BUT SERIOUS INJURIES STILL OCCUR

IN WORKSITES YOU MIGHT THINK ARE ABSOLUTELY SAFE.

NURSING HOMES AND PERSONAL CARE -

A FAST GROWING INDUSTRY,

AND A KEY PART OF OUR HEALTHCARE SYSTEM.

YET, THESE FACILITIES HAVE

ONE OF THE HIGHEST WORKER INJURY AND ILLNESS RATES

IN THE COUNTRY,

SIMILAR TO TRUCKING G,

OCCUPA

TO BE

JUST LOOK AT THE STATISTICS -

NURSING HOME WORKERS LOSE TWICE AS MUCH TIME ON THE JOB

AS OTHER WORKERS,

AND HAVE

AN

E

MORE T

TIMES

T

OVER HALF OF THEIR INJURIES OCCUR WHILE HANDLING RESIDENTS,

AND ALMOST HALF INVOLVE THE LOWER BACK.

THERE ARE MANY POTENTIAL HAZARDS IN NURSING HOMES:

AND

M

FROM BED TO CHAIRS, SHOWERS, OR OTHER AREAS IN THE NURSING HOME.

NURSING HOME WORKERS AREN'T THE ONLY ONES

WHO SUFFER FROM STRESS, STRAIN, AND OVEREXERTION.

SUCH PROBLEMS ACCOUNT FOR MORE THAN ONE IN FOUR

OF ALL ON-THE-JOB INJURIES EACH YEAR.

THESE DISORDERS ARE THE SINGLE LARGEST GROUP

OF PREVENTABLE JOB INJURIES IN THE UNITED STATES TODAY.

BUT WHEN ERGONOMIC PRINCIPALS ARE APPLIED,

EVERYONE BENEFITS.

SIMPLY PUT, ERGONOMICS MEANS FITTING THE JOB TO THE WORKER,

DESIGNING JOBS SO THAT WORKERS CAN AVOID

AWKWARD, UNNATURAL POSTURES, AND EXCESSIVE FORCE

THAT CAN LEAD TO SERIOUS INJURY AND ILLNESS,

SOMETIMES EVEN PAINFUL AND PERMANENT DISABILITIES.

OSHA, THE OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION,

HAD A SPECIAL EMPHASIS PROGRAM IN SEVEN STATES

TO REDUCE THE THREAT OF INJURIES IN NURSING HOMES.

NOW, IN LINE WITH NEW TARGETING PROCEDURES,

OSHA IS CONDUCTING INSPECTIONS IN NURSING HOMES NATIONWIDE.

EMPLOYERS ARE ENCOURAGED TO CREATE

COMPREHENSIVE SAFETY AND HEALTH PROGRAMS

TO REDUCE INJURY AND ILLNESS RATES,

INCLUDING THOSE ASSOCIATED WITH RESIDENT TRANSFERS.

INSPECTION OF A NURSING HOME INVOLVES SPECIAL CONSIDERATIONS.

BEFORE GOING ON-SITE, HERE ARE SOME FACTORS TO CONSIDER:

THE HEALTHCARE FINANCING ADMINISTRATION,

OR HCFA REPORT,

SHOULD BE OBTAINED IN ADVANCE

TO DETERMINE THE DEPENDENCY LEVEL OF THE RESIDENTS.

HELLO, MY NAME IS BRAD BAPTISTE,

I'M WITH DEPARTMENT

ONCE ON-SITE, THE INSPECTOR SHOULD CONDUCT

AN OPENING CONFERENCE AND WALK-AROUND.

REMEMBER, THESE INSPECTIONS ARE TAKING PLACE

IN THE HOMES OF RESIDENTS.

THEIR PRIVACY RIGHTS ARE PROTECTED BY LAW,

AND MUST BE RESPECTED DURING WALK-AROUNDS.

ANY PHOTOGRAPHY OR VIDEOTAPING OF RESIDENT ACTIVITIES

REQUIRES THE RESIDENT'S PERMISSION.

NEXT, THE INSPECTOR MUST DETERMINE

WHERE INJURIES AND ILLNESSES OCCUR.

THIS IS DONE BY STUDYING THE OSHA-200 LOGS,

THE OSHA-101 FORMS,

OR WORKERS COMP RECORDS DATING BACK THREE TO FIVE YEARS.

BY ANALYZING INJURY AND ILLNESS TRENDS OVER TIME,

THE INSPECTOR CAN DETECT PATTERNS.

