We've seen reality shows featuring dirty jobs, cops and coal miners. I wonder if it's time for one showing a day-in-the-life of nursing home workers. Most of us don't give much thought to what goes on inside of nursing homes, that is until a friend or family member needs to reside in one. What might appear as a quiet, slow-paced, restful setting is usually a stress-filled, physically-demanding environment for the people who work in them. Lifting and moving patients from beds, toilets, recliners, showers, and wheelchairs can cause all sorts of injuries, but then throw on top of that, the body fluids and infectious agents, staffing shortages, and violent patients and family members. On second thought, it's probably not a tv show that would attract many viewers.
More than 3 million people are employed in US nursing and residential care facilities, where the average wage for non-supervisory employees is about $14 per hour. According to the latest survey by the US Bureau of Labor Statistics (BLS) of work-related injuries and illnesses, the injury-incident rate in 2010 for workers employed in nursing homes was 8.6 per 100 full-time employees (FTEs), more than twice the rate for all private sector workers. When people think of dangerous jobs, I'm sure many think of coal miners or construction workers---not nursing aides at nursing homes.
The overall injury-incident rate of 8.6 per 100 FTEs for nursing home employees compares, for example, to rates of 5.6 for workers in underground coal mines, 4.8 for workers in tire manufacturing, and 3.5 for building construction. The situation is no better when you look at the incidence rates for more serious injuries, specifically those that result in days away from work, restricted-duty or transfer to a different job (DART rate). The lost-time/ restricted duty injury case rate for nursing home workers is 5.6 per 100 FTEs, compared to 3.7, 3.3 and 1.7 for these same sub-industries, respectively.
For the industries as a whole, the DART rate in the entire construction sector is 2.1 per 100 FTEs, and 2.4 in both manufacturing and health care and social assistance. Although the rates in these industries is comparable, federal OSHA conducts very few inspections in the health care and social assistance industry.
In 2010, 11.4 million workers were employed in manufacturing jobs and another 5.7 million in construction jobs. OSHA conducted nearly 78 percent of its inspections at workplaces in these industries. In contrast, the health care and social assistance industry employed more than 16 million U.S. workers. Federal OSHA conducted less than 2 percent of its inspections in these workplaces.
The injury rates for nursing home employees, which are predominantly women, are stratified in the BLS data by those facilities operated by state and local governments, and those controlled by private employers. Either way, and no matter whether one is interested in all injuries, or just those resulting in days away from work, restricted duty, or job transfer (DART rates) nursing home workers top the list for the highest rates.
In the news release announcing the BLS data, Labor Secretary Hilda Solis said,
"We remain concerned that more workers are injured in the health care and social assistance industry sector than in any other, ... [and] The Department of Labor's Occupational Safety and Health Administration (OSHA) will continue to work with employers, workers and unions in this industry to reduce these risks."
What the Labor Secretary failed to say was whether inspection resources would be directed to this problem.
The Admininstration has tremendous discretion in deciding where to focus OSHA's inspection resources. The OSH Act does not mandate a particular number of inspections or dictate which industries warrant special attention. Those decisions have evolved over time and special programs have been developed to identify high-hazard workplaces for inspection.
Just last month, OSHA made public one of its annual plans to program inspections, called site-specific targeting (SST). After collecting data from 80,000 worksites, the agency identifies sites with above-average injury rates and randomly selects hundreds of workplaces from the list for inspection.
Since at least 2001, this program has acknowledged the substantially higher rate of injuries among nursing home workers, and includes these workplaces on its list of high-hazard sites. What's particularly telling is the trigger for making the inspection list. Manufacturing plants on the targeting list, for example, aren't selected for a possible inspection unless their DART rate is 7.0 per 100 FTEs or greater. Nursing homes in contrast, have to have a DART rate of 16 per 100 FTEs or greater to "make the cut" for a possible inspection. As OSHA notes in its document, there are just too many nursing homes in its survey with very high injury rates. The agency limits the maximum number selected to 300. Last year, federal OSHA conducted 175 inspections in nursing homes in response to this targeting program. That's about 0.6 percent of all inspections conducted in 2010.
It's clear from the BLS data that too many nursing home workers are injured on the job. More attention by OSHA is warranted, especially enforcement measures that compel nursing home operators to address hazards related to lifting of patients. If OSHA can't make it happen, maybe the producers of CBS's Undercover Boss will challenge a few nursing home CEOs to walk in the shoes of their employees. It might be the quickest way to improve working conditions in some of these sites.
I wonder whether the nursing home injury rate would be much different if we had an ergonomics standard.
Nurses and other healthcare providers have not been waiting for federal OSHA to address the hazard of patient handling.
According to the American Nurses Association, nine States have passed laws requiring certain healthcare employers to implement safe patient handling policies and practices.
Over the past two years, I spent a lot of time visiting a skilled nursing facility in California which I thought was a good one, on the whole. I saw inspections happening several times; I think the inspecting agency was state, not federal. My impression was that the inspections resulted in demands on staff to do more and more paperwork and record-keeping, so their time available for actual patient care decreased. Inspections need to be focused on worker safety and patient care; staffing levels compared to job demands are an important part of that. Increasing job demands should result in increased staffing requirements.
This is a truly staggering statistic. I think hospitals need to lower the workload on these nurses. Give more work to the doctors, they do have the work and five times the pay.
An ergonomics standard would help a lot in this area. Many time-loss injuries in nursing homes are caused by hazards not addressed in current OSHA standards. Unfortunately, Congress has blocked an ergonomics standard every chance they get. The state-based patient handling laws have a better chance of increasing safety in this industry, at least at this time.
Regulations and inspections are part of the solution. If leaders in theses facilities provided proper patient handling equipment, teaching/training and a working environment that encouraged safety, teamwork and dedication their mod rates and premiums might actually decrease. I'll probably get a lot of flack from this simplistic answer but happy, well equipped employees may get hurt less often.
The amount of lifting and moving some of these workers do is staggering. You would think that modern technology would have caught up with this.