The Double Whammy for Older, Low-Wage Workers With Chronic Conditions
This research study shows what these workers need, but don't often get
Sixty percent of Americans have at least one chronic disease, such as heart disease or diabetes, according to the Centers for Disease Control and Prevention. Chronic diseases are even more common among older, low-income adults and minorities. But when Kendra Jason, a sociology professor at University of North Carolina at Charlotte, studied workplace supports for older, low-income black workers with chronic conditions, she found some serious problems.
Jason, who specializes in issues of work and inequality, interviewed 10 female and five male black workers at an urban university in the Southeast who were 50 and older, had two or more chronic conditions and earned $25,000 to $45,000 annually. Most had three chronic conditions — typically high blood pressure, diabetes and high cholesterol. They had jobs such as a housekeeping position and a dining room cashier.
"I thought my study offered an opportunity to bring a voice to a population of workers who are foundational to the American labor market, but invisible and who have high needs."
Jason’s study of workplace supports for low-wage older workers with chronic conditions, albeit small, was unusual in its focus on workers who researchers often ignore.
“It’s such a huge issue and not many are tackling it,” she told me in a recent interview. “I thought my study offered an opportunity to bring a voice to a population of workers who are foundational to the American labor market, but invisible and who have high needs.”
According to Jason, black adults in America are generally working longer with lower pay and poorer health than their white counterparts. “They have more chronic illnesses, poor health outcomes and higher rates of death,” she added. Consequently, they need to manage their health challenges while dealing with hard work. “Imagine mopping the college cafeteria with arthritis while feeling dizzy from your blood pressure medication,” said Jason.
A Study of Older Workers With Chronic Conditions
That kind of thing often wasn’t easy for the workers she studied.
For instance, their university employer and managers were typically inflexible when the workers wanted to adjust their schedules due to their health conditions.
“One worker had cataracts and asked to get off earlier and start earlier because the eye problems got worse as the days got darker, and that request was denied,” said Jason, when presenting her research at the Gerontological Society of America (GSA) conference I attended in Austin, Texas in 2019.
Similarly, Jason said, the employer “did not offer to adjust physical work responsibilities at all,” due to the chronic conditions. The employer was helpful, however, when it came to scheduling time off for medical appointments.
What Employers and Co-Workers Can Do to Help
The study raises important questions about what employers can, and should, be doing to assist such workers who typically can’t afford to retire. Jason noted workers like these “often can’t ask themselves, ‘When can I retire?’” Instead, they keep working “in spite of their poor health,” she said.
Based on her study, Jason concluded that having a “preferred employer” is an important factor for older, low-income workers needing to manage chronic health conditions. A preferred employer — and the university in her study was one — offers favorable pay and benefits, compared to others locally.
It also helps if managers are not just compassionate (which these workers said their bosses were), but willing and able to adopt changes in scheduling, tasks and workplace design if needed, which they often weren’t.
The workers Jason studied said their supervisors were generally “very friendly, but inflexible because they were under bureaucratic constraints.”
Jason also found that older, low-wage employees with chronic conditions sometimes need co-workers to step in when their health issues make things difficult.
The people she studied, Jason said, “often relied on teamwork with other older workers to get their job tasks done when they were sick.” But — and, again, this was just one small sample — the younger workers rarely stepped up to assist. “They were often deemed not helpful in sharing tasks or alleviating physical jobs,” said Jason.
What the Law Requires
The federal Americans With Disabilities Act requires employers to make “reasonable accommodations” to a job or work environment so an employee with a disability can perform the essential functions of a job. Accommodations may include such things as: providing or modifying equipment and part-time or modified work schedules.
But, Jason said, older, low-wage workers with chronic conditions are sometimes afraid to speak up and ask for such accommodations, for fear of reprisal or job loss. "They don’t like to disclose that they have a health issue. They like to fly under the radar and don’t want to be seen as a problem,” Jason noted.
A Surprising Finding in the Study
One thing surprised Jason in her research: “I went in with the notion that life is so hard for these workers that they would dread going to work every day. I was expecting the story to be: ‘How do I cope in this unfavorable situation, having to work while I’m sick and older?’ she said. “What I heard instead was that these older workers love their jobs and took a lot of pride in their work.”
And, Jason added, “I loved the resilience that showed through in their interviews.”
But, she concluded, based on her study and others such as work by Professor Mary Gatta at City University of New York: American workplaces can better support low-wage workers with chronic conditions by providing more support, flexible work arrangements and ergonomic workplaces.
It’s something that employers will increasingly need to do.
“Employers — and employees — need to get used to the idea that people want to, and need to, work longer,” said Jacqueline James, director of the Sloan Research network on Aging & Work at Boston College, at the GSA conference. “Employers’ awareness about the need to work longer is getting keener. The problem is they are not changing in ways to help meet older workers’ needs.”
What Walmart Will Do for Workers With Chronic Conditions
Only 19% of employers in the 2018 Best Places in Health Care Employee survey by Willis Towers Watson said their well-being policy is “effective at reducing the impact of chronic disease on employees and providing the support needed.”
A few big employers are taking steps to help manage chronic care of their workers, though.
For instance, Walmart (the nation’s largest private employer) is rolling out new benefits in 2020 such as a telehealth service in Colorado, Minnesota and Wisconsin that will include chronic care management; video visits will cost $4 per visit.
Advice to Older Workers With Chronic Conditions
Jason’s advice to low-wage, older workers with chronic conditions: “Try to work with your employer so you can go to your medical appointments. And go to HR to see what is already available where you work that you don’t know about.”
The Job Accommodation Network, a free service of the U.S. Department of Labor, can help, too. Its website has helpful advice and information, including a sample accommodation request form letter.
I look forward to Jason’s next research projects, looking at workplace characteristics that support older, black family caregivers and black grandmothers with health issues who are also custodians of their grandchildren.
(This article was written with the support of a journalism fellowship from The Gerontological Society of America, Journalists Network on Generations and the Silver Century Foundation.)