Canadian Survey on Disability Reports
The Dynamics of Disability: Progressive, Recurrent or Fluctuating Limitations

Introduction

The conventional view of disability is a limitation that is continuous and remains, more or less, permanent and unchanged over time. However, many disabilities may not follow this relatively stable pattern. Instead, persons with disabilities may experience periods of good health in between periods of their limitations (on-again/off-again episodes) and/or experience changes in the severity of their limitations over time (worsening, improving, or fluctuating). These types of disabilities may be characterized as dynamic because the very nature of the disability is one of change with different possible trajectories over time. As a consequence, the collective experiences of those with disability dynamics are likely to be different than those with so-called “continuous” disabilities.

This paper presents preliminary findings on four groups of persons with different disability dynamics^Note , based on data collected from newly developed questions from the 2017 Canadian Survey on Disability (CSD). Each of these groups has its own unique profile based on the length of time between episodes of the limitation (if such exist) as well as the limitation’s progression over time. The paper is divided into six main sections. Section one provides a brief review of research to date on disability dynamics and some of the key challenges in how they have been traditionally operationalized and measured. Section two covers the present paper’s underlying methodology and rationale for measuring four disability dynamic groups. Section three provides a basic overview of the demographic profile of each of these groups and how they differ from each other. Section four provides an overview of employment profiles and work potential for each group as well as highlighting key differences between them. Section five explores how disability dynamics may affect the work experiences of employed persons with disabilities by presenting findings on their requirements and level of needs met for accommodations in the workplace. Finally, Section six provides a summary and conclusions.

Section 1: Background

1.1 Background

Since the 1990s, Canada has had survey results suggesting that the conventional view of disability, as constant and unchanging, does not accurately depict the reality of disability for a sizeable number of people who may experience fluctuations or changes in their limitations (e.g., Canadian Council on Social Development, 2001; Fawcett, 1996). Based on longitudinal data, which come from surveys that interview the same individuals repeatedly over time, these dynamics became evident. However, since most of the longitudinal data in the 1990s [e.g., Survey of Labour and Income Dynamics (SLID; Statistics Canada)] permitted only the identification of “disability versus no disability” at one point in time each year, these dynamics were easily interpreted as “on again/off again” episodes—where disability was present in one year, but not necessarily the next.^Note

By the early 2000s, increasing attention was given to the fact that not only did disability fluctuate for some in “on again/off again” episodes, but that also, for others, the progression of their underlying conditions often led to changes over time in terms of increasing levels of severity. This increase in severity, in turn, could lead to changing requirements and needs for supports and services over time even though the same underlying conditions remained present. This concern was well-summarized in the stakeholder report called In Synchrony: Looking at Disability Supports from a Progressive Disability Perspective (Majeau, Gaucher, Fougeyrollas, & Lemieux-Brassard, 2003). This report called for a “progressive disability lens” to be applied to research on persons with disabilities since the dynamics of disability could take many forms—each with a unique set of barriers facing the individual when trying to enter (and remain in) the labour market as well as trying to meet often changing support and accessibility needs.

1.2 Episodic Disabilities

In recent years, the term “episodic disability” has attracted increased attention in Canada as a lens through which to distinguish those whose disabilities do not conform to the conventional continuous type. Episodic disability research has typically concentrated on the “on again/off again” episodes in which long term conditions are characterized by periods of good health interrupted by periods of illness or disability.^Note In this context, episodic disability is seen largely as part of a two-group construct in which disabilities are either “episodic” or “not episodic”.

However, within the literature on episodic disability there has been a range of conceptualizations regarding what “episodic disability” means. This is further complicated by a lack of data, until recently, that would allow researchers a more direct means of identifying those with episodic disabilities when using survey data^Note . What all the researchers in this area have in common, however, is that they view “change” in one’s experience of their disability as a key element that is not well integrated into the conventional approach. This increased attention recently culminated in the House of Commons, Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities, Taking Action: Improving the Lives of Canadians Living with Episodic Disabilities, Fifteenth Report, 1st Session, 42nd Parliament, March 2019 (HUMA, 2019).

