A new Occupational Safety and Health Administration ergonomic rule, released last week amid a storm of protest, sets up nursing homes as a top target for reform.
Provider associations said they still are determining the full impact of the 600-page regulation, but they know they don't like it.
Implementation will cost the nursing home industry an estimated $1.2 billion in the rule's first year, for an average of $30,000 per facility, said a spokesman for the American Health Care Association (AHCA), which opposed the rule. Lifting and moving patients is the most common cause of injury at nursing homes, and nursing homes interpret the rule as requiring them to buy expensive state-of-the-art assist equipment.
Home health agencies and hospitals also have expressed concern about the expense of complying with the rule. Home health workers, for example, may have to carry portable lifting devices, and that may mean they drive trucks instead of cars, said Tom Wilson, an attorney who wrote the 1994 OSHA Guide for Healthcare Facilities.
The ergonomic regulation affects the majority of U.S. industries. It covers
6.1 million worksites and 102 million workers. Among other mandates, it requires employers to assess the risks of musculoskeletal injury associated with each position, remedy problems that lead to injuries, and provide treatment and paid time off for workers recovering from musculoskeletal injuries.
OSHA estimates the total annual cost to employers at $4.5 billion. But the agency also believes the rule will save industry far more: It projects $9.1 billion in annual savings from reducing workers' compensation costs, absenteeism and employee turnover, as well as improving patient care.
The rule has been controversial from the start. Proposed a year ago, it attracted 8,000 written comments. Last week, the National Association of Manufacturers and the U.S. Chamber of Commerce led other business groups in filing lawsuits to block the standard's January implementation. The rule is too broad, overly vague and unsound scientifically, the critics charge.
The American Hospital Association is "very disappointed that (its) comments were basically disregarded by OSHA," said Carla Luggiero, the association's senior director for federal relations. A key AHA concern is lack of consensus in the scientific community about what causes musculoskeletal disorders, Luggiero said.
Labor groups staunchly support the rule. "Although it is a common-sense solution, not every provider uses common sense," said Andrew Stern, president of the Service Employees International Union.
The standard is set to become effective Jan. 16, although employers have until next October before they have to meet the first of its mandates.
Not every workplace will have to make significant changes, OSHA ergonomist Gary Orr said. Employers with working environments that don't lead to injuries have nothing to worry about, Orr said. And employers with existing ergonomic programs that meet limited conditions are excluded from the OSHA rule under a grandfather clause.
Many healthcare facilities, however, might find plenty to fix. According to the U.S. Bureau of Labor Statistics, nursing and personal-care facilities experienced 14.2 cases of work-related injury and illness per 100 employees in 1998--making the industry more dangerous than coal mining, lumber or steel. At hospitals, the injury and illness rate was 9.2 per 100 employees in 1998; and home health services had a rate of 8.2 per 100.
Nursing homes have been one of OSHA's five target industries for reducing workplace injuries for several years. They are not only one of the most dangerous places to work, they also are among the leaders in sprains and strains, which approximate the overall rate of musculoskeletal injury.
Charles Roadman, chairman and chief executive officer of the AHCA, believes the OSHA rule is unnecessary because providers around the country already are implementing ergonomics programs. His association represents assisted-living facilities, mental health facilities and nursing homes. Roadman's claim is bolstered by a 27% decline in the number of sprains and strains at nursing homes from 1993 to 1998.
Another concern of nursing homes is a possible conflict between the OSHA rule and HCFA's resident rights standards. HCFA requires caregivers to follow residents' preference for being lifted by caregivers or a mechanical device. The AHCA says OSHA's standard favors mechanical lifts.