Technology, education and the Americans with Disabilities Act have drastically changed the workplace in the last decade or two. The ADA, enacted in 1991, outlaws discrimination in hiring on the basis of disability. It also requires employers to provide "reasonable accommodations" to enable employees with disabilities to perform the "essential functions" of the jobs for which they were hired.

While the framework for a legally and physically accessible workplace exists, the reality varies widely. People with neuromuscular diseases have received on-the-job accommodations ranging from a piece of Styrofoam to rest a hand on, to a fully equipped, adapted van to drive to and from work. Others have been fired -- illegally -- when they reported their diagnoses or have seen their requests for accommodations ignored.

In determining what accommodations will be provided, the employee and the employer have specific roles. As an employee, you have to raise the subject of accommodations and disclose the nature of your disability in order to claim ADA protection. Employers are required to consider each case separately and to provide an effective solution to any problem you raise -- unless doing so would create an "undue hardship." The accommodation doesn't have to be exactly what you asked for as long as it works, and employers don't have to change their expectations for the quality or quantity of work you perform. At the same time, they can't pay you less or penalize you in any other way because you need accommodations.

The situation works best when both parties search for solutions in good faith. In preparing for an accommodation negotiation, the more you know about potential solutions, the more you can help your boss help you.

FIRST THINGS FIRST

To spend several hours in any work location, you first have to be able to get around: into the building, through the doorways, to and within your work space, and into the bathroom, cafeteria and other common areas.

Lori Generis is senior admissions liaison for the Social Services Department of Methodist Hospital in Houston. Based in an office in the hospital, she goes to various nursing units to evaluate patients for post-acute care in nursing homes or skilled nursing facilities. She's worked there for seven years.

The hospital has many automatic doors into and throughout the building. Two years ago, it installed an automatic door into Generis' department, so she no longer has to ask someone to open the door for her. The change was "exciting," she said. "I didn't realize how dependent I was. Now I can come and go as I want. It's been great."

The cost of an automatic door, which opens in response to pressure on the entryway floor or on a large accessible push button, starts at $1,200 to retrofit an existing door.

If a company can't afford to install several automatic doors, or even wider doors, perhaps it can install one. A lower-cost or temporary solution is to replace the doorknobs you use with levers (about $10 apiece), with ribbons or cords attached for grasping and pulling.

A handrail along the steps leading into the Automated Flight Service Station building at the Huron (S.D.) Regional Airport makes it possible for Donovan Decker to work as an air traffic control specialist. Decker is ambulatory with facioscapulohumeral (FSH) muscular dystrophy, and the rail helps him (and other employees) during icy weather and high winds.

Convenient parking spots, and safety rails in elevators, along hallways and in restrooms also assist workers with neuromuscular diseases. Hughes Defense Communications in Fort Wayne, Ind., installed modifications in an elevator that respond to a reflector on Laurie Williams' wheelchair, triggering the elevator to stop at the floor where her office as a software engineer is located.

TOOLS FOR THE JOB

After you know you can get around the facility, you need an accessible work space and usable equipment for doing your job.

One of the most common accommodations in offices is raising a desk a couple of inches so a wheelchair can slide underneath. Asking the maintenance staff to put wooden blocks under a desk, to replace a desk with a table or to switch the configuration of your office furniture costs your company virtually nothing.

Your employer can attach arm rests to a desk to keep your arms at a comfortable angle for typing or using a computer mouse for about $90. There are also mouse pads that attach to chair arms for about $35.

Several adjustments can be made to a telephone for those with limited hand and arm strength: A large-button key pad overlay may be only $15; speaker phones are available at any store that sells phones, starting at about $40. For more privacy in conversation, you can add a head set for about $100.

Rolling file cabinets, easy-to-grip pencils and other basic items are available from office supply outlets at a modest cost.

