurance coverage before the leave, it will continue under the same terms or conditions. Your employer can ask for medical certification stating that you have a serious illness, but cannot punish you for taking leave to have surgery or begin treatment. Your spouse, children, or parents may also be eligible for FMLA leave if you need them to provide you with care or transportation. The Department of Labor handles complaints under the FMLA.

If you think you have a grievance with your employer, the Equal Employment Opportunity Commission (EEOC) suggests that you first go through channels the company has set up. Union members should take their complaints to their locals.

Most towns and cities have departments that help if there is discrimination in the workplace. The name of the department depends on where you live. It may be called the Department of Human Services, the Department of Health and Human Services, the Office for People with Disabilities, or something similar.

On the state or federal level, you can contact the Human Rights Commission, the Department of Labor, or the EEOC. Your social worker may also be able to help you.

Most people need financial help if they can’t work. Your social worker can give you information about financial programs, what the qualifications are, and how to apply. The Federal government runs two of the best- known programs. Social Security Disability Insurance (SSDI) is a program of the Social Security Administration. It pays a monthly cash benefit to people who are not able to work for a year or more because of a disability. The amount you get depends on the length of time you worked before your disability and the amount of tax taken out of your earnings during that time.

Your family’s current income level doesn’t affect the amount that you get. There is a 3–5 month review period for applications. If you stopped working before you applied, you may qualify for back benefits. You can apply for SSDI online at: www.ssa.gov/applyfordisability/Supplemental Security Income (SSI) is also paid by the Social Security Administration. Benefits are calculated based on the person’s financial needs, not the amount of tax that they paid. SSI pays its benefits on a monthly basis. This amount may be supplemented by state or local benefits. You must file an application with Social Security to be considered.

Getting a job can be rewarding. Having a job helps people feel good. It allows you to earn money to pay your bills and do the things you enjoy. It can help you get health insurance. It can help you feel more useful. It may also help you to meet new people.

Your health must be your top priority. Before you think about finding or returning to a job, you must decide if you are physically and mentally ready to work. The process of getting yourself ready to begin working again is often called rehabilitation.

For people with kidney disease or kidney failure, rehabilitation involves:

• Returning to a healthier physical state
• Maintaining a positive outlook
• Enjoying relationships with family and friends
• Feeling more productive

To help you build your strength and endurance, see Staying Fit with Kidney Disease

Volunteering may be another way to feel good about yourself while gaining skills that could help you get a paying job in the future.

Yes. There are many services for people looking for jobs. Some are private companies. Others are government agencies. They can help you decide what kind of job you want and what you are qualified to do. They can help you write a resume and get ready for interviews. Remember that some private companies will expect payment for their services. Some popular job-hunting resources are:

• Monster.com
• Careerbuilder.com
• Craigslist.com
• Indeed.com
• SimplyHired.com
• Dice.com
• Glassdoor.com
• The Help Wanted section of local newspapers
• Employment and temporary agencies
• State client assistance programs
• Job Corps
• State or local employment agencies

Your social worker can help you. Some government agencies may even help pay for training. If you find work through a state or federal vocational rehabilitation agency, your employer may be able to get a tax credit for hiring you.

Social security has many programs to help you find work. See https://www.ssa.gov/work/

The Department of Veterans Affairs offers vocational rehabilitation services to qualified veterans. See US Dept of Veterans Affairs

For more information on finding a job and writing a resume, you can download a copy of NKF’s brochure Working with Chronic Kidney Disease by clicking this link.

If you think that your illness and treatment will not interfere with your ability to do the job, you do not need to mention it during an interview.

The ADA states that your employer may not ask you to take a physical exam until after a job offer has been made and only if all the applicants for that job are required to take a physical exam. If the job offer is taken back after you have the exam, the company must show that you cannot perform the essential functions of the job. You can be asked to take a drug test.

If the company offers health insurance to all of its employees who work the same number of hours that you work, you must be offered the same coverage. Read the policy carefully to see if it covers treatment for kidney disease. If the policy says there is a waiting period for employees with existing health conditions, there could be a delay in your coverage.

If you had health insurance less than 63 days before getting new coverage, you may have met all or part of the waiting period. Ask your old insurance company to give you a Certificate of Credible Coverage and give it to your new health plan’s administrator. Your state insurance commissioner’s office can tell you more about the laws covering group health insurance companies.

You may need help going back to a full, productive life after being diagnosed. The National Kidney Foundation can provide information. Call the NKF Cares Patient Help Line toll-free at 855.NKF.CARES (855.653.2273) or email nkfcares@kidney.org. You can also download some free brochures by clicking any of the links below:

Working with Chronic Kidney Disease

Staying Fit with Kidney Disease

Nutrition and Hemodialysis

Nutrition and Peritoneal Dialysis