Defining episodic: underlying conditions or diseases

A common element in episodic disability research has been the use of a number of conditions or diseases deemed to be episodic in nature as examples and even as a method of identifying individuals with episodic disabilities. For example, the recent HUMA report (2019) introduced the concept of episodic disabilities as follows:

Episodic disabilities are the result of medical conditions or diseases that are prolonged and often lifelong but have unpredictable episodes of illness and disability. These episodes of disability can vary in severity and duration and are often followed by periods of wellness. Examples of conditions and diseases that are episodically disabling are arthritis, Crohn’s and colitis, HIV/AIDS, mental illness, multiple sclerosis (MS), as well as some forms of cancer and rare diseases (p. 7).

The use of concrete examples of conditions that might lead to episodic disabilities can be an effective method of helping people understand that some types of disabilities may not follow the conventional pattern of a continuous limitation. The conditions cited above represent only some of the conditions that could be used to demonstrate this point and provide context to help people conceptualize the lived experiences of those whose disabilities follow more dynamic patterns.  However, even individuals with the same underlying health condition may experience limitations differently from others with the same diagnosis and can even experience different patterns of change in their own limitations at various points in their life.^Note As noted in the HUMA report (2019, p. 19): “Witnesses who have been diagnosed with MS explained that various forms of the disease carry different prognoses and expected levels, frequency and duration of impairments” (see Text Box 1). Similarly, the HUMA report further highlighted this complexity by outlining testimony which demonstrated the need to recognize that “episodic disability” can take various forms and include the added dimension of trajectories over time. For example, some trajectories associated with “episodic degenerative conditions” are “progressive in their decline”, while others may result in some type of “remission” (Yates, as cited in Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities [HUMA-130], 2018).

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For some persons, the primary challenge will be the “on again/off again” episodes of their disability; while for others it may be the progression of their disability over time; and for others still, the challenge may be experiencing  a combination of both the “on again/off again” episodes as well as its progression over time. However, in all instances, simply the presence of an underlying health condition – in the absence of any other information – provides, at best, an incomplete picture of the actual experiences and challenges persons with disabilities may have in their day-to-day lives. Further to this, any analysis of underlying conditions using the CSD is limited because it does not actually provide a checklist of all underlying conditions that each person might have (see Textbox 2).

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Defining episodic: work capacity

Some have defined episodic disability in terms of work capacity, and perhaps more precisely, as “intermittent work capacity”. However, it is not always clear how long these intermittent periods may last (hours, days, weeks, or months). As well, it is not always clear whether it is a matter of experiencing changes in the severity level of the limitation, experiencing episodes without any limitation, or some combination of both. Lysaght, Krupa, and Gregory (2011), for example, describe a person with an episodic disability as someone who is having “unexpected and/or periodically diminished capacity relative to the usual or expected workload because of a disability or health condition, or is absent from the workplace frequently or for extended periods of time because of a disability or health condition” (p. 5).  Furrie (2010), Gignac et al. (2011), Realize (2019), and Vick (2014), among others, view intermittent work capacity as being a product of fluctuating periods of illness and wellness; and, further to that, the length of these periods may vary considerably. Vick (2014) extended her analysis by examining the intersection of naturally fluctuating conditions with “precarious work”. In this view, work capacity is a function of both one’s underlying condition, which may fluctuate, and of one’s environment, which may involve mostly unstable, non-standard work opportunities (e.g., involuntary part-time, temporary, seasonal, or contract jobs that may also be low-paid, have poor working conditions, and lack benefits). As noted by Vick: “. . . the question is not whether persons with episodic disabilities can work but to what extent physical, emotional, organizational, attitudinal, institutional, programmatic, and environmental factors impede ability to seek, maintain, and negotiate the conditions of work” (p. 45). Similarly, Gignac et al. (2011) included a focus on the role of workplace accommodations, or lack thereof, in work capacity. Work capacity may not be impacted immediately for some, even with fluctuating conditions; however, over time, if episodes of limitation become longer and closer together, a threshold may be reached in terms of impact on work capacity. Lack of early intervention in terms of supports and accommodation can result in work capacity being impacted.

Defining episodic: severity and visibility of disability

Others (e.g., Wannell & Grekou, 2014) expand the notion of episodic disability to include conceptualizations based on the severity of the disability (such as including those with mild or moderate disabilities with episodic disabilities). Yet others bring into focus the idea of “invisible disabilities” when discussing episodic disabilities. As noted by Ontario Human Rights Commission (2014), episodic disabilities and invisible disabilities are separate categories, though there are some strong linkages and overlap: “disabilities are often invisible and episodic, with people sometimes experiencing periods of wellness and periods of disability” (p. 4). These approaches also have a common element in that they focus on a group of individuals with disabilities who do not necessarily fit the conventional view of someone with a disability or may not always appear to have a disability.

