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A new National Emphasis Program (NEP) for Nursing and Residential Care Facilities was released on April 5 by the U.S. Department of Labor‘s (DOL) Occupational Safety and Health Administration (OSHA) in an effort to reduce occupational illnesses and injuries in these long-term care settings.

The NEP (pdf) provides guidance for a three-year effort to use OSHA outreach and inspections to reduce specific occupational hazards in nursing and residential care facilities.

In 2010, workers employed in these settings experienced “one of the highest rates of lost workdays due to injuries and illnesses of all major American industries,” a DOL press release states.

“The incidence rate for cases involving days away from work in the nursing and residential care sector was 2.3 times higher than that of all private industry as a whole, despite the availability of feasible controls to address hazards,” DOL explains.

Nearly two thirds of the cases (62.5 percent) that involved days away from work were attributed to injuries in two categories: 1) overexertion and 2) slips, trips, and falls.

DOL identified the following hazards associated with providing care in nursing and residential facilities:

• exposure to blood and other potentially infectious material;
• exposure to other communicable diseases such as tuberculosis;
• ergonomic stressors related to lifting patients;
• workplace violence;
• slips, trips, and falls; and
• exposure to hazardous chemicals and drugs.

“These are people who have dedicated their lives to caring for our loved ones when they are not well,” said David Michaels, assistant secretary of labor for occupational safety and health. “It is not acceptable that they continue to get hurt at such high rates. Our new emphasis program for inspecting these facilities will strengthen protections for society’s caretakers.”

Nursing Aides Rank among the Highest for Job Injury and Illnesses

According to analysis by PHI of 2010 data on nursing aides from the Bureau of Labor Statistics, Injuries, Illnesses and Fatalities Program:

• Nursing aides ranked second in the list of occupations with the highest numbers of injuries and illness (53,030), after hand laborers and freight, stock, and material movers (65,040), and far ahead of police and sheriff’s patrol officers (29,150).
• Nursing aides also had one of the highest incidence rates of work-related illness and injuries (489.4 per 10,000 workers), placing them third in the list of the top five. In 2010, they experienced injury at a rate four times that of all workers combined.
• Nursing aides had the highest incidence rate for musculoskeletal disorders of all occupations (or ergonomic injuries) at 249.4 per 10,000 full-time, or more than seven times the national average (34.3 per 10,000).

Visit the OSHA website for more information, including guidance on nursing and residential care facility ergonomics and workplace violence.

– by Deane Beebe

Workers in nursing and residential care facilities experienced the highest injury rates of any occupational setting in 2010, according to data (pdf) recently released by the U.S. Bureau of Labor Statistics (BLS).

Overall, the country’s private-industry employees suffered nonfatal injuries and illnesses at a rate of 3.5 cases per 100 full-time workers last year, down from 3.6 in 2009.

But private nursing and residential care facilities reported an injury/illness rate of 8.3 per 100 workers — higher than couriers and messengers (7.2), air-transportation employees (8.1), and people involved in performing arts, spectator sports, and related industries (6.7).

Combined, the health care and social assistance industry reported a higher injury/illness rate than any other private sector.

Public-Sector Injury Rate Even Higher

Nursing and residential care facility workers employed in the public sector suffered even higher injury rates than their private-industry counterparts, the BLS report additionally found.

The injury rate among nursing and residential care workers employed by local governments was 11.4 per 100 full-time employees. Those employed by state governments, meanwhile, recorded an injury rate of 15.1.

BLS reports a total of just 218,200 workers in public-sector nursing and residential care facilities, compared with more than 3.1 million such workers in the private sector.

Labor Secretary Expresses Concern

“We remain concerned that more workers are injured in the health care and social assistance industry sector than in any other, including construction and manufacturing,” said Department of Labor Secretary Hilda Solis in a statement.

“The Department of Labor’s Occupational Safety and Health Administration will continue to work with employers, workers, and unions in this industry to reduce these risks,” Solis added.

Many of the people employed in the nursing and residential care industry are direct-care workers.

“Direct-care workers in nursing and residential care settings face a greater injury rate than nearly any other job type in the country,” said PHI Government Affairs Director Carol Regan.

“Unfortunately, more than one in four lack health insurance (pdf). It is wrong that direct-care workers who get sick or hurt while caring for others cannot get comprehensive care for their own injuries or illnesses,” Regan added.

In 2008, Regan appeared in a short video, “The Most Dangerous Job in America,” to highlight the inordinately high injury risks that nursing assistants face each day.

– by Matthew Ozga

A high rate of flu vaccination among direct-care workers helps to prevent flu outbreaks in long-term care facilities, according to a study published in the October issue of Infection Control and Hospital Epidemiology.

