Please stand by for realtime captions. Good afternoon, folks. If you joined us for the personal -- Prolonging Work -- sports to keep you on the job webinar, please stay tuned. We will be starting in just a few moments -- Supports to Keep You On the Job webinar. Good afternoon. Thank you for joining us today for Prolonging Work: Supports to Keep You On the Job. My name is -- muted -- if you can hear us, give us one moment. We seem to be having some technical difficulties. Good afternoon, everyone. Thank you for joining us for Prolonging Work: Supports to Keep You On the Job. My name is Elizabeth Jennings, and I work for National Disability Institute. And we are thrilled you are able to join us today. Today's agenda includes some housekeeping tips from my c olleague, Nakia Matthews, an overview of the financial wellness survey results, and the importance of economic empowerment, some great tips on Prolonging Work by Dr. Kenneth Mitchell, a special guest who's going to offer her. Perspective, and some suggested next steps. I'm going to hand it over to Nakia so she can give you advice on how to listen to the webinar and how to ask questions. Hello, everyone. The audio for today's webinar is being broadcast through your computer. Please make sure your speakers are turned on and your headphones are turned up. You can control -- control the audio broadcast by the broadcast panel, which you can see a photo of here. If you accidentally close this panel, you can reopen it from the top menu by going to communicate and then join audio broadcast. If you are listening to the webinar today via phone only, or if you do not have sound capabilities on your computer, you can dial 1(877)668-4490 with the meeting code of 969-62-7576. And you do not need an attendee ID. In the lower right-hand corner of your screen, you see a media viewer window. There we have captioning available for participants who are deaf, hard of hearing or English as a second language. If you don't want to see this window, you can collapse the media viewer window or if you'd like to make the media viewer window bigger, you can collapse some of the other panels like participants and chat. If you experience any technical difficulties, you can send a message to me via the chat box, or e-mail our host, Elizabeth Jennings, ejennings@ndi-inc.org. We are going to have a little bit of Q&A at the end, and throughout the webinar, you can send any questions you have to either me, the host, or to Elizabeth Jennings via the chat box or the Q&A box. If you are listening by phone or not logged into the webinar, you can also ask questions by e-mailing Elizabeth Jennings directly. Again, at ejennings@ndi-inc.org please note this webinar is being recorded and the materials will be placed on the NDI website at www.RealEconomicImpact.org. Before we get started today, we'd like to say special thank you to our sponsor, Acorda T herapeutics. We are very appreciative to them of their support. Just to remind you, today we are going to focus on Prolonging Work support. And we are going to start off with an overview of financial wellness and some of the relative strategies that we've been talking about two the first webinar and through the webinars that are still to come. We are also going to have Kenneth Mitchell here to talk to you about thinking differently about work and Supports to Keep You On the Job. Then we're going to hear from Nicole Lemieux, who is going to providing. Perspective. After that, we are going to look at some suggested next steps. These are a few things that we would like to recommend that you consider doing over the next few months, some practical steps that you could use to apply the knowledge that you learned today and then we hope that you get back to us on how successful you are. And we're going to round out today's event with a question and answer period so we can address any of the questions you may have. Don't worry. If you are not ready to ask questions today, you can always reach out to myself, Elizabeth Jennings, and any questions I can answer, I will pass on to Dr. Mitchell for you. So let's start off by talking a little bit about what is financial wellness. We know you've looked a lot at your general wellness, meaning your health. But we also hope you will think about your financial wellness. And what we mean by financial wellness is the state of your finances with the intent of working towards changing financial behaviors so that you can limit stress and the impact of stress on your daily life. Research shows that when you're finances are a point of stress, it can negatively impact other aspect of your life, including your health. We view that there are many components to financial wellness, including being financially literate. And some of you may have joined us last week for our webinar, being money smart. Also, accessing affordable financial services, utilizing favorable tax provisions, which will talk about later in the series, budgeting, understanding public benefit rules, if you haven't already registered, you might want to consider registering for one of our next two series which is understanding Social Security Disability Insurance and understanding Supplemental Security Income. Building and maintaining assets, accessing available healthcare subsidies, and understanding the impact of work of long-term disability, which we will be talking about today. I'd like to share with you some positive -- poverty estimates. For individuals age 18 to 64, back in 2010 is when these numbers come from. Individuals without disabilities across the country lived below the poverty level at a rate of 12.8%. For individuals with disabilities, that rate was more than twice that amount. It was 27.3%. We know that there are a lot of talks about economic recovery but really, there's no group in America more in need than individuals with disabilities as evidenced by their high rate of poverty. For millions of working age adults with disabilities, as many of you may know, when you look to public benefits, for income, healthcare, food, housing, it becomes a trap that requires you to have limited income and limited savings in order to remain eligible. One of the things we're going to talk about over the next two webinars is how, if you are someone who is receiving a public benefit, like Social Security benefits, how we can show you ways that you can work and earn and even save and maintain some or all of your public benefits. So why is financial wellness important? Well, for one, it impacts your mental and physical health. Some of you may know that as you experience financial stress, it can mean -- can impact your health negatively. And also it impacts your self concept. There's a lot of pride in being somebody who goes to work, who pays their bills. When those opportunities are taken from you, that can have a negative spin on how you view yourself. It changes your status with other community stakeholders. As many of you on the line may k now, even the option of going out to be a part of the community, to participate in community events can have a cost attached to it if you are in need of paratransit services or other support in participating in community life. Overall, it directly impact your quality of life. One of the things that we are hoping folks will take from this webinar series is that he will start to think about how you're finances impact your quality of life and in what areas there can be change made and in what areas we will need to look to other s upports. Before we started this webinar series last year, we did a survey with our partners at MSAA so that we could better understand the state of finances among people with MS and have an idea about what kind of learning tools would be sufficient and helpful. And this is part of what we found out. We found out that more than half of the households surveyed earn less than $35,000 annually. We asked about individuals, their ability to pay their bills on time in a typical month. As you can see, almost half reported a somewhat difficult time but 32% said they had a very difficult time paying their bills in a typical month. Also, 43% of respondents reported that their financial status had affected their ability to access medical care at some point. We also learned that almost two thirds -- over 71% of people did not