Assistive technology has made it possible for people with almost any level or type of disability to use a computer. Some examples: Voice recognition systems are available for around $1,000; on-screen keyboards for $350-$800; programmable keyboards, $300-500; electronic wands for no-hands keyboard operation, about $1,000; hand or mouth sticks, $15-60; copy holder attachment, $10 and up; joystick controls, under $100; and a trackball mouse for $75 to $130.

Non-office work environments can also be adapted. One man with a form of myopathy who works in retail sales sits on a stool behind the counter when his legs fatigue. The Job Accommodation Network has helped companies come up with many other solutions, including:

• A periscope attached to a microscope for a lab employee whose neck doesn't bend: $2,400
  
  
• A standup wheelchair for a chef: $3,000
  
  
• A rechargeable electric screwdriver: $65
  
  
• A three-wheeled motorized scooter with a basket to deliver paperwork in a multistory building: $2,000 - $2,500
  
  
• A spring-activated, mechanized seat for easy standing and sitting: $200

REDEFINING THE JOB

Devices and gadgets aren't the only approaches to accommodation. The ADA says you're qualified to hold a job if you can carry out its essential functions, not every single function that's involved in someone else's performance.

For example, you can be a receptionist if you can greet visitors, give information and answer the phone at the reception desk in a satisfactory manner. The fact that it's difficult for you to deliver an occasional package to another office can't disqualify you from being considered for the receptionist job (though package delivery might be considered an essential function of a messenger job).

An employer who values your skills can be asked to find ways to adjust hours or redistribute duties so you can perform the essential functions, as well as to provide adaptive devices.

Generis, who has SMA, relies on paratransit services to get to work. An 8 a.m. start time at the hospital meant that she had to ride at peak demand times. After three hours in transit, she still often arrived late. She asked for a change in her hours and now works from 6 a.m. to 3 p.m. with much less stress and greater productivity.

An adjustment was made for a teacher with a neuromuscular disorder who no longer had the hand strength or dexterity to create lesson plans, tests and other classroom materials. He was provided with a voice-activated computer, printer, software, and projector, at a cost of about $5,000, so he could keep teaching.

Dave Bruflodt went to work for Target Stores in 1976 as a bookkeeper, traveling to different stores in Iowa. A few years later, his FSH dystrophy made travel more difficult and he was given a position on the audit staff at the company's headquarters in Minneapolis.

By 1985, his disease had progressed to the point where a full day's work was very fatiguing. His supervisor offered a compromise: Bruflodt reduced his work week to 30 hours for a while. He now works 20 hours a week on four workdays. A senior internal auditor, he receives a full-time salary with the second half paid by the company's long-term disability insurance policy. He retains all the benefits of a full-time employee.

Bruflodt, the second Target employee to go on the plan, describes it as "an absolutely wonderful solution" that's allowed him the income and energy to have a full family life as well as to continue to do meaningful work.

"I've been blessed. Target was very foresighted, and I have done a good job for them. It's been win-win for both Target and us," he said.

Other virtually no-cost accommodations include:

• trading some job functions (you answer the phone for someone else, who does your filing)
  
  
• working on a buddy system (one person lifts boxes and the other person inventories the contents)
  
  
• moving into a different position in the company
  
  
• getting a few days' advance notice of meetings off-premises so you can arrange transportation
  
  
• getting a waiver from on-call duty in exchange for working an few extra regular hours a week

UNUSUAL ACCOMMODATIONS

Many companies don't have the financial clout to provide the kind of insurance program that enabled Bruflodt to stay on at Target. But a company's size isn't always a measure of its willingness to offer accommodations.

David J. Walters is a part-time consultant on organization and productivity for two companies in Fort Wayne, Ind. Because of the disabilities imposed by his ALS, one of the companies provides him with transportation to work and an aide to help him handle papers, eat lunch and meet other needs. Though it's a small company, it's much more accommodating than Walters' previous employer, General Motors. Walters and GM parted company when he told them he had ALS, and they ultimately settled their differences in a lawsuit.

