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Vocational Rehabilitation

The simplest definition of vocational rehabilitation was described as “Whatever helps someone with a health problem to stay at, return to and remain in work”.

The goals of vocational rehabilitation in our practice are to:

  • maximize levels of function following injury and/or illness to reach the ability to return to participation in productive activities / roles
  • facilitate the safe and timely return of individuals to work following injury and/or illness
  • prevent future injury or illness

This process in rehabilitation starts right in the beginning of your journey as an inpatient and continues as an outpatient basis depending on your injury, diagnosis or disability.

The doctor, occupational therapist and social worker’s focus in the initial phase is ensuring adequate communication between yourselves / your family and your employer. It is important to keep your employer informed on expected length of hospitalisation and to provide updated sick leave forms / reports if requested. One also needs to understand your rights and benefits and the employer’s responsibility with regards to payment of your salary and accessing sick leave or disability benefits.

Your ability to return to work will depend on your progress in your rehabilitation. At times, returning to work soon after discharge is possible but if you aren’t able to return to work on discharge and need to continue with rehabilitation the process can continue as an outpatient.

Aspects of the vocational rehabilitation that the treating therapists and vocational rehabilitation therapists (usually occupational therapists) address may include:

  • Conducting an in-depth assessment of your abilities in relation to your job requirements / job description e.g. functional capacity evaluations or assessment as part of your rehabilitation
  • Conducting a work visit to assess the environment and job requirements at your work premises.
  • Liaison with your employer to provide recommendations on your ability to return to work and any reasonable accommodations that may be required.
  • Developing a work hardening program that is aimed at improving your abilities to be able to function in the work environment safely and productively.
  • Developing a return to work program that is negotiated with your employers to allow you to gradually return to work or for reasonable accommodations to be made and may involve a work trial.
  • Follow up and monitoring once within the work environment.
  • Assisting with referrals to resources for job seeking, reskilling and finding employment in the open labour market.

Each person’s program or process in vocational rehabilitation is individualised and multi factorial. The best practice or highest success is when there is collaboration from admission and throughout the process between yourself, your employer, any 3rd parties such as insurers and your rehabilitation team.

How can I get back to work?

A simple definition of Vocational Rehabilitation was described by Waddell et al in 2008 as “Whatever helps someone with a health problem to stay at, return to and remain in work”.

During your rehabilitation process, the overall goal is to ensure that you can return to being as productive as possible in all aspects of your life. So your ability to return to work / school or to be employed is a key part of your therapy.

This process in rehabilitation starts right in the beginning of your journey as an inpatient and continues on an outpatient basis depending on your injury, diagnosis or disability.

What can you expect in each phase?

1. Inpatient phase:

  • The first step is to ensure that there is communication with your employer. The social worker will assist you to ensure you are informed about your sick leave and employee benefits / compensation you may qualify for.
  • The doctor will assist with necessary sick leave forms.
  • The team will start to collect information about your job / work requirements to be able to assess your abilities and make recommendations for return to work.
  • Depending on your progress we will assist you to access prolonged leave or disability benefits if you are not able to return to work at discharge.

2. Inpatient or Outpatient Phase:

  • If you can return to work soon after discharge or during your outpatient treatment, the treating therapists and vocational rehabilitation therapists (usually occupational therapists) will be involved in the following:
    • An in-depth assessment of your abilities in relation to your job requirements
    • A work visit or assessment to assess the physical environment and the job requirements
    • Liaise with your employer and provide recommendations on your ability to return to work and any reasonable accommodations that may be required.
    • Develop a work hardening program that is aimed at improving your abilities to be able to function in the work environment safely and productively.
    • Develop a return to work program that is negotiated with your employers to allow you to gradually return to work or for reasonable accommodations to be made. This may involve a work trial.

3. Outpatient Phase:

  • As part of your outpatient rehabilitation we will continually reassess your ability to return to work / school.
  • Outpatient therapy will also focus on improving all your skills to be able to return to work / school. This includes all aspects of your functioning e.g. self care, mobility and access to transport, cognition, communication, social skills and life skills
  • Once off assessments / reassessments are sometimes required for your employer or the insurance company managing your disability benefits. Our vocational rehabilitation therapists can conduct these and provide the necessary reports.

