Nursing home OHS – a 2001 interview with Kathleen Rockefeller

The last time I spoke with Kathleen Rockefeller was in 2001 on the eve of her speaking at a conference organised by the Ergonomics Society of Australia.  At that time Kathleen was a physical therapist and ergonomist within the Washington State Department of Labour & Industries.  Her latest profile says that she is now in Florida (via Chicago) as an Assistant Professor at the School of Physical Therapy & Rehabilitation Sciences at University of South Florida.

Rockefeller interview 2001_Page_1Kathleen’s career may have progressed (as probably has her tan) but the hazards and control solutions that we discussed in 2001, sadly remain relevant.  I have reproduced some of the interview I conducted with Kathleen in those early days when no-lift policies were radical and  patient-handling equipment was expensive and rare.

SAW: Around the world the no-lift policy is being introduced but why is that policy the most popular risk control measure?

KR: I don’t know where it actually originated or where the term “no-lift” came from. It’s a horrible term because everyone in healthcare knows that it is a little unrealistic. I think some people have been turned off by the name. I prefer to call it “low-lift” or “minimal-lift”.

Looking at the literature and research clearly shows that decreasing the amount of times per day that the human body has to act like a derrick is a good idea. Each episode exposes the body to forces of a magnitude high enough to potentially be injurious. Anyone who has nursed or worked in nursing homes knows that lifting is not the only activity that carries physical risk. There are tasks like leaning over the bed to delivering treatment to changing clothing, repositioning—these activities can be stressful as well. I wish it were simple to say “let’s get rid of the lifting” but it is an important first step.

SAW: In Australia the no-lift push came from the unions in order to push management to get into action on a whole range of manual handling issues.

KR: I’ve heard a rumour over here, and I don’t know how true it is, that the equipment manufacturers began using the term “zero-lift” but I really don’t know.

SAW: Your research shows that financial incentives were used to encourage the purchasing of new equipment. Were the incentives really necessary?

KR: Washington State is unique in the US in that the workers compensation insurance is handling by a State agency. So the insurance is handled by us unless the company meets the requirements for self-insurance. The agency has monitored the data and monitored the trends to try some initiatives with a number of different industries, nursing homes were chosen for a research project. They were hurting financially. A major reason for not buying lifting equipment was financial.

The agency decided to allocate some of their funds to the nursing home industry and to see if offering some of the funds allocated for injury prevention projects would help. The funds weren’t handouts but discounts on the workers’ compensation premium in return for investing in equipment and beginning a manual handling improvement process. The program was designed as a trial project to see what effect this type of incentive might have.

SAW: How applicable is your research to other States, given Washington’s unique processes?

KR: Many recommendations will be applicable as the program wasn’t just on the financial incentives. The study was a state-wide and industry wide look at how nursing homes were doing overall in implementing zero-lift programs. The research has identified the problems of implementing a large-scale intervention and we can all learn from these problems.

SAW: Other than manual handling what are the major OHS risks in nursing homes?

KR: Of course, patient handling has various tasks and the higher risks are certainly the physical transferring but also the repositioning, delivering incontinence care to residents, changing their clothing. The other thing I noticed in the homes while following nursing assistants and doing sampling is the total amount of time they stand or walk. I think that fatigue must be a contributing factor, both local muscle and total-body fatigue. There is very little recovery time. I knew this already but doing the research really emphasised this.

SAW: Did you observe a high stress level? Was resident violence an issue?

KR: Those are certainly issues as well. The issues of staffing and turnover is huge. The turnover for nursing assistants is an industry average of 100% a year and can go much higher. The constant turnover creates turmoil.

An unexpected element was the huge turnover in management personnel. This was striking. When you think of a facility trying to keep stable processes and procedures and the head person leaves within 3 years or even one year— that is a real problem.

I heard a lot from the nursing assistants and through the literature about the importance of knowing the residents. You mentioned potential problems with the residents but if you work with the resident for a while you get to know them and then you may be able to pick up warning signs on behaviour. If you’re a short term agency nurse and you don’t know the residents, it may increase your vulnerability.

SAW: Perhaps the no-lift policy has been introduced due to the throughput of staff rather than dealing with a root cause of the manual handling injuries? Perhaps because no-lift can give immediate results?

