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This section discusses your relationship with your employer while you are working. You may have just returned to your old job after being out on disability, recently started a brand new job in a fresh career after being out of the workforce, or considering leaving a job you've held for a while due to illness.
Regardless of where you are in the job cycle, there are laws to ensure that you are not discriminated against due to your HIV status. Additional laws determine what level of support the employer must provide to help you continue to perform your job despite your condition.
LEGAL PROTECTIONS
1
What legal protections do I have against on-the-job discrimination based on my HIV/AIDS status?
Discrimination based on HIV/AIDS is a type of disability discrimination. Federal and state laws prohibit discrimination based on a person's disability, including his or her HIV/AIDS status. Under the federal law called the Americans with Disabilities Act of 1990 (ADA), most employers with 15 or more employees cannot discriminate against qualified individuals with disabilities. California's Fair Employment and Housing Act (FEHA) prohibits discrimination by employers with five or more employees.
2
If I am HIV positive but asymptomatic (i.e. I currently have no apparent illnesses), do I have a "disability" under the ADA and the FEHA?
Under the ADA and the FEHA, a disability is defined as a physical or mental impairment that substantially impairs a major life activity. The U.S. Supreme Court has concluded that anyone with HIV has a disability from the moment they are infected, whether or not they have obvious symptoms. This means that an employer can never discriminate against a person with HIV just because of their status. Although the Supreme Court was talking about the ADA in its decision, it will undoubtedly also be applied in all cases involving the FEHA (for example, employers with only 5 to 15 employees).
3
What type of discrimination is prohibited?
Discrimination based on HIV/AIDS can take a wide variety of forms. Under the ADA and the FEHA, qualified employees with HIV/AIDS - employees who can do the essential functions of their jobs - cannot be harassed, demoted, terminated, paid less, or treated worse because of their HIV/AIDS. Disability discrimination is prohibited against both current workers and job applicants.
ON-THE-JOB MEDICAL INQUIRIES
4
What may an employer ask me about my health or HIV/AIDS status after I have started working?
According to the ADA, employers with 15 or more employees cannot ask questions about your disability, or require a medical examination, unless the questions or exam is "job-related and consistent with business necessity." Even if you seem sickly or ill, there must be a job-related reason. The following situations may justify limited medical inquiries. Otherwise, your employer is probably not entitled to any medical information.
Even if there is a job-related reason, the employer's request for medical information or documentation must still be reasonable and related to the situation. Requests may not exceed the scope of the employer's need to evaluate the impact of the disability on the situation or be unnecessarily burdensome to the employee. You can modify a written release for medical information that is overly broad by writing in what its limits are when you sign the authorization. For example, if your employer only needs to evaluate your current vision problem in order to provide an accommodation, a request for all your medical files is broader than necessary; in that case you could restrict requested medical records to those relating to your vision.
Most important, any medical information the employer does obtain must be kept confidential and stored in a separate medical file - not with your regular personnel file.
5
What if my employer has fewer than 15 employees, and is not covered by the ADA?
Intrusive medical inquiries or examinations of employees may still violate the state constitutional right to privacy. The California Supreme Court recently decided that on-the-job drug testing is an invasion of privacy and must be justified by an important reason, regardless of employer size. The same reasoning would likely limit on-the-job medical inquiries regarding HIV or AIDS.
REASONABLE ACCOMMODATIONS UNDER THE ADA AND FEHA
6
What is a "reasonable accommodation"?
Reasonable accommodations are adjustments or modifications made to the job or to the workplace that enable an employee with a disability such as HIV/AIDS to perform the basic duties of the job. A reasonable accommodation does not change the essential job functions. What constitutes a reasonable accommodation for a particular employee will depend upon the situation and the type of job. The accommodation, however, must not be unduly costly or burdensome for the employer. But the majority of accommodations cost the employer little or nothing, including things like changing schedules or altering office policies. Although the employee initiates the reasonable accommodation, it is ultimately up to the employer to choose which accommodation to use if there are alternatives.