Things to consider

  • The ability to return to work / school is a complex decision that requires involvement of all parties – yourself, your family or support system, your employer, doctors, all therapists, social workers and psychologists. Teamwork and communication between all parties is necessary for success.

    It is important to try avoid travelling this route on your own. Our teams have experience in understanding the complexities of this process and will support and advise you along the journey.

  • Adjusting to your illness / disability may take time. It is often important following inpatient rehabilitation to first readjust within the home environment before returning to work / school.
  • Timing your return to work is a delicate balancing act between success and failure. Respect the medical and therapy team’s recommendations – our aim is always to get you back to work at the right time.
What are your rights and responsibilities?

South African law does allow some protection and guidelines with regards to your employment if you suffer an illness or disability through the Labour Relations Act and Employment Equity Act. The law does however also ensure that employers are not under “undue hardship” to provide reasonable accommodations or alternate positions. Each case would need to be evaluated individually and the vocational rehabilitation specialists can assist you with accessing necessary information.

Your responsibility is to ensure that you or your family are updating your employer on your medical treatment according to your employment contract. If you fail to do this, you can be at risk of being dismissed. The team will assist you to provide the right type of information during your rehabilitation.

What does this mean?

Along your journey , there may be many terms you come across that don’t make sense to you – here is a brief explanation of some.

Disability benefits:

This includes insured benefits provided for by your employer (usually linked to your pension / provident fund benefits) and individual policies e.g. disability benefits as part of life policies or income protection policies. The type of benefits and whether you qualify is dependent on the policies. They may contain benefits such as temporary disability (usually for a defined period), permanent disability (usually only decided on after a reasonable time for recovering is allowed) and income replacement.

Speak to the human resources manager from your employer or your broker / insurer to find out about your specific benefits as they may not cover your full salary and additional benefits e.g. overtime, allowances etc. There may also be a waiting period before these benefits become available.

Reasonable Accommodations

This is the term used in the Labour Relations Act and refers to changes / alterations that need to be made to allow people with illness or disability to stay or be employed. These changes may be physical changes to the environment e.g. providing ramps or wheelchair accessibility or changes to the job e.g. reduced work hours, reduced work responsibilities or providing an alternate position.

The employer needs to make an effort to make reasonable accommodations but if the changes are too costly / disruptive they are not obliged to pay for them / allow them. It can be considered “undue hardship” for the employer and some costs may be borne by the person with the disability.

Compensation Commission for Injuries on Duty (COID)

If you have been injured whilst performing your usual duties at work your medical expenses related to your injury may be covered by the Compensation Fund. You may also qualify for compensation for your injury. The social worker, the human resources manager at your workplace and the Department of Labour can assist in understanding your benefits.

Work hardening program

Similar to your therapy program this is focused on gradually improving your abilities to be able to perform aspects of your job. It may also involve some re-skilling (teaching new skills to be able to perform an alternate job).

It is usually conducted over longer periods of time e.g. 2-4 hour sessions to be able to improve your physical and / or mental endurance. In the beginning you may need to do this at home as part of your outpatient therapy program.

Work trial

This is negotiated with your employers and / or insurers and involves returning to work whilst still being on insured benefits or sick leave. The aim is to “test” your skills in the workplace to see if you will cope and to assess if the employer is able provide the reasonable accommodations.

It is usually setup for a defined period and involves regular follow-up by your therapist.

Functional Capacity Evaluation / Functional Assessment

These are in-depth assessments of your overall functioning in relation to all aspects of your life. They usually are requested by the insurers and are aimed at providing recommendations with regards to your ability to return to work.

Our vocational rehabilitation therapists can perform these but the insurer may request you be assessed by an independent occupational therapist or medical practitioner. The cost may or may not be borne by the insurer.

So – When can you return to work? / How can I return to work” are tricky questions. The answers are complex and individualized but we will help you find them throughout your rehabilitation journey. Please don’t hesitate to discuss any concerns with your doctor, social worker or therapy team.

How can we help?