have enough savings to cover three months expenses. Just as a side note, this is an important question because in most financial stability projects or services, they see that an individual's ability to save three months of expenses is key to them being financially stable. Since the financial downturn, they've actually said that people should try to have six months of expenses in the bank, but the respondents that we surveyed -- the majority did not have three months available to them. We also found that a large majority, 67%, reported that their finances were worse since their MS diagnosis. And almost two thirds, 73%, reported that they were not aware or had not used several financial stability programs including the earned income tax credit, which is EITC, IDA, individual development accounts, FSS, family self-sufficiency program, and PAS as, plan for achieving s elf-support. Each of these stability programs -- PAS S. Ones that we will be discussing in future webinars. If you don't know what they mean either, keep joining us and we will advise you as we progress in the series. There are actually a lot of strategies that are available to individuals to improve their financial wellness. And we give you a grid of those. The ones in green are the ones that we've discussed on the first webinar. The one in blue, employment, we will be talking about today. And the majority of the other ones, we will be discussing in subsequent webinars. Certainly don't need to read them to you as most of you on the line can see them but I'm going to go over them just in case, for people who are not able to join us via computer but had to join by phone. The strategies that we want you to consider our financial literacy, budgeting, credit repair, getting bank, meaning banking with somebody who provides affordable financial services; using Work Incentives, which we'll discuss in the next two webinars; using tax incentives; accessing volunteer income tax assistance programs; claiming your Earned Income Tax Credit; learning about and enrolling with state Medicaid buy-in programs; using Family Self-Sufficiency programs; using individual development accounts; accessing Assistive Technology loan funds; utilizing student loans; better understanding investments and retirement a ccounts; and then the assets that we think you should consider building -- if you are able to -- postsecondary education, e mployment, self-employment, m icro-enterprise, homeownership, and again, investment in retirement accounts. The bottom grid our sources of support, which include production and advocacy, which are organizations available in every state. Taxpayer advocates, through the IRS, credit counseling services, volunteer income tax assistance sites, and benefits planning. Financial wellness strategies are new to a lot of people and it's something that you are not typically talked to about as you join the community of individuals with disabilities. So if you are curious about any of these strategies, even before we get to a webinar, I encourage you to reach out to me. I'll provide you some input or advise you as to which webinar to register for. And at any point in time if you need more information, we encourage you to reach out to us. I'd now like to introduce to you Dr. Kenneth Mitchell. He's a managing partner with work prescription group Limited in Worthington, Ohio. And we are very pleased to have him joining us to talk to you about work health and multiple sclerosis. Thank you, Elizabeth. I'm looking forward to the opportunity of sharing with you various points of view that I've been able to develop over the past some years in working with individuals of both individuals and trying to stay at work as well as employers attempting to support a person's continuing their work during and following any work disruptions they may have. From that standpoint, my intent today is to share with you some of the things I've learned, some of the things I've learned from individuals that have multiple sclerosis and have been able to sustain their employment, and also give you a plan, because I think overall the whole asset you bring to this particular situation is your ability to plan, organize, and begin to anticipate issues that may come up. So when I talk about work health and multiple sclerosis being an exercise in good judgment and decision-making, I think that's the essence of where I'd like to go today because we know that he returned to work plan and stay network is really the product of good judgment and decision-making. Next slide, please? Next slide, please? What I'd like to be able to do is start looking at the big p icture. And that is start to focus on good judgment and making decisions. The first thing that we invite a person to is figure out if they are in a currently -- currently involved in a work health predicament. What that means to me is that there is a collision between someone's health and the health status that they have right now. It may not be a crisis, but it may be a situation where they can start seeing emerging problems that may be arising, either due to strength, endurance, overall decision-making ability, cognitive functioning at work. The idea is to begin to anticipate the types of predicaments that may arise and then be conscious of the predicaments the purchase -- the person may be in. One of the first questions I ask an individual that is struggling with being at work or returning to work is, [Indiscernible -- background noise] and often times they say, well -- [Indiscernible -- background noise] didn't -- there's nothing I can do about it, the disease kept emerging, it kept progressing and I got where I'm at today and I'm stuck. Well, that's probably correct, but the important thing is that if a person feels like they are stuck or in fact are stuck, that we have to look at how to get unstuck. And that is there is a certain part of moving forward that we can coach a person on to help move them from being stuck to unstuck. What that starts is taking a look at the predicament they are in. How did you get in it? Secondly, what's important to me at this point in time? What has to change and what can change? This becomes a process of deciding what's important and what's not important. What capacity you have to create various options. What we like to do is be able to enhance those capacity to solve the work health predicament because it's your predicament. It may be a family issue, employer issue, it may be a variety of other people's issues, but the heart of it is it is your predicament and you have to become accountable for solving that predict -- particular predicament. From that standpoint, what we ask a person to do is begin to define the direction you want to go into. What needs to be done? What are the issues that have to be paid attention to? Than we want to look at the values that you have. How important is work to you? Is absolutely critical? Is it part of your essence? Is it part of your soul? Or is it someplace to be? From this particular standpoint, work is probably if not the most important source of income, that the person may have, so maintaining that employment, financial stability is obviously very critical. Then what we want to do is look at how you make decisions. Are you able to gather information? Are you able to sort out information that's real, accurate, from just missed or false information that one may find? And what kind of barriers stand in the way of solving this particular predicament? Ultimately, that starts with the type of vision you have. That is, do you have the capacity to look at the big picture? The long-term consequences of what you're doing today and how they may affect you tomorrow? Will show you a slide in a minute that begins to calibrate where you're planning horizon is at. And then we will ask you to develop a change plan. That is basically an incremental -- series of incremental steps that get you moving forward and begin getting you unstuck or solving the predicament you are in. When we do that, we ask you to start talking about and creating what if options. These are basically what if this happens? What if that happens? Sometimes people don't like to think about these things, but that's often times a source of why they get into the predicament is they haven't thought about them. We are not