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Modification of facilities An employee with a mobility impairment caused by HIV/AIDS may need a ramp or a special chair to accommodate the disability. Equipment or devices An employee with CMV or another vision impairment caused by HIV/AIDS may need a computer with voice recognition or enlarged type. Part-time work schedule An employee who has fatigue caused by HIV/AIDS may need a part-time schedule. Modified work schedule An employee who takes a regimen of prescription drugs for HIV/AIDS may need frequent breaks and access to drinking water, or a modified schedule to accommodate the side effects of the medications. Time away for treatment Time away from the workplace to attend doctor's appointments may be a reasonable accommodation. Unpaid leave of absence An employee with HIV/AIDS may need an unpaid leave of absence to recover from an episode of HIV-related illness, in the hospital or at home. Job restructuring An employee with decreased physical strength due to HIV/AIDS might seek to avoid manual tasks, where such tasks are not core duties of the job. Training and supervision An employee with an HIV-related condition interfering with concentration or learning may need additional or specialized training or supervision to master new job skills and duties. Modification of policy An employee taking medication for HIV/AIDS who experiences mid-day grogginess might need a break to lie down in the employee lounge, despite an employer's policy against napping. Education An employee with HIV/AIDS facing misunderstandings on the job might seek disability education of co-workers and supervisors to raise awareness and debunk fears and stereotypes. Transfer to a vacant position An employee who is not able to perform the essential job functions of his or her current position may seek a transfer to a vacant position for which the employee is qualified. A transfer may also be appropriate where the employee remains qualified for the current position with accommodation, but both the employee and the employer agree that a transfer is appropriate. |
7
When is an employer required to accommodate an employee?
An employer is only required to accommodate known disabilities. Sometimes an employer's knowledge of a disability may be implied. However, to guarantee the legal right to accommodation, an employee should explicitly disclose the existence of a disability. Otherwise, the employer may escape liability for refusing to accommodate an employee, or for firing someone due to "performance problems" by pointing out that they knew of no disability.
DISCLOSURE TO THE EMPLOYER
8
What do I have to tell my employer in order to get an accommodation?
Because the ADA and FEHA define a disability as a physical or mental impairment that substantially impairs a major life activity, you must provide the employer with enough information to show the existence of such an impairment, and its substantial impact. To be safe, the employee should use such words as "disability," "impairment," "substantially limiting," "major life activities," and "accommodation."
9
Do I have to specifically disclose my HIV/AIDS status to receive accommodation?
Not necessarily. The general rule is that the information provided must be specific enough for the employer to understand that the employee is disclosing a substantially limiting physical or mental impairment. The employee may disclose an "immune disorder," or a separate disability such as cancer caused by the HIV/AIDS status. One benefit of simply disclosing HIV/AIDS is that employers may more readily recognize this condition as an ADA disability. A drawback is the risk of stigma or discrimination associated with HIV/AIDS.
10
Do I have to put the request for an accommodation in writing?
No. You can request accommodation in writing, orally, through e-mail, or any other form of communication. However, you may want to keep records of accommodation requests in case there is a dispute in the future over whether you made the request.
11
Do I have to disclose my disability to everyone at work? Can my employer tell anyone?
No. If you are seeking an accommodation, you must disclose to someone who represents the employer, such as a supervisor or a human resources person. However, you are not required to disclose to co-workers. Moreover, your employer is not permitted to reveal this information to them. Medical information obtained by an employer must be kept confidential, and can only be revealed to supervisors and managers who need to know about the accommodation and any restrictions on the employee's work or duties. In California, it may be a crime to disclose someone's HIV test results without their authorization.
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Disclosure of one's HIV/AIDS status to an employer is an extremely personal decision. Employees considering disclosing their HIV/AIDS status should consider the costs and benefits, including: |
12
What happens after I request an accommodation?
Once you request an accommodation, your employer must make a reasonable effort to determine the appropriate accommodation. However, you must also be willing to participate in the process of developing and implementing the accommodation.
You must fully participate in the process or else you may lose your ADA rights. This participation may require you to submit requested medical documentation or attend scheduled meetings. If you or the employer reject a suggested accommodation, you must take steps to continue the process.
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To protect ADA rights, employees with disabilities who need accommodations should take proactive steps, such as:
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MEDICAL LEAVE UNDER THE FMLA AND CFRA
13
Who is eligible for FMLA/CFRA leave?
If you are too sick to do your job and need a medical leave, you may be eligible for a job-protected leave under the Family and Medical Leave Act (FMLA) and the California Family Rights Act (CFRA). You are entitled to a FMLA/CFRA leave if you have worked at least 12 months for your employer (these do not have to be consecutive months), you have actually worked at least 1,250 hours in the past 12 months, and your employer employs at least 50 people within a 75 mile radius of your worksite.
