I try to gauge how sick they are… if they are unable to function, they have to go home, I don’t give them a choice. If they just have the sniffles, or a headache, I let them stay.
If they have run out of sick and/or vacation days, I give them a choice… they can either take shorter lunches (1/2 hour instead of the full hour) and pay back the time they owe, or they can dip into the next year’s allotment. Or, they can take the time unpaid.
Of course, if they leave prior to time being paid back, it would be deducted from their last paycheque.
Hope this helps.