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Appendix A

Four Basic Exercises for Good Back Care

The following exercises are helpful for many people. They can be done every day in the order listed below.

Note: Everyone's body is different. Don't do any exercise that causes pain or gets more difficult to do over time. If the exercise relieves pain or gets easier after a few repetitions, keep doing it.

If you are under medical care for a back problem or if you have back pain, be careful. Ask your health-care provider before you try these exercises.

The Pelvic Tilt

The pelvic tilt exercise helps strengthen your stomach, buttocks, and thigh muscles as well as stretching the lower back muscles. This exercise flattens the back and then let the back return to its natural curve.

1. Lie flat on your back on a hard surface with head resting on a small pillow.

2. Bend knees and hips so both feet are flat on the hard surface.

3. Push lower back flat to the floor. Make sure your back is flat by trying to place your hand between your back and the hard surface. When done correctly, your hand shouldn't fit.

4 Tighten your "stomach" (abdominal) muscles.

5. Tighten your "buttock" (gluteal) muscles.

6. Lift your hips from the floor and tilt your whole pelvis forward while keeping your back flat against the hard surface.

7. Hold for a count of ten.

8. Slowly relax.

9. Repeat this exercise ten times.

The best way to do this exercise is on the floor. You can also do it against a wall. Once you are familiar with the "feel" of the pelvic tilt, you can do this exercise in any position and you can practice at work or at home. The pelvic tilt can be done standing up against a wall or while you are standing in line, waiting at a red light, or wherever you can focus on your back for a few minutes.

Lumbar Stretches

When lumbar muscles are tight, they become shortened and interfere with bending, twisting, and pelvic rotating. Keeping these muscles stretched also helps keep the natural curves of the spine in shape.

1. Lie flat on your back on a floor or hard surface with your head on a small pillow.

2. Bend your knees and slowly bring them toward your chest. Reach your hand behind your thigh to help bend the knees. (Note: pulling from the top of the knee isn't good for the knees.) Don't bounce.

3. Keep your head on the pillow and elevate your butt as high as possible off the floor. Your knees should be as close as possible to your chest.

4. Hold this position for a count of 10. Relax, but continue to hold onto your thighs.

5. Again, pull knees as close to your chest as possible. Do this exercise 10 times.

Hamstring Stretches

When hamstring muscles are shortened or tight they interfere with bending. You can stretch them by doing the following exercise. Begin by lying on a hard surface.

1. With your knees close to the chest but in a relaxed position, slowly extend one leg toward the ceiling.

2. Flex your foot and push your heel upward to feel the hamstring muscles stretch. Count to 10 while holding this position.

3. Now bend this leg and bring the knee back toward your chest, while extending the other leg. Repeat Step 2 with the other leg.

4. Repeat this exercise 10 times, one leg at a time.

5. When you are done, bring both knees toward your chest and roll to the side as a safe way of returning to a standing position.

Reverse Situps

Many people have weak abdominal ("stomach") muscles and tend to arch their backs while doing situps. That's why we recommend "reverse" situps to strengthen the three groups of muscles that make the abdomen strong.

1. Sit on the floor in an upright position with knees bent.

2. Lock hands together behind your head and hold your arms out to your side.

3. Tighten your stomach muscles and slowly lean back about 15 degrees, which is like going from 12 noon to 11 o'clock on a timepiece. Hold this position for a count of 5, and 10 if you can.

4. Slowly lean back to the 10 o'clock position. Hold and count again.

5. Return slowly to an upright position.

6. Repeat the whole exercise.

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Appendix B

Activity Evaluation


1. How important is this Activity for nursing home workers? Please rank on a scale of 1 to 5. (5 is the most important, 1 is the least important).


2. Which factsheets are the most important to share with your co-workers?


3. How could we improve this Activity?

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Appendix C

Directory of Equipment Manufacturers

Mechanical Lifts

Care Equipment Corp.
1900 A West Stone St., Fairfield, Iowa 52556
Tel. (800) 695-4479 Fax: (515) 472-3152 Contact: Kevin Carey

ARJO, Inc.
SARA and Maxi lifts
8130 Lehigh Avenue, Morton Grove, Ill. 60053
Tel. (800) 323-1245 ext. 504 Fax: (708) 967-9691 Contact: Andy Hepburn

Medi-Man Rehabilitation Products, Inc.
5630 Tomken Rd., Mississauga, Ontario L4W1P
Tel. (905) 238-9199 Fax (905) 625-6980 Contact: David Roy