14
How much leave can I take?
You can take up to 12 weeks of unpaid FMLA/CFRA leave per year. Different employers count the FMLA year in different ways. If you are unsure, ask your employer what method it uses.
15
Do I have to take all 12 weeks at once?
You do not have to take your leave all at once, depending upon what is medically necessary. For example, you may use leave time to reduce the number of hours you work per week. You may also use FMLA/CFRA leave to go to treatment or to get medical tests, even if it is only on an occasional or periodic basis. Your employer cannot force you to use more leave than you need by taking your leave all at one time.
16
What if I need leave but also need continued medical coverage?
Your employer must continue your medical coverage while you are on medical leave on the same terms as if you continued to work. This means that if your employer normally pays all of your monthly premium, it must continue to do so. If you normally pay part or all of the premium, you must continue to pay your part while on leave; your employer should tell you how to do this. Also, if your partner or your dependents receive medical benefits from your employer through you, your employer must continue their benefits too.
17
How do I request FMLA/CFRA leave?
You should tell your employer that you have a serious health condition that temporarily prevents you from performing your job, and that you need to take FMLA leave. You should also tell your employer the anticipated time and length of your leave, if you know. If you know in advance when you will need leave, you must give your employer at least 30 days advance notice, or as much notice as possible if you find out less than 30 days before your leave. If you need leave without advance warning, you should tell your employer as soon as possible, and no later than one or two days after you learn you need leave.
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To: ...................................................... From: ................................................... Date: .....................................................
This memo is to notify you of my need for leave under the Family and Medical Leave Act and the California Family Rights Act. I require a leave of absence from ................ to ................I have a serious health condition that involves continuing treatment by a health care provider. Because of this serious health condition, I am temporarily unable to work during this period of time. [I have attached a completed certification from my doctor documenting my need for leave.] It is my understanding that I am eligible for up to 12 weeks of leave per year under the Family and Medical Leave Act and the California Family Rights Act, and that I will be reinstated to my job after my leave. [It is also my understanding that ................ will continue my health insurance during my leave.] The Family and Medical Leave Act specifies that employers must provide specific, written notice to an employee of rights and responsibilities regarding leave within a few business days of when that employee gives notice of the need for leave. 29 C.F.R. § 825.301. I look forward to receiving this information from you. Please let me know immediately and in writing if you require anything further from me. I appreciate your assistance with this matter. |
| Sample Request for FMLA Leave (Intermittent Leave/Reduced Schedule) | |
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To: ...................................................... From: ................................................... Date: .....................................................
This memo is to notify you of my need for leave under the Family and Medical Leave Act and the California Family Rights Act. I have a serious health condition that involves continuing treatment by a health care provider. [Because of this serious health condition, it is medically necessary to change my work schedule to ................ ] [Because this serious health condition is chronic and causes episodic periods of incapacity, it was medically necessary for me to take leave on ................ ] [Because this serious health condition is chronic and causes episodic periods of incapacity, it is medically necessary for me to take leave when I am temporarily incapacitated due to this condition.] [I have attached a completed certification from my doctor documenting my need for leave.] It is my understanding that I am eligible for up to 12 weeks of leave per year under the Family and Medical Leave Act and the California Family Rights Act, that intermittent leave may be taken in increments as short as one hour, only the amount of intermittent leave taken may be counted as FMLA/ CFRA leave, and that I will be reinstated to my job after my leave. [It is also my understanding that................ will continue my health insurance during my leave.] The Family and Medical Leave Act specifies that employers must provide specific, written notice to an employee of rights and responsibilities regarding leave within a few business days after that employee gives notice of the need for leave. 29 C.F.R. § 825.301. I look forward to receiving this information from you. Please let me know immediately and in writing if you require anything further from me. I appreciate your assistance with this matter. |
You can ask for FMLA leave orally, but it is better to make your request in writing if possible. Your employer may also have forms that it requires you to fill out to take FMLA leave, but your employer may not deny or delay your leave if you provided sufficient verbal or other notice of your need for leave.
18
Can my employer require me to sign a release disclosing my diagnosis and all of my medical records to them before I can take medical leave?