KR: Expecting a zero-lift program to have miraculous results in light of these other issues leading to instability is an unreal unrealistic expectation. I think introducing the program and getting it to work as best you can while at the same time, people who can affect change, maybe us baby boomers, need to start screaming very loudly because our parents are next.

Injuries related to manual handling have a number of causes and efforts to decrease these injuries require multi-faceted approaches. The point is well taken because if you are going to expect a zero-lift program in itself to have miraculous results in light of these other issues leading to problems and instability, it is not a realistic expectation.

Kevin Jones

Alarming statistics on young workers and compensation

Safe Work Australia has issued some important statistical reports on workplace injury statistics.  One statistic, in particular, stood out:

“…young workers aged 15 to 24 incurred much higher rates of injury than other age groups and were the least likely to apply for workers compensation”

The injury statistic is not surprising and is consistent with other data but why are young workers “least likely to apply for workers compensation”?  Are they unaware of their rights?  Do they work in a situation where claiming compensation is taboo?  Is illiteracy a deterrent?  Has their employer deterred them from applying?  Is their type of work illegal, casual, or in the black market?

SafetyAtWorkBlog asked Safe Work Australia, if not through workers compensation, how are young people funding their medical/rehabilitation costs.  A spokesperson provided the following non-age specific response:

“We are unable to provide an answer to this question as the data has not been analysed separately by age.

However, the last section of the report on workers’ compensation applications shows the various forms of financial assistance that all injured workers used.

For all injured workers, 34% received workers’ compensation, 39% did not access any financial assistance (these were mostly injuries involving no time lost from work) and the remaining 27% did access some form of assistance. Within this latter group regular sick leave was the most common.

Of the injured employees who did not access workers’ compensation, 18% used their regular sick leave, 9% accessed Medicare or other social security benefits, 7% had costs paid by their employer, 5% used other resources such as money from family and friends while 4% access private health insurance or income protection insurance.

Respondents to the survey could select more than one response to this question.”

Inverting some of these stats raises some concerns. (Please note that statistics is not the strongest skill of SafetyAtWorkBlog, so please correct any issues through the comments section below).

For all injured workers, 66% did not receive workers compensation. This should be a big red flag to OHS regulators and deserves more analysis.

Of the 66% over half  (57%) funded their injuries without recourse to health insurance, sick leave, employer contributions, support from family or friends, Medicare or social security.  Expanding the young worker question above to workers generally, how are these injured workers funding their rehabilitation from outside the regulated and social support mechanisms?

Some years ago SafetyAtWorkBlog attended an international conference on OHS.  There were many people at this Melbourne conference who spoke about the Asian and African countries where injured workers must rely on family, or other social security mechanisms, for an income, as workers’ compensation was non-existent.  This is one element of  economic integration into the Asian region that Australia should not be tolerating.

A spokesperson for Safe Work Australia told SafetyAtWorkBlog (read slowly as there are numbers involved):

“The survey estimated that 689,500 workers were injured at work during 2005-06. Of these, 625,900 were employees and hence eligible for workers’ compensation. However, 388,100 did not apply for compensation and 23,800 applied but did not receive compensation.

This means that 66% of injured employees did not receive compensation. While this equates to 60% of injured workers not receiving compensation it is not correct to use this figure as 12% of workers were not eligible for it.

Looking only at the 411 900 injured employees who did not apply for workers’ compensation

  • 75,700 accessed regular sick leave
  • 30,100 had their employer pay their costs
  • 35,500 used Medicare/social security
  • 18,200 used private health insurance/ income protection insurance, and
  • 18,700 accessed money from other sources such as family and friends.

Please note that when looking at these figures that 42% of injuries involved no time off from work and hence costs would be very small.

Analysis of additional data from the survey, that has not been included in this round of reports shows that over 60% of injured workers aged 15 to 24 felt their injury was too minor to claim or that they felt it was not necessary to claim. This is double the percentage for all workers. While this may sound like young people had more minor injuries, this is not the case. Young workers had the same proportion of injuries that involved no time off work as the workforce as a whole and the same proportion that involved longer periods of time off from work.”

The last paragraph cycles this article back to the start.

….over 60% of injured workers aged 15 to 24 felt their injury was too minor to claim or that they felt it was not necessary to claim. This is double the percentage for all workers.

