POLITICS OF SAFE PATIENT HANDLING

Health-care workers are rallying again around legislation that would compel hospitals and nursing facilities to install patient handling equipment to stem a staggering tide of lifting musculoskeletal injuries.

The issue of a federal standard being promulgated to address safe patient handling has percolated with urgency in Washington since the early part of the decade -- part of a larger, very contentious labor-industry debate over ergonomics. Safe patient handling is one of those workplace issues that touches down to the core of workers because it involves personal care, such as in nursing in hospitals, nursing homes and home care.

When the American Nurses Association Inc. puts out the talking point that "every day the average nurse lifts 1.8 tons per shift" repeatedly lifting, moving, transferring and repositioning patients, that is a statistic stakeholders can understand. The Silver Spring, MD-based ANA contends that back injuries affect up to 38 percent of all nurses and prompt many of them to leave the profession early thus contributing to a shortage.

But the politics of new regulation – especially one that would demand capital purchases of new, physical equipment such as patient lifts – has caused the issue to emerge in fits and starts.

Conyers, Franken Introduce Bills
Rep. John Conyers, D-MI, introduced the Nurse and Health Care Worker Protection Act of 2009, HR 2381, in the House May 13, and Sen. Al Franken, D-MN, dropped a companion bill, S 1788, in the Senate Oct. 15. It was the third time since 2006 that Conyers has introduced a version of his bill. The other versions languished in committee.

If enacted, compliance would be given over to OSHA, adding another significant duty to an agency already viewed widely as having a full plate of statutes to enforce. The legislation would compel OSHA to issue a rule that would require, among provisions, that facilities employ lift equipment and conduct worker training on safe patient handling.

Ergonomics regulation is nothing new at OSHA. The agency promulgated an ergonomics standard at the end of the Clinton administration, but the Republican-controlled Congress repealed it under the Congressional Review Act shortly after President Bush’s first term began in 2001. The act allows Congress the opportunity to review and overrule new federal regulations. It should be noted that current interim OSHA head Jordan Barab played a key role in developing the repealed standard nearly a decade ago. In March 2003, OSHA issued ergonomics guidelines for the nursing home industry that included safe patient handling, but the guidelines (which were updated in March 2009) do not have the force of regulation.

At a stakeholder meeting in November 2002 to review the draft of the guidelines, the meeting offered the spectacle of seemingly vulnerable and politically insignificant nursing aides, orderlies and attendants complaining on one side about debilitating musculoskeletal injuries while briefcase-carrying industry executives on the other side countered that the science of ergonomics was not firmly established. The draft targeted an array of improvements, but safe patient handling dominated the discussion.

Workers' Comp Savings

Proponents of lift equipment could not seem to sway opponents that day that the costs of implementation would be more than offset through lowered workers’ compensation insurance payments employers make when workers are away from the job. The administrator of a 100-bed Ohio nursing home offered information at the meeting that the facility’s workers’ comp costs had declined from an average of nearly $140,000 per year to less than $4,000 per year with reduced absenteeism and overtime. The administrator had put the cost of buying the equipment at $280,000.

The Franken bill calls for a $200 million grant program to cover the cost of acquiring safe patient handling equipment for cash-strapped facilities, and that may ease some of the financial burden.

The ANA is clear that it is seeking the "elimination of manual patient handling," arguing that 12 percent of nurses leave the profession annually because of back injuries.

The Conyers-Franken legislation would move the narrow issue of safe patient handling beyond the realm of guidelines and represent an opportunity to get something related to ergonomics workplace enforcement on the books. That would be a victory for proponents, who complained that during the Bush years the agency did not vigorously promote the guidelines. That notion is borne out by OSHA’s recent announcement – under the new Democratic-led regime headed by Barab – that it has stepped up ergonomics enforcement at nursing homes as part of its annual Site Specific Targeting program.

One influential group, the American Industrial Hygiene Association, in adopting a position favoring safe patient handling legislation on June 30, recommended that hospitals, nursing homes and other facilities develop written safe patient handling policies or related policies that incorporate necessary elements of a safety and health management system. Policies should address patient handling hazard assessments, task types and frequencies, patient dependency levels, environmental restrictions and enhanced use of mechanical devices among elements, the AIHA said.

Favorable Signs for Action

Proponents believe now is the time to get their way on the issue, pointing to likely support by the Obama administration and significant majorities in the House and Senate. Additionally, one early cosponsor with Conyers, Rep. Lynn Woolsey, D-CA, is chair of the Workforce Protections Subcommittee, part of the House Education and Labor Committee, likely guaranteeing a future congressional hearing. The bill has garnered 11 other cosponsors among Democrats in the House so far, but whether it will push beyond committee with a groundswell of support is uncertain.

Helping proponents’ cause is successful legislation on the state level. Five states, Ohio, Texas, New York, Washington and Rhode Island, have enacted legislation. Nine others have introduced legislation; they are California, Florida, Hawaii, Illinois, Iowa, Massachusetts, Michigan, New Jersey and West Virginia.

But politics still may dog the issue of safe patient handling. While favorable conditions do exist for momentum to drive passage, poor national economic conditions present a dilemma as many facilities are already straining under the weight of the recession and rising health-care costs. A consensus has emerged that technologically feasible solutions that can control ergonomic hazards do exist in the marketplace, but matching that ambition with cost and practicality may present additional hurdles.

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More: Senate safe patient handling legislation, OSHA ergonomics guidelines for nursing homes

Safe Patient Handling images: OSHA, 2003