You do not have to tell your employer your diagnosis, or sign a release giving your employer access to your medical records, to take medical leave under FMLA/CFRA. If you request leave, your employer may ask that you provide medical certification from your doctor, but your employer is only entitled to know the following information:
If your doctor's certification contains all this information, your employer must accept it as sufficient. Your employer may not contact your doctor directly about your FMLA/CFRA leave without your permission.
19
What can my employer do if he or she doesn't accept my doctor's statements?
If your employer has reason to doubt your doctor's medical certification, your employer can get a second opinion from a doctor of its choice, at its expense. This doctor cannot be regularly employed by your employer. In addition, you have a right to privacy in your medical records, and the employer's doctor may not release medical information, other than verifying that you are eligible for leave, to your employer without your consent. If your employer makes you get a second opinion, you should tell the second opinion doctor that he or she may only verify your need for leave, and may not release your diagnosis or other private medical information to the employer.
If the first and second opinions differ, the employer may obtain (and pay for) a third opinion from a doctor mutually agreed upon by you and your employer, and the third opinion is final. If you think you may need a third opinion, you should have the name of another doctor ready to propose to your employer.
Even if your employer requires a second and third opinion, you are entitled to take leave on a provisional basis while the medical certification process is pending.
20
I used FMLA/CFRA leave to reduce my schedule to twenty hours per week. Now my employer says I no longer get health benefits because I'm not full time. Is that legal?
No. Your employer is required to continue your medical coverage while you are on FMLA/CFRA leave. As long as you have enough FMLA/CFRA leave left to cover the reduction in hours in your schedule, your employer must continue your benefits as if you were working your regular, full-time schedule.
21
I requested FMLA/CFRA leave to reduce my schedule to twenty hours per week, and now my employer has transferred me to a different job. Is that legal?
Probably. If you take leave on an occasional
or part time schedule basis, your employer is allowed to transfer
you to an alternative position with the same pay and ben>
dates your leave. The alternative position does not have to have the same duties. However, your employer cannot transfer you to discourage you from taking leave or otherwise create a hardship for you. For example, your employer may not transfer you from the day shift to the night shift, or reassign you to a work location that is significantly farther from your home. Once you no longer need a reduced schedule, your employer must reinstate you to the position you held before your leave. (An exception may apply, however, if you are a "key employee" that the employer cannot do without for even a short period of time.)
22
What if I need FMLA/CFRA leave now, but I'm not sure if I will ever be able to go back to work?
Once you tell your employer that you are definitely not coming back to work, your employer is no longer obligated to give you leave, or to continue your health benefits for the 12 week period. If you are not sure yet that you will be able to go back to work, you should tell your employer that you need an FMLA leave, and that you would like to return to work after your leave. If by the end of 12 weeks you learn that you will need additional weeks or months off for recovery, you can then request more leave as a reasonable accommodation under the ADA. Once the 12 weeks under the FMLA have ended, however, the employer is no longer required to give you health benefits.
23
I requested FMLA/CFRA leave, and now my employer is forcing me to use all my vacation and sick days during my leave. Is that legal?
Yes. If you take FMLA/CFRA leave for your own serious health condition, your employer may require you to use your accrued sick time and vacation time during your unpaid leave. If you are receiving short term disability benefits through your employer's plan, however, your employer may not require you to use vacation and sick time while you are receiving short term disability benefits.
24
I can't afford to take unpaid leave. Is there any way I can take paid leave under FMLA or CFRA?
Sometimes. If you have any accrued sick time or vacation time, you may use this accrued paid leave during your FMLA/CFRA leave. In addition, your employer may have a short term disability policy that will provide you with some income; contact the person at your employer who handles employee benefits. California also provides short term disability pay to some individuals who are unable to perform their usual and customary work; contact the Employment Development Department for information about State Disability Insurance (SDI). (See the Resource List.) If you have a collective bargaining agreement, it may also provide for paid medical leave; check your collective bargaining agreement or contact your union representative.
25
I have missed work on several days to see my doctor or because my HIV-related conditions made me too sick to work. I told my employer why I missed work, but my employer counted all of those days as "points" under the no-fault attendance policy. Now if I miss any more work I may lose my job. Can they do that?