COPIES OF ANY REQUIRED WRITTEN PROGRAMS, INSURANCE REPORTS,

OR OTHER PREVIOUS AUDITS OF THE FACILITY CAN ALSO HELP.

OVERALL INCIDENT RATES

AND ERGONOMIC INCIDENT RATES CAN BE CALCULATED.

THE SAME CAN BE DONE FOR DIFFERENT DEPARTMENTS,

DIFFERENT SHIFTS, AND DIFFERENT WINGS,

IN ORDER TO PINPOINT AREAS OF SPECIFIC HAZARDS.

BRAD BAPTISTE, A COMPLIANCE OFFICER IN DENVER,

HAS CONDUCTED NUMEROUS NURSING HOME INSPECTIONS.

YOU WOULD FOCUS YOUR EFFORTS ON THE TWO OR THREE AREAS

WHERE YOU'RE HAVING THE HIGHEST INCIDENT RATES.

MORE THAN LIKELY IT'S ALWAYS GOING TO BE NURSES AIDES DOING TRANSFERS.

THAT'S THE MOST HAZARDOUS OF ALL THE JOBS,

AND YOU'LL FIND THAT'S WHERE YOU WANT TO FOCUS YOUR ATTENTION.

AS A NORMAL PART OF ALL OUR INSPECTIONS WE DO EMPLOYEE INTERVIEWS.

WHAT I'D LIKE TO DO IS AUDIOTAPE OUR CONVERSATION.

DO YOU HAVE ANY OBJECTION TO THAT?

NO, NONE AT ALL.

WHAT YOU NEED TO DO IS INTERVIEW ALL THESE EMPLOYEES

WHO HAVE BEEN INJURED, IF POSSIBLE,

FIND OUT EXACTLY HOW THEY WERE INJURED,

AND THEN DETERMINE THOSE TWO, OR THREE, OR FOUR LIFTS

THAT YOU'RE GOING TO WANT TO EVALUATE.

THEN YOU'RE GOING TO OBTAIN YOUR VIDEOTAPE

IT'S IMPORTANT TO HAVE A REFERENCE OF KNOWN SIZE IN THE PICTURE.

YOU WANT HELP UP?

YES.

>> RESIDENTS ARE ON DIFFERENT SCHEDULES,

BUT GENERALLY THEY'RE AWAKENED BETWEEN 7:00 AND 9:00 AM,

DRESSED, BATHED, AND HAVE BREAKFAST.

THEN THERE ARE MORNING ACTIVITIES, LUNCH,

AND FOR SOME, A NAP.

OTHERS ENJOY AFTERNOON ACTIVITIES BEFORE DINNER.

MANY HAVE AN EVENING ACTIVITY, AS WELL.

THE MOST IMPORTANT TIMES ARE DURING RESIDENT TRANSFERS.

IT'S IMPORTANT TO LOOK AT MORE THAN ONE SHIFT,

AND TO PAY SPECIAL ATTENTION

TO THE WORK OF THE CERTIFIED NURSES AIDES.

>> YOU MIGHT FIND THAT YOU HAVE A SIGNIFICANT NUMBER OF INJURY

OR ERGONOMIC INCIDENT RATE DURING THE NIGHT SHIFT,

WHEN TYPICALLY YOU'LL FIND A LOWER LEVEL OF STAFFING AT NIGHT.

YOU MIGHT FIND THAT THE DAY SHIFT HAS ACCEPTABLE INJURY RATES,

BUT THE NIGHT MIGHT BE EXTREMELY HIGH.

SO, IT'S IMPORTANT THAT YOU ADJUST YOUR SCHEDULE

SO YOU CAN EVALUATE HOW THEY'RE DOING THEIR LIFTS AT VARIOUS TIMES.

>> SAFETY AND HEALTH TRAINING IS ALSO IMPORTANT.

SOME QUESTIONS TO ASK ARE:

HERE ARE SOME OTHER THINGS TO CONSIDER.

>> EXPECT A LOT OF TIME BEING SPENT

EVALUATING THE DIFFERENT LIFTS, LOOKING AT THE AREAS.

THE PLACES ARE LARGE,

SO YOU'VE GOT TO LOOK AT EACH DEPARTMENT.

NORMALLY THE WALK-AROUND TAKES AT LEAST A HALF A DAY TO A DAY INITIALLY

JUST TO GET FAMILIARIZED WITH THE SITE.

