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  OSHA Releases Nursing Home Guidelines
Nursing Home GuidelinesThe agency's first industry-specific ergonomics guidelines provide practical, real-life solutions for protecting workers.

OSHA is engaged in an ambitious outreach and education effort to share the agency's new ergonomics guidelines for nursing homes with nursing home employers and employees. These are the first industry-specific guidelines issued by OSHA to prevent musculoskeletal disorders (MSDs) in the workplace.

"Guidelines for Nursing Homes" offers practical recommendations based on methods proven to be successful in the nursing home environment, developed through close coordination with a wide range of stakeholders. The guidelines incorporate best practices and programs already in effect within the industry and information from trade and professional associations, labor organizations, the medical community, individual firms, state OSHA programs, and available scientific information.

"These guidelines represent the best available information and best practices for tackling ergonomics
problems in this industry," said OSHA Administrator John L. Henshaw. "We're very excited about working to get these tools out to the people who need them."
OSHA chose to develop industry-specific ergonomics guidelines for nursing homes last year, based on the large number of ergonomic injuries reported within the industry. "Nursing home workers are suffering too many ergonomic-related injuries," said Henshaw. "But, the experiences of many nursing homes provide a basis for taking action now to better protect these workers."

Henshaw acknowledged that the new guidelines are not a cookie-cutter solution to every nursing home's ergonomics issues. "What we are presenting are a wide range of potential problems and an equally broad array of possible solutions," he said. "Nursing homes need to evaluate their individual facilities, in cooperation with their frontline workers, to determine what strategies make the most sense for them, their workers, and their residents, and then take action to address ergonomic risks."

The nursing home guidelines open with a recommended seven-point process for employers to use to protect their workers. (See box, "Protecting Workers.") They also provide suggestions for nursing home employers to help reduce the number and severity of work-related MSDs in their facilities-including low back pain, sciatica, rotator cuff injuries, epicondylitis, and carpal tunnel syndrome. Also included is a section on training for nursing home staff and sources for additional information.

The guidelines emphasize solutions for the leading cause of work-related ergonomic injuries: resident lifting and repositioning. They recommend that workers avoid manual lifting of residents whenever possible, and eliminate it altogether if feasible. Included is a series of decision charts to help nursing home operators and staff determine the best approach based on the patient's ability to participate in patient transfers. Simple illustrations help make the guidelines as practical as possible.

Also addressed are other nursing home activities not related to patient lifting and repositioning that could lead to MSDs. The guidelines recommend safe ways to store and transfer food and supplies, use mobile medical equipment, work with liquids in housekeeping and in kitchens, operate hand tools, use linen carts, handle bags, work in deep sinks, and load and unload laundry.

A case study included with the guidelines describes the step-by-step approach that one particular nursing home used to develop a highly effective approach to ergonomics. The Wyandot County Nursing Home
in Upper Sandusky, Ohio, spent $280,000 on lifting equipment, but saved $55,000 per year in payroll because of reduced overtime and absenteeism associated with ergonomic injuries. Further, the facility
estimates savings of more than $125,000 in turnover costs, and its workers' compensation payments have dropped from $140,000 to $4,000. "The bottom line," said Henshaw, "is that Wyandot not only recouped its investment, but saved nearly $35,000, and those savings continue to add up."

Wyandot is an excellent example-but far from the only one-that shows that taking steps to protect nursing home workers from ergonomic injuries makes good business sense. It's a message the agency will continue to send as it promotes the nursing home guidelines.

"Now," Henshaw said, "all that remains is for individual nursing homes around the country to take the information, identify what is applicable to their facilities, and put it into practice.

"The only way these guidelines will make a difference in reducing injuries," he summarized, "is if nursing homes actually make use of these strategies." JSHQ

The Industry Reacts

Nursing home industry leaders praised the new ergonomics guidelines for nursing homes, commending OSHA for working with the industry to produce realistic guidelines that will help protect workers.

