Health care workers represented approximately 12 percent of the 2011 U.S. workforce and included 15.2 million professionals, technicians, support workers and others not directly providing patient care (e.g., maintenance and laundry).
Within that group, the worker population identified as being in nursing and residential care was reported at 3.4 million, including private and state and local government facilities.
In fiscal year 2012 the U.S. Occupational Safety and Health Administration (OSHA) conducted 519 inspections (1.1 percent of its total) of nursing and residential care facilities, while state programs conducted 880 (1.6 percent of their total). Though trending upward, the numbers of inspections are very low for the workforce size. Based strictly on worker population, at 2.7 percent of the 2011 U.S. workforce (assuming no change in 2012), nursing and residential care facilities would have been the focus of 2,781 of the 102,990 federal and state OSHA inspections conducted. They were subjected to only half that amount.
The low rate of inspections is not due to good safety performance. Nursing and residential care facilities recorded injury and illness case rates of up to more than triple the U.S. average for all industries for fiscal year 2011, with state facilities having the highest rates by far.
A closer look at the data reveals that nursing and residential care facilities suffered a reported 59,390 lost-time (days away) injuries in 2011. Their most frequently injured employee was a 45- to 54-year-old female who had been on the job for one to five years. She was on duty two to four hours between 8:01 a.m. and noon on a Monday before being injured and most likely sprained or strained her back from overexertion while handling patients. The second most common accident was falling onto floors.
Time lost to days-away injuries was significant. In fiscal year 2011 the median time away from work due to a sprain or strain was 10 days. For back injuries, that number dropped to seven, but for shoulders (another common injury) it jumped to 23. When patients were the source of injury, again the average time out was seven days, while falls onto floors accounted for 10 lost days. When overexertion was the causal event, the typical injured worker was out 10 or 11 days. In short, for an ordinary lost-time injury the nursing and residential care worker can count on being out for nearly 10 days, meaning that in 2011, nursing and residential care facilities had to do without 593,900 workdays because of lost-time injuries.
Loading lost-time-injury data into the OSHA “$afety Pays” calculator produces an estimate of the direct and indirect cost of injuries, along with the amount of additional sales needed (based on a given profit margin) to recover those losses. In 2011 nursing and residential care facilities spent $3.9 billion on injuries, requiring $39.1 billion in sales to recover (at a reported 10 percent profit).
Of course, these sales are actually patient billing; so where to find the savings? Eliminating staff is not the answer, since most of these injuries came as a result of overexertion, often from a lack of staff and/or expertise to do the heavy lifting. Forcing even fewer staff (mostly female nurses) to do more only exacerbates the issue. Is the answer simply to raise fees?
The 2012 Genworth Cost of Care Survey of nearly 15,300 providers found that the median annual rate for a private nursing-home room ($81,030) reflects a 4.3 percent yearly increase since 2007. With demands for health care reform making headlines daily, the idea of a $39.1 billion cost increase to pay for injuries that largely should not be happening seems untenable.
A sign of the emerging link between worker and patient safety, infection control officially became an OSHA issue when the agency published a request for information (RFI) in 2010 to collect information from the health care industry on “occupational exposure to infectious agents in settings where health care is provided.” OSHA described health care as having “a weak culture of worker safety” related to a lack of data on the prevalence of infections among health care workers and “a lack of effort by health care employers” in tracking or documenting them. OSHA believes that too many health care workers are getting sick at work and that voluntary standards are not effective, largely due to poor safety programs and lack of regulatory oversight. In the RFI, OSHA observed that infectious agents are transmitted between employees and patients and that the RFI was intended to evaluate whether and how the agency might intervene to manage the issue. Comments are still being reviewed.
In March 2013, federal OSHA sent letters to 9,413 workplaces experiencing high rates of Days Away from Work, Restricted or Transferred (DART) injuries and illnesses. These workplaces had recorded fiscal year 2011 DART case rates higher than their respective sector averages. Employers were told to develop better safety and health plans and to seek expert advice if needed and that they might be targeted for inspection. Of the 1,218 letters sent to health care employers, 97.5 percent (1,187) went to nursing and residential care facilities.
OSHA’s 2012 Nursing Home National Emphasis Plan (NEP) will focus for three years on ergonomics hazards related to patient handling, exposures to bloodborne pathogens, tuberculosis, and slips, trips and falls. Under the NEP, approximately 1,000 nursing homes have been targeted for inspection by specially trained teams. Enforcement for ergonomics hazards will be under the general duty clause.
Nursing and residential care pays dearly in human and economic capital for its lack of a safety culture. Losing $3.9 billion per year on tens of thousands of lost-time injuries and nearly 600,000 workdays makes a strong argument that finding the money to pay for a safety program is the easy part. Finding the will to do it? That’s what defines high-performance organizations.
Dr. Scott Harris is a senior EHS advisor with UL Workplace Health and Safety, an advisory member of the ASSE Healthcare Practice Specialty and a course director at the UNC – Chapel Hill Occupational Safety and Health Education and Research Center.
Adapted with permission from UL. © 2013 UL. All Rights Reserved.
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