talking about an obsessive sense of worry, not talking about a set of pessimism on this, but the understanding of what the options are if certain issues come up. Sometimes we call this fire drill counseling. The idea is that you begin to look at doing a fire drill. Preparing if a fire occurs. You are preparing if this crisis occurs, so you know what to do. And so when a person has multiple sclerosis, certainly in your Dick -- early stages, we are at a point in time where you can begin to define what if. Then you can create the solutions, if those things actually happen. And then obviously we want the person to continued -- to adapt and realign. I think that's always a term that people don't like to hear, I've adjusted to multiple sclerosis. I've adjusted to this disability. I've adjusted to this particular condition. People don't like that. If you don't like the term adjustment or readjustment I like to use the term realignment. That is, you realign your values, realign your goals, realign the process of achieving those goals. Because that's reality. And a person that doesn't realign based on the different things going on in their life will become stuck and will have difficulty adapting to the overall process. Next slide, please. This is just an illustration related to the whole idea of planning. You can pick where you are at. The person who is only planning for tomorrow -- they miss a lot of opportunities. Those of the people that get stuck. They're the ones who don't think about where they need to be at next week, next month or next year. So this begins to calibrate the opportunity for your planning and where you fit into this particular process. Some people say, I can't do long term planning because I don't know what the disease is going to do for me or have an impact on me. Well, that's probably accurate that the idea is you still can plan. You still can focus but you can always realign. I always enjoy the people that are the big thinkers, the long-term horizon people, the people we talk about being in the cloud. Well, that's interesting to talk with those people but also they are no different than the person who is looking just at tomorrow because they are not paying attention to what needs to be done. They are dreaming and off into some type of fantasyland. So we need to have that middle-of-the-road planning for not only next month but also next year. Next slide, please. Work and health are connected. There's no two ways about that. Our research, our experience says that the two are so connected that when you maintain your health, you are able to maintain your work. If work gets disrupted, it affects your health, both physical and emotional as well as economic. So when we talk about these connections, we invite the person to begin to sort out what this means for them. The first thing I like to do in working with an individual and also working with an employer is to begin to understand the work health myths out there. One of the most important ones I think people make is that they make a decision -- it's really a premature decision -- that I've got this diagnosis of multiple sclerosis and I won't be able to work. Or you have an employer that says, this person has both bull sclerosis or any type of health condition. They can't work. That's a myth. The idea behind that is the person says, if I can't do 100% of my job, I can't do any of that. That's one of the common myths that employers and individuals come to the premature conclusion about. Oftentimes affects their long-term ability to sustain employment and the long-term ability to have an employer hire individuals and maintain enrollment. From that standpoint, the remainder of these types of connections often deal with very specific areas. Let me touch on those as we go through there. You will see where you fit in terms of the types of decisions, the type of judgment you have in looking at the nature of your work, the capacity to work. First of all, I want to find out and have the person explore what the implications of the multiple sclerosis, the treatment, not only the disease but the treatment? How does that affect your work capacity? This includes every -- everything from medication, strength and endurance, and obviously mobility. From that standpoint, those are important aspect that needs to be monitored and assessed so that you constantly have a good, accurate understanding of what you have going for you in terms of capacity. The reason that's important is because we have a formula that's very simple that work capacity should equal job demands. If there's a gap between those, that's where a person gets in trouble at the workplace. So we want to maintain as little a gap between what a person's work capacities are and what the job demands are. And we will show you a chart in a minute that helps you figure out how to do that. Also, one of the areas we want to pay attention to is oftentimes with a chronic disease like multiple sclerosis, you have points of exacerbation and points of remission. And so you might have some of the consequences, may be that you have the opportunity to have a work disruption. A break in employment. What does that mean to you? Is that something you can workaround? Is is that something you're employment -- has to work around? What's the reality of that? So I'm always -- I want to make sure that the employee and the employer, along with their physician and treatment partners understand what happens if I have a break in my employment? What are the benefits? What does it do to my seniority? What does it do for my overall skill level and my team level that I might be working at? One of the unfortunate things is -- I've worked with people who are self-employed and they have an exacerbation of the symptoms of multiple sclerosis and they decide, this is it. I'm going to sell my business. And him for -- or they quit. Or they think they are going to on disability and retirement all of a sudden, things change and what they've done is they have made a premature decision that's got them in a real predicament. From that standpoint, breaks in employment are important. And obviously when a person makes a decision about continuing work versus leaving work, not only the health consequences, but what are the economic consequences? We will talk a little bit as I close my discussion this morning or this afternoon on the nature of Disability Insurance. That's an important part of a person's life. Disability Insurance can be an important life -- financial lifeboat but also an important way of sustaining employment because most disability insurers have programs to help support a person during periods of breaks in employment. And then one of the areas I look at is the work health connections, the potential work-health barriers. I refer to these as the cornerstones of -- the barriers to staying at work and returning to work. I'm just going to mention them because they oftentimes are very common with individuals who have injuries, illnesses, chronic health problems. These four conditions are ambiguity -- that is, not sure that things are unclear. That may be related to the diagnosis. May be related to treatment, may be related to outcomes. Ambiguity can be a very difficult barrier to overcome, because it leaves people in a quandary. Not sure what to do. Ambivalence on the other hand is the push poll. That is, there's -- push-poll. I can work -- push-pull. It's yes, I want to, but -- the ambivalence can be very debilitating to an individual, because the stronger the ambivalence, the greater the push and pull, either/or and often times people get stuck by this ambivalence and become immobilized, paralyzed if you will. Resistance and fear are important. What the common denominator there is, basically resistance and fear to change. Now, in many types of chronic health problems, there is change in the physical structure of what you can do and how you get around. That's the reality. But through treatment, through therapy, one can minimize that to some degree. What we want to do is create a process by which the person is not resistant to change or fears c hange, but embraces it and create strategies to mold the change to their particular benefit, to mold it to their particular direction they would like to go. And the other issues of work health connections are more