William L. Minnix, Jr., president and CEO of the American Association of Homes and Services for the Aging, commended OSHA's willingness to tap into the group's experience-based understanding of ergonomics in nursing homes to develop the guidelines. "OSHA listened to what we had to say and worked with us," he said.

Dr. Charles H. Roadman II, president and CEO of the American Health Care Association, said the collaboration resulted in realistic guidelines that address real-life needs. "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 said.

"We cannot ignore the clinical needs of our patients when discussing employee
safety, and the OSHA guidelines recognize this."

A new alliance between OSHA and the National Association Directors of Nursing Administration in Long-Term Care will focus on ergonomics and promote outreach on the nursing home guidelines.

Lessons Learned, What's Next
Lifting Equipment
The nursing home guidelines recommend that workers avoid manual lifting of residents whenever possible, and that facilities consider purchasing lifting equipment.
The new nursing home guidelines reflect a long, collaborative development process that OSHA Administrator John L. Henshaw said establishes an important framework for more industry-specific guidelines.

OSHA announced plans to develop guidelines for the nursing home industry in April 2002, released the draft guidelines for public comment last August, and held a stakeholder meeting last November to discuss the guidelines. The agency's Directorate of Standards and Guidance incorporated comments received, and OSHA released the final guidelines on March 13.

"We've worked with nursing home stakeholders to develop them, and the guidelines have been refined based on written public comments and information gathered at the stakeholder meeting last fall," said Steven Witt, director of OSHA's Directorate of Standards and Guidance. The result, he said, is exactly what OSHA promised in announcing last year that it would develop industry- and task-specific guidelines: workable, real-life solutions that give employers and workers the flexibility they need to tailor the recommendations and best practices to their workplaces.

"The strategies we are proposing in the nursing home guidelines are not theoretical," said Deputy Assistant Secretary Gary Visscher. "We are sharing a set of practical approaches. They have been proven, and they are in place for many nursing homes in the U.S."This is the same approach Visscher said OSHA will apply when developing additional guidelines, and he expects those for other industries to advance at a steady pace.

The agency is working with stakeholders to prepare draft guidelines for the retail grocery store and poultry processing industries, expected to be released for public review and comment soon. In addition, OSHA will soon begin work on industry-specific guidelines for shipyards.

Protecting Workers"From the beginning, we promised that we'd focus on industries where the need for guidelines was clear, that we'd set up a fair and transparent process to develop the guidelines, and that we'd work with employers and employees to develop the guidelines," Visscher said. "We have kept and will continue to keep those commitments."

Meanwhile, Henshaw said OSHA is encouraging other industries to come up with their own guidelines to prevent workplace musculoskeletal disorders. The agency is also working through its cooperative programs to promote ergonomics programs. At press time, 13 OSHA alliances that involve 29 companies, associations, or other organizations included an ergonomics component, and more were expected.

Guidelines: Advisory, Not Regulatory
OSHA's new nursing home guidelines are advisory, not regulatory. OSHA will not enforce these, or any guidelines. But OSHA Administrator John L. Henshaw says that doesn't mean employers can turn a blind eye to ergonomics issues in their workplaces.

"The guidelines are voluntary," he said. "What is not voluntary for an employer is dealing with hazards in the workplace. Just because we will not enforce guidelines does not mean that nursing homes-or any other industry-can ignore their responsibilities and not address musculoskeletal disorders, if their workers are experiencing injuries," Henshaw said.

OSHA is providing extensive training to its compliance safety and health officers and solicitors so they know how to apply the tenants of the Occupational Safety and Health Act's general duty clause to ergonomic issues. The agency has conducted nearly 500 ergonomics inspections: 388 in nursing homes and 103 in other industries. In response, OSHA issued four citations for ergonomic hazards and is progressing with several other cases. Henshaw promised that more will come.

"We mean business," he said. "We also mean to help business. And that's what these guidelines are all about."