Alternative approach to episodic: focus on wider range of dynamic patterns using 2017 CSD

In response to this diversity of conceptual definitions, one of the most recent reviews of the episodic disability literature (Office for Disability Issues, 2016) recommended that future work on the subject “investigate more precise approaches to defining episodic disability” (p.13). However, defining episodic disability goes hand in hand with methods of identifying those with episodic disabilities. It can be particularly difficult to identify those with episodic disabilities in a survey environment.^Note

The 2017 CSD contained two new questions which were designed to help identify those with “episodic disabilities”; and the methodology involved with this is explained below. It is important to note, however, that this paper does not provide or recommend a particular approach to identifying those with “episodic disabilities”. This paper focusses on a wider range of dynamic patterns that were developed from the new questions contained on the 2017 CSD. This wider range of dynamic patterns adopts, among other things, a “progressive disability lens” by separately identifying those who are experiencing increasing levels of limitation over time, while also identifying those experiencing other types of dynamics. For those experiencing the latter, this paper also provides some additional context regarding whether the individual ever experiences “a month or more” without feeling limited since this group may be at a heightened risk of appearing “not disabled” when, in fact, they are. Depending on one’s particular focus, a different configuration of the groups that can be identified from these questions may be chosen.

Note: The information in this paper is intended to be a first look at some key dynamic patterns which provide a better understanding of how different patterns might lead to different outcomes. It is also important to remember that some individuals may experience various patterns during the course of their life; and, as such, these categories are not categories of people, but rather categories of how people are experiencing their disability at a particular point in time.

Section 2: Methodology

2.1 Methodology and Rationale

In Canada, the conceptualization of “disability” has changed over time, with the movement away from disability within a “medical model” toward a “social model” (Grondin, 2016). This movement is reflected in both the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), ratified by Canada in 2010, and in Canada’s new Disability Screening Questions (DSQ), which were developed between 2010 and 2012 to identify persons with disabilities on Statistics Canada’s surveys including the CSD (Grondin, 2016). This move has resulted in a focus on the limitations experienced in everyday life by those with impairments and how those with impairments interact with their environment.

However, there is another “dimension” of disability that has presented greater challenges both conceptually and methodologically, and this has involved the “dynamic nature” of the experience of disability over time for many individuals. While Canada’s new DSQ were designed to capture both those with continuous limitations as well as those who experience dynamics or changes over time in their limitations, there has been no direct method of distinguishing between the two until recently.  In an effort to address this gap in data, the 2017 CSD included new questions that were intended to identify disability dynamics (see Appendix for an overview of qualitative testing of questions).  These questions were:

1. EPD_Q05, which asked “Do you ever have periods of one month or more when you do not feel limited in your daily activities due to your overall condition?” and had two possible response options: a) yes or b) no. 
2. EPD_Q10, which asked “Is your ability to do your daily activities…?” and had four possible response options: a) getting better, b) getting worse, c) staying about the same, or d) you are able to do more activities during some periods but fewer activities during other periods.

The advantage of these two questions is that they simultaneously address periods or episodes of the disability (EPD_Q05) as well as its progression over time (EPD_Q10), resulting in eight possible combinations or categories. Table 1 shows the combinations of these questions and the resulting categories that are numbered one through eight.

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Given the complexity of examining each of the eight categories as distinct groups and associated issues with sample size restrictions, a number of different options were considered to reduce the number of categories to generate a more meaningful typology regarding disability dynamics. For the purposes of this paper, a four-group typology was created (see below for descriptions). The methodology followed to develop this typology is based on the following:^Note a) issues raised during the qualitative testing sessions, b) underlying similarities/differences among some groups with respect to disability type, severity, and other characteristics, and c) logic with respect to the wording of each combination listed above. For this paper, the eight categories were combined to form the following four disability dynamic groups: ^Note