Smaller companies may truly be unable to afford all the accommodations you'd like. (See "Dollars and Sense," below.) But realistic and imaginative compromises can be affordable and allow you to continue working for some time.

Decker and his boss came up with the idea of installing a pair of bookcases that he can use as props when he gets in and out of office chairs on wheels. Cost for this double-duty accommodation: $100 to $200 for each bookcase.

Working from home is sometimes feasible, particularly in areas with extremes of weather and transportation problems. A full home office may require an investment of $10,000 or more for computer, printer, software, fax, furniture, phone line and messenger service. But you could start with a basic desktop PC with internal modem, and a multifunction printer-copier-fax machine for less than $2,500.

A few other more ingenious solutions:

• A sales agent with paralysis who worked in an office was given a drafting table, page turner and a pressure-sensitive tape recorder to help in handling paperwork, at a cost of $950.
  
  
• For a furniture maker with balance problems, the company installed a plywood platform to raise part of the work station, located tools more conveniently and gave him a cart for carrying items. The cost: $200.
  
  
• Scott Luber began working for a public accounting firm in Milwaukee in 1982 when personal computers were new to the field. As his limb-girdle muscular dystrophy progressed, he added adaptations and now uses a mouthstick with a standard keyboard and a T-TAM device that turns his numeric keypad into a mouse and allows him to hold down multiple key combinations. His employer, in turn, has used his expertise in computers in developing a companywide computer system.

INTANGIBLES

There are some accommodations that can't be ordered from a catalog or contractor. For example, co-workers' attitudes make a big difference for Decker.

"The people I work with watch out for me a lot, when it's icy and stuff like that," he said. "My coworkers are very good about helping if I need something. If someone's running back to get a cup of coffee, they'll bring me a pop or something like that."

This kind of "help" doesn't take any special planning or cost. It's just common courtesy.

Your own attitude as a worker with a disability can also make a difference. There's no substitute for pulling your share of the weight to make accusations of special treatment ring hollow.

In asking for accommodations, you'll probably get the best results by setting priorities and taking a cordial tone. When Williams started at Hughes, the company made the bathroom near her office accessible "right away." She added, "As I discovered other things I needed, they were done, kind of gradually."

At the same time, don't hold back on important needs, and don't think that you're requesting "special treatment." In most workplaces, a variety of accommodations can be found: special chairs or cushions for those with bad backs; rearrangement of equipment for a left-handed person; support belts for lifting; safety shoes and helmets in construction areas; convenient location of files; adjusted hours to allow for children's schedules or medical appointments; placement of computer screens for different visual acuities and light sensitivities.

Disability leave, maternity leave, coffee breaks, salary raises and overtime pay are inconvenient and costly for companies, but they're generally considered worthwhile to secure experienced employees for the long term. Even the choices of background music and snacks take individuals' preferences into account.

Likewise, every worker has different abilities. Typing speed, skills with customers, memory, verbal or auditory learning, writing skills, creativity, problem-solving and mathematical abilities -- all come in different combinations and affect just how a worker does a job. Every workplace reflects the individuals there, not just the job description.

The claim that "we can't spend so much money for just one person" can also be refuted. Just as curb cuts benefit parents pushing strollers as well as wheelchair users, many accommodations provide convenience and safety for the entire staff. And once electric doors, accessible bathrooms, railings, elevators and speaker phones are in place, that workplace is now accessible to future employees with disabilities, as well as to visitors and customers, without additional major investment.

PROBLEM SOLVING

Most of the people cited in this story have had smooth sailing in acquiring job accommodations. Generally, they spot a problem, suggest a solution to the immediate supervisor and it gets done in a short time, without any discussion of cost. That can happen if you're a valued employee and your boss understands there are many ways to get a job done. Bruflodt and several others have even been asked for advice on accessibility in the design of new company offices or facilities.

Walters, who's writing a book about adjustment to life with a disabling illness, said the most important factors in getting accommodations are your relationship with the decision makers at your workplace and "what you give back to the company."