The study’s authors found that the likelihood of flu outbreak continues to decrease until around 75 percent of a facility’s direct-care staff is vaccinated, at which point a plateau effect occurs.

“This is important because 75 percent vaccination coverage among direct-care employees might be a more achievable goal than universal vaccination,” write the researchers, who relied on survey data culled from long-term care facilities in New Mexico to reach their conclusion.

“Meaningful benefits can be achieved with relatively modest increases in vaccination coverage (i.e., increasing from 50 percent to 75 percent),” the authors continue.

The federal Centers for Disease Control and Prevention recommends that all health care workers receive annual flu shots.

“Ensuring high vaccination rates for direct-care workers would be much easier if they had access to affordable and comprehensive health coverage to pay for the shots,” said PHI Government Affairs Director Carol Regan.

“Both workers and residents in long-term care facilities will benefit from guaranteed health coverage under the Affordable Care Act,” she added.

The team of researchers responsible for the study was led by Aaron M. Wendelboe, an assistant professor of epidemiology at the University of Oklahoma Health Sciences Center.

– by Matthew Ozga

(L-R) Jane Lipscomb of the University of Maryland Baltimore Schools of Nursing and Medicine; Carol Rodat, PHI New York Policy Director

Occupational hazards and safety in home care were the focus of “Home Health Care Health and Safety: Emerging Occupational and Patient Safety Issues in Home Care for Patients,” a conference sponsored by the National Institute for Occupational Safety and Health (NIOSH) and the Columbia University Mailman School of Public Health (MSPH).

At the May 19 conference, three researchers presented their findings on the many serious health risks that home care aides and nurses face while on the job.

Hazards in the Home

Jane Lipscomb, PH.D., R.N., F.A.A.N., of the University of Maryland Baltimore Schools of Nursing and Medicine, says that a lack of health insurance and other job benefits combined with certain unique features of the job — such as working alone in a work environment over which they have little control — put direct-care workers at disproportionate risk of occupational illness and injury.

Lipscomb reported on the numerous hazards (pdf) that direct-care workers face when working in the home setting, including:

• back, shoulder, and neck injuries
• falls
• needle sticks
• verbal assaults
• physical violence
• sexual harassment
• infectious disease
• motor vehicle accidents
• irritating household chemicals such as cleaning compounds

Margaret Quinn, Sc.D., of the University of Massachusetts Lowell, presented her research findings (pdf) on sharps injuries and blood exposures. She noted that while nurses have higher rates of such incidents, home care aides are also at a “sizeable” risk.

Among the factors that put home care aides at risk for sharps injuries and blood exposures are handling consumers’ trash, poor container designs, and sharps left in bed linens and around the house.

Quinn recommends that all aides be covered by the OSHA Bloodborne Pathogen Standard to prevent exposure.

Double Set of Hazards

Robyn Gershon, M.H.S., Dr.P.H., of MSPH and conference director, discussed how workers who provide care in the home are vulnerable to hazards both in the household environment and also those typically associated with the delivery of healthcare.

The first step to reducing injuries in home care is to identify household hazards (large pdf), explained Gershon, who developed a Home Health Care Household Safety Checklist. (Contact Dr. Gershon for the checklist.)

“Importantly, household hazards that present a threat to home healthcare workers may also be hazardous to patients — most of whom are frail and elderly,” Gershon noted. “Combined, this results in injuries, exposure to blood/body fluids, and lack of job satisfaction and high turnover.”

Following the presentations, panelists — including PHI New York Policy Director Carol Rodat, direct-care workers, consumers, family members, and representatives from government agencies, unions, and community-based organizations discussed the research findings — shared their experiences in the field, and reported on education and training programs that could help to reduce home care occupational injuries.

For more information, see NIOSH’s Occupational Hazards in Home Healthcare (pdf).

– by Deane Beebe

Logo from a North Carolina campaign advocating for paid sick day legislation.

As panic spread last month about a potential swine flu epidemic, Americans were advised to stay home if they were feeling ill. But for millions of workers who receive no paid sick days — including large percentages of direct-care workers — taking a day off from work can be a hard decision as it directly affects their income.

For example, 55 percent of the nation’s full-time personal and home care aides were not offered sick days in 2006 (“Women and Paid Sick Days: Crucial for Family Well-Being,” IWPR, 2007, pdf).

In response to this problem,  Rep. Rosa DeLauro (D-CT) and Sen. Ted Kennedy (D-MA) have introduced the Healthy Families Act, which would allow  workers up to seven paid sick days a year to recover from their own illness, to care for a sick family member, or to seek diagnostic and preventative care.  Several states and cities have introduced similar bills. Read the full story