How to handle an employee with dementia? A guide for managers and HR

According to the Alzheimer's Association, more than 6 million Americans are living with Alzheimer’s dementia, and a number of these individuals are still active in the workforce. Knowing how to handle an employee with dementia? with compassion, legal awareness, and practical support is an essential skill for modern leaders and HR professionals.

Quick Summary

Approaching an employee with suspected dementia requires a sensitive, objective focus on performance issues, not diagnosis. Establish confidential communication with HR to explore support, including legal accommodations, while prioritizing the employee's dignity throughout the process.

Key Points

• Objective Documentation: Document specific, observable performance issues rather than speculating on the underlying cause, respecting the employee's privacy.

• Compassionate Communication: Initiate a confidential conversation with empathy, focusing on observed performance changes and encouraging a medical consultation.

• Leverage HR Expertise: Involve HR early to ensure legal compliance and guide the process of exploring reasonable accommodations.

• Implement Accommodations: Provide legally required and practical accommodations, such as task simplification or flexible scheduling, to support the employee's ability to continue their role.

• Protect Privacy: Maintain strict confidentiality regarding the employee's health condition when communicating with other team members.

• Cultivate a Supportive Culture: Educate the wider team on general health support and empathy to reduce stigma and build a compassionate workplace environment.

Recognizing and Documenting Early Signs of Change

When an employee is in the early stages of dementia, their behavior and performance may change in ways that can be mistaken for poor work ethic or disengagement. A compassionate and legally compliant response begins with accurate observation and documentation of specific, objective performance changes, rather than making assumptions about their cause.

Common workplace signs to observe:

• Forgetfulness: Missing meetings, forgetting deadlines, or misplacing important documents.
• Difficulty with tasks: Struggling with familiar tasks that were once routine, having trouble with complex problem-solving, or needing more time to complete assignments.
• Communication issues: Difficulty finding the right words, repeating conversations, or showing less engagement in meetings.
• Changes in mood or personality: Becoming more easily frustrated, confused, irritable, or withdrawn from colleagues.
• Safety concerns: In roles involving machinery, driving, or critical decision-making, a decline in judgment can pose a significant risk.

Documentation should focus on the observable performance issues themselves. For example, instead of writing "The employee seems confused," document "The employee failed to complete the quarterly report by the deadline for the third consecutive time." This objective approach is crucial for privacy and legal compliance.

Initiating a Compassionate and Confidential Conversation

Once performance issues have been consistently documented, it is time to have a structured, empathetic conversation. This should be a collaborative process involving HR to ensure all legal and ethical considerations are met.

How to prepare for the conversation:

• Choose the right setting: Conduct the meeting in a familiar, private, and quiet space, away from distractions.
• Schedule sufficient time: Do not rush the conversation. Allow plenty of time for the employee to process and respond.
• Consult HR: Involve a human resources representative from the outset. This protects both the company and the employee and ensures confidentiality.

During the conversation, focus on the documented performance issues. Frame the discussion with care and concern for the employee's well-being, rather than a disciplinary tone. You might say, "I've noticed some changes in your work lately, and I'm concerned about you. Is there anything going on that you'd like to talk about?"

Encourage the employee to speak with a medical professional. Reassure them that seeking a diagnosis is the best path to understanding their health and determining potential workplace accommodations. Confidentiality must be a cornerstone of this discussion, stressing that their health information will be protected.

Navigating Legal Requirements and Reasonable Accommodations

Employers in many countries have a legal obligation to provide reasonable accommodations for employees with disabilities, including dementia, under laws such as the Americans with Disabilities Act (ADA) in the United States. Reasonable accommodations are modifications or adjustments that enable an employee with a disability to perform the essential functions of their job.

Types of reasonable accommodations:

• Task simplification: Breaking complex projects into smaller, more manageable steps.
• Assistive technology: Providing digital reminders, voice-recognition software, or other tools to aid memory and communication.
• Flexible scheduling: Allowing for flexible work hours or supported homeworking to manage fatigue or concentration issues.
• Modified workspace: Reducing clutter and noise in the work environment to decrease distractions.
• Redistributing non-essential tasks: Removing tasks that are no longer feasible while retaining the core responsibilities of the role.
• Creating a 'buddy' system: Pairing the employee with a trusted, trained colleague for support and guidance.