1. Progressive limitations (3, 4):  This includes those who indicated that their ability to do daily activities was getting worse over time, regardless of whether or not they had periods of one month or more without feeling limited. This gives primacy to the dimension of progressive limitations over the experience of some lengthy periods without feeling limited. Examining numerous underlying characteristics showed a great deal of similarity between both groups of people indicating their abilities were getting worse—quite distinct from those selecting other response options.
2. Recurrent limitations (1, 5, 7): This includes those who indicated that they had periods of one month or more when they did not feel limited and that their ability to do daily activities was either: staying about the same; getting better; or able to do more activities during some periods but fewer activities during other periods.^Note This group includes all those who reported periods when they did not feel limited, except those who also indicated that their ability to do their daily activities was getting worse (i.e., progressive limitations, as defined above).
3. Fluctuating limitations (8):  This includes those who indicated that they never had periods of one month or more without feeling limited but that they were able to do more activities during some periods but fewer activities during other periods. These fluctuations could be an indication of shorter time periods (i.e. less than a month) when they did not feel limited, or they could indicate changes in level of severity, where individuals always felt limited to some degree but did have periods where these limitations were getting better or worse.
4. Continuous limitations (2, 6): This includes those who indicated that they never had periods of one month or more without feeling limited and that their ability to do daily activities was either staying about the same or getting better. It is important to note that “getting better” could mean either a certain amount of stabilization over time (possibly due to medical intervention or a better system of supports) or, in some instances, this could signal recovery from a long-term illness or injury resulting in no disability. While for some research purposes it might be valuable to examine this “getting better” group separately, examination of several underlying characteristics (disability types, severity, etc.) suggests that these individuals are relatively similar to those who reported their ability to do daily activities was “staying about the same”. This “getting better” group was also relatively small; thus, for the purposes of this paper these two categories were grouped.

Section 3: Profile

3.1 Overall Rates of Disability Dynamic Groups

Three in five persons with disabilities do not experience conventional continuous limitations

Of the nearly 6.2 million persons with disabilities aged 15 years and over, almost 3.8 million (61%) experienced some type of disability dynamic, while 2.4 million (39%) experienced “continuous” limitations (Table 2).^Note Among those with disability dynamics, nearly 1.4 million had limitations that were worsening over time (“progressive”); over 1.5 million had experienced periods of a month or more without being limited (“recurrent”); and over another 0.8 million experienced fluctuations in limitations (“fluctuating”).

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Prevalence of progressive limitations increases with age

An age breakdown of these data suggests that these patterns of dynamics could change over the course of an individual’s lifespan. While roughly two in five people experienced continuous limitations across all age groups, it was the relative proportions among those with progressive, recurrent, and fluctuating limitations that differed across the life course. For example, among youth aged 15 to 24 years, less than one in ten experienced progressive limitations, while a third of older seniors aged 75 years and over, experienced progressive limitations. At the same time, the proportion who experienced recurrent limitations decreased from 34% among youth to 17% among older seniors. Similarly, fluctuating limitations were experienced by 17% of youth, but this percentage dropped to 8% among older seniors. Among older age groups, limitations that were dynamic were more likely to be associated with progressive limitations than with either recurrent or fluctuating limitations.

3.2 Rates of Disability Dynamic Groups by Sex, Age, and Severity

Women are more likely to experience fluctuating limitations; men are more likely to experience continuous limitations

Women with disabilities were less likely than men to experience continuous limitations and more likely to experience fluctuating limitations. Among youth, women were more likely than men to experience both fluctuating and recurrent limitations. Overall, women were more likely than men to experience fluctuating limitations (16% vs 10%), but less likely to experience continuous limitations (36% vs 43%) (Table 3). In many cases, these trends held across age groups; but among seniors aged 65 years and over, men and women experienced fluctuating limitations in roughly equal proportions. Among youth, women were more likely than men to experience recurrent or to have fluctuating, and less likely to experience continuous limitations.

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Four in ten persons with “more severe” disabilities experience progressive limitations versus one in ten with “less severe” disabilities

Persons with “more severe” disabilities were much more likely to experience progressive limitations, and less likely to have recurrent limitations, compared to those with “less severe” disabilities. These differences between “more severe” and “less severe” disabilities held across age groups. However, among those with “more severe” disabilities, the percentage with progressive limitations increased by about 30 percentage points from 17% among youth to 46% among seniors, while among those with “less severe” disabilities, this increase was 11 percentage points, from 3% among youth to 14% among seniors (Table 4).

