OSHA issues ergonomic rules for nursing homes

In a move that will add one more regulatory concern to the risk manager’s plate, the Occupational Safety and Health Administration (OSHA) recently issued the first in a series of industry-specific guidelines for the prevention of musculoskeletal disorders in the workplace. Its target: nursing homes.

The good news, however, is that the guidelines could help reduce workers’ compensation expenses and other costs related to ergonomic injuries, and the guidance is equally applicable to other health care settings.

OSHA’s Guidelines for Nursing Homes focuses on what the agency calls practical recommendations for employers to reduce the number and severity of workplace injuries by using methods found to be successful in the nursing home environment. OSHA administrator John Henshaw announced the guidelines by saying they were the result of a close collaboration with the long-term care industry.

The guidelines are divided into five sections: developing a process for protecting workers; identifying problems and implementing solutions for resident lifting and repositioning; identifying problems and implementing solutions for activities other than resident lifting and repositioning; training; and additional sources of information.

OSHA emphasizes that specific measures or guideline implementations may differ from site to site. Still, the agency recommends that all facilities minimize manual lifting of residents in all cases, and eliminate such lifting when feasible. Further, OSHA encourages employers to implement a basic ergonomic process that provides management support while involving workers, identifying problems and implementing solutions, addressing reports of injuries, providing training, and evaluating ergonomics efforts.

"Nursing home workers are suffering too many ergonomics-related injuries," Henshaw said. "But the experiences of many nursing homes provide a basis for taking action now to better protect these workers. These guidelines reflect best practices for tackling ergonomic problems in this industry."

Industry leaders say guidelines are good

The ergonomic guidelines were endorsed by the American Health Care Association (AHCA) and the American Association of Homes and Services for the Aging (AAHSA), which issued statements saying the guidelines demonstrate an understanding of the complexities involved with applying ergonomics to the lifting, transferring, and repositioning of nursing home residents.

Praising OSHA for its inclusion of key stakeholders early on in the process, AHCA president and CEO Charles H. Roadman II, MD, CNA, says the guidelines specifically appear to acknowledge the indelible connection between patient handling tasks and clinical care, by recommending the use of the Minimum Data Set to assess resident handling tasks.

"Nursing home professionals are in the business of caring for the frail, elderly, and disabled. When we talk about ergonomic safety for our staff, we aren’t talking about moving boxes. We are talking about moving real people," he says. "We cannot ignore the clinical needs of our patients when discussing employee safety, and the OSHA guidelines recognize this."

Similar praise comes from William L. Minnix Jr., DMin, president and CEO of AAHSA. He commends OSHA for making sure the guidelines take into account the groups’ experience-based understanding of ergonomics in nursing homes.

"These final guidelines are far superior to the draft guidelines issued last summer in large part because OSHA listened to what we had to say and worked with us," Minnix says. "As a result, these guidelines not only are stronger and will do a better job of protecting our direct care staff, but they are more realistic."

In April 2002, OSHA issued a comprehensive plan to reduce ergonomic injuries through a combination of industry-targeted guidelines, tough enforcement measures, workplace outreach, advanced research, and dedicated efforts to protect immigrant workers.

Secretary of Labor Elaine L. Chao subsequently announced the first industry-specific guidelines to reduce ergonomic-related injuries would be developed for nursing homes. Information for the guidelines came from numerous sources, including existing practices and programs, trade and professional associations, labor organizations, the medical community, individual firms, state OSHA programs, and available scientific information.

Minimize manual lifting of residents

Arranged into five sections, the guidelines open with a seven-point process to protect workers. The guidelines provide recommendations for nursing home employers to help reduce the number and severity of work-related musculoskeletal disorders (MSDs) in their facilities. MSDs include conditions such as low back pain, sciatica, rotator cuff injuries, epicondylitis, and carpal tunnel syndrome.

The guidelines are designed specifically for the nursing home industry. However, OSHA officials emphasize that they hope employers with similar work environments, such as assisted living centers, homes for the disabled, homes for the aged, and hospitals also will find the information useful.

In its primary suggestion, OSHA recommends that manual lifting of residents be minimized in all cases and eliminated when feasible. It also recommends that employers develop a process for systematically addressing ergonomics issues in their facilities and incorporate this process into an overall safety and health program. OSHA says an effective process will include these components:

  • Provide Management Support. Employers should develop clear goals, assign responsibilities to designated staff members, provide resources, and ensure responsibilities are fulfilled. A sustained effort is paramount.
  • Involve Employees. Encourage employees to submit suggestions or concerns; discuss workplace and work methods; participate in training and procedural designs; respond to surveys; and participate in task groups with ergonomics responsibilities.
  • Identify Problems. Establish systematic methods for identifying ergonomic concerns in the workplace, e.g., analyze information from OSHA injury and illness logs, workers’ compensation claims, insurance company reports, etc.
  • Implement Solutions. Effective solutions usually involve workplace modifications that eliminate hazards. Changes can include the use of equipment, work practices, or both. (The guidelines include solution examples in Sections III and IV.)
  • Address Reports of Injuries. Manage work-related MSDs in the same manner and under the same process as any other occupational injury or illness. Like many injuries and illnesses, employers and employees can benefit from early reporting of MSDs. These reports also can help the establishment identify problem areas and evaluate ergonomic efforts.
  • Provide Training. Provide ergonomics training to nursing assistants and other workers at risk of injury, charge nurses and supervisors, and designated program managers.
  • Evaluate Ergonomics Efforts. Evaluation and follow-up are central to continuous improvement and long-term success. They help sustain the effort to reduce injuries and illnesses, track whether or not ergonomic solutions are working, identify new problems, and show areas where future improvement is needed.

OSHA offers other resources

The guidelines list a number of protocols designed to help employers with resident assessment and the determination of appropriate methods for transferring and repositioning residents. Some examples include the Resident Assessment Instrument published by the Centers for Medicare & Medicaid Services.

This information can be accessed at www.cms.hhs.gov/medicaid/mds20/. OSHA also recommends the Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement, published by the Patient Safety Center, Veterans Health Administration and the Department of Defense. This information is available at www.patientsafetycenter.com.

OSHA notes that a number of work-related MSDs occur in activities other than resident lifting. Some activities a nursing home operator may want to review include bending, lifting food trays above shoulder level or below knee level; waste collection; pushing heavy carts; lifting and carrying while receiving and stocking supplies; and laundry removal from washing machines and dryers.