For more detailed guidance on workplace support, employers can refer to authoritative sources such as the Canadian Centre for Occupational Health and Safety (CCOHS).

The Role of HR and Leadership

HR plays a critical role in managing the process, from ensuring legal compliance to facilitating access to support resources, such as Employee Assistance Programs (EAPs). Leadership must foster a culture of support, ensuring the employee feels valued and respected, which is vital for morale and dignity.

Supporting Colleagues and the Workplace Environment

Managing the situation with colleagues is a delicate process that requires maintaining the affected employee’s privacy. Without disclosing the medical condition, a manager can inform the team about changes in workflow and provide general training on how to be supportive of colleagues facing health challenges. This can help address potential stigma and ensure a compassionate working environment.

Comparison of handling approaches

Feature	Uninformed, Passive Approach	Informed, Compassionate Approach
Issue Identified	Employee performance declines and becomes a source of frustration.	Specific, objective performance changes are documented and recognized as potential signs of an underlying health issue.
Initial Action	Manager gives generic warnings or places the employee on a performance improvement plan without considering the root cause.	Manager consults HR and schedules a private, supportive meeting to discuss performance and encourage medical evaluation.
Communication	Vague, possibly accusatory feedback; no mention of support resources.	Open, empathetic conversation focused on objective observations and company resources like EAP; emphasizes confidentiality.
Accommodations	None offered or implemented, leading to continued struggle or potential termination.	Based on medical feedback, reasonable accommodations are explored and implemented to support the employee in their role.
Team Impact	Colleagues may become confused, resentful, or gossip, damaging team morale.	The team is educated on general support strategies while maintaining privacy, fostering a more compassionate culture.

Conclusion

Handling an employee with dementia requires a proactive and empathetic strategy that protects the employee’s rights and dignity while also ensuring business needs and safety are met. By focusing on objective performance issues, facilitating open communication, and implementing appropriate accommodations, organizations can navigate this sensitive situation successfully. A compassionate response not only upholds legal and ethical standards but also reinforces a supportive workplace culture that values all employees, regardless of their health challenges. Investing in training and clear policies prepares managers to respond humanely and effectively when these complex issues arise.

Frequently Asked Questions

What are the first steps to take if I suspect an employee has dementia?

If you notice a decline in performance or changes in behavior, consult with your HR department immediately. They can help guide you through the process, focusing on performance issues and ensuring legal compliance. The first step is to document specific observations objectively, not to attempt a diagnosis yourself.

What kind of performance issues should I document?

Document specific examples of job functions that are not being performed correctly. This could include missed deadlines, errors in work, difficulty following new instructions, or safety concerns. Avoid subjective language and stick to measurable facts.

How do I start the conversation about performance concerns with an employee who may have dementia?

Approach the conversation with empathy in a private setting. Frame the discussion around specific, objective performance changes you've observed. State your concerns for their well-being and encourage them to speak with a doctor. Reassure them that the conversation is confidential and support is available.

What is a 'reasonable accommodation' for an employee with dementia?

A reasonable accommodation is a change in the work environment or the way things are done that allows a person with a disability to enjoy equal employment opportunities. For dementia, this might include simplifying complex tasks, providing memory aids, offering flexible work hours, or modifying their workspace to reduce distractions.

Is it legal to ask an employee if they have dementia?

No, it is not legal to directly ask an employee if they have dementia. It is considered a medical inquiry. Instead, you should discuss observed performance issues and encourage them to see a medical professional to understand the cause. The focus should always be on job performance and the impact on the workplace, not on their health condition.

How can I support the team without violating the employee's privacy?

Maintain confidentiality by not disclosing any information about the employee's health condition. You can explain changes in workflow or roles generically. You can also offer general training to the team on how to be supportive of colleagues facing health challenges, promoting empathy without revealing specifics.

What if an employee with dementia poses a safety risk?

If an employee poses a direct threat to their own safety or the safety of others, you must address this immediately. Involving HR and legal counsel is critical. Depending on the severity, a temporary reassignment or leave of absence may be necessary while seeking professional medical evaluation to determine if they can perform essential job functions safely with or without accommodation.