THE ERGONOMIC INCIDENT RATE EVALUATION FROM THEIR RECORDS

COULD TAKE A DAY, OR TWO, OR MORE,

SO, A TIP WOULD BE TO EXPECT THAT WHEN YOU GO IN.

THESE ARE NOT SIMPLE CUT AND DRY INSPECTIONS,

AND YOU NEED TO BUDGET YOUR TIME WISELY

SO YOU CAN FIT IN ALL YOUR INTERVIEWS.

>> WHEN EVALUATING PATIENT TRANSFERS,

REMEMBER THAT LIFTING ANY HEAVY OBJECT

CAN POSE A SERIOUS HAZARD FOR WORKERS,

BUT LIFTING A PERSON IS PROBABLY THE MOST DANGEROUS.

SOME RESIDENTS MAY BE COMBATIVE,

OTHERS MAY HAVE DIMINISHED MOBILITY.

MAKING A PROPER LIFT CAN BE VERY DIFFICULT.

>> THERE ARE SOME RESIDENTS IN THE NURSING HOME

WHO HAVE COMPLETE MOBILITY.

THEY CAN DRESS THEMSELVES,

THEY CAN GET THEMSELVES OUT OF BED, THEY'RE AMBULATORY.

THAT VARIES ALL THE WAY TO THE OTHER END OF THE SPECTRUM

WHERE YOU HAVE RESIDENTS

WHO ARE ABSOLUTELY UNABLE TO DO ANYTHING WITHOUT ASSISTANCE.

THAT ARE MORE THAN LIKELY THE MOST DIFFICULT TO HANDLE,

TO TRANSFER THEM FROM THE BED TO A CHAIR,

THEY HAVE TO BE TRANSFERRED TO TOILETS,

THEY HAVE TO BE TRANSFERRED TO SHOWER AND WHIRLPOOL FACILITIES.

THOSE ARE EXTREMELY HAZARDOUS SITUATIONS

FOR ANYONE WHO'S LIFTING,

WHETHER IT'S A SOLO UNASSISTED LIFT,

OR A TWO PERSON UNASSISTED LIFT.

THEY PUT A LOT OF STRESS ON PEOPLES SHOULDERS, BACKS, KNEES,

AND WE'RE SEEING A NUMBER OF INJURIES IN THESE NURSING HOMES.

>> AND THEN, OF COURSE, THERE'S THE RESIDENT TO CONSIDER.

IS EXTREMELY PAINFUL TO MANY PEOPLE.

THESE PEOPLE HAVE VERY SENSITIVE SKIN,

VERY SENSITIVE BONES, OSTEOPOROSIS,

THERE ARE REPORTS OF RESIDENTS

WHO HAVE LITERALLY HAD THEIR SHOULDERS BROKEN OR DISLOCATED

JUST BY PHYSICALLY BEING LIFTED FROM UNDERNEATH THE ARM.

>> FORTUNATELY, THERE ARE WAYS TO MINIMIZE RISKS, SUCH AS:

THE SIMPLEST ASSIST USED IN NURSING HOMES

IS THE TRANSFER BELT.

A CERTIFIED NURSES AIDE LOOPS THE BELT BEHIND THE RESIDENT

AND HELPS THE PERSON STAND UP.

THE BELT HELPS SUPPORT THE RESIDENT

WITHOUT STRAINING THE AIDE'S BACK.

ONE HAND.

OKAY.

ALL RIGHT.

PUT YOUR HAND RIGHT HERE.

YEAH.

KEEP YOUR ARMS IN LIKE THIS BY YOUR SIDE.

FOR RESIDENTS WHO DO NOT HAVE THE STRENGTH IN THEIR LEGS,

OR MOBILITY TO USE A TRANSFER BELT,

OTHER ASSISTS ARE AVAILABLE.

>> YOU NOW CAN STRAP A VERY COMFORTABLE HARNESS ON THESE PEOPLE,

LI

Y,

IT'S SAFER AND MORE SECURE FOR THE RESIDENT,

AND IT'S MUCH SAFER FOR THE EMPLOYEE

WHO NO LONGER HAS TO PUT THAT STRESS ON THEIR BACK.

NOW GOI

>> SPECIAL DEVICES, SUCH AS LIFT ASSISTS,

CAN GO A LONG WAY TOWARD PREVENTING INJURIES.

SOME PEOPLE WORRY THAT THE USE OF LIFT ASSISTS

MAY BE UNSAFE FOR RESIDENTS,

OR LESS PERSONAL THAN THE WORK OF THE AIDES.