Probably not. Your employer cannot count as "points" any time off that would qualify as protected leave under FMLA/CFRA. You are required, however, to give your employer at least verbal notice that you missed work on those days for a FMLA/CFRA reason. For example, if you told your employer that you were seeing your doctor because you had a serious, life-threatening illness, your employer cannot count your time away from work as "points" under its attendance policy. You also must give your employer advanced notice of any planned medical treatment; 30 days notice if possible, or as much notice as you can if less than that.
If your time off would not qualify as protected leave under FMLA/CFRA, you can still seek a modification of the employer's policy as a reasonable accommodation under the ADA.
DISCRIMINATION AND HARASSMENT ON THE JOB
26
Can I be rejected or fired by an employer for having HIV/AIDS?
No, not if you can safely perform your job, with reasonable accommodation if necessary. People with HIV or AIDS are often viewed as dangerous because of myths regarding the transmission of the virus. However, in order to terminate an employee with HIV or AIDS because of safety reasons, an employer must show a "direct threat" - a specific and substantial risk of harm to others posed by the individual. Courts have held that school teachers, food service employees, factory workers, pharmacists, firefighters and police officers with HIV/AIDS do not pose a direct threat to others, and may not be terminated on the basis of their HIV/AIDS.
On the other hand, despite the absence of any confirmed cases of doctor-to-patient transmission of HIV, a few courts have found that HIV positive surgeons, operating room personnel, phlebotomists, and sometimes nurses pose a "direct threat," and may be terminated.
27
What if I am not fired, but my employer makes comments about my HIV and treats me badly?
It is unlawful for an employer to harass a worker on the basis of their HIV or AIDS. If an employer's comments and poor treatment are so severe or pervasive that they create a hostile working environment for you, then the conduct is unlawful harassment.
28
Does HIV/AIDS discrimination also include sexual orientation discrimination?
No. Sexual orientation discrimination is different than disability discrimination. Sexual orientation discrimination is prohibited by the California Labor Code. If you believe that you are being discriminated against based on your sexual orientation, you should contact the California Labor Commissioner immediately. The law gives you only 30 days to file a sexual orientation discrimination claim with the Labor Commissioner. (See the Resource List.)
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What do I do if I think my employer is discriminating against me due to my HIV/AIDS status?
Informal Actions
Company Grievance Procedures
If your supervisor is unable or unwilling to help you, you should consider talking to another manager, or even to someone from human resources or personnel. If you have a union, you should also discuss the discrimination with your union representative. Finally, consider using any grievance procedure that the company may have available for employees who have a dispute with the employer.
Formal Discrimination Claims and Lawsuits
If none of these actions work, you may want to file a formal disability discrimination claim against your employer. You can file a disability discrimination charge with the California Department of Fair Employment and Housing (DFEH) if your employer has at least five employees. You must file the charge of discrimination within one year of the discrimination. (The date of the discrimination is usually the date the employer disciplined you, failed to accommodate you, or treated you unnecessarily differently due to your HIV/AIDS status.) The DFEH investigates and tries to help resolve the dispute. Another reason to file with the DFEH is that it is required before you can file a private lawsuit against the employer for violating the FEHA.
You can also file a disability discrimination charge with the federal government's Equal Employment Opportunity Commission (EEOC) if your employer has at least 15 employees. You must file your charge with the EEOC within 300 days of the discrimination. You can also file with the EEOC by filing with the DFEH within 300 days and asking the DFEH to cross file your complaint with the EEOC. You must have a file on record with the EEOC in order to sue the employer for violating the ADA.
If you have exhausted all of the administrative procedures of the DFEH or EEOC, then you may be able to file a disability discrimination lawsuit on your own in state or federal court.
There may also be local ordinances that allow for a complaint; you might want to check with city or county offices, such as the San Francisco Human Rights Commission or the Los Angeles City Attorney's Office.
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Title 2 Fair Employment and Housing Commission §7297.11
Fair Employment & Housing Commission
1. Employee's Name: 2. Patient's Name (If other than employee): 3. Date medical condition or need for treatment commenced [NOTE: THE HEALTH CARE PROVIDER IS NOT TO DISCLOSE THE UNDERLYING DIAGNOSIS WITHOUT THE CONSENT OF THE PATIENT]: 4. Probable duration of medical condition or need for treatment: 5. The attached sheet describes what is meant by a "serious health condition" under both the federal Family and Medical Leave Act (FMLA) and the California Family Rights Act (CFRA). Does the patient's condition qualify under any of the categories described? If so, please check the appropriate category. (1) (2) (3) (4) (5) (6) 6. If the certification is for the serious health condition of the employee, please answer the following:
7. If the certification is for the care of the employee's family member, please answer the following:
8. Estimate the period of time care needed or during which the employee's presence would be beneficial: 9. Please answer following question only if the employee is asking for intermittent leave or a reduced work schedule.
