On March 13, 2003, OSHA released voluntary guidelines for nursing homes regarding the prevention of work-related musculoskeletal disorders (MSDs) as part of a comprehensive plan to prevent and reduce ergonomic injuries. These guidelines are the first of several industry-specific guidelines OSHA intends to release. They can be found here.
The guidelines were developed after OSHA last year announced a four-pronged approach to reduce the number and severity of ergonomic injuries. The four prongs include guidelines, enforcement, outreach and assistance and advanced research. The nursing home guidelines were issued as part of the first prong.
Summary of the Nursing Home Guidelines
Although the guidelines were written for the nursing home industry, OSHA notes that assisted living centers, homes for the disabled, homes for the elderly and hospitals may also benefit from the guidelines.
OSHA’s primary recommendations for reducing and preventing nursing homes injures are minimizing or eliminating manual lifting of residents and implementing a workplace ergonomics program to identify and prevent ergonomic hazards. The nursing homes guidelines are divided into five segments: an ergonomic program, resident lifting and repositioning, other activities, training and additional information.
An Ergonomic Program
OSHA recommends that employers create a program to prevent and reduce ergonomic injuries. The program should include management support, employee involvement, identification of hazards, implementation of solutions, review of injury reports, training and evaluation of the program’s effect.
Resident Lifting and Repositioning
The guidelines offer numerous recommended solutions to minimize or eliminate manual lifting or repositioning of residents.
The guidelines list examples of other activities that can cause ergonomic injuries, such as bending, lifting food trays, waste collection, pushing heavy carts, lifting and carrying supplies and laundry removal. Additionally, the guidelines suggest possible solutions, such as using mobile medical equipment, hand tools and linen carts.
OSHA suggests that employees be trained to understand resident lifting and repositioning procedures, how to recognize ergonomic-related injuries and the methods for reporting injuries. The guidelines recommend that supervisors reinforce the facility’s safety program and ensure proper work and injury reporting practices.
The guidelines list other sources of information about ergonomics in nursing homes.
Legal Consequences of the Guidelines
OSHA states that the nursing home guidelines are strictly voluntary. They are not new standards or regulations and create no new duties. Although the general duty clause of the Occupational Safety and Health Act requires employers to provide, to the extent feasible, a workplace free from recognized ergonomic hazards that are causing or are likely to cause serious injury or death, failure to adhere to the guidelines is not a violation or evidence of a violation of any OSHA standard or the general duty clause.
Nothing in the guidelines, however, prevents OSHA from using the guidelines as a roadmap for evaluating the quality of a nursing home’s ergonomics program and then, if it believes recognized serious ergonomic hazards are not being addressed through feasible abatement measures, issuing a citation under the general duty clause. OSHA has attempted to do this with other guidelines in the past.
As a practical matter, OSHA is under political pressure to show that it is “doing something” with regard to ergonomics. A nursing home that does not consider the guidelines or disregards them entirely runs a substantial risk that an OSHA inspector will conclude that available feasible measures to address ergonomic hazards are not being taken and a citation or citations under the general duty clause should be issued. The guidelines are flexible, however, and nursing homes and similar facilities should consider them in addressing ergonomic issues that may be presented in their workplace.