There is something missing from how OHS is promoted to young workers.  The quote above indicates that young workers know about OHS but do not understand OHS.  But that’s not something that can be provided in a 30 minute TV ad, a medium that young people are increasingly less interested in.

Perhaps, we should be spending less time telling people not to stick their hands in a guillotine and more time empowering them in their workplace rights.

Kevin Jones

The harmonisation challenge in Australia gets more difficult

There are few motivations that are more effective for improving workplace safety than facing a grieving relative.

On 17 September 2009, the impact of the OHS law harmonisation on workers and their families came to the fore in an article in the Sydney Morning Herald (SMH) entitled “Deaths at work put sharper focus on liability”.  The workplace support advocates make a clear case for holding those who control the workplace accountable for injuries, illnesses and fatalities that occur in their businesses.

A letter sent to the Federal Minister for Workplace Relations, Julia Gillard, by the Workplace Tragedy Family Support Group reportedly says

”Dealing with a serious injury or the death of a family member is difficult, particularly if there is no sense of justice.  Employees must be able to seek justice against employers who do the wrong thing,” said the conveners’ letter.

Families wanted to know the responsible organisation had been held to account, the letter said.

Justice, but not revenge.  The avoidance of this justice and accountability through companies choosing to go out of business has been highlighted in New South Wales many times, so it is understandable that the reduction of the avenue to pursue justice that may occur in the OHS harmonisation process can generate such letters to politicians.

A significant element in the SMH article is the inclusion of the union perspective.  Trade unions often provide grieving relatives the only support, particularly in the period shortly after a workplace fatality.  And there is the shared grief of losing a loved one and losing an often long-serving union member.

This article and the letter to the Minister add an important emotional and social element to the development of the new national model OHS laws.  Whether the government will incorporate mechanisms to achieve justice in the legislative framework or in secondary processes could give a good indication to the broader political picture of workplace safety over the next decade.

Kevin Jones

Safety Leadership push in Queensland

Expect quite a few OHS statements coming from Australian politicians as the country approaches Safe Work Australia Week in late October 2009.

On 16 September 2009, the Queensland Attorney-General and Minister for Industrial Relations, Cameron Dick, sought support for a

“…groundbreaking new program to reduce workplace deaths and injuries.”

Groundbreaking? Not sure. Perhaps for Queensland.

According to his media statement the “Zero Harm at Work ” program “aims to reduce the shocking number of deaths and injuries in Queensland workplaces.”  Dick goes on to say

“Ensuring safety in the workplace is one of the most important challenges facing industry in Queensland… Every year around 100 Queenslanders are killed at work and 30,000 people suffer serious injuries or work related diseases.  The cost to our State of these tragic deaths and injuries is more than $5 billion a year.  And worst of all, mums, dads, husbands, wives and children are left mourning the family member that never came home from work.”

Dick hits the right targets in the media statement but does safety leadership, particularly these types of programs, stop incidents from occurring in the workplaces?

Or is the effect of these programs to have senior executives feel that they are reducing injuries because they are talking about safety?

SafetyAtWorkBlog has long believed that safety awareness does not necessarily equal the reduction of workplace injury and illness.  “Zero Harm” cannot be achieved without financial cost and it is unclear whether industry is willing to invest the amount of money required to genuinely achieve this aim.

But then if “zero harm” is only a goal, an aspiration, then it doesn’t matter if it is not achieved “at least we tried”.  (Or the total cynic would say “at least the voters saw that we tried”)

There are sure to be more such statements and launches in the next six weeks.  SafetyAtWorkBlog will be looking for evidence not aspirations.

Kevin Jones

When ATV helmets are “best practice”

A recent media statement from the New Zealand Department of Labour on all-terrain vehicle (ATV) safety is annoying and disappointing.

On 15 September 2009, the Palmerston North District Court today fined farmer Trevor Mark Schroder $25,000 and ordered him to pay reparation of $20,000 to his employee John Haar over an  ATV accident on 26 November 2008 that left Mr Haar with serious head injuries.