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3.3 Disability Dynamic Groups by Number and Types of Disabilities

Over 90% of persons with progressive limitations have more than one disability type

Those with progressive and fluctuating^Note limitations tended to have a higher number of disability types^Note than the other groups. For example, those with progressive limitations had an average of four disability types compared to two for those with recurrent.^Note In fact, three in five of those with progressive limitations had four or more types of disabilities compared with one in five with recurrent. In contrast, nearly half of those with recurrent limitations had only one type of disability compared with one in ten of those with progressive (Chart 1).

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Although it is instructive to examine the pattern of disability types that occur among the various disability dynamics, care must be taken when interpreting the data because, as described above, individuals can (and often do) have more than one disability type. As shown in Table 5, pain-related disabilities were relatively common among all groups, and this is consistent with overall findings regarding prevalence of disability types. However, the highest concentration of both pain-related and physical disabilities (roughly 84%) was found among those with progressive limitations. The higher rate of multiple disability types among the progressive group may be resulting in this group having a higher prevalence of almost all of the disability types. The exception to this higher prevalence involves mental health-related disabilities. Approximately one third of those with progressive limitations indicated having a mental health-related disability, while 43% of those in the fluctuating group had a mental health-related disability.

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Section 4: Employment

4.1 Employment Rates among Adults Aged 25 to 64 Years

Employment rate is highest for those with recurrent limitations; lowest for those with progressive limitations

When taking into account disability dynamics, among persons with disabilities aged 25 to 64 years, clear asymmetries in employment rates become apparent. The employment rate was highest for those with recurrent limitations (65%) and lowest for those with progressive limitations (40%) (Chart 2). The employment rate was in the middle range for those with fluctuating (53%) or continuous (59%) limitations. No statistically significant differences between men and women were found within each of the four disability dynamic groups. 

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Regardless of age, employment rates tend to be lowest for those with progressive limitations

When examining age-specific employment rates by disability dynamic groups, some noteworthy patterns emerge. Those with recurrent, progressive, or continuous limitations showed fairly consistent levels of employment between ages 25 to 54 years, but showed significant declines in employment rates for those aged 55 to 64 years (Table 6).^Note Regardless of age groups, however, those with progressive limitations consistently had lower rates of employment (a difference of between 5 to 27 percentage points) than did their same-age peers with either recurrent or continuous limitations.

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Drop in employment rates for those aged 55 to 64 years is more pronounced among women than men—particularly for women with fluctuating limitations

The intersection between age and sex also resulted in some key differences in employment rates. For those aged 25 to 54 years, the gap in employment rates between men and women was not significantly different within each disability dynamic group. However, employment rates for both sexes—in this age group—were lowest for those with progressive limitations (48%) and highest for those with recurrent (74%) (Table 7). Among those aged 55 to 64 years, significant differences in employment rates were found between men and women with fluctuating limitations. In this case, employment rates were lower for women than they were for men.  Although employment rates declined for both men and women from age group 25 to 54 years to 55 to 64 years across all disability dynamic groups, the magnitude of the decline was greater for women.

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4.2 Employment rate and Severity of Disability

Regardless of disability dynamic, those with “less severe” disabilities are twice as likely to be employed as those with “more severe” disabilities

Severity is an important factor for understanding employment rates. Persons with “less severe” disabilities were significantly more likely to be employed than those with “more severe” disabilities within each disability dynamic group (Chart 3). In each case, those with “less severe” disabilities were approximately twice as likely to be employed as those with “more severe” disabilities.

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However, examining both severity and disability dynamics allows for a richer understanding of key factors in employment. For example, among those with “less severe” disabilities, while there are few differences among those with recurrent, fluctuating, or continuous limitations, having a progressive limitation (even if it is “less severe”) presents an added employment challenge. The lowest rate of employment is found among those with “more severe” progressive limitations.

4.3 Full-Time/Part-Time Employment

Men and women with progressive limitations are at least 1.5 times more likely to work part-time than are those with continuous limitations

Women and men with disabilities were both more likely to work on a full-time basis than part-time^Note (Table 8). However, women were more likely to work on a part time basis than were men. Among women, those with continuous limitations had the highest rate of full-time employment (79%), while those with progressive or fluctuating limitations had the lowest (approximately 70%). Among men, those with recurrent limitations had the highest rate of full-time employment (93%) while those with progressive had the lowest (78%). The highest rate of full-time employment for women was the same as the lowest rate of full-time employment for men.

