John L. Henshaw
American Health Care Association
54th Annual Convention and Exposition
San Diego, California
October 13, 2003
Thank you, Chip [Roadman]. I'm delighted to be here as part of this panel with Betty [Bogue] and Hal [Engel] to focus on ways to prevent injuries in long -- term care facilities.
First, I want to especially thank the American Health Care Association -- as well as individual nursing homes. We appreciate your assistance in developing the voluntary ergonomics guidelines for nursing homes. We announced the final guidelines seven months ago today. And we couldn't have done it without your help.
Secretary Chao announced in April 2002 that we would pursue a four -- pronged strategy to address musculoskeletal disorders in lieu of other approaches. However, we realize we must find ways to reduce MSDs since they account for about one -- third of the lost -- time occupational injuries and illnesses in this country.
Guidelines
A central component of the Secretary's strategy was to be voluntary guidelines based on effective industry practices. In addition, a key commitment that we have made -- and kept -- was to work with those industries that were willing to step up to the plate. We needed real -- world help to identify practical strategies proven effective in reducing injuries and illnesses.
You were the first industry to step forward … the first to volunteer to join us in developing guidelines.
I salute you for your willingness to work with us. I appreciate your commitment to reducing injuries and illnesses among your workers. I also applaud your putting safety and health ahead first … by sharing effective practices with us and with others in your industry.
For our part, OSHA has sought to be sensitive to your concerns. We carefully considered nearly 100 comments on the draft guidelines. And we went back to the drawing board after about 50 stakeholders met with us last fall.
We listened and we responded. Our final guidelines reflect many helpful suggestions we received from you. I believe the result is a document that offers real value to the long -- term care industry based on real -- world observations and practices.
Since March 13, more than 30,000 individuals have viewed the guidelines on OSHA's website. We've also given away thousands of copies of the printed version. We are delighted that there has been so much interest in the guidelines.
Reducing Injuries/Illnesses
But, of course, guidelines are only one means to an end. Our goal is very simple: we want to help you reduce injuries and illnesses. That's our bottom line.
Over the past 10 years, we have seen a significant decline in MSDs -- as all injuries and illnesses have dropped. That's good news.
Overall injury and illness rates at nursing homes have declined about 10 percent -- and serious injury rates have dropped about 20 percent -- in the past decade. But rates remain high.
More than 13 of every 100 nursing home workers experienced a work -- related injury or illness in 2001. That's more than double the 5.7 private sector average rate. We're committed to reducing those injuries -- and I know you are as well.
I'm convinced that our guidelines can make a big difference -- and, in fact, are already making a difference. But we need more facilities to implement the suggestions that make sense for them. That will lead to a further decline in injuries among certified nursing assistants and other staff in your facilities.
You have been a major part of bringing the guidelines to reality. Now we need to take the next step. I want to do everything I can -- and I hope you will do everything you can -- to encourage facilities to adopt those recommendations that work for them.
Cooperative Approaches
One of the ways we might work together on an ongoing basis is through an Alliance. OSHA Alliances are joint commitments to address safety and health issues through training, education, outreach and communication.
We've already begun talking about an Alliance -- and I am hopeful we can put that agreement together soon. We were so successful in joining forces to develop the guidelines. I'd like to see us ensure the success of the guidelines by working jointly to promote them.
Your work with us as part of an Alliance would also help follow through on a second aspect of Secretary Chao's commitment on ergonomics -- outreach and assistance.
We already have a number of partnerships that are making a difference for nursing home workers. The Louisiana Nursing Home Strategic Partnership is one of those. This past April, I toured Covenant Nursing Home in New Orleans -- a participant in that partnership.
Covenant is an ICF -- one [intermediate care facility, level one] nursing home with 96 beds and 100 employees. In 1999, this facility had 25 claims and a loss ratio of 44. But in 2002, there were no injuries. And they've only had two minor ones this year -- for a loss ratio of less than 1 and total claims costs of $163. That makes Covenant's experience modifier less than 1 also. An additional bonus is hardly any turnover among employees.
According to administrator Peggy Hoffman, the difference at Covenant came from purchasing lifting equipment, along with conducting extensive in -- services for CNAs. Plus Covenant has a genuine focus on -- and concern for -- the health of employees -- who respond by being more careful.
We also have 10 nursing homes participating in our premier partnership program -- Voluntary Protection Programs. One of the newest is Community Springs Healthcare in El Dorado Springs, Missouri. It's the 6th site for Citizen's Memorial Healthcare, parent company for the first VPP nursing home site.
Community Springs has 92 employees at its 120 -- bed nursing home and injury and illness rates below industry averages. That's because injuries have decreased by 66 percent since they implemented their ergonomics strategy. Community Springs' approach includes ergonomic risk assessments for each job, assisting devices for lifting and employee training in body mechanics and injury avoidance.