Home Hospital Equipment
EZ Lift
3634 Central Avenue N.E., Minneapolis, Minn. 55418
Tel. (900) 627-8940 Contact: Fred Downing

Parker Bath Corporation
Alpine Lifts
805 Teal Drive, Gallatin, Tenn. 37066
Tel. (800) 457-8827 Contact: Jack Metz

Guardian
Hoyer Lifts
4175 Guardian Street, Simi Valley, Calif. 93063
Tel. (800) 252-1464 Contact: Jeff Cline

Moving Solutions
Faaborgliften Lifts
7980 Alabama Ave., Clarendon Heights, Ill. 60514
Tel. (800) 228-7980 Voice: (708)789-6995 Fax: (708)789-3399
Contact: Mark Niedbalec

Transfer Devices

Ergonomic transfer belt

The Posey Company
Posey Waking Belt
5635 Peck Road, Arcadia, Calif. 91006
Tel. (800) 447-6739 Contact: Emit Posey
Central (Ill.): (800) 627-7686 NE (Conn.): (800) 243-0627
SE (Tenn.): (800) 251-5731

Pelvic lift for in-bed toileting

Health Services Research and Development, Inc.
Kimbro Pelvic Lift
10470 Waterfowl Terrace, Colombia, Md. 21044
Tel. (410) 964-9678 Fax: (410) 740-2335 Contact: Clara Kimbro, Pres.

Horizontal transfer aids

Incentives Inventive Products
SLIPP device
PO. Box 51 1450 East North Street, Decatur, Ill. 62521
Tel. (800) 356-6911, (217) 423-6911 Contact: Vallery Mullens;

Patient transfer systems

Air Pal
805 Harrison Sheet, Allentown, Pa. 18103
Tel (800) 633-4725 Contact: Bob or Donna Wheedling

Beatrice M. Brantman Inc.
Beasy Trans
207 East Westminster, Lake Forest, Ill. 60045
Tel. (800) 232-7987 Fax: (708) 615-8894

Repositioning aids

Patient Care Corporation
EZ Repositioner
PO. Box 3716, Carson City, Nev. 89702
Tel. (102) 882-0300 Contact: Evan L. Gannon

Adaptive Clothing

Caring Concepts
20-21 Wagaraw Rd. Bldg 36 Fair Lawn, NJ 07410
Tel: 800-500-0260 Fax: 800-433-1407 Contact: Paul Cohen

Note: This list was assembled in Mach 1995 and is not complete. It will be updated periodically. Devices have not been evaluated for their safety or efficiancy. Please contact your regional health and safety coordinator or the SEIU Health and Safety Department with recommendations for other equipment to help prevent back, shoulder and other strain and sprain injuries.

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Appendix D

OSHA Regional Offices

Region I
(Conn*, Mass., Maine. N.H.,R.I., Vt.*)
John Miles, Regional Administrator
133 Portland Street First Floor, Boston, Mass. 02114
Telephone: (617) 565-7164

Region II
(N.J., N.Y*, P.R.* V.I.*)
Patrcia K. Clark
201 Virick Street Room 670, New York, NY 10014
Telephone: (212) 337-2378

Region III
(D.C., Del., Md.*, Pa., Va.*, WV)
Linda R. Anku, Regional Administrator
Gateway Building, Suite 2100, 3535 Market Street
Philadelphia, Pa. 19104 Telephone: (215) 596-1201

Region IV
(Ala., Fla., Ga., Ky.*, Miss., N.C., S.C.*,Tenn.*)
R. Davis Layne, Regional Administrator
1375 Peachtree Street, N.E. Suite 587
Atlanta, Ga. 30367 Telephone: (404) 347-3573

Region V
(Ill., Ind.*, Mich.*, Minn.*, Ohio, Wisc.)
Michael G. Connors, Regional Administrator
230 South Dearborn Street Room 3244, Chicago, Ill. 60604
Telephone: (312) 353-2220

Region VI
(Ark., La., N.M.*, Okla., Texas)
Emzell Blanton, Jr.
525 Griffin Street Room 602, Dallas, Texas 75202
Telephone: (214) 767-4731

Region VII
(Iowa*, Kansas, Mo., Neb.)
John T Phillips, Regional Administrator
911 Walnut Street, Room 406, Kansas City, Mo. 64106
Telephone: (816) 426-5861

Region VIII
(Colo., Mont., N.D., S.D., Utah*, Wyo.*)
Bryon R. Chadwick, Regional Administrator
Federal Building, Room 1576 1961 Stout Street
Denver, Colo. 80294 Telephone: (303) 844-3061

