Injuries in Nursing Homes u Nursing Homes are ranked fifth among all industries for low back injuries u 17 Injuries For Every 100 Full Time Workers u Nursing Home Workers Have the Most Injuries Related to Overexertion of Any Industry (no. 1 for overexertion) u Injuries Rose 55% in the Last Decade

Why Injuries Are Increasing u Pressure in the Industry to Drive Down the Price of Health Care u Nursing Home Sector Seeing More Acutely Ill Patients - Hospitals Move Patients Out Faster u More Acutely Ill Patients Means More Dependant Patients who Requires More Handling

Other Injury Risks u Nursing (in general) has the highest rate of Falls to the Floor on the Same Level of any Group of Workers u 96 Cases per 10,000 workers u Lack of Adequate Housekeeping Staff Contributes to Slipping/Falling Problem

Risks for Injury: Patient Handling Tasks u Frequent Manual Lifting of Patients is the Primary Risk u Two-person Manual Lift is the most common patient transfer method u Average Nursing Home Worker Lifts More Than 10,000 Human Pounds Per Day

Other Stressful Tasks u Lifting Patient Up in Bed u Weighing Patient u Repositioning Patient u Making Bed With Patient In It u Making Bed Without Patient In It u Lifting Carrying Equipment or Supplies

Hoists Have Not Worked u One study found that mechanical hoists were used for only 2% of patient transfers u The reasons for not using hoists: u hoist not available u takes too much time u lack of staffing u the physical effort required to use hoist

For Dependant Weight Bearing Patients u For patient transfers, the two-person walking belt was found to be least physically stressful among several methods u Using a pulling technique (not lifting) was important to minimize stress to the worker u Training of workers to use the pulling technique with walking belts was required

Lifting Devices Differ Widely u Several Mechanical Lifting Devices were compared u Arjo-Century’s Ambulift Device was found to be least physically stressful to workers u Hoyer Lifts were found to be as physically stressful as manual lifting of patients

Comparing Three Lifting Devices u Using Hoyer lifts is more physically stressful than most manual methods u Trans-Aid lifts reduced physical stress compared to manual methods u Arjo-Century lift was least stressful mechanical device, and patients preferred this device (felt more secure)

Staff to Patient Ratio u Inadequate staffing is a major obstacle to injury prevention efforts u Many transfers require two workers, but are performed by one worker u Lifting Teams have been used successfully in hospital settings to dramatically reduce workers compensation losses

Adequate Equipment u Adequate equipment includes: u Walking Belts u Shower Chairs u Shower Chairs fit over toilet u Shower Chair fits easily into shower u Adaptive Clothing as needed

Ergonomics Efforts Do Work u In one study losses were reduced by 50% by making ergonomic improvements u Classifying patients and applying consistent transfer methods per category was important u Compliance Required Adequate Staff to Patient Ratio

Classifying Patients u dependent/non-weight bearing u dependent/weight bearing u independent

Patient Handling Per Classification u non-weight bearing: Use Mechanical Device u weight bearing dependant: Use Two-Person Walking Belt with Pulling Technique u independant: Patient Moves on Their Own

Lifting Team Approach u Also relies on classifying patients into categories u Lifting Team specially trained in each method or patient category u Lifting Team adheres strictly to prescribed methods per category u Adequate staffing ensured by Lifting Team approach

Lifting Team Approach u Team members selected for strength, ability u Nurses and Nurses Aids free to perform other tasks u May increase number of Full Time Equivalents (FTE) required u Has been cost-effective in hospital settings due to reductions in injuries and costs

Administrative Issue u Handling of Patients By Prescribed Method Per Patient Classification Required u Compliance Must Be Monitored and Enforced/Reinforced u Adequate Staffing is Required for Compliance

Other Equipment u Adjustable height beds u Slings attached to beds u Adequate number of mechanical lifts u Adequate type of mechanical lift

Most Stressful Tasks u Ratings of Perceived Exertion has been useful in job/task evaluations of nursing home tasks u Transfers from wheelchair to toilet was most stressful task u Transfers from chair to bed also stressful u Two-person manual lifting method most stressful of several methods examined

Walking Belts and Gait Belts u Walking belts differ from gait belts in that they have handles and better secure the patient u For best results with walking belt method, nurses were instructed “Pull with your hand, not your back. Do not lift” u Many nurses have old habit of lifting when transferring - which must be “unlearned”

Improving Ergonomic Conditions u Consistent Use of Lifting Devices for Non- Weight Bearing Patients u Easily Adjustable Chair and Bed Heights u Adequate Staff to Patient Ratio - Increase Staff if Necessary u Training in Proper Techniques u Walking-Belts With Pulling Method

Standards and Regulatory u OSHA Launced an Initiative To Improve Conditions for Nursing Home Workers in 1996 u Unions Pushing for Enforceable Staffing Standards u OSHA’s Proposed Regulation on Ergonomics Could Stimulate Dramatic Improvement - If Made Into Law