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What OSHA's new injury-reduction program means to LTC employers

April 18, 2012
by Edward N. Boehm Jr.
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Data released by the U.S. Bureau of Labor Statistics last fall prompted the Occupational Safety and Health Administration (OSHA) on April 5 to announce a new program that targets the high incidence of injuries to employees in the long-term care industry.

The referenced data showed a significant increase in injuries to employees in nursing homes and other healthcare facilities, especially as compared to employees in other industries such as manufacturing and mining. According to the data, the number of injuries increased 6 percent in 2010 for healthcare support employees in general, a rate that is nearly 2.5 times the rate for all private and public workers. The injury rate for nursing aides, orderlies and attendants rose 7 percent. Perhaps most notably, the rate of musculoskeletal injuries, which includes back injuries, increased 10 percent for those same workers.

OSHA’s program, a National Emphasis Program (NEP), is aimed at reducing these injuries. The NEP will have a three-year term and will cover establishments in three North American Industry Classification System categories: nursing homes, residential mental retardation facilities and continuing care retirement communities. Businesses such as assisted living facilities that do not have on-site nursing care will not be affected by the NEP.


The NEP provides specific instructions as to how OSHA compliance officers are to conduct their inspections. The primary focus of the inspection will be an evaluation of “resident handling” within the facility. Inspectors are required to evaluate whether the facility has adequate policies and procedures for lifting and transferring residents. The adequacy of the policies and procedures will be evaluated, in part, on the basis of whether employees were given the opportunity to provide input in the development of those policies and procedures.

In addition, inspectors will evaluate whether the establishment has adequate “lift, transfer or reposition” assistive devices available. On this point, OSHA cautions that no single lift-assistance device is appropriate in all circumstances. The facility’s “decision logic” for when to use assistive devices instead of manual transferring by employees will also be evaluated.

Another area being primed for inspection is the “lift, transfer or reposition” training that is provided to employees. The NEP encourages inspectors to videotape employees during resident handling activities, provided that informed, written consent is obtained from the resident or family members. Inspectors are directed to obtain facility census data and information regarding the degree of ambulation of the residents, as OSHA deems such information to be a good indicator of possible hazards at the facility.

In the name of maximizing agency resources, OSHA will afford corporate entities owning multiple facilities the opportunity to exempt its member facilities following a successful demonstration of a corporate-wide policy to address resident handling hazards. A corporate owner can make such a demonstration after OSHA has inspected at least six facilities within the corporate system and where OSHA has not issued a citation or hazard alert because of resident handling hazards at any of those six establishments.

While the NEP focuses on resident handling and the prevention of related musculoskeletal injuries, other injuries and illnesses will be addressed as well. For example, the NEP addresses injuries and illnesses such as bloodborne pathogens, tuberculosis, workplace violence and drug-resistant organisms (such as Methicillin-resistant Staphylococcus aureus, commonly known as MRSA).

The NEP also encourages its field offices to develop outreach programs to support the strategic goals of the NEP. Examples of the outreach include letters to employers, local unions, local safety councils and other industry employer organizations. The outreach will include OSHA-approved training tools designed to address the relevant hazards.


OSHA plans to inspect LTC facilities with a “days away, restrictions and transfers” (DART) rate of 10 or higher in 2010. This means, for example, that OSHA could inspect any nursing home or continuing care retirement community that had 10 or more employees who missed at least one day of work because of work-related injury or illness during 2010. In arriving at this DART threshold, OSHA compared the DART rate of employees in nursing homes and continuing care retirement communities against the DART rate of employees for all private industry.

According to OSHA, the national average DART rate for private industry in 2010 was 1.8, while the rate for nursing homes and continuing care retirement communities was 5.6 and 4.7, respectively. The most frequently cited injury was musculoskeletal injuries related to resident handling. According to OSHA, this DART rate cut-off will position at least 700 facilities for possible inspection.

While OSHA eventually will make this list public, establishments on the list will have no way of determining whether they actually will be inspected. OSHA will assign each of the 700 facilities a random number, and inspections will be scheduled in the order called for by the random number assigned. Each OSHA area office will inspect at least three facilities in its geographic jurisdiction during the three-year term of the NEP.