practical. That is, what information needs to be shared with my employer? Medical information, diagnosis, symptoms, obviously privacy is very important. But we find that employers need to understand what the conditions are and in most cases, when they understand, they are very likely to be cooperative and collaborate with you to protect and sustain your employability. Now, if you are an employee that has performance problems, you haven't been successful, that may change the equation about a p erson's willingness to support and accommodate. Now, they can't do that because Americans with Disabilities Act -- not dependent on whether they like you or not, not dependent if you are a good performer or okay or bad performer. The idea is that you as the individual need to make some decisions about the type of information you want to share with your employer. That may mean with coworkers, it may mean with supervisors, but certainly a discussion needs to be established with a very senior person within an organization. By senior, I don't just mean colleagues. I mean such things as a senior occupational health nurse, senior human resource manager so that -- or in combination with your physician, that you're able to explain what the conditions are, you can explain the accommodations necessary. My experience over so many years has been that -- employers are typically responsive to that. If not, there's probably a reason for it. And finally, when we talk about employer discussions, what we want to be able to think about is what transitions are possible? What incremental change may be located within a person to accommodate periods of exacerbation or periods of remission? That's an important part -- part of the discussion with the employer. The remainder of these things that we have identified here are all related to things about expectations. What do you want to do? What do you need to do to sustain your employment? Those expectations can be shared in terms of the discussion with the employer and your coworkers. Maybe your team needs to make accommodations to cover for you sometimes or other to help during times of treatment, times you might not be physically able to do certain things. Those are negotiated. Those are things that you don't just show up one day and say, I need this. You try to do this ahead of time, try to plan for this in a way that gives you some idea of some controlled influence on that process. Finally, we talk about post work plan. Oftentimes, people don't like to think about this, that they continue to work forever. At some point in time, it may be because of the disease or the disability or the level of function you have. It may be to your advantage to decide that work and what you are doing right now is something you'd eat to continue or should continue. What's the plan after that? Just like anyone who decides to retire, not necessarily medically retire but just retire. There's a transition that goes on. Being able to think about it and plan that post work plan, whether at 65 or 55 or 45, the thoughtfulness put behind that allows you to create a series of expectations that can be met and anticipate any changes that may not be able to be met and come up with solutions to them. Next slide, please. When do you start? In terms of your work health -- sustaining your work health relationship? That's really today. Or at the time you have a d iagnosis. Maybe even start at the time you have symptoms and you are not sure what's going on. As you begin to think about the potential impact of this, you may not know exactly where it's going to go. And you probably likely will not know the time. From that standpoint, you can start today in thinking differently about the relationship between you, your work and your health. When you think differently, what that means is you are not a victim. It means you are not drifting off based on things in your life you have no control over. What we want you to be is a p lanner. A driver. The influence. Certainly not a spectator to this whole thing. We want you to be able to be in control of the process of making sure that you are able to be part -- to be the principal decision-maker on the employment activities you are engaged in. You may not have the final decision because there may be an employer or group of people that will make a decision along with you, but in fact, you need to be not a spectator but an active p articipant. Now, we're going to get into some of the more specifics that I think are going to be useful. Let me identify a couple areas real quickly. As I mentioned before, job demands and work capacity is a very important equation. I will show you how you might want to do this in an organizational -- organized way that help you identify things that need to be done specifically. And then what we can do to talk about is having plan be, and the type of financial coverage -- plan B. To the point where you have to go on Disability Insurance or that's the best path for you to go at this particular time. Let me make one comment here on the last bullet. This is something that when I work with individuals and I work with employers who are dealing with individuals that are having some type of health issues, to remember that hope and panic are not strategies. They are emotional responses to an event. We could hope that you will get better, we could hope you would be able to sustain employment, but it won't get you far. You can look at things and gets very excited, get very stressed out and panic. Once again, that's not a strategy. The strategy we are looking for is a planned and thoughtful way of making decisions about where you want to go and what you are able to do in managing the effects of multiple sclerosis. Next slide, please. One of the practical ways we do this is we invite employers to create this type of matrix, if you will, or table, how you want to refer to it. What it does, it creates 2 directions. You have your job demands, that is, the job demands necessary? Is it trickled? Do you do it sometimes or never? And then we look at the work capacity. I'm not talking about general work capacities. The ones I have listed here are very specific related -- may be affected by multiple sclerosis. That is, memory, strength, m obility, visual spatial relationships, focus and concentration, reaction time, we shouldn't -- communication. This also can be related to such things as chemo brain. Someone going through cancer treatment. They -- therapy may have the same effect on these type of functions, work capacities based on jobs. These are the ones I've selected just for illustration. What I've done here is you can see in terms of memory, it's a necessary function. And you can see under visual spatial, that's a necessary function. You can see under communication, this is necessary. This job can be done without that particular function. Now, you can see in my first column outside the work capacity is there an impairment? Existing situation that suggests this person -- there's some effect on their memory? On their strength? And mobility? You can take the first three as an impairment that measurable. The only one out of this would be in terms of memory -- that may be an issue we need to deal with. What kind of adjustments do we need to do in relationship to the nature and scope of this particular job? Under visual spatial, this has -- there's no impairment. So it's not a problem. When we get down to the area -- I've lost the screen here -- there we go. Thank you very much. The idea here is that endurance seems to be the most critical issue in this whole area. It's necessary and there's probably some significant impairment in that particular area. The remainder of these might be issues or possible issues or no issues. So this is the type of specificity that you can help an employer -- we hope the employer will be able to provide this type of information but this type of demonstration allows you to look very specifically as -- at a particular set of job demands and then be able to look at the work capacity and the type of impairment or sustained function you might have in that particular area. And then you can determine, is this a problem? Is it not? Is it something we have to deal with? Is it not? Next slide, please. If there is an issue and a person has a break in their employment, Disability