Region IX
(American Samoa, Ariz.*, Calif.*, Guam, Hawaii*, Nev.*,Trust Territories of the Pacific)
Frank Strasheim, Regional Administrator
71 Stevenson Street Room 420, San Francisco, Calif. 94105
Telephone: (415) 744-6670

Region X
(Alaska*, Idaho, Ore.*, Wash.*)
Richard S. Terrill
1111 Third Avenue Suite 715, Seattle, WA 98101-3212
Telephone: (206) 553-5930

^*These states and territories operate their own OSHA approved job safety and health programs (Connecticut and New York plans cover public employees only). States with approved programs must have a standard that is identical to, or at least as effective as, the federal standard.

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Appendix E

SEIU Health and Safety Offices

New York Region
Laura Kenny, Susan McQuade
330 West 42nd Street Suite 1905, New York, NY 10036
Telephone: (212) 947-1944 Fax: (212) 947-0835

New England Region
Steve Schrag
14 Quentin Street, Waterbury, Conn. 16706
Telephone: (203) 574-7966 (and fax)

Northern California Region
Maggie Robbins
7901 Oakport Street Suite 4900, Oakland, Calif. 94261
Telephone: (510) 568-2500 Fax: (510) 568-3652

Pacific Northwest Region
c/o Local 6 
John Mehring 
150 Denny Way, PO. Box 19360, Seattle, Wash. 98109
Telephone: (206) 448-7348, Extension: 334 Fax: (206) 441-5120

Central Region
Joe Zanoni
940 West Adams Suite 400, Chicago, IL 60604
Telephone: (312) 455-1500 Fax: (312) 455-8184

SEIU Michigan State Council
Eleanor Holbrook
419 S. Washington Street, Lansing, MI 48933
Telephone: (517) 372-0903 Fax: (517)482-5361

Canadian Region
Ted Mansell
75 The Donway West Suite 1410, Don Mills, Ont. M3C 2E9
Canada
Telephone: (416) 447-2311 Fax: (416) 447-2428

Southern California Region
Michael Kushner
3055 Wilshire Blvd. Suite 1050, Los Angeles, Calif. 90010
Telephone: (213) 368-7400 Fax: (273) 368-7348

MidAtlantic Region
Fran Cameo c/o SEW Local 585 
237 Sixth St. Pittsburgh, PA 15238 
Telephone: (412) 828-5100 Fax: (412) 828-2607

SEIU Health and Safety Department
1313 L Street, N.W. Washington, D.C. 20005
Telephone: (202) 898-3386 Fax: (202) 898-3491

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Appendix F

COSH Groups


Alaska

Alaska Health Project
1818 W Northern Lights Blvd, Anchorage, Alaska 99517
Telephone: (907) 276-2864 Fax: (907) 279-3089

California

Worksafe/Francis Schreiberg
c/o San Francisco Labor Council
660 Howard Street, 3rd Floor San Francisco, Calif. 94105
Telephone: (415) 543-2699 Fax: (415) 882-4999

LACOSH (Los Angeles COSH)
5855 Venice Blvd. Los Angeles, CA 90019
Telephone: (213) 931-9000 Fax: (213) 931-2255

SACOSH (Sacramento COSH)
c/o Fire Fighters Local 522
3101 Stockton Boulevard Sacramento, Calif. 95820
Telephone: (916) 442-4390 Fax: (916) 446-3057

SCCOSH (Santa Clan COSH)
760 North First Street, San Jose, Calif. 95112
Telephone: (408) 998-4050 Fax: (408) 998-4051

Connecticut

ConnectiCOSH (Connecticut COSH)
77 Huyshoup Ave. 2nd Floor, Hartford, Conn. 06106
Telephone: (203) 549-1877 Fax: (203) 251-6049

District Of Columbia

Alice Hamilton Occupational Health Center
410 Seventh Street, SE, Washington, D.C. 20003
Telephone: (202) 543-0005 Fax: (202) 543-1327
Telephone: (301) 731-8530 (Md.) Fax: (301) 731-4142 (Md.)