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4.4 Impact of Disability on Employment Experiences

Persons with progressive limitations are the most likely to report that their condition impacts their employment

Those with progressive limitations were the group most likely to report that their condition had an impact on their employment, with 65% having difficulty changing jobs or advancing at their current job and 62% experiencing limitations on the amount or kind of work they could perform (Table 9).^Note By comparison, persons with either recurrent or continuous limitations were around half as likely to report these same two impacts on employment. Persons with either progressive or fluctuating limitations were more likely than those with continuous limitations to have taken a leave of absence from work of one month or more due to their disability.

Persons with recurrent or continuous limitations did still, however, report that their condition impacted their employment, particularly in the areas of difficulties changing or advancing at their job, and limits on the amount or kind of work they could do. These patterns underscore the importance of considering each of the four disability dynamic groups in turn.

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4.5 Employment Discrimination

Among persons with recurrent limitations, those with “more severe” disabilities are three times more likely to experience employment discrimination than are those with “less severe” disabilities

Overall, employed persons with progressive (25%) or fluctuating (18%) limitations were almost twice as likely as those with recurrent (12%) or continuous (12%) limitations to report experiencing some type of employment discrimination in the past five years. These experiences of discrimination could include being refused a job interview, a job, and/or a promotion.

Within each dynamic group, those with “more severe” disabilities were approximately two to three times more likely to report employment discrimination compared to their counterparts with “less severe” disabilities (Table 10). Among those with “less severe” disabilities, persons with progressive limitations (16%) were the most likely to report having experienced employment discrimination related to their disability. Among those with “more severe” disabilities, persons with progressive (31%) or fluctuating (29%) limitations were more likely to report having experienced employment discrimination than were those with continuous limitations (20%). No statistically significant differences were found between men and women in rates of reported employment discrimination within these groupings.

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4.6 Work Potential among Non-Employed^Note Adults

Persons with recurrent limitations have highest rate of work potential; those with progressive limitations have the lowest

The concept of “work potential” is an attempt to provide an indication of the total size of the potential labour force with disabilities under the best-case scenario—an inclusive labour market without discrimination, with full accessibility, and accommodation. The work potential variable used here is a way to assess how the labour market could change under this scenario, by classifying non-working individuals who might be likely or able to enter paid employment under these more inclusive conditions. It is not a measure of people who are currently looking for or willing to work.^Note

For both non-employed men and women, those with recurrent limitations were the most likely to be potential workers (52%), whereas those with progressive limitations were least likely to be potential workers (27%) (Table 11). Of those with recurrent limitations, 60% of men and 47% of women had work potential. No other sex-based differences were significant. Those with progressive limitations, regardless of severity level, had a consistently lower likelihood of work potential than those with fluctuating, continuous, or recurrent limitations.

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Section 5: Workplace Accommodations

5.1 Requirements and Access to Workplace Accommodations

Employed persons with progressive or fluctuating have highest level of WPA requirements

Workplace accommodations (WPA) such as flexible work schedules or workstation modifications play an important role in creating an inclusive and accessible work environment for many employed persons with disabilities (Morris, 2019). At half of their respective populations, employed persons with progressive limitations (56%) or fluctuating limitations (49%) were the most likely to require at least one or more WPA^Note (Chart 4). By comparison, less than a third (about 31%) of those with recurrent or continuous limitations required WPA.  In all instances, those with “more severe” disabilities were more likely to require WPA than those with “less severe” disabilities regardless of disability dynamic group. However, this was most pronounced for those with either recurrent or continuous limitations, among whom those with “more severe” disabilities were twice as likely to require WPA as those with “less severe” disabilities.

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Flexible work arrangements is the most required WPA^Note among all four disability dynamic groups

When it came to flexible work arrangements, employed persons with progressive (45%) or fluctuating (38%) limitations had the highest WPA requirements (Table 12). On the other hand, those with recurrent and continuous limitations indicated lower levels of requirements (around 21%). In terms of level of needs met for flexible work arrangements, no statistically significant differences were found among disability dynamic groups. As a whole, around 70% of employed persons had all of their needs met for flexible work arrangements, 9% had some of their needs met, and 22% had none of their needs met. 

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With respect to workstation modifications, once again, employed persons with progressive (23%) or fluctuating (22%) limitations had the highest WPA requirements. Those with recurrent and continuous limitations again had lower levels of requirements at around 12% for both. In terms of level of needs met for workstation modifications, those with progressive (48%) or fluctuating (50%) limitations were less likely to have all of their needs met, relative to those with continuous (65%). No statistically significant differences were found for those with none of their needs met among the four disability dynamic groups. 

