Ergonomics: Nursing Home Case Study
Ergonomics: Guidelines for Nursing Homes
Appendix - A Nursing Home Case Study
Wyandot County Nursing Home used a process that reflects many of the recommendations in these guidelines to address safety and health concerns and phase-in its current program that entails no manual lifting of residents. First and foremost, Wyandot's administrator provided strong commitment and support in addressing the home's problems. He also involved Wyandot's workers in every phase of the effort. He talked to his employees, learned about stressful parts of their jobs, and then found solutions. He and his employees identified existing and potential sources of injury at the home and worked to implement solutions. He trained employees each time the nursing home introduced new equipment. He continually checked new equipment, and he continues to evaluate the overall effectiveness of his safety and health efforts.
This case study was developed from information provided by Wyandot County Nursing Home. OSHA visited the nursing home to discuss the ergonomics program with the nursing home administrator, observe ergonomics corrective actions, and talk to employees, residents, and family members about their experiences.
Wyandot is located in Upper Sandusky, Ohio. It is a 100-bed, county-run facility that has served Wyandot County in its present building for the past 28 years. It is divided into two sections to serve residents with different levels of need. The A-Wing, with 32 rooms, serves residents who are mostly ambulatory and require only a minimum of help with daily living. In the B-and C-Wings, with 32 double rooms and four private ones, residents receive care that ranges from extensive to total. Wyandot has 90 employees, 45 of whom are nursing assistants. This makes for a nursing staff ratio of 2.4 hours for each resident per day.
Before Wyandot implemented its ergonomics program, the home was experiencing problems that were a growing concern to both the county and Wyandot's administrator. According to Wyandot, workers' compensation costs averaged almost $140,000 from 1995-1997. The turnover rate among nursing assistants averaged over 55 percent during that same time period. This meant that of the 45 nursing assistants working at Wyandot, on average 25 new ones had to be hired each year.
Wyandot's administrator began to look for more effective ways to address injuries among workers and the high turnover rate. A back injury suffered by a worker that cost Wyandot $240,000 in workers' compensation expenses provided significant motivation to find a strategy that would work. As Wyandot's administrator investigated that injury, he also examined other sources of potential injury within the home. In doing so, he learned that resident transfer and repositioning tasks presented high risks for injuries.
He called on the Ohio Bureau of Workers' Compensation (OBWC), for help because he thought Wyandot was following best practices and people were still being injured. An OBWC ergonomist visited the home and told him that he had unrealistic expectations about his nursing staff's ability to manually lift and reposition residents.
Wyandot's administrator thought that he could better use his existing staff. After hearing about a "no lift" policy and seeing an impressive demonstration of mechanical lifts at an industry conference, he began to consider setting up a program at Wyandot. He became convinced that such a program would keep employees safer and help slow the turnover rate while ensuring safety and high quality care for residents.
He decided that the best approach was to involve employees at every level in reducing injuries and slowing the turnover rate. More than 30 workers volunteered to examine the tasks of moving and repositioning residents.
Wyandot employees concluded that better body mechanics -- the traditional method of lifting and transferring residents at most nursing homes -- was not the answer. In fact, he and his staff determined that there was no safe way to lift a resident other than with mechanical lifts. To determine what equipment would work best, Wyandot tried out various pieces of equipment, evaluated each lift, and then decided what would be most appropriate for Wyandot's needs.
With recommendations from employees, Wyandot's administrator bought several portable mechanical lifts for the B- and C-wings. These involved portable sit-to-stand lifts, walk/ambulating lifts, and total lifts. Nurses and assistants could move each of these from room to room as they worked with individual residents. However, many of the staff remained unconvinced of the value of using equipment. In fact, initially only the workers who had actually evaluated the lifts were using them.
According to Wyandot's administrator, it was very difficult getting workers to overcome their insistence on doing things the old way. Because many workers said it took too long to use the mechanical lifts, one of the co-charge nurses decided to do a time study. She wanted to test how long it took to lift a resident manually compared to using a mechanical lift. The mechanical lift took about 5 minutes. Meanwhile, to perform the manual lift, a nursing assistant first had to find someone to help. This took 15 minutes. Thus, the time study showed that using the equipment actually saved time.
One worker, who admitted that she did not initially use the sit-to-stand lift because it was a "hassle," reconsidered her opinion after an outbreak of the flu reduced the number of staff members available for assistance. In her words, "I was forced to use the lift. Awesome. It was just great. I was so sorry my fellow employees had to suffer with the flu bug to get me to use this contraption."
Wyandot's administrator also wanted to replace the old hand-crank beds at Wyandot with electric beds. To do this, he also needed to find beds that would be used in the "low-bed" system in place for many residents. There were not many options available, so he took his ideas and engineering background to a bed company and inquired about having beds designed to fit Wyandot's needs. The bed manufacturer designed the new beds to lift from the floor to a height of about 30 inches in 20 seconds. In addition, these fast beds were designed so that residents would be less likely to slide to the foot of the bed as they were raised to a sitting position. As a result, residents would not need to be repositioned. Also, the beds could be used with a gait-belt for ambulatory residents to assist them from a sitting to a standing position.
About three years after Wyandot began its ergonomics effort, the nursing home received a grant from the OBWC Division of Safety and Hygiene through an ergonomic emphasis program to deal with cumulative trauma disorders. The grant enabled Wyandot's administrator to purchase 58 fast electric beds, a turning point for staff acceptance. When the first ceiling lifts were installed seven months later, employees were ready to use them.
One nursing assistant, who has been with Wyandot for 19 years, explained why she liked the new beds so much. "We can quickly bring the bed up to our work height with a push of a button and we can reposition a resident . . . with ease without stooping or struggling."
The final phase of Wyandot's program began with the introduction of the ceiling lifts. Wyandot's administrator evaluated several ceiling lift systems. Wyandot chose a system with a motorized lift and a ceiling mounted track. Tracks were retrofitted into the rooms at a cost of about $12,000 for two double rooms and one bathroom. The first double room had a track that extended into the bathroom. However, newer systems used a transfer between the room and bathroom, which simplified the system and reduced costs.
Occupational Safety & Health Administration (OSHA)
200 Constitution Avenue, NW
Washington, DC 20210