6. Compensatory efforts

Work accommodations are a central employment measure in helping persons with disabilities maintain or return to work. In this chapter, we present existing research on the effect of work accommodations on the employment of persons with disabilities.

The purpose of providing work accommodations is to support persons with disabilities in obtaining or maintaining a regular job and is an important means to ensure equal opportunity for employment among persons with disabilities (Nevala et al., 2014). Work accommodations include reduced and flexible work schedules, modified work duties, the use of assistive devices, and personal assistance. Flexible working hours and modified work duties for people with disabilities are often combined with wage subsidies for the employer. The employment effect of jobs with wage subsidies is discussed in chapter 7.

A work accommodation is an adjustment to a job or work environment that makes it possible for an individual with a disability to perform their job duties. Corbiére et al. (2014) note that some settings naturally offer many of the work accommodations asked for by persons with disabilities and that these accommodations can be considered ‘natural’ supports. However, when such natural support is not in place at the workplace, employees with a disability need to be supported to obtain or maintain employment. The authors also emphasise that this support should only be given when demand is reasonable and the accommodation is feasible. An accommodation is considered reasonable if it does not slow down the productivity of the company, cause undue hardship, or generate excessive cost (Corbiére et al., 2014).

In the Nordic countries, persons with disabilities can apply for support with work accommodations from public services. Work accommodations may include reduced and flexible work schedules, modified work duties, assistance with transportation, the use of assistive devices, and personal assistance. Assistive devices include teaching materials, specialised equipment (e.g., special tools and IT aids for individuals with dyslexia or limited vision), and minor workplace modifications (for an overview of the latest digital and technical solutions, see, e.g., Lindberg (2021)). The tasks of a personal assistant can include practical assistance for specific lifts, secretarial or driver assistance, proofreading, sign language interpretation, and help with creating structure, providing an overview, and ensuring the quality of tasks.

We have not identified any literature on the employment effect of work accommodations in the Nordic countries in our systematic literature search. However, we have found four systematic literature reviews on the subject: two from 2014 (Nevala et al., 2014; Larsen & Høgelund, 2014) and two from 2021 (Wong et al., 2021; Gulliksen et al., 2021).

The literature reviews show some evidence of a positive impact of various workplace adaptations on employment. For instance, there is moderate evidence that assistance from others, special transportation, and changes in work schedules and organisation have positive effects on the employment of physically disabled individuals. However, the evidence on the effectiveness of job accommodations is weak due to reliance on primarily observational study designs, making it difficult to account for the non-random assignment of accommodations.

Additionally, evidence on the effectiveness of specific work accommodations for people with functional limitations is particularly weak. It is generally noted that extensive research is being conducted to develop technologies that facilitate work for people with disabilities. However, literature on the implementation of such technologies – examining whether and how these technologies are used in the workplace and whether they genuinely result in increased employment – is scarce (Gulliksen et al., 2021).

One of the significant barriers regarding the use of work accommodations in helping persons with a disability fulfil specific job demands is lack of knowledge of the accommodations themselves (Nevala et al., 2014; Wong et al., 2021). Similar conclusions are evident in a qualitative analysis of the use of work accommodations, which shows that both employees and employers lack knowledge about work accommodations and that it is often through contact with the public employment service that they gain this knowledge (Marselisborg, 2021).

Further, American research has found that workers with mental illness, such as a major depression or alcohol abuse, were significantly less likely to receive work-related accommodation than employees with physical disabilities (see, e.g., Chadola and Rouxel (2021)). One explanation may be that mental illness is stigmatised. Corbiére et al. (2014) emphasise that a person with a mental disease needs to disclose his or her disability to the employer to obtain the needed work accommodations and that many prefer not to disclose their mental problem because of stigma.

There may also be some barriers in relation to legislation. In Denmark, for example, according to the Compensation Act, assistive devices and personal assistance are granted in connection with a specific job after the engagement at a workplace. It has been highlighted, for example by The Danish Disability Counsel, that this is problematic because it creates uncertainty and insecurity for both the person with a disability and the employer (The Danish Disability Counsel 202#). Marselisborg (2021) also concludes that assistive devices and personal assistance in the Danish context are primarily used to keep people with disabilities in jobs and education. However, assistive devices are used to a greater extent than personal assistance in getting persons with disabilities into the labour market.

The caseworker interviews add little extra knowledge to what has already been pointed out above. Many caseworkers are not involved in devising work accommodations (e.g., having a dialogue or negotiation with an employer about such accommodations) or granting assistive devices or specialised equipment. Often, other caseworkers in a different (specialised) department are responsible for this. However, almost all caseworkers tend to agree, whether they work primarily with persons with disabilities or primarily with youth, seniors, or immigrants who may suffer from some type of long-term health problem, that such accommodations can be crucial if a person is to keep a job. A Swedish occupational therapist argues that access to the right assistive devices can make a person with a disability feel safer in a work environment. She argues that such tools can be crucial in helping a person keep a job thanks to the aforementioned psychological effect. She says, “It is a sort of placebo effect. Assistive devices are a good tool with a good effect.”

If workplace accommodation is about adaptation of work hours or work intensity, caseworker interviews also suggest that it can be harder to convince the employers that they should agree to this, especially if such adaptation is required in relation to onboarding a new employee with a disability. A Finnish caseworker explains that persons with mental health problems, e.g., depression, may only be able to work part-time, but finding such jobs in his municipality is difficult, because most of these jobs involve evening or nighttime work. This is slightly different in a Danish context, where the flex job scheme (fleksjobordning) has been a success in terms of assisting persons with permanent health problems find a job. Flex jobs are a governmental scheme aiming at assisting persons with a permanently reduced work capacity in finding an ordinary part-time job with a permanent wage subsidy. A Danish caseworker explains that a flex job is typically the solution for persons with mental illnesses, provided that the person’s impairment is not of such a severity that a disability pension is warranted. We turn back to the evidence of the effectiveness of flex jobs in chapter 7.

The effectiveness of work accommodations in the Nordic countries is supported by some evidence, particularly in improving employment outcomes for physically disabled individuals. However, the overall evidence is limited due to the reliance on observational studies, and the effectiveness of specific accommodations for people with functional limitations is particularly weak.

Key barriers to the effective use of work accommodations include a lack of knowledge among both employees and employers, as well as challenges related to legislation, such as the requirement in Denmark that assistive devices can only be granted after securing a job, which creates uncertainty.

Although many of the interviewed caseworkers are typically not directly involved with devising work accommodations, they emphasise that such measures can play a significant role in helping a disabled individual keep a job. However, they do point out that it can be difficult to convince employers to modify the work duties and/or the working hours of a job.