Illinois

CACOSH (Chicago COSH)
37 South Ashland, Chicago, Ill. 60607
Telephone: (312) 996-3228 Fax: (312) 243-0492

Maine

Mane Labor Group on Health
Box V, Augusta, Maine 04330
Telephone: (207) 622-7823 Fax: (207) 622-3483

Massachusetts

MassCOSH (Massachusetts COSH)
555 Amory Street, Boston, Mass. 02130
Telephone: (677) 524-6686 Fax: (617) 524-3508

Western, MassCOSH
458 Bridge Street, Springfield, Mass. 01103
Telephone: (413) 731-0760 Fax: (413) 732-1881

Michigan

SEMCOSH (Southeast Michigan COSH)
1550 Howard, Detroit, Mich. 48216
Telephone: (313) 961-3345 Fax: (313) 961-3588

Minnesota

MN-COSH (Minnesota COSH)
c/o Lyle Krych M330
FMC Corp. Naval System Division
4800 East River Road, Minneapolis, Minn. 55421
Telephone: (612) 572-6997 Fax: (612) 5721956

New Hampshire

NHCOSH
c/o NH AFL-CIO
110 Sheep Davis Road, Pembroke, N.H. 03275
Telephone: (603) 22226-0516 Fax: (603) 225-1956

New York

ALCOSH (Allegheny COSH)
100 E. Second Street, Jamestown, NY 14701
Telephone: (716) 488-0720 Fax: (716) 487-0968

CNYCOSH (Central New York COSH)
615 W Genessee Street, Syracuse, NY 13204
Telephone (315) 471-6187 Fax: (518) 393-3040

ENYCOSH (Eastern New York COSH)
c/o Larry Rafferty
121 Eric Blvd. Schenectady, NY 12305
Telephone (518) 372-4308 Fax: (518) 393-3040

NYCOSH (NewYork COSH)
275 Seventh Avenue 8th Floor, New York, NY 10001
Telephone: (212) 527-3900 Fax: (212) 627-9812
(914) 939-5612 (Lower Hudson) (515) 273-1234 (Long Island)

ROCOSH (Rochester COSH)
46 Prince Street Rochester, NY 14607
Telephone: (716) 244-0420 Fax: (915) 244-0956

WNYCOSH (Western New York COSH)
2491 Main Street Suite 438, Buffalo, NY 11214
Telephone: (716) 833-1416 Fax: (716) 833-7507

North Carolina

NCOSH (North Carolina COSH)
PO. Box 2514, Durham, N.C. 27715
Telephone: (919) 286-9249 Fast: (919) 286-4857

Oregon

c/o Dick Edgington ICWU-Portland
7440 SW 87 Street, Portland, Ore. 07223
Telephone: (503) 244-8429

Pennsylvania

PhilaPOSH (Philadelphia OSH)
3001 Walnut Street 5th Floor, Philadelphia, PA 19104
Telephone: (215) 386-7000 Fax: (215) 386-3529

Rhode Island

RICOSH (Rhode Island COSH)
741 Westminster Street, Providence, RI 02903
Telephone: (401) 751-2015

Texas

TexCOSH (Texas COSH)
c/o Karyl Dunson
5735 Regina, Beaumont, TX 77706
Telephone: (409) 898-1427

Washington

WASHCOSH (Washington COSH)
6770 E. Marginal Way S., Seattle, Wash. 98108
Telephone: (205) 757-7426 Fax: (206) 762-5433

Wisconsin

WisCOSH (Wisconsin COSH)
734 North 25th Street, Milwaukee, Wisc. 53230
Telephone: (414) 933-2338

Canada

WOSH (Windsor OSH)
547 Victoria Avenue, Windsor, Ont. N9A 4N1
Canada
Telephone: (519) 254-5157 Fax: (519) 254-4192

COSH Related Groups

Califorina

Labor Occupational Health Program
2515 Channing Way, Berkeley, CA 94720
Telephone: (510) 632-1507 Fax: (510) 643-5698

District of Columbia

Workers Institute for Occupational Safety and Health
1125 16th Street, NW Room 403, Washington DC 20036
Telephone: (202) 887-1980 Fax: (202) 887-0191

Louisiana

Labor Studies Program/LA Watch
Institute of Human Relations Loyola University
Box 12, New Orleans, La. 70118
Telephone: (504) 861-5830 Fax: (504) 861-5833

New Jersey

New Jersey Work Environment Council
452 East Third Street, Moorestown, NJ 08057
Telephone: (609) 866-9405 Fax: (609) 866-9708

Ohio

Greater Cincinnati Occupational Health Center
10475 Reading Road Cincinnati, Ohio 45241
Telephone (513) 759-0561 Fax: (513) 769-0766

West Virginia

Institute of Labor Studies
710 Knapp Hall West Virginia University
Morgantown, W.Va. 26506
Telephone: (304) 293-3323 Fax: (304) 293-7153

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Footnotes

1. The incidence are for nonfatal injuries and illnesses among nursing home workers was 16.9 (per 100 fulltime workers) in 1993. That same year, the rate in mining and construction was 6.8 and 12.2, respectively. From United Sates Department of Labor, Bureau of Labor Statistics. News, Wednesday, Dec. 21, 1994. USDL-94-600.