ITEM 10 IS TO BE COMPLETED BY THE EMPLOYEE NEEDING FAMILY LEAVE. ****TO BE PROVIDED TO THE HEALTH CARE PROVIDER UNDER SEPARATE COVER. 10. When family care leave is needed to care for a seriously-ill family member, the employee shall state the care he or she will provide, and an estimate of the time period during which this care will be provided, including a schedule if leave is to be taken intermittently or on a reduced work schedule: 11. Signature of health care provider: Date: 12. Signature of health care provider: Date: A "Serious Health Condition" means an illness, injury, impairment, or mental condition that involves one of the following: 1. Hospital Care Inpatient care (i.e., an overnight stay) in a hospital, hospice, or residential medical care facility, including any period of incapacity or subsequent treatment in connection with or consequent to such inpatient care. 2. Absence Plus Treatment: (a) A period of incapacity of more than three consecutive calendar days ( including any subsequent treatment or period of relating to the same condition), that also involves:
3. Pregnancy [NOTE: An employee's own incapacity due to pregnancy is covered as a serious health condition under FMLA but not under CFRA.] Any period of incapacity due to pregnancy, or for prenatal care. 4. Chronic Conditions Requiring Treatment A chronic condition which:
5. Permanent/Long-term Conditions Requiring Supervision A period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective. The employee or family member must be under the continuing supervision of, but need not be receiving active treatment by, a health care provider. Examples include Alzheimer's, a severe stroke, or the terminal stages of a disease. 6. Multiple Treatments (Non-Chronic Conditions) Any period of absence to receive multiple treatments (including any period of recovery therefrom) by a health care provider or by a provider of health care services under order of, or on referral by, a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period or incapacity of more than three consecutive calendar days in the absence of medical intervention of treatment, such as cancer (chemotherapy, radiation, etc.), severe arthritis (physical therapy), or kidney disease (dialysis). |
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This section discusses your relationship with your employer while you are working. You may have just returned to your old job after being out on disability, recently started a brand new job in a fresh career after being out of the workforce, or considering leaving a job you've held for a while due to illness.
Regardless of where you are in the job cycle, there are laws to ensure that you are not discriminated against due to your HIV status. Additional laws determine what level of support the employer must provide to help you continue to perform your job despite your condition.
LEGAL PROTECTIONS
1
What legal protections do I have against on-the-job discrimination based on my HIV/AIDS status?
Discrimination based on HIV/AIDS is a type of disability discrimination. Federal and state laws prohibit discrimination based on a person's disability, including his or her HIV/AIDS status. Under the federal law called the Americans with Disabilities Act of 1990 (ADA), most employers with 15 or more employees cannot discriminate against qualified individuals with disabilities. California's Fair Employment and Housing Act (FEHA) prohibits discrimination by employers with five or more employees.
2
If I am HIV positive but asymptomatic (i.e. I currently have no apparent illnesses), do I have a "disability" under the ADA and the FEHA?
Under the ADA and the FEHA, a disability is defined as a physical or mental impairment that substantially impairs a major life activity. The U.S. Supreme Court has concluded that anyone with HIV has a disability from the moment they are infected, whether or not they have obvious symptoms. This means that an employer can never discriminate against a person with HIV just because of their status. Although the Supreme Court was talking about the ADA in its decision, it will undoubtedly also be applied in all cases involving the FEHA (for example, employers with only 5 to 15 employees).
3
What type of discrimination is prohibited?
Discrimination based on HIV/AIDS can take a wide variety of forms. Under the ADA and the FEHA, qualified employees with jury, or for a condition that would likely result in a period or incapacity of more than three consecutive calendar days in the absence of medical intervention of treatment, such as cancer (chemotherapy, radiation, etc.), severe arthritis (physical therapy), or kidney disease (dialysis).