Last winter’s flu outbreak highlighted an issue in many businesses: presenteeism, that is, employees showing up even when they’re sick because they need the money and potentially spreading their illness to others. When those employees are handling food and interacting with customers, it’s an even bigger issue.

Rolf Wilkin, owner of Eureka Pizza, which has nine locations in Arkansas, says many of his workers caught the flu last year. “I guess the strains of the flu shot in our area weren’t ones that we’d planned on,” he says. “It’s a problem because they’re contagious and I don’t want them to be a risk to the public and certainly to their coworkers. You just have to tell them to go home and get better.”

Wilkin doesn’t pay workers when they’re home sick, but he points out that skipping one shift to rest may help them get back to work sooner than dragging themselves through several shifts and making themselves sicker.

Arranging shift coverage for workers who are home sick isn’t always easy but Wilkin tries to crosstrain workers so they can fill in as needed. “When somebody calls in sick, you can call (another worker) and not have to worry if they can do that task,” he explains.

Cross-training is a smart strategy but it’s not as effective at establishments with high turnover, says Alex M. Susskind, associate professor of food and beverage management at Cornell University’s School of Hotel Administration. He suggests creating a work swap board so that employees can take some responsibility for covering their shift themselves. “By switching the shift, they’re not losing the revenue, they’re just postponing it to a later time,” he says. “If you had a day shift and you spend the day in bed, you might be better to come in the next day.”

For more long-term health issues, workers might be eligible for unpaid, job-protected leave under the Family and Medical Leave Act (FMLA). Some cities and states also mandate that businesses offer paid sick leave, even to part-time workers (see sidebar for more details). San Francisco, where Craig Stoll co-owns Pizzeria Delfina, became the first city to require paid sick leave in 2007.

Stoll is planning to open two more locations on the San Francisco Peninsula, and although those locations won’t be subject to the same city ordinance, he plans to maintain a consistent policy of paid sick leave. “At the end of the day, it’s really a good thing, especially for the kitchen and the front of house as well,” he says. “For morale and well-being, it’s just the right thing to do. Being a cook or a waiter is not a high-wage job. The difference between missing a shift and not missing a shift makes a huge impact. If they really are sick, they can still pay rent.”

Like Wilkin, Stoll says covering for sick workers isn’t easy. “As much as possible, if they can find a replacement that’s great,” he says. “With front of the house it’s more of a requirement than back of the house. It’s a different mindset. They own their shifts, and our expectation is that they try to cover their shifts.” If that’s not possible, a manager might jump in at the last minute or Stoll might call in someone from one of the two restaurants he co-owns. “Sometimes someone will pull a double or someone will come in on their day off,” he adds.

Another potential solution is to give workers paid time off to use for sick leave, vacation or however they see fit. “This benefits hourly employees because it provides them with greater flexibility as they can use time off at their discretion, as well as accountability in managing their time off,” says Xan Raskin, a New York City-based employment attorney and founder of Artixan Consulting Group, a human resources risk management company. “For employers, it cuts down on the administrative time because it keeps things simple. They do not have to spend time questioning whether the employee was out for a legitimate illness or using sick time inappropriately.” Once the worker uses up their paid time off, the expectation is that further time off would be unpaid. How can you ensure that employees don’t abuse these paid leave policies?

Some employers require a doctor’s note for a prolonged absence due to illness but others take a more trusting approach. “If someone abuses a policy of your goodwill, you might want to unhire them,” Susskind says. “If you communicate with your employees and you’re concerned about their wellbeing, I think that goes a long way in working with them to come to a better solution.”

Paid Sick Leave by Geography

Here’s a look at states and cities that require paid sick leave. In many cases, paid sick leave can also be used to care for a family member. Several more regions including New York City have paid sick leave campaigns or pending legislature, so consult your state’s Labor Department for the most current information.

• Connecticut — With a few exceptions, businesses with 50 or more workers must provide paid sick leave annually to service workers. Paid sick leave accrues at a rate of one hour of paid sick leave for each 40 hours worked and in one-hour increments up to a maximum of 40 hours per calendar year.
• District of Columbia — D.C.’s Accrued Sick and Safe Leave Act of 2008 (ASSLA) requires a certain amount of paid leave depending on the number of employees. However, restaurant wait staff and bartenders who work for a combination of wages and tips are not entitled to paid leave under ASSLA.
• Portland, Oregon — Portland’s protected sick leave goes into effect in January 2014 and accrues at one hour of sick leave for every 30 hours worked, up to 40 hours a year. Workers cannot use paid sick leave for their first 90 days of employment.
• San Francisco, California — For every 30 hours worked, employees accrue one hour of paid sick leave.
• Seattle, Washington — Under Seattle’s Paid Sick and Safe Time Ordinance, workers accrue one hour of paid time for every 40 hours worked if their employer has 4-249 employees. At companies with more than 250 employees, the accrual rate is one hour for every 30 hours worked.

Susan Johnston is a freelance writer in Boston, Massachusetts. She writes about business and lifestyle topics.