Prevent Nursing Home Injuries and Costly Workers’ Comp Claims

Posted in: Commercial Insurance

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From slips and falls to the wear and tear caused by lifting and repositioning patients, nursing home employees experience more injuries and miss more days of work recuperating from injuries than construction and manufacturing workers, miners, foresters, and loggers, according to 2013 data from the Bureau of Labor Statistics. In addition, nursing aids, orderlies, and attendants suffer from more musculoskeletal disorders than workers in any other industry. In fact, the rate is seven times greater than the average rate across all industries.

These numbers explain why the Occupational Safety and Health Administration (OSHA) launched a major initiative to raise awareness about nursing home safety and put preventive measures in place. They also underlie the recent passage of legislation in California, Illinois, Maryland, Minnesota, and a number of other states tightening patient lifting protocols and making work safer and more manageable for employees.

If you own or operate a nursing home or elder care facility, it’s in your best interest to make the work environment as safe as possible for your staff. Not doing so can lead to costly workers’ comp claims, gaps in your workforce caused by employee absences, and even litigation.

How can you prevent the many slips, falls, and aching backs and muscles that happen all too often at nursing homes? In this third post in my blog series on workers’ compensation, I walk you through the steps to lower your risk of the two most common kinds of injuries (causing workers’ comp claims) at your facility.

Lifting and Repositioning  

There’s no way around it: nursing home residents need to be transported and moved. Yet how your employees maneuver residents is largely up to the facility manager and a result of the procedures in place and the equipment on site.

Patient lifting and repositioning injuries account for the large majority of workers’ comp claims in the healthcare industry. However, with the consistent use of mechanical lifting equipment and other lifting aids, and with frequent and ongoing ergonomic training in proper patient handling techniques, these injuries can be reduced or even eliminated.  

Most healthcare facility operators understand and train staff in proper handling, but few go back and retrain or implement protocols to hold employees accountable for following the guidelines. Over time, employees forget what they learned in their initial training, or they get in a rush and take short cuts.

Follow these steps to lower your risk of lifting and repositioning injuries at your facility:

  1. Take time to observe employees at work in their departments. Are they using proper techniques?
  2. Hire wisely. Is the potential employee physically capable of performing the job tasks? Is he or she fit for duty?
  3. Conduct pre-employment physicals on all individuals after you make the conditional job offer (and before the employee starts working). This will give you a doctor’s perspective on whether an employee can handle the job. If the doctor deems an individual unable to perform the job, you will need to demonstrate that the reason for the rejection is “job-related and consistent with business necessity,” as stipulated by the Americans with Disabilities Act of 1990.
  4. Educate and train employees using the OSHA publication, Guidelines for Nursing Homes: Ergonomics for the Prevention of Musculosketetal Disorders.
  5. When feasible, minimize or eliminate the manual lifting of residents. Use lifting aids like roller boards, transfer belts, trapezes, and mechanical lifts.
  6. Develop and put in place an effective ergonomics process that:
  • provides management support;
  • involves employees;
  • identifies problems;
  • implements solutions;
  • addresses reports of injuries;
  • provides training; and
  • evaluates ergonomic efforts.

7.  Understand the specific requirements of your state. In the past five to 10 years, a number of states have passed legislation on patient handling in healthcare facilities. Legislation passed in 2011 in California, for instance, mandates replacing manual lifting techniques with powered transfer devices. Additional states have similar requirements, so make sure you know what,  specifically, the law stipulates for you.

Slips, Trips, and Falls

The mopped floors, frequent use of showers and sinks, and assortment of medical equipment onsite make slips, trips, and falls incredibly common among workers of nursing homes and healthcare facilities. Often, these injuries stem from a lack of awareness, and with the right training, protocols, and accountability measures in place, the large majority can be prevented.

How can you create a robust prevention program for slips, trips, and falls? Start with these questions and steps:

  1. Does your facility have a shoe safety program in place? If not, develop one. Shoe safety programs prohibit employees from wearing open-toed or open-heeled shoes and croc-style shoes. Instead, shoes must be slip resistant, closed-toed, and closed-heeled.
  2. Use hazard assessment checklists to inspect the workplace for any slip, trip, or fall hazards, such as protrusions, loose guardrails, extension cords, unstable or damaged chairs, and poor lighting. Correct any hazards immediately.
  3. Create a “No Slip, No Trip” policy that requires all employees to do something about every slip, trip, and fall hazard as soon as they spot it. This might involve cleaning up a spill, removing a damaged piece of furniture, or clearing an entryway or exit.
  4. Use wet floor signs appropriately and only when needed. If you leave them out all of the time, your employees will stop paying attention to them.
  5. Keep all walkways and hallways clear.
  6. Use door mats, shower mats, and umbrella bags to prevent water from leaking onto the floor.
  7. Increase the slip resistance of slippery floor areas.
  8. Regularly inspect all floor surfaces for wear and damage. Make repairs immediately.
  9. Install proper lighting indoors and outdoors.
  10. Plan ahead for clearing snow and ice timely from sidewalks and parking areas around the facility.

To learn more about preventing slips, trips, and falls, view these OSHA recommendations.

Our experience and research reveal that your facility can significantly lower your risk of workers’ comp claims by focusing on the two most common types of nursing home injuries — lifting and repositioning, as well as slips, trips, and falls. The guidelines covered here will get you started but in no way represent everything you need to do. After all, it’s not enough simply to develop policies around the issues. You also need to enforce them.

If you need assistance developing and implementing an effective safety program, PSA’s Healthcare Risk Solutions team can help. Reach out to me at, and stay tuned for my next post about workers’ compensation due diligence.