2. Ibid.

3. Owen, B. The magnitude of low-back problems in nursing. West. J. Nurs. Res 11:234-242. April 1989.

4. United States Department of Labor. Bureau of Labor Statistics. Unpublished data provided to the Service Employees International Union, February 1995.

5. United States Census Bureau, based on 1990 statistics.

6. Fein, Esther B. "As Competition Expands, Nursing Homes Diversify," The New York Times, April 30, 1995, p. 26.

7. "Existing nursing homes propel strong revenues," Modern Healthcare, April 25. 1994, p. 28.

8. Unpublished data from the Bureau of Labor Statistics, 1992.

9. Ibid.

10. Wisconsin Department of Health and Social Services, Center for Health Statistics, Division of Health. The 1993 Wisconsin Annual Survey of Nursing Homes.

11. Brook, Steve. "The Back Track," Contemporary Long Term Care, February 1995, pp. 56-64.

12. Pennsylvania nursing homes paid about $12.08 for each $100 of payroll; in contrast, hospitals pay only $2.49 for each $100 of payroll, or 4.8 times less. From: The High Cost of Short- Staffing, Service
Employees International Union, 1992, p. 12.

13. According to the Bureau of Labor Statistics, the average nursing home worker earned $8.67 per hour at 32.8 hours per week for a total of $14,788 per year. Percent of payroll spent on workers' Compensation premiums varies. In Wisconsin, which is lower than many other sates, the percentage is 4.9 percent of payroll. With 1.651 million nursing home workers in the United Sates, $1 billion in premiums is probably on the low side.

14. At $725 in premiums per worker (see Note 13), a nursing home with 100 workers pays about $72,500 a year. A range of $50,000 to $100,000 per home is a reasonable range that would cover homes with varying numbers of employees. Actual figures may be higher.

15. Health Care Investment Analyses. Guide to the Nursing Home Industry, 1993.

16. Arum Garg and Bernice Owen. "Reducing Back Stress to Nursing Personnel: An Ergonomic Intervention in a Nursing Home," Ergonomics,
1992, Vol. 35, No. 11, pp. 13531375.

17. G. Pascal Zachary. "Nursing Homes Are Often Hotbeds of Injury for Aides," Wall Street Journal, March 20, 1995, P. BI, B6.

18. Maria Fern Gold. "The Ergonomic Workplace: Charting a Course For Long Term Care," Provider, February 1994, pp. 21-26.

19. Bernice Owen and Arun Garg. "Back Stress Isn't Part of the Job," American Journal of Nursing, February 1993. PP. 48-51; and Jensen, Roger C., "Prevention of Back Injuries Among Nursing Staff," Essentials of Modern Hospital Safety, vol. I (Charney, William and Joseph Schirmer, eds.). Chelsea, Mich.: Lewis Publishers, pp. 237-258.

20. Owen, B.D. and Garg,A. "Patient handling tasks perceived to be most stressful by nursing assistants." 1989. In A. Mital (ed.), Advances in Industrial Ergonomics and Safety I (Taylor and Francis, London), pp. 775-781.

21. The average nursing home with 100 employees pays $72,500 per year in workers' Compensation premiums. This is based on figures from Wisconsin which state that premiums are 4.9 percent of payroll. The average nursing home worker makes $14,798 per year. Other states pay a high percentage of payroll for compensation insurance costs. Actual figures may be higher than this.

22 Brooks, Steve. "The Back Track: Ergonomics training programs are cutting costs and employee back injury rates." Contemporary Long Term Care, February 1995, p. 56.

23. National Institute for Occupational Safety and Health (NIOSH). Back Belts: Do They Prevent Injury? USDHHS (NIOSH) publication No. 94-127, Centers for Disease Control and Prevention, 1994.

24. A. Garg and B. Owen. "Reducing Back Stress to Nursing Personnel: An Ergonomic Intervention in a Nursing Home," Ergonomics, 1992, Vol. 35, No. 11, pp. 133-135.

25. Centers for Disease Control and Prevention and National Institute for Occupational Safety and Health, U.S. Department of Health and Human Services. "Workplace Use of Back Belts: Review and Recommendations." July 1994, DHOWS (NIOSH) No. 94-122.