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Ergonomics in Nursing Homes

Good afternoon, I'm Mike Seymour. I am the director of the office of physical hazards in OSHA's directorate of standards and guidance. I appreciate the opportunity to speak to you today about OSHA's ergonomics guidelines for nursing homes. In April of 2002 Secretary Chao announced OSHA's comprehensive strategy for addressing ergonomics. This four-pronged approach included:

  • Industry and task specific guidelines,
  • Effective enforcement,
  • Compliance assistance, and
  • Research.

The office of physical hazards was assigned the task of developing the industry and task specific guidelines, the first of which addressed ergonomics in nursing homes.

In preparing to develop the guidelines OSHA staff collected literature and statistics and we conducted site visits to several nursing homes that had already implemented effective ergonomics programs. We felt strongly that we needed to understand the environment, listen to the administrators and workers in nursing homes and build on your industry's successes if we were to develop guidelines that would provide assistance in addressing the difficult ergonomics issues in nursing homes. All of the data we collected showed that the primary issue in nursing homes is resident lifting and repositioning. Successful nursing home programs have found effective ways to deal with this issue. I would like to give you a flavor for some of the comments we heard during our site visits:

  • The wife of one totally dependent resident who has been in the nursing home for eight years reports that it took three and sometimes four nursing assistants to move him from the bed to his cart or to the toilet. He had numerous bruises from falling. He dreaded being moved. With the lifts in place, the staff "can easily move him about to his chair and to the toilet. He cannot sit without help but the sling gives him comfortable support and makes it possible to have some dignity."

Worker satisfaction has increased greatly. One nursing assistant, who has spent most of her career working in nursing homes, confessed to being sore and unhappy before lifts were introduced. After the innovations at the nursing home, she reported that she is no longer hurting. She concluded that "I think my career is right here 'til my time is due to retire comfortable. And you know if my time comes to be in a nursing home, I do hope I get one like ours."

It was not uncommon to hear workers say:

  • Doubling the staff would not have helped us as much as the equipment has.
  • The lifts made my job 75% easier.
  • I would not work at another nursing home without the equipment even if they paid me $10 an hour more.
  • Now at the end of the day, I have energy to go home and take care of my family.
  • My husband is thankful that his wife has been given back to him.
  • No more aches and pains.

A nursing supervisor told us:

Every day she would ask "why aren't you using the lifts", and the response would be "I don't have time to use the lifts." This went on for weeks until she decided to time how long it took to find help and perform a two-person lift. The time was 15 minutes. On the next two-man lift, I made the nurse aide use a sit to stand lift. The resident was moved from the bed to her wheelchair in 5 minutes." 15 minutes for a two-man lift and 5 minutes for a mechanical lift.

We also talked to nursing home administrators who told us that the financial benefits of implementing ergonomics were easily seen in terms of:

  • Workers compensation costs that were dramatically reduced,
  • Employee turnover -- one small nursing home we spoke to typically hired more than 30 nurse aids per year. In the year following full implementation of an ergonomics program, only two nurse aids were hired. And
  • Overtime - overtime pay fell dramatically following implementation of ergonomics.

What one nursing home administrator called a "miracle" -- we call ergonomics.

Ergonomics in nursing homes is a win-win-win proposition.

  • Residents win - they are injured less, they are more comfortable and they have more dignity.
  • Workers win -- they are also injured less, they spend more time with the residents and they have greater job satisfaction.
  • Nursing home managers win -- not only financially, but one administrator told us that when he no longer spent his days interviewing new workers, he could focus on improving the nursing home the way he wanted to.

I would like to thank those of you that have had the vision and leadership to see the opportunities that ergonomics presents in nursing homes.

Let's talk a little bit about OSHA's ergonomics guidelines. The first step in developing ergonomics guidelines was to establish a protocol. OSHA's protocol stressed public participation. During the initial drafting phases, we met with:

  • Trade associations,
  • Labor union representatives, and
  • Individual employers during our site visits.

We published draft guidelines based, in part, on the information we collected from these valuable resources. The publication of the draft was followed by a 60-day comment period during which OSHA received 98 comments from a variety of stakeholders.

In November of 2002 we held a stakeholder meeting in which more than 50 stakeholders shared their experience and ideas for improving the draft guidelines.

Based on the public comments we revised the draft guidelines to simplify the language - we eliminated the safety and health jargon and formatted the document to make it easy to read. Other revisions clarified the relationship of the guidelines to OSHA's enforcement activities. On March 13, 2003 we published the final ergonomics guidelines for nursing homes.

OSHA provided two fundamental recommendations in the executive summary. These recommendations are:

(1) That manual lifting of residents be minimized in all cases and eliminated when feasible.

(2) And that employers implement an effective ergonomics process that:

  • Provides management support
  • Involves employees
  • Identifies problems
  • Implements solutions
  • Addresses reports of injuries
  • Provides training, and
  • Evaluates ergonomics efforts

In the executive summary we also emphasize that the guidelines are advisory in nature and informational in content. They do not impose any new OSHA compliance burden. An employer's failure to implement the guidelines is not a violation. Finally in the executive summary we recommend that nursing homes adapt the information contained in the guidelines to the specific needs of each place of employment.

In the introduction the guidelines address the risk factors that nursing home employees face including:

  • Force
  • Repetition and
  • Awkward postures

We also briefly describe the success that some nursing homes have had in addressing these risk factors.

Section 2 of the guidelines describes a process for protecting workers.

  • It provides recommendations for how managers can demonstrate management support,
  • It outlines ways that employees can be involved,
  • It describes methods for identifying ergonomics problems,
  • It proposes solutions ... and suggests factors that should be taken into account when implementing solutions such as the resident's rehabilitation plan, the need to restore the resident's functional abilities, medical contraindications, emergency situations and resident's rights and dignity.
  • It describes methods for addressing reports of injuries
  • It addresses training needs and
  • It discusses the need to evaluate progress.

Section 3 of the guidelines provides recommendations for methods for of identifying and implementing solutions for resident lifting and repositioning. This section contains flow charts that address resident assessment that were drawn from excellent work done by the veteran's administration. This section also provides 22 graphical representations of solutions for resident lifting and repositioning problems. Each provides a brief description, lists when a solution should be used, and presents points to remember, including safety considerations when they are appropriate.

Section 4 of the guidelines provides recommendations for methods of identifying problems and implementing solutions for other activities such as the laundry, food services and general cleaning. This section provides brief guidance on how to identify risk factors in these activities and provides 11 examples of possible solutions for addressing these risk factors.

Section 5 establishes learning objectives for workers, supervisors and managers in nursing homes. The section provides lists of topics that could be included in ergonomics training for each type of employee.

Section 6 provides additional sources of information for nursing homes that need a little help in getting started. Such sources include the OSHA consultation program as well as OSHA's training institute and educational centers.

The Appendix to the guidelines contains a case study of a nursing home that has successfully implemented an ergonomics process and integrated it into their day-to-day operations.

Copies of the guidelines are available at OSHA's website at Copies are also available at our booth here at the conference. As Mr., Henshaw, the assistant secretary for OSHA, said in a recent article about the guidelines, "the only way these guidelines will make a difference in reducing injuries is if nursing homes actually make use of these strategies." Finally, I wish you success in your efforts to implement an ergonomics process in your facilities.

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