"You have to know what relationship you have within the organization and with the person you're talking to," he said. "If you think you have a relationship that will not be discussed outside, that's one thing. If they report upstream to people that may not know you from other people, you may not get the same consideration. It comes down to the effect of other people you're working with and what kind of morals they have."

Exactly whom you approach, when and what you tell them is an individual decision based on factors unique to your disability and your workplace. Walters advises being frank with your employer about your current and future needs, making it clear what you can continue to do as well as what accommodations you'll need.

When he first received his diagnosis of ALS, Walters said, "I wanted to continue to do everything I could do on my own. So therefore I wanted to look as normal as possible. In that mode, you're not looking for things to help you." He believes that postponing a discussion of accommodations made it harder for his employer to accept changes when they became necessary.

Another risk of keeping things to yourself is that you may not receive promotions or transfers because of a supervisor's misunderstanding of your abilities or preconceptions about your disease. "Then they're making decisions for you without talking to you," Walters said.

The ADA requires your employer to consult with you before choosing an accommodation. In working out reasonable solutions, both sides have to be realistic. You must be honest about what you can and can't do. Your boss has to acknowledge that good workers justify some expense.

If your neuromuscular disease is continuing to progress, you may want to plan ahead. There may be things you do now that won't be possible later. What other positions could you hold in your company when your physical abilities change? At what point would you like to reduce your hours?

If you believe you can do the essential functions of the job but your boss stubbornly resists providing accommodations, here are a few more tacks to take:

• Do your own research and come up with specific solutions. Find the prices and sources of accommodations that will work. Anticipate questions or objections that may arise and be prepared to spell out the benefits.
  
  
• Tell your boss about the long-term benefits of accommodations. The company owns what it pays for. Give information about tax credits. (See "Dollars and Sense," below.)
  
  
• Bring your own. If the company won't buy you voice recognition software or a scooter, offer to buy it yourself if they'll pay for installation. You could also suggest splitting the cost, or do it all at your own expense, with the understanding that you take it with you when you leave.
  
  
• If you got your job through your state's vocational rehabilitation program, that agency will usually help pay for accommodations.
  
  
• For help in finding specific solutions, call the Job Accommodation Network (see Resources, below).
  
  
• If your boss can't understand the nature of your disorder, ask your doctor to write a letter explaining your functional limitations. This may happen when disabilities aren't obvious. InaSue Shapiro, a teacher in Chandler, Ariz., used such an approach to explain the effects of her myasthenia gravis on her eyesight and muscle stamina. The ADA allows employers to request medical documentation when you say you're disabled, even if the disability is visible.
  
  
• If the accommodation question becomes a battleground, and you're willing to stay the course, you can get support and information from the Equal Employment Opportunity Commission, your state's Governor's Committee on the Employment of People with Disabilities, or an independent living center in your area.

DOLLARS & SENSE

The ADA outlaws job discrimination against people with disabilities by all state and local governments and by private employers that have 15 or more full-time employees. The provisions also apply to employment agencies, labor organizations and labor-management committees.

All covered employers and organizations must provide reasonable accommodations unless doing so would cause "an undue hardship" for an employer. The ADA defines undue hardship, rather vaguely, as "an action requiring significant difficulty or expense."

The EEOC's publication, "The Americans with Disabilities Act: Your Responsibilities as an Employer," explains, "Undue hardship means that an accommodation would be unduly costly, extensive, substantial or disruptive, or would fundamentally alter the nature or operation of the business. Among the factors to be considered in determining whether an accommodation is an undue hardship are the cost of the accommodation, the employer's size, financial resources and the nature and structure of its operation."

However, an employer who considers a particular accommodation to be an undue hardship must try to identify a lower-cost accommodation. It must also consider whether funding for an accommodation is available from an outside source, such as a vocational rehabilitation agency, and whether the cost would be offset by state or federal tax credits or deductions. And the employer must give the employee with a disability an opportunity to provide the accommodation or pay part of the cost.