Dr Geraint Emry, the DoL Chief Adviser for Health and Safety, says

“…Mr Haar was riding an ATV supplied by Mr Schroder when he apparently drove into a wire used to direct cows into specific areas of the farm.  Mr Haar had not been wearing a helmet and the severity of his injuries increased as a consequence.  Nor had he been told that the wire he rode into had been put across the race.”

atvguide2 coverThe statement goes on to state

“The Agricultural Guidelines – Safe Use of ATVs on New Zealand Farms – advise that the wearing of helmets by quad bike riders is considered best practice.”

SafetyAtWorkBlog strongly knows that New Zealand is very active in ATV safety but finds it hard to believe that the “wearing of helmets…is considered best practice”.  This admits that, in using ATVs, personal protective equipment is the best hazard control option available.

The guidelines mentioned above are from 2003 and do mention ROPS:

“Until such time as there is evidence to the contrary, farmers have the right to choose whether or not they fit ROPS to their ATVs.”

The NZ DoL and, by inference, the Chief Adviser are quoting a 2003 guideline as best practice in 2009?!

Relying on helmets may be the reality but is also an admission of defeat with ATV designers and manufacturer.  In many circumstances ATVs cannot be fitted with roll-over protective structures (ROPS) due to the nature of the work – orcharding for example.  But Australia and New Zealand insist on ROPS for tractors, with similar criteria and exceptions to ATVs.

VWA Farm_ROPs coverIn one ROPS FAQ from the NZ DoL it says

“Evidence both in New Zealand and overseas has shown that the risk of injury in a tractor overturn can be substantially reduced when the tractor is fitted with ROPS of the appropriate standard.”

and

“Where the nature of the operation makes it not practical for ROPS to be fitted to an agricultural tractor, then, under the terms of this code of practice, the General Manager, Occupational Safety & Health Service, may issue a notice excluding the tractor from the requirement to have a ROPS.”

Some States in Australia have had rebate schemes for ROPS for many years.

It is suggested that a better level of driver protection from rollovers is evident on forklifts through the use of seatbelt and an integrated protective structure.  Applying logic to safety is fraught with danger but the rollover hazard is the same whether in a warehouse or a paddock and having only a helmet for a forklift driver would be absurd and unacceptable.  Why is only a helmet considered best practice for ATV drivers?

Rather than comparing ATVs to motorcycles as in this 2003 report, the comparison should be between ATVs and tractors or, maybe, forklifts.

The New Zealand Transport Agency says this about ROPS and ATVs in June 2008:

Many ATVs have a high centre of gravity, and are prone to tipping over when cornering or being driven on a slope. Rollover is the leading cause of injury associated with ATVs – riders can be crushed or trapped under an overturned machine.

If you attach a rollover protection structure (ROPS) to your ATV, make sure it’s securely fastened, doesn’t interfere with rider mobility and doesn’t raise the ATV’s centre of gravity. Contact OSH for guidelines on how to fit ROPS safely, and make sure the ROPS is strong enough to protect you.

So why aren’t ROPS considered best practice by the DoL?

The ATV injury case quoted above is unlikely to have occurred if the ATV had some form of structure around the driver or, admittedly, the wire was more visible or known to the driver.  The relevance in this case was that the helmet most probably reduced the severity of the injury but would not have avoided contact with the wire.

Research is occurring on ROPS for ATVs but the rollover hazard has existed for as long as ATVs have existed.  Are ATVs simply unsuitable for the work they are being used for?  Is the design wrong for workplace use?  Are they being advertised or promoted for inappropriate use?  Should farm workers be encouraged legislatively or financially to fit ROPS?  Perhaps the only safe ATV is a tractor?

Is the requirement for ROPS for tractors, but only helmets for ATVs, an acceptable double standard for workplace safety?

Kevin Jones

Principal Contractor duties clarified in the High Court of Australia

Managing contract labour is almost always a pain.  The extension of OHS obligations through the “supply chain” has not helped although it was intended to.

Companies have been expected to treat contractors as employees for the sake of OHS obligations.  This was intended to generate a cultural change where a certain safety standard was extended through the links of project management.  To some extent safety awareness in the small suppliers of services to large companies and projects has improved.  But whether that safety awareness has changed to an active safety management or simply a belief that OHS is an unavoidable evil is debatable.

Regardless of the reality, the High Court of Australia recently provided some clarification on the duty of care of a principal contractor.  According to a summary of the High Court decision, Australian law firm Allens Arthur Robinson report that

“The High Court’s decision means that a ‘principal contractor’ does not have a common law duty to train or supervise the employees of specialist subcontractors in the specifics of their work.”

