Nursing home caregivers work in one of the most hazardous occupations in the country, but can’t count on federal legislation to protect them. The Occupational Health and Safety Administration (OSHA) heeded legislators’ distaste for regulations again recently, issuing guidelines, not rules, that cover the hazards. Toothless, but not worthless, the OSHA recommendations focus needed attention on the issue. And there’s a chance arguments for stronger protections will receive a more sympathetic hearing at a national conference on aging in December.
In 2003 the Bureau of Labor Statistics identified nursing homes as the fourth most dangerous workplaces in the United States. They were ranked just behind certain manufacturing sites, busy streets and landfill operations in an 84-workplace sample.
The physical hazards for caregivers? In “Ergonomics: Guidelines for Nursing Homes,” OSHA identifies work-related musculoskeletal disorders (MSDs) that include low back pain, sciatica, rotator cuff injuries, epicondylitis and carpal tunnel syndrome. It isn’t difficult to pinpoint why MSDs are such a problem. Nursing home employees care for residents who are disabled by frailty, stroke, fractures, Alzheimer’s disease and other conditions. The work involves heavy lifting, often in confined and awkward spaces.
The OSHA publication also mentions added risk from residents who strike their caregivers, and the problems they share with health workers in general. The list includes infectious diseases, radiation, chemicals used for sterilization of instruments and shocks from electrical equipment.
The disproportionate amount of heavy and awkward lifting is one characteristic of nursing home work. The other is short staffing. In July 2000 a report to the US Senate from a Special Committee on Aging noted that “54 percent of nursing homes have less than the minimum staffing level for nurses aides.