 The American workplace is becoming safer, but serious injuries still occur in worksites you might think are absolutely safe. Nursing homes and personal care, a fast-growing industry and a key part of our health care system, yet these facilities have one of the highest worker injury and illness rates in the country. Similar to trucking and shipbuilding, occupations often thought to be more dangerous. Look at the statistics. Nursing home workers lose twice as much time on the job as other workers and have an over-exertion rate more than four times the national average. Over half of their injuries occur while handling residents and almost half involve the lower back. There are many potential hazards in nursing homes. Disease, infection, chemical exposures, slips and falls, even workplace violence. But perhaps the greatest worker hazard involves lifting residents and transferring them from bed to chairs, showers or other areas in the nursing home. Nursing home workers aren't the only ones who suffer from stress, strain and over-exertion. Such problems account for more than one in four of all-on-the-job injuries each year. These disorders are the single largest group of preventable job injuries in the United States today. But when ergonomic principles are applied, everyone benefits. Simply put, ergonomics means fitting the job to the worker, designing jobs so that workers can avoid awkward unnatural postures and excessive force that can lead to serious injury and illness, sometimes even painful and permanent disabilities. OSHA, the Occupational Safety and Health Administration, had a special emphasis program in seven states to reduce the threat of injuries in nursing homes. Now, in line with new targeting procedures, OSHA is conducting inspections in nursing homes nationwide. Employers are encouraged to create comprehensive safety and health programs to reduce injury and illness rates, including those associated with resident transfers. Inspection of a nursing home involves special considerations. Before going on-site, here are some factors to consider. The Health Care Financing Administration, or HICFA report, should be obtained in advance to determine the dependency level of the residents. Hello. My name is Brad Baptiste. I'm with the U.S. Department of Labor, OSHA. Once on-site, the inspector should conduct an opening conference and walk around. Remember, these inspections are taking place in the homes of residents. Their privacy rights are protected by law and must be respected during walk-arounds. Any photography or videotaping of resident activities requires the resident's permission. Next, the inspector must determine where injuries and illnesses occur. This is done by studying the OSHA 200 logs, the OSHA 101 forms, or workers' comp records dating back three to five years. By analyzing injury and illness trends over time, the inspector can detect patterns. Copies of any required written programs, insurance reports, or other previous audits of the facility can also help. Overall incident rates and ergonomic incident rates can be calculated. The same can be done for different departments, different shifts, and different wings in order to pinpoint areas of specific hazards. Brad Baptiste, a compliance officer in Denver, has conducted numerous nursing home inspections. You would then focus your efforts on the two or three areas where you're having the highest incident rates. More than likely, that's always going to be nurses' aides doing transfers. That's the most hazardous of all the jobs, and you'll find that that's where you'll want to focus your attention. As a normal part of all of our inspections, we do employee interviews, and what I like to do is audiotape our conversation. Do you have any objections to that? No, none at all. What you need to do is interview all these employees who've been injured, if possible. Find out exactly how they were injured, and then determine those two or three or four lifts that you're going to want to evaluate. Then you're going to obtain your videotape from two to three different angles. It's important to have a reference of known size in the picture. Residents are on different schedules, but generally they awaken between 7 and 9 a.m., dress, bathe, and have breakfast. Then there are morning activities, lunch, and for some a nap. Others enjoy afternoon activities before dinner. Many have an evening activity as well. The most important times are during resident transfers. It's important to look at more than one shift and to pay special attention to the work of the certified nurses' aides. You might find that you have a significant number of injury or ergonomic incident rate during the night shift, when typically you'll find a lower level of staffing at night. You might find that the day shift has acceptable injury rates, but the night might be extremely high. So it's important that you adjust your schedule so that you can evaluate how they're doing their lifts at various times. Safety and health training is also important. Some questions to ask are, has the organization provided specific safety and health training to the aides, the supervisors, the management? Here are some other things to consider. A lot of time being spent evaluating the different lifts, looking at the areas. The places are large, so you've got to look at each department. So normally the walk around takes at least a half a day to a day, initially, just to get familiarized with the site. The ergonomic incident rate evaluation from their records could take a day or two or more. So a tip would be to expect that when you go in. These are not simple cut and dry inspections. They do take some time and you need to budget your time wisely so that you can fit in all of your interviews. When evaluating patient transfers, remember that lifting any heavy object can pose a serious hazard for workers, but lifting a person is probably the most dangerous. Some residents may be combative, others may have diminished mobility. Making a proper lift can be very difficult. There are some residents in the nursing home who have complete mobility. They can dress themselves, they can get themselves out of bed, they're ambulatory. That varies all the way to the other end of the spectrum where you have residents who are absolutely unable to do anything without assistance. And those are the residents that are more than likely the most difficult to handle and they require the nurses' aides to transfer them from the bed to a chair. They have to be transferred to toilets, they have to be transferred to shower and whirlpool facilities. Those are extremely hazardous situations for anyone who's lifting, whether it's a solo unassisted lift or a