The High Court acknowledged that this may not relate to the New South Wales legislative situation but it is an important decision for the harmonised future of Australian OHS Law.

What it also indicates is the length of time it can take for a legal concept to be clarified and, hopefully, defined.  What does a company do in the meantime?  This is important for businesses to consider as the OHS law moves into a new national regime where individual State jurisdictions are expected to provide clarity on the legislative vagaries of “reasonably practicable”.  The government seems to be comfortable that the legal processes (cost and time) are worth the flexibility offered in OHS law.  Some see flexibility, others may see confusion, complexity and the need to reeducate.

Kevin Jones

The changing asbestos campaigns

As the incidence of asbestos-related diseases increases, the issues associated with asbestos have evolved beyond occupational health and safety.

The corporate conduct of James Hardie Industries and the prosecuting of its directors by the Australian Government had asbestos as the product around which corporate misbehaviour occurred.   The prosecution has not improved the lot of the victims.  The compensation fund which the director’s lied about will still be inadequate to deal with work-related claims.

Asbestos has become a true public-health hazard and issue, in a similar way that lead went from work to the community or even, perhaps, how cigarette smoke went from the personal to the public.  Increasingly, useful results will be gained from lobbying the government through the public health sphere rather than through OHS.

Today in Tasmania, Matt Peacock‘s book called “Killer Company” was launched with the support of the Australian Workers’ Union.  According to a media release in support of the event, the AWU National Secretary Paul Howes will “call for the creation of a federal National Asbestos Taskforce to manage the prioritised recall of all asbestos containing materials in all forms from the nation.”

Howes says

“The Federal Government must establish a national body with a regulatory mandate to map priority areas for asbestos product removal, such as schools and public places, and oversee its careful and total removal.”

“A National Asbestos Taskforce could facilitate and resource an Asbestos Summit, to bring together industry leaders, regulatory bodies and the nation’s top medical asbestos disease experts. Together with Governments, state, federal and local, such a summit could identify urgent priority areas for asbestos removal and develop a national strategy to deal with this ‘slow burn’ national emergency once and for all.”

Businesses in Australia must have an asbestos register but Paul Howes is also calling for

“…the establishment of a National Asbestos Register for all Australians ill from, or exposed to asbestos. He will also call for the establishment of a Register of all priority areas linked to a national Asbestos Present in Buildings Register.”

“We believe that [an] actuarial study will show that it is cheaper to remove asbestos containing materials completely from Australia, than fund the extraordinary medical cost of treating thousands of Australians contracting very serious asbestos-related disease over some decades to come.”

Unions have a proud history of effecting social change.  Asbestos fits this tradition as it concerns the spread of a manufacturing component that is, arguably, going to have more of a social cost than it ever had as a social benefit.

There is enough of a social awareness of the complexity of issues related to asbestos that traction should be achievable with the government on a public health scheme.  The challenge for the union movement and asbestos-safety advocates is that the campaigns still need to convince the whole community that this cannot be dismissed as a “union issue” but is a public health issue “championed by the unions”.

As more and more cases of asbestosis and mesothelioma start appearing in people who have not been involved in manufacturing or using asbestos, or washing the dust out of clothing, or living near asbestos mines, the seriousness of the health hazard will become evident.  But we should not have to wait till then and a socially-aware government as the Rudd Labor Government in Australia claims to be should be able to acknowledge the sins and mistakes of the past and plan for the future, as it has done on other social concerns.

Kevin Jones

A video and audio interview with Matt Peacock is available online .

UPDATE: 17 September 2009

Tasmania’s Minister for Workplace Relations, Lisa Singh, has released a media statement about her launch of Matt Peacock’s book.  In the statement she outlines her government’s action on asbestos:

“Shortly after becoming the Minister for Workplace Relations, I arranged a forum on Asbestos which was held by Workplace Standards on the 18th of March this year.

“A whole of Government Steering Committee was established following the forum and will make recommendations to me later this year.

The Committee is considering a range of issues including prioritised removal, mandatory reporting and disclosure, disposal, current legal and compensation issues and community awareness and education.

An audio report on the call for asbestos registers by the AWU  was in the ABC Radio program AM on 17 September 2009 and is available online.

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