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

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

New safety campaign – making the invisible visible

hi res moving cement vwaThe last week of October each year is Safe Work Australia Week.  This theme is enacted in each State with their own resources and events.  WorkSafe Victoria is one of the more active of the state regulators and 2009 seems no different.

On 13 September 2009, WorkSafe Victoria will launch a new campaign of graphic advertisements but what makes these different is the injuries result from “simple” work activities.  They are not in high-risk industries where workers may perform high-risk tasks.  These ads concern the (mis)use of an office chair, lifting a bag from a pallet, not using the stairs, slipping on a wet floor and lifting a person.

hi res office chair vwaThere has always been the challenge of how to generate interest in manual handling injuries as they are internal or invisible, and cumulative.  WorkSafe has done well by illustrating the physical consequences of what many dismiss as “taking a fall”.  In fact, the images that are less confronting than the noise of the bones breaking or the hernia appearing.

WorkSafe’s Executive Director, John Merritt, describes the campaign this way

“There’s no ‘blood on the floor’ or spectacular images on the nightly TV news or in the morning paper, yet the consequences of these injuries are enormous for individuals, their loved ones and their employers.

“For business, the average cost of treating these people through Victoria’s workers compensation system averages $45,000 per claim.

“Individuals lose quality of life and many, the capacity to work for at least a short period, some require surgery or have permanent pain and never fully recover.

“For employers productivity is cut, there may be staff replacement costs, retraining and safety improvements to be made after the event. Industries lose people permanently.

“Identifying and preventing these issues has benefits for all.”

Merritt also provides the statistic that  60% of all reported workplace injuries* – more than 17,000 a year in Victoria – involve manual handling.

The new campaign is graphic but it is hard to see how the total costs – social, personal and business – could have been described better.  Having a worker clutch their lower back and grimace with pain has been seen in campaigns and images repeatedly for decades and a new approach was needed.  Making the invisible visible should help.

Kevin Jones

* Based on Victorian Workers compensation claims where people are off work 10 days or more and / or medical treatment costs in excess of $520.

Lawyers identify contentious OHS law elements

The Safety Conference scheduled for Sydney at the end of October 2009 has finally got an OHS issue that is contentious and is also a work in progress.  The unions are starting to make noise on the OHS laws.  The employer groups are manoeuvring cautiously.  The safety professionals are largely silent (again) but the lawyers – the group with perhaps the most to gain from the new harmonised OHS laws – are set to analyse and debate.

A media statement from the conference promoters was distributed on September 8 2009 and, very differently from most media releases, is informative without being pushy.  Below is the body of that statement:

Three issues are set to dominate discussion: the burden of proof, the personal liability of company officers, and the impact on prosecutions. Neil Foster, senior law lecturer from the University of Newcastle, believes personal liability is at the heart of the changes.

“The harmonisation process seems to have been driven by directors’ fears of personal liability and the hope that there would be some watering down of the laws,” he says.  “In my view, the Model Act inappropriately waters down the personal responsibility of company officers, although I do support some of the proposed changes in this area, including the acknowledgement that the officer has obligations to exercise due diligence to protect the workers. But with the change to the current onus of proof provisions, it is quite possible that guilty people will now escape justice.”

Michael Tooma of Deacons law firm, who will moderate The Safety Conference’s harmonisation panel discussion, says that while current state laws differ in their approach to the approach to personal liability of officers, all will be reshaped by the proposed Model Act.

“Despite the range of liabilities, all have one thing in common: the officer will be personally liable only if their company commits an offence,” Mr Tooma says. “The new regime does not require this.”

“Under the approved recommendations for the new OHS laws, officers will be liable if they fail to exercise due diligence. That is, the duty has been recast as a positive obligation on officers to proactively ensure compliance with OHS laws rather than an attributed liability in the event of a breach by the company. This is a landmark shift in approach which will have a significant impact on OHS enforcement and compliance.”

The definition of “due diligence” may also be contentious.

“The Workplace Relations Ministers’ Council (WRMC) did not approve the recommendation for a definition of due diligence,” Mr Tooma says. “The Committee had recommended that due diligence be defined in line with existing case law on its meaning, drawn largely from NSW where the term has been in use for almost 30 years.”

“Instead, WRMC preferred to rely on the Courts to interpret due diligence. Practically, that means that the true harmonisation of the scope of the personal liability of officers may have some way to go as each State Court and Territory Court attempts to interpret due diligence in the context of the case before it until a case is brought to the High Court so that an authoritative determination of that term is made which is binding on all state and territory Courts.”

Michael Selinger of Holding Redlich Lawyers points out that company officers found guilty will face increased penalties, rising from the from the current maximum in NSW of two years in prison or fines of $55,000 to fines of up to $600,000 for an individual and five years in prison.

New South Wales employers, however, may enjoy some relief as the burden of proof shifts to prosecutors.

“The new Model Act will have a more significant impact on New South Wales employers than those in any other states because the Model Act is largely based on the Victorian and Queensland Acts,” says Mr Selinger.

“For New South Wales, the onus of proof will move away from the employer as a result of the inclusion of the qualifier of ‘reasonably practicable’ in the general duty to ensure safety under the Act. When it comes to proving liability, the prosecutor will now need to show the employer has not taken all reasonable steps to prevent injury.

“In 95 per cent of cases, shifting the burden of proof to the prosecutor won’t affect the outcome. This is because when an injury occurs, employers examine the workplace to see what actions need to be taken to prevent a recurrence – by doing that, they show that there were reasonable steps that could have been taken, which makes it easier for the prosecution to prove liability. To some extent, there’s always been this tension between trying to improve the safety system and protecting your legal position.”

“The legislation in NSW has historically been enforced more vigorously than in other jurisdictions but most OH&S regulators only initiate a prosecution if it is in the public interest and they have a good prospect of success. Under the new Act, there’s likely to be more of an emphasis on education and cooperation between the regulator and business. We won’t really know the answer to whether there’s likely to be fewer prosecutions until the new Act is implemented – at the end of the day, how it is enforced will be the key factor. The regulator will still have plenty of enforcement tools and there is likely to be a uniform enforcement policy applied across the country.”

On the other hand, Neil Foster believes the onus of proof belongs with employers.

“The Model Act has been legitimately described as ‘a race to the bottom’,” Mr Foster says. “The onus of proof should be placed on employers because they have the greatest control over safety: how hard people work; safety procedures; how money is spent; and safety policies. There is still a lot of carelessness in workplaces and WorkCover sensibly doesn’t launch prosecutions unless there’s a good chance the employer is guilty and hasn’t taken reasonable precautions. I think the NSW safety system has been working well.”

Scarlet Reid, special counsel for Henry Davis York says the impact of reversing the onus of proof is uncertain.

“From a practical perspective, this could make convictions more difficult to obtain in New South Wales,” she says.  “In the absence of any changes that stipulate which courts hear prosecutions at first instance, it remains to be seen if this is in fact the case. It is questionable as to whether real uniformity can be achieved without examining this important issue.”

Ms Reid says employers were likely to benefit from other changes under the proposed Model Act.

“Defendants in NSW and Queensland should benefit from the proposed expanded appeal rights,” she says. “Defendants in NSW may also find comfort in the proposal to abolish the prosecutor’s right to appeal against an acquittal.”

If employers are winners under the changes, unions, who will lose the right to launch prosecutions, protest vigorously against the proposed Model Act, claiming it would be detrimental to safety. Neil Foster agrees.

“The changes to be brought in under the harmonisation process send a message from government to employers: safety’s been too tough and that we’re not so worried about it anymore. It’s very sad.”

Kevin Jones

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