Human or technical supports were the least required WPA among all four disability dynamic groups. Nonetheless, similar patterns were found—with those with recurrent (4%) or continuous (6%) limitations being less likely to require human or technical supports compared to those with progressive (10%). In terms of level of needs met for human or technical supports, no statistically significant differences were found among disability dynamic groups.  

5.2 Number of Required Workplace Accommodations

Employed persons with progressive or fluctuating limitations are the most likely to require at least three or more WPA

In addition to requiring different types of WPA, employed persons among the four disability dynamic groups also varied in terms of the number of WPA they required. Those with progressive or fluctuating limitations had the highest likelihood of WPA requirements, and, also tended to require more types of accommodations. Overall, around 36% of these individuals required three or more WPA compared to around 20% of those with recurrent or continuous limitations (Table 13). Conversely, half of employed persons with recurrent or continuous limitations who required WPA only required one compared to just over one-third of employed persons with progressive or fluctuating limitations.

When broken down by severity level, no statistically significant differences were found between the four disability dynamic groups in terms of percentage who required one WPA. Among those with “less severe” disabilities, the percentage or proportion who required one WPA were similar for all four disability dynamic groups. This was also the case among those with “more severe” disabilities. Of those who required three or more WPA, no statistically significant differences were found by severity level between the disability dynamic groups with the exception of those with recurrent limitations. For these employed persons, those with “more severe” disabilities were significantly less likely to require three or more WPA compared to those with progressive limitations.

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5.3 Level of Needs Met for Workplace Accommodations by Selected Characteristics

Younger employed persons with progressive limitations are more likely to require WPA than older persons

Requirements for WPA did not vary as a function of age for most disability dynamic groups, with the exception of those with progressive limitations (Table 14). In this instance, those aged 25 to 44 years (64%) who were employed were more likely to require WPA than those aged 45 to 64 years (53%). For  employed persons with either recurrent or continuous limitations, requirements for WPA remained somewhat stable at around 30% regardless of age group while this figure was at around 49% for those with fluctuating limitations. 

In terms of the level of needs met, older employed persons aged 45 to 64 years with progressive limitations were more likely to have all of their needs met and less likely to have none of their needs met compared to younger ones. In contrast, older employed persons aged 45 to 64 years with fluctuating limitations were less likely to have all of their needs met than their younger counterparts. No other statistically significant differences were found by age groups in level of needs met for any of the other disability dynamic groups.

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With the exception of those with progressive limitations, women are more likely than men to require WPA

Requirements for WPA varied between men and women within most disability dynamic groups with the exception of those with progressive limitations (Table 15). In each instance, women were more likely to require WPA than men. For example, women (55%) with fluctuating limitations were 1.4 times more likely to require WPA than men (38%) with fluctuating limitations. In terms of level of needs met, women with recurrent limitations were more likely to have none of their needs met and less likely to have all of their needs met compared to their male counterparts. On the other hand, women with continuous limitations were less likely to have none of their needs met compared to men but equally likely to have all of their needs met. No statistically significant differences were found between men and women in level of needs met for those with fluctuating or progressive limitations.

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Section 6: Conclusions

Three in five persons with disabilities do not fit the conventional view of disability

The findings from this paper highlight the importance of considering disability dynamics when looking at the demographic and employment profiles of persons with disabilities. Despite the conventional belief that disability is fairly continuous, permanent, and with very little change over time, the findings show that the majority of persons with disabilities do not follow this pattern. In fact, of the approximately 6.2 million persons with disabilities aged 15 years and over, 61% do not fit this classification. Instead, 23% experienced progressive limitations; 25% had recurrent limitations; 13% experienced fluctuating limitations. The remaining 39% experienced continuous limitations.

Disability dynamic groups have different age and sex distributions

Examination of the four disability dynamic groups revealed a number of patterns associated with age and sex In particular, progressive limitations were more commonly experienced among seniors compared to youth; whereas recurrent limitations were more common among youth compared to seniors. Women were more likely to experience fluctuating limitations, whereas men were more likely to experience continuous limitations.

Certain disability dynamics are consistently associated with better employment experiences than others

Relative to the other three disability dynamic groups, persons with progressive limitations were less likely to be employed, and when employed, they experienced greater employment discrimination and impacts on their employment. Employed persons with progressive limitations also tended to have more workplace accommodation needs, with younger persons aged 25 to 44 years being less likely to have all their needs met compared to older persons aged 45 to 64 years. Among non-employed persons, those with progressive limitations were the least likely to be potential workers compared to the other three dynamic groups.

