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Home health agencies, along with other employers across the nation, got a last-minute reprieve earlier this year when Congress repealed a new ergonomics standard issued by the Occupational Safety and Health Administra-tion (OSHA).
The standard would have required businesses to implement comprehensive programs for preventing, recording, and responding to musculoskeletal injuries employees suffered on the job. Business leaders, including those in the home health industry, protested that the new rules were too burdensome and costly.
In response, Congress voted to rescind the directive in March.
But that doesn’t mean that agencies are off the hook for protecting their employees from workplace injuries. And there’s a chance that the ergonomics standard could reappear in some form — Labor Secretary Elaine Chao has promised to revisit the issue, and legislation has been introduced in Congress that would require OSHA to develop a new standard within two years.
Regulations in limbo
Chandra Branham, associate director of regulatory affairs for the National Association for Home Care, says it’s not clear whether these new efforts at increased ergonomics regulation will go anywhere.
"I think that for everyone who’s in favor of an ergonomics rule there’s somebody else who’s opposed to it because it’s too burdensome," Branham says. "There’s still a lot of opposition, however, if a law gets passed, mandating a standard within two years, then we would have to work with that."
The reversal of the ergonomics standard wasn’t the only recent OSHA activity that will affect home health agencies and their employees.
Revised bloodborne pathogens requirements increase agencies’ responsibilities to include employees in reviews of devices designed to prevent needlesticks. OSHA is set to implement a new form for reporting on-the-job injuries and illnesses, including more detailed reporting on both musculoskeletal injuries and needlesticks next year.
"They’re not home health-specific, but they’re going to have an impact on home health," Branham says.
The ergonomics standard that was rescinded in March had been envisioned by OSHA as a tool to combat crippling disorders such as carpal tunnel syndrome, herniated spinal discs, tendinitis, sciatica, and lower back pain. These disorders often are caused either by repetitive motions or movements that require people to contort their bodies in unsafe ways, and can be suffered in the workplace.
OSHA particularly had noted that patient handling, associated with nursing home employees and home health aides, was a typical task that would be covered by the standard.
Agencies are not off the hook
The new standard would have required employers to designate someone to be respon-sible for ergonomics issues and report risk factors for workplace injuries. If an employee was injured, an employer would have to work to eliminate or reduce ergonomic risks in that job and pay the injured employee up to 100% of pay and benefits while the employee was restricted or even barred from working.
No wonder home health agencies were among the businesses vehemently protesting that the new rules were too expensive to implement.
But Branham says even without an enhanced ergonomics standard, employers still are bound by OSHA’s "general duty" clause, which states that employers have a duty to provide a safe working environment for their employees.
Currently, violations or citations that result from this general duty clause usually occur after someone has made a complaint about an employer prompting an OSHA inspection, she says. "They don’t go out and inspect annually, like [Joint Commission] surveyors do."
And of course, OSHA still requires an agency to report any injury or illness an employee suffers on the job.
Branham says that based on her information from home health agencies, most have some sort of employee safety program that includes educating workers about the reporting process for injuries.
Denton TX-based Foundation Management Services has always provided education to its employees on ergonomics issues during orientation and through annual safety updates, says Larry Leahy, vice president for business development.
"We’re going to spend a little bit more time on it this year," Leahy says, including a presentation to management that covers employers’ responsibilities under the general duty clause.
Both he and Branham say if employers are willing to continue those types of programs, it’s possible there wouldn’t be a need for a stronger standard.
"I feel we have an opportunity to show that we can police ourselves, and through employee input, come up with some good preventive measures that can prevent injuries," Leahy says.
In November 1999, OSHA issued a directive to its inspectors requiring that health care providers beef up their bloodborne pathogen exposure control plans.
The plans now must include the use of "engineering controls" such as sharps injury protection or needle-free devices. The goal is to reduce employee exposure to bloodborne diseases such as HIV, hepatitis B, and hepatitis C.
Last year, Congress passed the Needlestick Safety and Prevention Act, calling for OSHA to revise its bloodborne pathogens standard. In January, the new standard was published, clarifying health care employers’ responsibilities in preventing accidental needlesticks.
Branham says there was only one provision in the new standard that amounted to a new requirement for agencies: They now must include employees in ongoing review of new needle safety devices.
The change doesn’t require agencies to rush out and stock up on every new safety device that comes on the market, Branham says.
"Health care providers don’t have to constantly replenish their supplies with the newest, best, safest technology that’s out there," she says. "But they would have to document why they didn’t choose it. It could be that the device isn’t compatible with other equipment being used by the patient. Or it could be that a device being used currently is considered safe, and staff have mastered using it."
This review, including the employee input, would be required as part of an annual review of the employer’s exposure control plan.
Branham says some agencies already have figured out efficient ways to get that employee input. Foundation Management Services, for example, already has surveyed its frontline" staff to find out about their experiences with needlesticks and the merits of safer devices they may have encountered at other jobs, Leahy says.
Branham says she doesn’t believe the requirement will entail more effort from employers than they’re already exerting. She says many agencies already have switched to safer devices, seeing that the investment can save them costly follow-up from accidental needlesticks.
A new OSHA reporting form for injuries and illnesses is slated for use beginning in 2002, Branham says.
The new form will require agencies to break out both needlesticks and musculoskeletal injuries and report them separately from other injuries.
The new form also will require health care providers to report specifically on tuberculosis exposures that result in infection.
Leahy calls the new reporting form a "step forward" for OSHA.
"I wouldn’t call it a simplified format for reporting injuries, but I think it’s more user-friendly than in the past," he says.
• Chandra Branham, Associate Director of Regulatory Affairs, National Association for Home Care, 228 Seventh St. S.E., Washington, DC 20003. Telephone: (202) 547-7424. Fax: (202) 547-3540.
• Larry Leahy, Vice President for Business Development, Foundation Management Services, 2220 San Jacinto, Denton, TX 76206. Telephone: (940) 243-5858. Fax: (940) 380-9605. E-mail: email@example.com