Reports from the Job Accommodation Network, a federal agency that helps employers and employees find accommodation solutions, seem to indicate that few employers could claim undue hardship. In 1996, JAN reported that only 4 percent of the accommodations reported to the agency cost over $5,000, and the average cost was $200. Some 71 percent cost $500 or less, and 82 percent cost $1,000 or less.

In addition, JAN says companies reported an average return of $34 in benefits for every dollar invested in making an accommodation. These savings come through increased productivity, reduced worker's compensation and insurance costs, and retaining trained employees.

Several federal tax incentives offset the cost of accommodations:

• Under IRS Code Section 44, a small business may take a tax credit of up to $5,000 a year for making its premises accessible to people with disabilities. The credit could cover half the cost of eligible expenditures over $250 and less than $10,250, including purchase or modification of equipment. To qualify, the business must have 30 or fewer full-time employees and a maximum revenue of $1 million.
  
  
• All businesses are eligible for an annual tax deduction of up to $15,000 for expenses of removing certain architectural or transportation barriers. These include barriers created by steps, narrow doors, inaccessible parking spaces, restroom facilities and vehicles. Small businesses can sometimes take both the tax credit and the tax deduction on the same expense.
  
  
• The Work Opportunity Tax Credit, previously known as the Targeted Jobs Tax Credit Program, may be available for employers who hire individuals with disabilities referred by state or local vocational rehabilitation agencies and certain other government programs. A tax credit may be taken for up to 35 percent of the first $6,000 of first-year wages of a new employee with a disability.

More information on all three programs can be obtained from a local IRS office, or the Office of Chief Counsel, Internal Revenue Service. Check state tax laws for further incentives.

RESOURCES

PUBLICATIONS

"The Americans with Disabilities Act: Your Responsibilities as an Employer" and "The Americans with Disabilities Act: Your Rights as an Individual with a Disability." Both published by the U.S. Equal Employment Opportunity Commission and distributed by the EEOC and JAN (see Organizations, below).

"Computer Resources for People with Disabilities," 2nd edition, by the Alliance for Technology Access, 1996. 340 pages. Paperback $17.95, spiral-bound $22.95, hardcover $27.95, ASCII disk, $22.95. Hunter House, P.O. Box 2914, Alameda, CA 94501-0914, (800) 266-5592.

"An Employer's Guide to Hiring Persons with Disabilities" by Wayne Husted, director of Keene State College Career Initiatives Project. (603) 358-2353. www.keene.edu/academics/aspire/CIHandbook.html.

"Fighting for the Rights of Employees with Disabilities" by the American Federation of State, County, Municipal Employees. (202) 429-1217. www.afscme.org/afscme/wrkplace/disab_03.htm.

"The Job of Interviewing," Quest, MDA, Winter 1996. (800) 572-1717.

Reasonable Accommodation: Profitable Compliance with the Americans with Disabilities Act, by Jay W. Spechler, 1996, St. Lucie Press, 100 E. Linton Blvd., Suite 403B, Delray Beach, FL 33483, (407) 274-9906.

"Technology Transforms the Workplace," and "Writing and Talking -- the High-Tech Way," Quest, Fall 1995.

"Your Rights in the Workplace" by Barbara Kate Repa. www.inter-law.com.

Job-Hunting Tips for the So-Called Handicapped or People Who Have Disabilities, by Richard Nelson Bolles, 1991, Ten-Speed Press, Box 7123, Berkeley, CA 84707, (510) 559-1600.

Job Strategies for People with Disabilities, by Melanie Witt, 1992, Peterson's Guides, P.O. Box 2123, Princeton, NJ 08543-2123, (800) 338-3282.

Also see the articles and advertisements in Quest and other magazines, and product catalogues from companies that market to people with disabilities.

ORGANIZATIONS