Insurance is an important area that needs to be looked at. Now, many employers who have Disability Insurance available to you -- under short-term disability -- they also may have long-term disability. These are different than Social Security disability, which usually requires a person be off work for six months or longer. Under short-term disability, it may go into effect right away, within days of not being able to work. Long-term disability usually goes on for six months. And then will be a transition onto short-term -- Social Security disability if that is necessary. I'm not going to go through all of these but here are the four areas that -- when you consider the Disability Insurance that -- if that's a likely strategy or path you have to follow. First of all, Disability Insurance is not an entitlement program. It's a contracted benefit that that employer pays for. Now, you also may be paying for this if it is a voluntary program offered at your worksite. You may be paying for it or a certain amount of your wages may be pulled off or drawn off to pay for that particular benefit. Many employers will pay that as a benefit for their employees. Understand the rules. Understand clearly how much time you are -- that's available on short-term disability? Typically from three to six months. Sometimes it's less. Usually never more. So make sure you understand the reasons -- the latitude, the length of time. Long-term disability usually starts at six months and may go up to two years. At that point in time, definitions of disability will change. It's maybe you can't do your permanent job you are in now. The definition may be the disability -- you can't do any job. That makes a difference now in terms of relationship with your employer. You also need to understand how long he will be staying employed or connected to the employer. Some employers have a two-year limit. If you are off work for two years, then you are not hired here a nymore. You are not employed anymore. We are seeing employers shortening that to a year and even some employers have it if you are off for six months, you are no longer employed after six months. Take a look at the pre-existing conditions. Most disability benefits -- Private disability benefits have a one-year pre-existing period, that is if you're treated prior to the disabling condition before the insurance may have some impact on that. From that standpoint, understand that pre-existing condition. Second -- thirdly, look at the Job Accommodations. Almost every employer I've worked for will offer accommodations. Most insurers will be your advocate on that. They want you working. It's not to their vantage to have you off of work. Make sure that disability insurer is your partner, not your a dversary. From that standpoint, make sure that disability insurer is going to be partnering with you to work with you and they could be your advocate with the employer in terms of helping them understand what Job Accommodations are possible. There are a lot of resources out there about Job Accommodations. We will share some of those at the end of my presentation. Finally, on the Disability Insurance, almost every disability carrier has some type of return to Work Incentives. That is, they will be able to pay for partial disability, provide you different benefits if you are able to work and return to work. Pay attention to those. It's not all or nothing going back to work. They have -- the insurer offers return to Work Incentives that are possible. Next slide please. Private disability is a -- goes directly into Social Security disability to the Social Security Administration. From that standpoint, the long-term disability is usually the bridge. That is, after you've been on short-term disability for three to six months, long-term disability benefits will kick in. You have to make sure that that's available. That's usually the bridge to Social Security disability. So what you need to be able to do there is understand the rules and regulations of how to move on to disability. In many cases, the employer will work with you as you go on long-term disability to help get you ready for Social Security disability because they are anticipating if you are off work for six to seven, eight months, the likelihood of you going on Social Security is going to be fairly h igh. They are going to want you to start planning and moving in that particular direction. From that standpoint, they will be able to be a support group to help you do that. Now, the definition of disability will change when you go on Social Security. It will be different than what you have under the private disability contract. You are going to need to be aware of that and be a good consumer of the disability -- Social Security disability program. If you do go on Social Security disability, they have also returned to Work Incentives. They will protect your Medicare benefits, protect other healthcare benefits and also will help you make the transition back to work. What we know is once the person goes on Social Security disability, the likelihood of them going back to work is very low. From that standpoint, you want to try to sustain your employment as long as possible before using the Social Security disability process. And that particular benefit. So keep that in mind. I guess as you build that return to work plan, focus on the capacity to maintain your employment as long as possible. Make sure you are able to realign that job demand that supports your particular work capacity. And to be a good consumer and understand the Disability Insurance benefits both from your employment and then the transition onto Social Security if at some point in time it appears that the likelihood of you continuing full-time employment is just not possible. Next slide, please. Once again, in terms of the useful Disability Insurance questions once again, make sure you understand eligibility. That is am I in fact covered under my employer's LTD policy? Oftentimes, there may be subtle changes. If there's breaks in employment, especially pay attention to that because sometimes when a person moves from full-time to part-time work, that can have an impact on their eligibility for benefits. Be very conscious of pre-existing conditions. That is, the nature of the amount of time you've had, the symptoms and have they've been identified? Recognized? And would they be in some way making you ineligible for giving you benefits with a diagnosis of multiple sclerosis? Finally, the actual benefit itself. How long it is. How much it is. And be sure that it fits within the certain jurisdiction you are. Certain states have certain different types of benefits, such as California, Hawaii, New Jersey in that they have temporary short-term disability programs offered by the state that you might be eligible for. Finally, the last to our financial. Make sure you understand what the expected monthly benefits are. Those are specific -- those are not hidden but we find that people that don't know this have not asked or not paid attention or they have not read up on it because these benefits are not arbitrary. They are designed to be part of the program and are defined by negotiation and they have a specific percentage of a person's salary that may range from anything from 60% to 100% depending on what the employer has developed or agreed to with the disability insurer. Finally, there's going to be a lot of talk of this on future programs, the overall impact of benefits in terms of income tax. It's always important to understand the relationship between short-term and long-term disability benefits as to taxation as income. It's difficult to offer that up as a recommendation other than be aware of it, understand it, especially in the various states where you might have -- there might be variations that you might not be involved with. So these are important questions that we think are important to ask as the overall sustaining of employment and making decisions about whether to leave work or not based on a myriad of options. And then the final slide I would like to leave you with, actually two slides -- they are summarizing work health resources. These are resources that you as an individual -- they may be in a predicament of dealing with work and health issues that you should be accessing and