Workplace injury rules could affect home health industry
Proposed OSHA ergonomics standard could create another burden
A proposed new workplace ergonomics standard could have a profound effect on home health agencies already buffeted by regulatory and financial winds.
In November, the Occupational Safety and Health Administration (OSHA) issued its proposed ergonomics standard for American workplaces. If the rules become final, they will require employers to put in place ergonomics programs for jobs described as manufacturing and manual handling, which is an area specifically defined to include patient handling, such as that received in a nursing home or by a home health aide.
Chandra Branham, associate director of regulatory affairs for the National Association for Home Care, says that because of the vagueness of the proposal, it’s hard to know exactly how home health would be affected. But she said it’s clear that aides are intended to be covered by the ergonomics rules.
"The initial reaction is we do feel that it’s going to apply to at least to some jobs within home care, for example, home health aides," she says. "They refer to patient handling as a typical job that would be covered by this standard."
OSHA’s goal is to combat crippling musculoskeletal disorders (MSDs) such as carpal tunnel syndrome, herniated spinal discs, tendinitis, sciatica, and lower back pain. (See MSD Conditions, Symptoms on p. 14.)
The proposed rules would require any employer with manufacturing or manual handling jobs to initiate a basic ergonomics program that includes these two elements:
1. Management leadership and employee participation. The employer would have to designate someone to be responsible for ergonomic issues and training. He or she also would have to ensure that employees know how to become involved in the ergonomics program and are not discouraged from reporting problems.
2. Hazard information and reporting. The employer would have to provide information to employees about ergonomic risk factors, the signs and symptoms of MSDs, the importance of reporting them early, and other requirements of the ergonomics standard.
Employer checklist
If a job had a reportable MSD, the employer would have further obligations under the proposed rules:
• Job hazard analysis and control. The employer would have to analyze jobs for ergonomic risks, work with employees to eliminate or reduce them, provide protective equipment as needed, and track progress.
• Training. The employer would have to periodically train employees in jobs with reported MSDs, as well as their supervisors and staff responsible for the ergonomics program. Training would have to be in a language the employee understands.
• MSD management. The employer would be required to provide prompt response to an injured employee, and access to health care at no cost to the employee. The employee also would be entitled to work restriction protection during a recovery period (100% pay and benefits for an employee on light duty, 90% pay, and 100% benefits to an employee removed from work). Those protection benefits would last until the employee returned to work or the MSD hazards are fixed or six months have passed, whichever occurs first.
According to OSHA, those protection benefits can be offset by workers’ compensation or similar benefits.
• Program evaluation. The employer would have to periodically evaluate the ergonomics program, consult employees on its effectiveness, and correct any deficiencies.
• Record keeping. An employer with 10 or more employees would have to retain ergonomics records for three years.
According to OSHA, an employer who has already implemented an ergonomics program may continue to use it, provided that it meets the basic requirements of the standard, and eliminates or materially reduces MSD hazards.
The standard would be implemented in stages, beginning 60 days after a final version is published.
Branham says she has not yet received many questions from home health agencies regarding the proposed standard, but is unsure whether agencies don’t know about it yet, or simply believe their existing programs will be sufficient.
Her analysis of the standard has identified some possible problem areas for home health:
• Direct observation of workers. The job hazard analysis required of employers in the event of a reportable MSD directs the employer to "observe employees performing the job in order to identify which of the physical work activities, workplace conditions, and ergonomic risk factors are present."
"That’s a particular concern for home care, because a lot of home health employees are operating very independently in the homes," Branham explains. "Home health aides are supervised on a regular basis, and I think that training would not be a problem as far as proper patient handling and those kinds of things. But the actual one-on-one observation would be, especially for employees spread out geographically in the community."
• Vagueness of rules. Branham says that because of the general language in the standard, employers who already have ergonomics programs in place may not be able to know whether they are in compliance.
• Pay requirements. The requirement to pay an employee up to 100% of pay and benefits while the employee may be restricted or even barred from working, could impose a severe financial burden on an employer.
Branham notes that this potential burden could come at a particularly vulnerable time for home health agencies. "We have PPS coming, which is going to completely revamp the payment system that home health has been operating under," she predicts. "We’re expecting revised conditions of participation around the same time that PPS goes into effect. Surety bond regulations are going to come back, probably around that same time.
"I think it’s just to the point where home health probably can’t take one more burden that’s going to cost them anything," Branham says. "We’ve already seen the closing of so many home health agencies these past two years. There may be some agencies who may say the cost of compliance is just too high with all of these regulations."
| MSD Conditions, Symptoms |
| Examples of musculoskeletal disorders to be covered by the proposed OSHA ergonomics standard: |
| Carpal tunnel syndrome |
| Epicondylitis |
| Herniated spinal discs |
| Tarsal tunnel syndrome |
| Raynaud’s phenomenon |
| Sciatica |
| Ganglion cyst |
| Tendinitis |
| Rotator cuff tendinitis |
| DeQuervain’s disease |
| Carpet layer knee |
| Trigger finger |
| Lower back pain |
| Examples of MSD signs and symptoms: |
| Deformity |
| Decreased grip strength |
| Decreased range of motion |
| Loss of function |
| Numbness |
| Tingling |
| Pain |
| Burning |
| Stiffness |
| Cramping |
| Source: Occupational Safety and Health Administration, Washington, DC. |
• Chandra Branham, Associate Director of Regulatory Affairs, National Association for Home Care, 228 Seventh St. S.E., Washington, DC 20003. Telephone: (202) 547-7424. Fax: (202) 547-3540.
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