NOTHING COULD BE FURTHER FROM THE TRUTH.

>>

LE

UNDERSTAND WHAT'S GOING ON,

AND COMFORT THEM IF THEY NEED IT,

BALANCE THEM,

AND YET, THEY STILL HAVE THE ABILITY TO CONTROL THE LIFT

WITHOUT PLACING THAT STRESS ON THEIR BODY.

>> A SLING AND HOIST DEVICE CAN BE USED

TO GET A RESIDENT FROM A BED TO A CHAIR.

THE SLING IS PUT AROUND THE BACK AND UNDER THE RESIDENT.

THEN, IT IS FASTENED TO A LIFTING ARM.

THE RESIDENT IS TRANSFERRED

WITHOUT CAUSING UNDO EXERTION TO THE AIDES

WHO ARE STILL ABLE TO PROVIDE PERSONAL COMFORT AND CARE.

FEEL COMFORTABLE?

YES.

ALL SET.

THE QUESTION OF WHICH DEVICE SHOULD BE USED FOR WHICH RESIDENT

IS ANSWERED BY CYRILLE YOUNG, AN INSPECTOR IN BANGOR, MAINE.

>> A LOT OF THAT I DETERMINE BY TALKING WITH THE EMPLOYEES,

AND LOOKING AT THE JOB THAT THEY'RE DOING,

THE SIZE OF THE PATIENT THAT NEEDS TO BE MOVED,

WHERE THEY'RE BEING MOVED TO.

THE EMPLOYEE IS A WEALTH OF INFORMATION.

IF THEY'RE FINDING THERE ARE PROBLEMS WITH THIS PARTICULAR DEVICE,

THEY'RE NOT GOING TO USE IT,

OR MAYBE IT'S NOT BEING USED PROPERLY.

THE LARGE AMOUNT OF PATIENT TRANSFER

IS REALLY LOOKING AT THE FACILITY,

THE DEVICES THAT ARE BEING USED,

TO MAKE SURE THAT THESE DEVICES ARE BEING USED PROPERLY,

THAT THEY'RE BEING MAINTAINED,

BECAUSE IF THEY'RE NOT BEING MAINTAINED PROPERLY,

THE MOST IMPORTANT THING TO DO

IS NOT REALLY RECOMMEND A SPECIFIC VENDOR,

BUT TO HAVE THE ADMINISTRATION OF THAT FACILITY

BRING IN VENDORS OF ALL TYPES,

LET THE EMPLOYEES TRY OUT THE EQUIPMENT.

THE VENDORS WILL LEAVE THEM FOR A MONTH AT A TIME,

AND ALLOW THE EMPLOYEES TO USE THESE DEVICES

DURING THEIR NORMAL COURSE OF WORK.

THEY'LL TRAIN THEM, THEY'LL LET THEM USE THEM.

THEN THE EMPLOYEES SHOULD HAVE INPUT

INTO WHICH ONES THEY LIKED, WHICH ONES THEY FIND THE BEST,

WHICH ONES THE RESIDENTS LIKE AND WILL USE.

>> TOILETING A RESIDENT DEMONSTRATES ANOTHER LOOK AT HAZARDS.

THE RESIDENT MUST BE LIFTED OUT OF THE WHEELCHAIR,

BALANCED IN AN UPRIGHT POSITION,

AND THEN LOWERED ONTO THE TOILET.

BACK SUPPORT FOR THE WORKER IS NON-EXISTENT,

AND MANY BATHROOMS, UNLIKE THIS ONE,

ARE DESIGNED SO THAT TWO AIDES CANNOT WORK TOGETHER,

THEREBY ADDING TO THEIR STRESS AND STRAIN.

THIS IS ONE DEVICE THAT CAN BE USED

THE

URE.

IT IS EASILY ATTACHED TO THE RESIDENT

WHO CAN BE LIFTED, BALANCED,

AND THEN LOWERED ONTO THE TOILET.

MOST OF THE RESIDENT'S BODY WEIGHT

IS SUPPORTED BY THE LIFT AND NOT THE NURSES AIDES.

THIS TYPE OF LIFT IS ONLY USEFUL

IF THE RESIDENTS HAVE SOME STRENGTH IN THEIR LEGS.

A SLIP DEVICE IS USED TO SLIDE PATIENTS UP AND DOWN IN THEIR BEDS.