making available to yourself and having access to. We just put them out here -- I'm not going to go through them but recognize that if you're looking for accommodations, there are a number of sites that can be very specific in taking a job that you might have, whether a clerical position, manufacturing, service, construction, whatever it may be, they have already sought out ways of creating various accommodations. The idea about retraining and reeducation and employment supports can certainly be looked at by the state vocational agencies. The state vocational rehab agencies are intimately connected with Social Security disability p rograms. And so if you're going to go on Social Security disability and that's part of your plan or anticipated direction, they are going to ask you to talk to the agency to see if you -- if there are ways they can help you to maintain your employment. There other various Department of Labor and federal sites -- websites that can help in gathering information. And certainly, one of the things I'm focusing on is making sure that as -- the decisions you make are informed and done in collaboration. This particular site, informed medical decisions foundation based in Boston has a large number of what they call decision-making aids that can help a person, a physician, the individual, the patient, person dealing with the disability, gives them a well-thought-out series of decision points that they need to be conscious of and where to gather information to seek out the best path to make the most informed decision. The last slide is just representing the gathering of information for Disability Insurance. These are the websites that are readily available to individuals to get more informed about Disability Insurance, what it means, the questions to ask, who to work with, things like that. As I mentioned before, Disability Insurance on the private side is always going to go through the employer, unless it's part of a state program. The same thing goes on -- you need to understand the eligibility criteria, the benefit structure, the requirements for work, and how it plays into various employment -- breaks in employment. With that, I'm hoping that you walk away from this particular discussion, now there's very specific steps that can be done to bring forward an opportunity to first of all prevent the work health predicament or getting stuck, but also if you do find yourself in that predicament where there are difficulties in matching job demands with your particular work capacity, there are solutions to it that you can bring forward and that you can look forward -- collaboration with your employer, healthcare provider, ensure, that will allow you to solve this predicament in a way that will allow you to sustain your employment as long as possible. Thanks for the opportunity to share the points with you. Elizabeth? Great but -- great job. Thank you so much, Dr. Mature. -- Dr. Michel. I've been working in the field of disabilities for 13 years now, and not until I met Dr. Mitchell did I really ever hear anybody talking about staying on the job for as long as you can. Typically, what I heard was a kind of negative spin on, let's talk about getting people on to disability, meaning Social Security disability, rather than let's talk about utilizing all of the resources that are out there and available around Job Accommodations and using Assistive Technology to help people stay on the job as long as possible. We're going to go to the next slide so we can hear from a peer perspective. If you do have any questions for Dr. Mitchell, now would be the time to send them into the Q&A. As we are going to have him for just 10 minutes longer and then he's going to be on his way. So if you have any questions for him, please send them in now. So we have joining us today, Nicole Lamell. She is a writer, activist and a woman living with MS. She has a great blog called my new normal.com. And we have the pleasure of having her with us today, so that she can share Elizabeth about her experience in having that moment in time where she realized perhaps work wasn't going to be an option for her much longer. And she's going to share with us a little bit about how she made her decisions and whether or not she had had access to this kind of information that you received t oday. Nicole, thank you so much for joining us. Thank you for having me. It's funny because I went through this process point by point. I went through the short-term disability that led to long-term that led to Social Security. And it never occurred to me that I could stay on my job longer than I did. It never occurred to me to ask my employers to help me. I was too afraid. I was too scared. I didn't want anybody to know I couldn't do my job, which with MS I couldn't do my job physically -- physically, cognitively or the dexterity in my hands -- I couldn't do it. I figured that means I couldn't work there. So I went on short-term disability. That was what I thought was the next step. I didn't think of anything else. So it's good to hear these things. I wish I would have had a couple years before now, but I kind of reimagined my life now as a blogger and activist and things like that. But I also wanted to note, I am a long-term -- on long-term disability through my company. But I know I have a cap on that, which is $500,000. And when using it conservatively -- I know that one day I'm going to hit the cap. So I'm wondering how hard it's going to be for me to find long-term disability now that I do have this previous condition of MS. That's one of my big questions. Because I went to one company and they said, flat-out, no. We don't ensure you. And long-term disability has been my savior for lack of a better w ord. Because it allows my husband to be here with me and we will -- get a stipend, so to speak, to the company I'm with now. But they are ending their program. I like to think it has nothing to do with me, but they are ending it, needless to say. And so now, I blog. That's what I do now. Since I have so much time and I'm just 37, but I'm living like so much older. Anyway, that's another story. Thank you for this opportunity to share. And if anybody has the opportunity, please get long-term disability. It's a game changer. Thanks, Elizabeth. Nicole, thank you so much for sharing a bit of your story with u s. And we did -- we have a slide for all of you out there on Nicole's blog, my new normal. One of the things you mentioned, really aligned with one of the comments that Dr. Mitchell made. As you progress and -- with your MS and as your expectations for your life change, you sometimes have to realign what you're going to do. And I like that you've had the chance to realign what you do from being somebody in the healthcare field to being somebody in this online world of being a blogger and an activist and a writer. So thank you so much. Thank you. So we're going to take some questions and we're going to start with one from Lisa. Her question is, to Dr. Mitchell, how have people with disabilities sabotage ourselves when it comes to work? Financial health? We can only change what we do, not necessarily the outcomes. Yeah. I think that's one of -- probably the more frustrating parts that I'm working with individuals is when they sabotage the process themselves. It goes back to those for barriers I talked about. The ambiguity, the ambivalence, the resistance and the fear. And I think that's what an individual will sabotage t hemselves, they will be afraid to do something. They will be ignorant of the process. And I use the term ignorant in the sense they may not be informed about what their options are. And that lack of curiosity, the lack of interest, and maybe not lack of interest but lack of self-confidence or a lack of energy to pursue it. I think those are some of the factors where I believe a person sabotages their ability to sustain employment over time. What I've found is that if you can control what you can control, the outcomes to change. And so from that standpoint, I think that's what I and truck -- encourage a person. If you can change your behavior and not get caught up in those for barriers, the outcomes do in fact, out differently. Our next question is from Lisa. My planning horizon is 30 minutes from now. [Laughter] I do look to next month and