Aging of baby boomers may cause a work comp boomlet in health care

Safe patient lifting, wellness can reduce risk of injury

As the Baby Boom ages into an elderly boom, and demand for long-term and home health care soars, health care employees face changing realities at work. You can expect rising workers' compensation claims. Aging employees may need accommodations to stay in patient care. And keeping older workers will be a challenge.

Those are the trends detected through workers' compensation claims and injury data and analysis of workplace changes. While injury rates are dropping in workplaces overall, they have stayed stable in hospitals and nursing homes. The frequency of workers' compensation claims in nursing homes are double the national average for private industry, and the frequency of claims in home health is 17% higher than average, according to a report by the National Council on Compensation Insurance (NCCI) in Boca Raton, FL.1

Meanwhile, home health care will have the strongest employment growth through 2014, according to the Bureau of Labor Statistics. Registered nurses, home health aides, and nursing aides are all the in the top 10 occupations with the largest job growth.2

"The biggest asset you have is your employees. They're expensive to replace, even those low-paid ones in nursing homes," cautions Lynda Enos, RN, MS, COHN-S, CPE, an ergonomics consultant with HumanFit consulting firm in Oregon City, OR. "The biggest challenge is turnover. A lot of that is due to the physical demands of the job."

Wellness, injury prevention and safe patient handling will be the keys to maintaining the aging work force even as demand for workers grows, Enos says. "I do see that employers look at the aging work force as a liability, but I think that's the wrong way to look at it," she says. "If you're proactive as an employer and you design safety programs, then you're looking at being able to accommodate all workers and keep your older workers at the workplace."

Nationally, the average age of nurses was 47 in 2004. About 41% of nurses were 50 or older, and only 8% were younger than 30, according to a study by the Health Resources and Services Administration.3 The cost of replacing a single nurse is $92,442, according to a Robert Wood Johnson Foundation study.4

The retirement age is rising, and employees want to keep working, says Sherry Taxer, RN, COHN/CM, CCM, CPDM, senior clinical risk management consultant with Medical Protective, a consulting firm based in Beaverton, OR. But employers will need to be flexible, she says.

"We want the good, seasoned, hard-working person who's dedicated to the job," says Taxer, who previously worked as an employee health nurse in home health care. "If the employer's not open to accommodating, they're going to lose that work force — and they need them."

Greater total WC losses

Workers in hospitals and nursing homes are injured at about twice the rate of all workers in general industry. The primary reason: Greater risk of musculoskeletal injuries due to patient handling.

NCCI estimated total loss costs by multiplying the incidence rates by the average incurred severity from its claims database. Total loss costs for home health care and nursing and personal care were higher than for general industry in 2004. About a quarter (23%) of all workers' compensation claims in long-term care were related to lifting.

The growth of a high-injury industry is an "emerging issue for workers' compensation," says Tanya Restrepo, MBA, an economist with NCCI and a co-author of the report.

"We want people to be aware that [health care] is a growing industry due to the aging of baby boomers," she says. "It's a good idea to be aware of the characteristics of injuries in that industry."

For example, a worker older than 40 with a musculoskeletal injury will be off work 12 days longer, on average, than a younger worker, according to data from UnumProvident, a Chattanooga, TN-based disability insurer.

Home health care in particular presents challenges for safe patient handling. While some home health nurses may have access to portable lifts, others try to assist patients without any mechanical devices. The rise in obesity increasingly puts home health workers at risk, Taxer notes.

"The back strain in home health is unbelievable," she says. "You're in the home and you're expected to lift with whatever [assistance] you have available. You could be by yourself [and be] expected to lift the patient."

Hospitals should do more to bring those nurses back to work in a job that isn't physically demanding, says Kenneth Mitchell, PhD, vice president of Health and Productivity for Unum.

"It always amazes me that some of the hospitals have the least progressive transitional work programs," he says. "A hospital can save money by having an incremental return-to-work program. [You should] show you're committed to bringing people back to work."

Employers should take a "holistic" approach to preventing injuries, says Enos. In addition to ergonomic programs to reduce risks of musculoskeletal injuries, employers should provide wellness and stress management programs to encourage a healthier work force.

"If you keep your body fit and healthy and you're flexible as you get older and you deal with your stress, you're a happier worker," she says. "[Being fit] may also provide some immunity against the microtraumas and musculoskeletal disorders. You may also heal more quickly. It's all interlinked."


1. Restrepo T, Shuford H, and De A. An Emerging Issue for Workers Compensation — Aging Baby Boomers and a Growing Long-Term Care Industry. NCCI Research Brief Fall 2007. Available at Accessed on Jan. 21, 2008.

2. Hecker DE. Occupational employment projections to 2014. Monthly Labor Review 2005; 70-101. Available at Accessed on Jan. 21, 2008.

3. Health Resources and Services Administration. The Registered Nurse Population: Findings from the 2004 National Sample Survey of Registered Nurses. February 2007. Available at Accessed on Jan. 21, 2008.

4. Hatcher B, Bleich MR, Connolly C, et al. Wisdom at Work: The Importance of the Older and Experienced Nurse in the Work-place. Princeton, NJ: The Robert Wood Johnson Foundation; June 2006. Available at Accessed on Jan. 25, 2008.