Employee injury/illness rates in nursing and residential care 3X national average

Nursing and Residential Care Employee Health and Safety at a Glance

  • Smallest worker population (3.4 million) within the healthcare sector
  • Under-inspected by OSHA, but heavily targeted this year
  • Injury and illness rates up to triple the U.S. average
  • At least 732,850 work days lost from 69,590 lost-time injuries in 2011
  • $4.8 billion spent on injuries, requiring $48.1 billion in patient billing to offset


Healthcare workers represented approximately 12% of the 2011 U.S. workforce (126 million) and included 15.2 million professionals, technicians, support workers and others not directly providing patient care (i.e., maintenance and laundry). Steadily growing, the healthcare worker population already far exceeds that of the manufacturing sector (11.6 million). Nursing and Residential Care (NAICS 623) reported a 2011 worker population of 3.4 million, including private and state and local government facilities.

In FY2012, federal OSHA conducted 519 inspections (1.1% of their total done) on Nursing and Residential Care facilities, while state programs conducted 880 (1.6% of their total done). Though trending upward, the numbers of inspections are very low for the workforce size. Based strictly on worker population, at 2.7% of the 2011 U.S. workforce (assuming no change in 2012) Nursing and Residential Care facilities would have experienced 2,781 of the 102,990 federal and state OSHA inspections conducted. They received only half that amount.

The low rate of inspection is not due to good safety performance. Nursing and Residential Care facilities recorded injury and illness case rates of up to more than triple the FY2011 U.S. average for all industries, with state facilities by far the highest.

A closer look at the data reveals that in 2011 the most frequently injured Nursing and Residential Care employee was a 45-54 year old female with 1-5 years on the job. She was on duty 2-4 hours between 8:01 a.m. and noon on Monday before being injured and most likely sprained or strained her back from overexertion during patient handling. Just behind that were falls onto floors.

Time lost from Days Away injuries was significant. Based on the lowest end of the ranges reported by BLS, Nursing and Residential Care lost at least 732,850 work days in 2011 from their 69,590 DART-related injuries. The median time lost was five days per injury, with over 20% of those injured out for 31 days or more.

Loading Days Away injury data into the OSHA “$afety Pays” calculator produces an estimate of the direct and indirect cost of injuries along with the amount of additional sales needed (based on a given profit margin) to recover those losses. In 2011, Nursing and Residential Care facilities spent $4.8 billion on injuries, requiring $48.1 billion in sales to offset (at a reported 10% profit).

Of course these sales are actually patient billing, so where to find the savings? Eliminating staff is not the answer, since most of these injuries came as a result of overexertion, often from a lack of staff and/or expertise to do the heavy lifting (pun intended). Forcing even fewer staff (mostly female nurses) to do more only exacerbates the issue. Is the answer simply to raise fees?

The 2012 Genworth Cost of Care Survey of nearly 15,300 providers found that the median annual rate for a private nursing home room ($81,030) reflects a 4.3% annual increase since 2007. With demands for healthcare reform making daily headlines, the idea of a $48.1 billion cost increase to pay for injuries that largely should not be happening seems untenable.

A sign of the emerging link between worker and patient safety, infection control officially became an OSHA issue when the agency published a Request for Information (RFI) in 2010 to collect information from the healthcare industry on “occupational exposure to infectious agents in settings where healthcare is provided.” In the RFI, OSHA described healthcare as having “a weak culture of worker safety” related to a lack of data on the prevalence of infections among healthcare workers (HCWs) and “a lack of effort by healthcare employers” in tracking or documenting them. OSHA thinks too many HCWs are getting sick at work and that voluntary standards are not working, largely due to poor safety programs and lack of regulatory oversight. OSHA observed in the RFI that infectious agents are transmitted between employees and patients and that the RFI was intended to evaluate whether and how OSHA might intervene to manage the issue. Comments remain under review.

In March 2013, federal OSHA sent letters to 9,413 workplaces experiencing high rates of Days Away from Work, Restricted or Transferred (DART) injuries and illnesses. Recipients of the letters had recorded FY2011 DART case rates higher than their respective sector averages. Employers were told to develop better safety and health plans, to seek expert advice if needed to do that and that they might be targeted for inspection. Of the 1,218 received by Healthcare, 97.5% (1,187) went to Nursing and Residential Care facilities.

A 2012 Nursing Home NEP (National Emphasis Plan) will focus for three years on ergonomics hazards related to patient handling, exposures to bloodborne pathogens, TB and slips, trips and falls. Under the NEP approximately 1,000 nursing homes with DART incidence rates greater than 10 are targeted for inspection by specially trained teams. Enforcement for ergonomics hazards will be under the general duty clause

Nursing and Residential Care pays dearly in human and economic capital for lack of safety culture, which brings us to investing in safety. Losing $4.8 billion and over 700,000 work days per year on tens of thousands of lost-time injuries makes a strong argument that finding money to pay for a safety program is the easy part. Finding the will to do it? That’s safety culture in the making.

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UL empowers healthcare organizations to maximize the efficiency of employee safety programs, reduce workplace incidents and strengthen the safety culture.