We know from scientific studies and anecdotal evidence that “brain fog” is among the most common symptoms of long COVID. According to the Solve Long COVID Initiative, 58% of people with post-COVID symptoms lasting seven months or longer have experienced brain fog — cognitive impairment significantly affecting everyday functioning. With many in the workforce struggling to adapt to life with brain fog and other lingering COVID-19 symptoms, there is renewed interest in how employers can best accommodate workers with cognitive limitations.

Defining factors

The Americans with Disabilities Act (ADA) requires employers to provide reasonable accommodations to qualified individuals, unless doing so poses an undue hardship. A reasonable accommodation is any change to the work environment or the way things are customarily done that enables an individual with a disability to enjoy equal employment opportunities. Solutions that can help employees stay at work safely and productively are a win for everyone.

Cognition is the act of knowing or thinking; it’s the ability to understand, remember, and use information. Cognition is what enables us to process input, make decisions and judgments, get organized, and plan for the short- and long-term future.

A wide variety of conditions can affect a person’s cognitive abilities, including chronic fatigue syndrome, autism, attention deficit disorder (ADD), sleep apnea, brain injury, stroke and, now, long COVID. Cognitive impairment manifests differently for everyone. People with conditions like these may at times have difficulty thinking or concentrating or feel slow, confused, dysregulated or forgetful.

Thinking differently

In the absence management and accommodations arena, we rarely dwell on an employee’s diagnosis — focusing instead on any limitations that affect their ability to do the job. Therefore, when it comes to cognitive impairments, employers should be primarily concerned with the aspects of a job that rely on cognition and if/how the employee’s limitations may affect performance.

Regrettably, accommodations for cognitive impairments lag far behind those for physical limitations. One reason for this is that most job descriptions and job demand analyses do not clearly outline cognitive requirements. We’re accustomed to postings that say qualified candidates must be able to lift 50 pounds or have the physical endurance to stand for two hours, but they don’t often include details on the job’s cognitive, emotional and psychological requirements. Another reason for the discrepancy is that cognitive limitations can be more difficult to quantify and assess.

Because there are few established standards for accommodating cognitive impairments at work, some creativity may be needed to successfully support employees with such limitations. However, at a time when organizations are struggling to find and keep enough people to meet operational demands, employers cannot afford to simply dismiss current and future employees with differing cognitive abilities.

Accommodations at work: two examples

Some employers are tapping into a notoriously underemployed segment of the population — people on the autism spectrum. Many with autism have trouble reading interpersonal cues and encountering new people or situations, so companies are adapting the interview process to alleviate barriers to employment. People on the spectrum may need some on-the-job accommodations that support their limitations, which can include executive functioning, stress management, socialization and sensitivity to sound and light. Employers report that the benefits of hiring people with autism for jobs suited to their strengths — including attention to detail, sustained focus and looking at problems differently than their neurotypical peers — far outweigh the costs. (For more, refer to this “60 Minutes” segment and the recommendations of the Job Accommodation Network (JAN) regarding employees with autism.)

Another burgeoning area of cognitive accommodations relates to the brain fog associated with long COVID (as described above). Because this is a new condition, there are no established standards for its accommodation. Based on other disorders that present with comparable cognitive limitations, JAN published these options that may bolster the performance of employees with COVID-related brain fog:

• Providing a quiet workspace and/or allowing remote work.
• Noise cancellation/white noise.
• Uninterrupted work time.
• Memory aids, such as flowcharts and check lists.
• Apps for concentration, memory and organization.
• Rest breaks.
• Job restructuring to remove marginal functions, facilitating focus on essential job duties.

The far-reaching impact of long COVID isn’t expected to let up any time soon. Employers need effective standards and strategies for managing employees’ accommodations, return to work and more. To that end, the Disability Management Employer Coalition (DMEC) has established an interdisciplinary think tank focused on long COVID, with an eye toward developing best practices and resources for the employer community. Sedgwick is proudly sponsoring the think tank to support our industry in addressing these significant workforce challenges. DMEC is expected to release the group’s first white paper* on long COVID in the months ahead, so please watch for that publication soon.

Could education be the key?

An area we hope to see further explored in the future — particularly for young adults entering the workforce — is the leveraging of individualized education programs (IEPs) in the workplace accommodations space.

Students with physical, intellectual and learning disabilities are customarily assessed through the school system and receive appropriate services and accommodations to support their educational engagement and progress. However, when students age out of the school system, their IEPs end, too.

IEP reports can shed a lot of light on the kinds of accommodations that can help those with limitations succeed in the workplace. If, for instance, learning specialists, school psychologists and other expert professionals determined that a teenager with some cognitive limitations needed untimed testing in high school, it’s likely they’ll also benefit from extra time to complete assignments or additional time management support when they enter the workforce a few years later. If an employee knows what kinds of accommodations contributed to their success in school as part of their IEP and then asks for similar accommodations at work, their employer will be well-served to seriously consider the request.

The education system has robust resources in place to accommodate children of differing cognitive abilities, but most of the information generated through the IEP process is lost once students graduate to the workplace. The employment sector can learn a great deal from the educational accommodations process, and we recommend more information-sharing to bridge the gap in the transition from student to employee.

Amid today’s stiff competition for talent and emphasis on workplace inclusion, it is imperative that employers make the effort to offer meaningful accommodations that enable individuals with cognitive, as well as physical, limitations to be valuable and contributing members of the workforce. Our team of experts at Sedgwick is at the ready to support the management of your organization’s accommodations program.

*DMEC and Sedgwick released the “Long COVID: Assessing and Managing Workforce Impact” white paper on January 18, 2023. You can access it here.