The obesity epidemic in the United States may be responsible for the emergence of a new trend in long term care staffing, and it appears to be spurring the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) into action.
It is well known that the obesity rate in America has risen dramatically over the last several decades. Currently, approximately 34 percent of adult Americans are considered obese, which is more than double the percentage of adult Americans who were considered obese in 1980.
Obesity is linked to numerous other health problems, which, unsurprisingly, often result in such individuals seeking treatment in health care facilities.
As an increasing number of overweight Americans enter nursing homes and other long term care settings, employers will be faced with addressing the growing number of workplace injuries related to resident handling. 

Staff Injury Rates On The Rise

In November 2011, the Bureau of Labor Statistics reported that injuries to employees in nursing homes and other health care facilities were on the rise. According to the data, the number of injuries increased 6 percent for health care support employees in general, a rate that is nearly 2.5 times the rate for all private and public workers.
The injury rate for nursing aides, orderlies, and attendants rose 7 percent. Perhaps most notably, the rate of musculoskeletal injuries (which includes back injuries) increased 10 percent for these employee groups.
In response to this trend, OSHA launched in April a three-year National Emphasis Program (NEP) for Nursing and Residential Care Facilities. The program covers the following provider categories: nursing homes, residential facilities for individuals with developmental disabilities, and continuing care retirement communities (CCRCs).
Businesses such as assisted living facilities without on-site nursing facilities will not be affected by the NEP.

National Emphasis Program Launches

The purpose of the NEP is to reduce the unusually high rate of injury and illness among employees in the nursing home and long term care industries. In support of the NEP, OSHA compared the days away, restrictions, and transfers, or DART, rate for nursing homes and CCRCs against the DART rate for all private industry.
According to OSHA, the national average DART rate for private industry in 2010 was 1.8, while the DART rate for nursing homes and CCRCs was 5.6 and 4.7, respectively. The most frequently cited impairment was musculoskeletal injuries related to resident handling.
For example, OSHA noted that 48 percent of all reported injuries in nursing homes were due to “overexertion.”

DART Rates Dictate Inspections

OSHA plans to inspect facilities that have a DART rate at or above 10. This means that OSHA could inspect any nursing home or CCRC that has 10 or more employees who missed at least one day of work because of injury or illness sustained at work during a one-year period.
According to OSHA, this DART rate cut-off will position at least 700 facilities for possible inspection. While OSHA will eventually make this list public, facilities on the list will not receive advance notice of any inspection. OSHA will assign each of the 700 facilities a random number, and inspections will be scheduled in the order called for by the random number assigned.
Each OSHA area office will inspect at least three facilities in its geographic jurisdiction during the three-year term of the NEP. States with their own workplace safety programs, such as South Carolina, are required to participate in the federal program.
Notably, OSHA will take changes of ownership into consideration during the selection process. If an establishment selected for inspection has changed ownership since Dec. 31, 2009, and has been under new ownership for more than six months, OSHA will recalculate that establishment’s DART for the period of new ownership.
If the recalculated DART is below 10, OSHA will not proceed with the inspection. 

Focus On Resident Handling

The NEP provides specific instructions as to how inspections should be conducted. The primary focus of OSHA compliance officers’ inspections will be an evaluation of “resident handling” within the facility.
Inspectors are required to evaluate whether the facility has adequate policies and procedures for lifting and transferring residents. The adequacy of the policies and procedures will be evaluated, in part, on the basis of whether employees were given the opportunity to provide input in the development of those policies and procedures.
Inspectors also will evaluate whether the establishment has adequate “lift, transfer, or reposition” assistive devices available. On this point, OSHA cautions that no single lift-assistance device is appropriate in all circumstances. The facility’s “decision logic” for when to use assistive devices in lieu of manual exertion by employees will also be evaluated.
Inspectors also will evaluate the training provided to employees. In particular, OSHA will evaluate lift, transfer, or reposition training that is provided to employees. The NEP also encourages inspectors to videotape employees during resident handling activities, provided that informed and written consent is obtained from the resident or family members.
In the name of maximizing agency resources, OSHA will provide corporations that own multiple facilities the opportunity to exempt its various facilities upon a successful demonstration of a corporate-wide policy to address resident handling hazards.
A corporate owner can make such a demonstration after OSHA has inspected at least six facilities within the corporate system and where OSHA has not issued a citation or hazard alert because of resident handling hazards at any of those six establishments. 
While the NEP focuses on resident handling and the prevention of related musculoskeletal injuries, other injuries and illnesses will also be addressed. For example, the NEP also addresses injuries and illnesses such as bloodborne pathogens, tuberculosis, workplace violence, and drug-resistant organisms such as Methicillin-resistant Staphylococcus aureus (MRSA).

Implications For Nursing Homes, CCRCs

Long term care employers must take proactive steps in the face of this NEP and also must consider the underlying factors that prompted the NEP. Those factors are likely to become more pronounced in coming years. Baby boomers are now hitting retirement age and will have an enormous impact on the long term care profession.
Moreover, recent data indicate that this segment of the population may not enter long term care facilities in ideal shape. A poll released by the Associated Press in July 2011 found that baby boomers are more obese than any other generation. As a result, resident handling may soon become even more problematic for long term care employees, due to increasingly heavy residents.
Because resident handling is such an integral part of a nursing home employee’s job duties, the incidence of injuries, particularly musculoskeletal injuries, is likely to rise unless employers implement adequate procedures to prevent them.
While employers will not have advance notice of an inspection, they should conduct an internal audit of the DART rates at their facility. If the rate is 10 or more, employers should assume that their facility will be inspected.
Employers should take necessary measures to minimize or mitigate resident handling injuries by also conducting an audit of existing safety training programs, resident handling policies and procedures, and related recordkeeping practices.
A modest investment of time and resources now will pay dividends if an OSHA inspector comes calling in the future.
The NEP directive can be found at:*. Information for employers and employees in nursing homes and residential care facilities, including guidance on ergonomics and workplace violence, is available at
Ted Boehm, an associate attorney in the Atlanta office of Fisher & Phillips, represents management in all aspects of labor and employment law. Boehm’s practice focuses on the defense of employment-related lawsuits in federal and state courts, including claims arising under Title VII, the American with Disabilities Act, the Fair Labor Standards Act, and the National Labor Relations Act.​