Education and Training
Education and training are important aspects of any ergonomics effort. To help nursing homes with training, OSHA recently selected six nonprofit organizations to receive more than $700,000 to develop training programs for long -- term care facilities. This training will specifically focus on the voluntary ergonomics guidelines.
We offer additional help as well. A number of our 35 Education Centers -- local colleges and universities -- provide OSHA training in ergonomics. We also have an extensive eTool for healthcare facilities. That's interactive software on our website. The nursing home eTool includes a module on ergonomics.
Further, small sites can call on our consultation program -- available in every state -- for help with ergonomics or other safety and health issues. And each of our local offices has a compliance assistance specialist available to assist with training and education on the voluntary nursing home guidelines and other matters.
We want to help you -- and your members -- find the best ways to address ergonomics for your facility. We want to work with you to help reduce injuries and illnesses.
Research
I know one of the concerns has been that there are gaps in the scientific research -- that we could do more if we knew more. The National Advisory Committee on Ergonomics has recommended that OSHA sponsor a research symposium. The idea is to draw together top researchers to discuss further some of the most challenging topics on ergonomics.
We're planning to hold that symposium on January 27, 2004, in Washington, in conjunction with the next advisory committee meeting. We're calling it "Musculoskeletal and Neurovascular Disorders -- The State of Research Regarding Workplace Etiology and Prevention."
The one -- day symposium will include up to four 90 -- minute sessions. We expect to have six to twelve researchers participate in two to four -- person panels. Each speaker will give a short presentation, and then the panel will discuss the issues. At the close of each session, advisory committee members will be able to question panelists.
Just over a week ago we put out a call for abstracts. We expect to focus on definitions and diagnoses of MSDs, cause and work -- relatedness, exposure -- response relationships, intervention studies and study designs. What we are looking for is researchers who can share approved peer -- reviewed research proposals or work that has already been published in peer -- reviewed journals.
We hope that hearing about new and relevant research data from ergonomics experts will help the committee to recommend to OSHA ways to reduce the incidence of MSDs in the workplace.
Enforcement
Let me turn now to enforcement. This is the final prong of Secretary Chao's program to address work -- related MSD's.
We began in July 2002 with a national emphasis program in nursing homes. We said we would conduct about 1,000 inspections, and we have completed nearly that many. We have cited 7 facilities under the general duty clause for failing to protect workers from ergonomic hazards, and we have issued alert letters to 104 additional sites.
For five of the seven nursing homes with citations, we've signed settlement agreements, and we are working toward settlement with the other two sites. Further, sites that have received ergonomic hazard alert letters are moving forward to address the problems at their facilities as well.
For example, Tandem Health Care in Bellville, Ohio, received one of those letters. Later, they wrote our Toledo Office to let OSHA know about the steps they have taken to reduce injuries and illnesses among their workers. The nursing home has established a new ergonomics program, including implementing a low -- lift policy, purchasing new equipment to assist with lifting and training employees. Others have taken similar steps.
I want to be very clear about one thing when it comes to enforcement. We do not, have not and will not enforce voluntary ergonomics guidelines. We make this point on page six of the guidelines. And I have made it in letters to senators and representatives, in the frequently asked questions section on our ergonomics webpage, in news releases and in speeches I have given.
But that doesn't mean that we have abandoned our inspection program. We have not. We will continue to inspect workplaces where there are numerous MSDs, and we will cite employers if they have ignored their responsibility to protect their workers from injury.
In the last year and a half we have written letters and issued citations to companies that have evidenced corporate commitment to lowering ergonomic hazards in their workplaces BUT that have failed to effectively implement that commitment at specific sites. This is a critical point. The corporate commitment must be translated to positive action at the individual workplaces.
We've also made very clear to our inspectors that when they issue citations and provide examples of ways to fix problems, they should NOT use the guidelines for these recommendations. Rather they should turn to the literature -- there are plenty of examples available.
As I said earlier, we began a national emphasis inspection program in nursing homes about 15 months ago -- before we had developed guidelines. We said we would conduct about 1,000 inspections, and we have done that. I want to let you know today that we have now completed that emphasis program, and we are not renewing it.
Nursing homes with high injury and illness rates will be subject to our regular site -- specific targeting program. But we have also modified that somewhat for nursing homes.
This means that in Fiscal Year 2004, which began October 1, we will probably inspect about 400 long -- term care facilities with the highest injury and illness rates -- rather than 800 that might naturally rise to the top of our list.
Of course, the bottom line is not the numbers of inspections or citations we issue. It is reducing workplace injuries and illnesses. That is our goal. And I know it is yours as well.
Closing
Nursing homes have a long tradition of serving those who need care beyond what families can provide. Your employees provide patient, dignified assistance for residents who cannot fully care for themselves. This is an invaluable gift to our country and our communities.
OSHA's goal is to help nursing home operators provide the same measure of care to their caregivers so they can do their jobs safely. I trust we can work together toward that end.
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