Conversely, those with recurrent limitations were the least likely of the four disability dynamic groups to report that their disability impacted their employment experiences. Persons who experienced recurrent limitations were more likely to be employed, required fewer workplace accommodations, and experienced less employment discrimination and impacts on their employment. Among non-employed persons, those with recurrent limitations also had a greater likelihood of being potential workers than the other disability dynamic groups.

Disability dynamic groups have different levels of severity; however, severity of disability is important even within groups

When examining the four disability dynamic groups, severity emerged as a key variable. While those with progressive limitations were the most likely to experience “more severe” disabilities, those with “more severe” disabilities – regardless of disability dynamic group – still reported greater impacts on employment.  For example, irrespective of disability dynamic group, employment rates were nearly double for those with “less severe”, compared to “more severe”, disabilities.

Appendix: Testing new questions

Qualitative Testing of New Questions from the 2017 CSD on Disability Dynamics

A number of proposed questions and modules^Note about episodic disabilities were tested by Statistics Canada during two extensive periods of qualitative testing of the 2017 CSD questionnaire. Early results of this testing revealed that the average Canadian did not interpret the term “episodic disability” in a consistent manner, and many individuals reported not understanding what was meant by it at all. As well, feedback from respondents during qualitative testing indicated that the phenomenon under consideration was much more complex—with many indicating that the “change” they felt most strongly about reporting in a survey environment was that their limitations were getting increasingly “more severe” or that they experienced such unpredictability in their situation that they did not feel they had discrete episodes, but rather just constant change. Additionally, the rather high rate of co-occurrence among disability types^Note experienced by individuals further complicated efforts to capture episodic disabilities—while some individuals might experience “on again/off again” patterns for one disability type, they were often more concerned about the limitations presented by another, more constant or progressive disability type. In the end, two questions appeared to provide background information that was consistently understood in the same manner across all types of respondents and that attempted to capture some of the critical dimensions of the dynamics reported during testing. In particular, it was clear that some opportunity to report progressive limitations was needed. Another concern that was important to address from a program and policy perspective was the need to identify those who may experience fairly long periods without limitation and may be at risk of failing to qualify for required programs or supports. With limited space and time on the survey, two questions passed qualitative testing and were placed on the survey.

Goodness of Fit with Main Underlying Condition

In an effort to better understand the four disability dynamic groups identified in this paper, the main underlying conditions data (i.e., write-in responses) in the 2017 CSD were examined for all respondents, with the caveat provided in Textbox 2. Specifically, it is important to emphasize that the analyses below only represent a subset of the actual number of persons who in fact had the underlying condition; those who did not report it as one of their top two conditions leading to their limitations are not represented here. Using a number of “main underlying conditions” often deemed to be “episodic” in nature, the findings suggests that using the CSD to capture disability dynamics based on underlying condition data would fail to capture the true nature of disability dynamics. For example:

1. Multiple Sclerosis (MS) is an example of a condition often used as an example of an “episodic” disability (HUMA 2019 report). Yet, of those who reported MS as their main underlying condition in the 2017 CSD, nearly five in ten indicated that their limitations were progressive in nature and nearly a quarter indicated a fairly continuous limitation pattern. Only one in five indicated having recurrent limitations (one month or more without limitation) and another one in five reported fluctuating limitations.
2. Anxiety is one of the more common conditions leading to a mental health-related disability and is often deemed to be episodic in nature. However, on the 2017 CSD, nearly two in five of those reporting anxiety as a main underlying condition reported having recurrent limitations (one month or more without limitation) and another one in five experienced fluctuating limitations, while a third reported continuous limitations.
3. Of those listing migraines (also often associated with episodic disabilities) as the main underlying condition leading to their disability, a third reported recurrent limitations, another third reported a more continuous limitation pattern, one in five reported a progressive limitations, and one in ten reported fluctuating limitations.

While no definitive conclusions can be drawn from the main underlying condition data in the CSD, it is clear that those with any particular underlying condition can be found in any of the four dynamic groups identified in this paper. The same underlying condition can impact different people in different ways as evidenced by their pattern of responses to questions EPD_Q05 and EPD_Q10. 

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