next year and I definitely am ahead in the -- a head in the clouds kind of open. How can I to start balancing between all of these time frames to focus on what I need to be accountable for? Well, the first thing is to define what you are accountable f or. That's really part of the planning process. I admire your ability to have such a range from the clouds to 30 minutes from now, but you are r ight. When a person bounces back and forth, that can be very frustrating for everybody. So my suggestion is usually is to find the things you're accountable for. Things that have to be done. And you can regulate -- not regulate -- calibrate them in relationship to this week, this month, today, or a year from now. And then you can assign resources. You can assign priorities. You can define the energy required to do that. But it's really creating a plan. And that plan aligns with what's possible in terms of what's important to you. And so from that standpoint, it's a part of discipline that people have. And what you described has nothing to do with MS. It has nothing to do with cancer. It's the way people tend to do things. And so from that standpoint, often times people that have a health issues say, I can't think about next week because I have to think about tomorrow. Well, what is it about tomorrow you have to deal with? And then what do you have to deal with next week that's going to have an impact on tomorrow? That's what we try to do is make it as practical, as focused and work it from that starting in i ncrements. Our next question comes from Brian. The question is, I have a primary progressive MS and plan to work as long as possible. It is a lots different than RRMS. How is PPMS deferred? The way I look at it is what are the potential features in terms of the remissions and exacerbations, the level of change, the level of duration of the impairment i nvolved? That's usually what is the critical factor in terms of its impact on the various jobs. So if there's a pattern, identified a pattern. And if the pattern has some predictability to it, you can work around that in terms of schooling or training. One of the more frustrating things is when someone says I can't do my job that I want to get retrained and they start their reeducation program but they have ups and downs and they can participate or maintain it. One thing we have in our favor right now is the Internet. And online education programs. It gives us a lot more flexibility in doing things that you don't have to be in classes all the time. You can do it from home. Being able to track the ups and downs and aligning your time and activities both in short and long-term with that will at least be a start. I think that ties in nicely with our next question. And our last question, which is from Shayna. I'm newly diagnosed with MS. And I was laid off from my job shortly after my diagnosis due to downsizing. I do work temp jobs but I would like to look for employment in this market, which with a disability is difficult to do. What should be my first step? Don't panic. It's my first advice. That's the important thing, keep your head about yourself and -- in terms of you've experienced some bad luck obviously with the multiple sclerosis diagnosis and getting laid off. So the strength of what I would suggest your first step is, take a look as you would if you were downsized without MS. What would you be doing? What will be your next steps? What would you be looking at? Where would you be looking at for employment based on skills, experience, knowledge, overall capacity to contribute in employment area? Then begin to understand the realities of the disease. What difference will it make? What needs to be shared? What needs to be introduced at the time of discussion with the employer? That's always a big question. I don't have a real answer for you on that. How much should be shared at the point of initial interview. There are different thoughts about that in terms of introducing it to the person. To the job -- it makes a difference in terms of the type of work you need, the type of accommodations. If accommodations are needed, those need to be reported and identified. Well that make a difference in terms of how the employer will see you? Maybe. Maybe not. Hard to say. The first step -- I'm going to respond to your question is act like you don't have MS at this point or no diagnosis. What would you be doing to get reemployed after being downsized? And then apply the overlay of how the MS may sit with that or impact of that. Then you can make some decisions as to how to approach an employer. And that will at least get you started. Just to add one more thing to that, because this is a series on financial wellness, we want to remind you that as you look at what your needs are, don't forget your financial needs. Most of us when we look for a job we think about what do I need to cover my budget? And so sometimes in the disability field, that gets lost because we are so focused on individual capacity to do certain jobs based on disability that you don't want to lose the perspective. We have just one more question, and that is if you could recommend one place to start in getting back into the work field, where would you start? I would start where you left off. That's about the best thing is, see where you fit -- why you are unemployed or where you want to get employed if you have not been employed before. Start where you left off and then begin to determine, is that where you need to be? If not, that's where you can create the options as to where you want to go. That's based on not MS at this point in time but your values, interests, skills, where you want to be. What your capabilities are. As you begin to define those, then look at the nature and scope of how the MS may have an impact on this. If it's related to endurance or strength or mobility or things like that, then you want to be able to realign your thinking if those jobs in areas of the relationship to that. Those are probably not going to be winners for you. So the idea is to see where you want to go and then align it with your physical capacity and then you can move forward and start the process moving in the direction you want it to go. Great. Thank you so much, Dr. Mitchell, for your time today. We can't tell you how much we appreciate your expertise and willingness to share it with all of us on the line. So for those of you who asked specific questions about return to work, we're going to provide another few resources. Hold tight. Were going to get to those slides in just a minute. Let's talk about some suggested next steps. Got a lot of great information today. And sometimes you get so much information that it's hard to boil it down into a few great next step suggestions. We wanted to provide some for you. The first is to consider Dr. M itchell's initial question. At the very beginning of the webinar, he said define your work health predicament. And he mentioned that when doing so you should consider what is important to you. What has to change. What can change. To try to define for yourself what your work health life is going to look like. So we challenge you to do that. To sit down with your loved ones, your support team and think about your own work health predicament and really think about what is truly important to me. What is social expectations and what are my expectations? The second step we suggest is to develop an accurate picture of your functional capacities, meaning your physical, cognitive and emotional capacities as they are today and identify gaps between your job demands and your work capacity. You may remember that Dr. Mitchell gave us a grid that showed this. It was on slide 19 if you want to go back to it. This will give you a chance to think about the functional capacities you need for your job. And where your current capacities lie in relation to them. I have to say that many of you asked for advice on where to go for work. I'm going to provide some resources that will be available in your local community. One of the things that can happen when you go to support for work for finding a job is that you can have individuals who start to identify what your functional capacities are, what the capacities of the job are going to be and where the gaps are. So utilizing Dr. Mitchell's approach of defining