two-person unassisted lift. They put a lot of stress on people's shoulders, backs, knees, and we're seeing a number of injuries in these nursing homes. And then, of course, there's the resident to consider. Being lifted from under the shoulders is extremely painful to many people. These people have very sensitive skin, very sensitive bones, osteoporosis. There are reports of residents who've literally had their shoulders broken or dislocated just by physically being lifted from underneath the arm. Fortunately, there are ways to minimize risks, such as increased staffing, adjusted schedules for peak periods of resident handling, and lift assist devices. The simplest assist used in nursing homes is the transfer belt. A certified nurse's aide loops the belt behind the resident and helps the person stand up. The belt helps support the resident without straining the aide's back. For residents who do not have the strength in their legs or mobility to use a transfer belt, other assists are available. You now can strap a very comfortable harness on these people, lift them up gently. It's safer and more secure for the resident, and it's much safer for the employee who no longer has to put that stress on their back. Now we're going to go up. Special devices such as lift assist can go a long way toward preventing injuries. Some people worry that the use of lift assist may be unsafe for residents or less personal than the work of the aides. Nothing could be further from the truth. They're still able to help that resident understand what's going on and comfort them if they need it, balance them, and yet they still have the ability to control the lift without placing that stress on their body. A sling and hoist device can be used to get a resident from a bed to a chair. The sling is put around the back and under the resident. Then it is fastened to a lifting arm. The resident is transferred without causing undue exertion to the aides who are still able to provide personal comfort and care. Feel comfortable? Yeah. All set. The question of which device should be used for which resident is answered by Cyril Young, an inspector in Bangor, Maine. Well, a lot of that I determined by talking with the employees, looking at the job that they're doing, the size of the patient that needs to be moved, where they're being moved to. The employee is a wealth of information. If they're finding there are problems with this particular device, they're not going to use it, or it may be not being used properly, the large amount of patient transfer is really looking at the facility, the devices that are being used to make sure that these devices are being used properly, that they're being maintained, because if they're not being maintained properly, they're not going to be used. The most important thing to do is not really recommend a specific vendor, but to have the administration of that facility bring in vendors of all types, let the employees try out the equipment. The vendors will leave them for a month at a time, and allow the employees to use these devices during their normal course of work. They'll train them, they'll let them use them, then the employees should have input into which ones they like, which ones they find the best, which ones the residents like and will use. Toileting a resident demonstrates another look at hazards. The resident must be lifted out of the wheelchair, balanced in an upright position, and then lowered onto the toilet. Back support for the worker is non-existent, and many bathrooms, unlike this one, are designed so that two aids cannot work together, thereby adding to their stress and strain. This is one device that can be used to assist the toileting procedure. It is easily attached to the resident who can be lifted, balanced, and then lowered onto the toilet. Most of the resident's body weight is supported by the lift and not the nurse's aids. This type of lift is only useful if the residents have some strength in their legs. A slip device is used to slide patients up and down in their beds. This may be a pad that contains a silicone-like substance, a sliding board, or some other device that reduces the friction associated with resident transfer. Using the device may take more time, but it is much easier on the resident and safer for the aid. Many nursing homes have already made some ergonomic improvements on their own. Why? Because it saves money. Sandra Billing, manager of Employee Health at the Kennebick Health System in Augusta Maine, explains. What was occurring to us in the early 1990s is that we were seeing our workers' comp in this state start to escalate. And in particular, in our own health care facility, it was growing by leaps and bounds. Our workers' comp in 1991 was up to $1.5 million, and we're a relatively small facility. But in 1996, their premiums were down to $770,000, and the lost workdays, well over 1,000 in 1991, were down to 121 days. Greg Gravel, CEO of the Kennebick Long-Term Care Facility, initially invested $60,000 in devices that eliminated the hazards that were causing the injuries, the injuries that made their workers' comp payments so high. When you think of what the return is on that investment of $60,000, it's a no-brainer. The return was there. It's significant. The staff understands it. They recognize it. We recognize it from a variety of ways, not just from a bottom-line point of view. But we had a healthier work environment. If we have that, then we have better patient care. We have better patient care, then that's what we're here for. Change takes time and money. Management commitment is key. Top managers must decide that high injury and illness rates are unacceptable, and they must provide the necessary resources to reduce or eliminate the hazards. Managers, supervisors, and employees working together as a team can effectively evaluate whether or not the program is working. Written goals, policies, and procedures help the members of the team know what is expected of them. I think one of the most significant findings is the awareness level has drastically increased, not only on the part of management, but also employees. And when I talk with the employees, the morale has greatly increased also. They're much more likely to bring problems up to management, or if they've got a safety committee in place, they're more aware of hazards that are in their environment. OSHA believes that nursing homes can and will be safer workplaces. A safer workplace helps the employers with lower costs and fewer absences. It helps the worker by preventing injuries and illnesses. And it helps the residents by providing better and safer care. Everyone comes out ahead with OSHA's Nursing Home Initiative.