the gaps for yourself first really puts you in a position of empowerment when you go and seek out support for finding a job or keeping a job. If you've never done this practice, I can imagine some pieces of it will be very difficult. But it is still a wonderful opportunity for you to make an accurate description of your current abilities for yourself before anybody else besides them for you. So that's the second step. The third step is determine one way that you can take one step towards making a change plan. So if you recall, Dr. Mitchell advised you think about your work health predicament, identify your capacity and the gaps related to the work that you do. And then you make a change plan. So this may mean that you need to gather more information or use some of the resources we provide to ask for accommodations or even speak with your Disability Insurance provider or your employer. Really, the point of this third step is for you to do your best to have really good information to make decisions about what you're going to do about your work, whether you're going to stay or go, what your opportunities may be to stay on the job with accommodations or Assistive Technology. But as Nicole mentioned, to not sit there and think, if my functional capacity is decreasing, it must mean I can't keep my job. So this is a challenge for you to try to gather as much good information as you can so that you can make an informed decision that meets your personal values and personal functional capacities. So we hope will set a goal to complete items one, two, and three over the next few months. And we're going to reach out to you to share your experience with us so that we can find out how you did, or if you needed more information or -- it kind of helps us form the next set of webinars, but it also gives us a chance to hear back from you on what you did with this information. So let's talk about some of the resources. These mirror many of the resources that Dr. Mitchell provided. For those of you on the line that are still getting -- kind of new to this disability world, I want to make sure you know what the purpose of these different organizations are. And how you connect with them. The first ones are about accommodations. So the ADA national network is a national network of entities that are funded by the federal government to provide ADA information to anybody who requests it. It's provided at no charge. And say your employer is curious about the ADA. They can call in to the ADA national network. They are not whistleblowers. They can call in and feel safe that they are not going to be reported for not currently abiding by the ADA. Maybe they are doing their best. Let's hope they are doing their best. So the ADA national network also has on their trainings, information on accommodations, it has a wealth of information. When you go up to their website, they also have a hotline. You can use them online or call and talk to them. Next, we have the Job Accommodation Network. Again, this is a national entity that is funded by the federal government. Specifically, they try to find answers to accommodation questions. So if you think you need a specific accommodation or you can recognize I'm having this limited capacity in this functional area that is required for my job, but you don't know what the accommodation might look like for that, then I would say, call JAN. The Job Accommodation Network. They would be the entity would be poised and ready and have the mission to figure out for you what that accommodation may look like. And they have a lot of experience in it. It's most likely that the accommodation you need is one they have suggested before. And the third one under accommodations are independent living resource centers. Every community has an independent living resource Center. There are also sometimes -- there are also sometimes called centers for independent living. And independent living resource Center has several things that they do. One is stated in their name. They are there to help you maintain your independence in living in the community. They also help with employment issues. They can help with advocacy if you need advocacy in any area related to your MS. They can be a really great resource. I find as I answer people's questions that most people aren't aware of this resource, but they are a free resource available in every local community. The next resources are maintaining and obtaining employment. Some folks talked about -- I want to stem the job longer or maybe I need to start looking for a job. And I would say a great first step as far as receiving service would be the state Vocational Rehabilitation agency. Every state has an agency that is responsible for assisting individuals with disabilities in obtaining and maintaining employment. What that means is that if you're on the job now, that your disability, your MS is starting to impact you, you can talk to your state Vocational Rehabilitation agency about what services might they provide? Sometimes they can cover the cost of accommodations. Sometimes they can cover retraining. Sometimes they can cover people going back to school. They can -- sometimes they can cover -- for those of you on the line starting to look at accessible vehicles, if you are working, state Vocational Rehabilitation agency may be able to cover the cost of making your vehicle modified. They can cover a lot of different services. We give you a website. When you get to that website, you click on state agencies contact information. You can also Google for your state Vocational Rehabilitation. You will likely get right to the site. The process of participating in this kind of service means you will go and meet with the state Vocational Rehabilitation agency. You may be asked to sign a plan for employment, but in most states, the services are free. Unless you have a high income, there may be some costs. It's a great first step and one that I would highly recommend to anybody who is seeking to either stay on the job or make a return to work. Also under obtaining employment, the One-Stop centers, which are now called America's job network, they are also available in every community. We gave you the link to the service locator. One-Stop centers are quite a bit more anonymous. Than working with your state Vocational Rehabilitation agency. Anyone is able to walk into a One-Stop center and receive return to work supports. The support to get there may be as simple as looking at job leads. Or you could take classes. You can end up getting more focused services, more intensive services is what they call them there. Depending on what your needs are and what they determine they will be able to provide for you. This is another entity that does provide some return to work training meaning they may help you to completely switch fields. It just depends on what you are looking for and what your specific local One-Stop is able to provide. And then I also provided for you this federal hiring of people with disabilities. There is a significant push within the federal government to hire individuals with disabilities. And so I gave you -- it's called schedule A, hiring. And you can better understand how you apply under schedule A. And what the process will be. If you haven't considered this, it could be a very viable option for you. As the federal government is set apart to be basically the premier employer. They are the ones who set the rules around the ADA. So we as a community expect them to abide by them as -- as an example to other employers. If anything that you heard today you would like to get more information on or your personal situation, you don't feel was touched upon, maybe there's some other things you are interested in, I invite you to reach out to me. E-mail is best. But you are welcome to also call me if you prefer. Again, I am Elizabeth Jennings be and I work for National Disability Institute. We hope that today you got some good information on how you might look at your work health predicament and think about prolonging work and finding the sports you need to stay on the job. This is part of our financial wellness series sponsored by Acorda therapeutics. I hope you will join us again in a few weeks for our next webinar. Thank you all so much for joining us today. Have a great day. [event concluded]