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Workers' compensation issues in long-term care

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Major reforms to California's workers' compensation system over the past four years have had a significant impact on compensation rates and medical and indemnity losses.

A February 2006 report by California's Commission on Health and Safety and Workers' Compensation found that the rating schedule reduced average permanent disability awards by 50 percent. Despite this good news for employers, in 2006 legislation was introduced that sought to increase disability benefits. According to a preliminary review by the Workers' Compensation Insurance Rating Bureau, this measure would have doubled permanent disability payments over three years and increased the total system costs by a cumulative 16.6 percent by 2009. While the governor vetoed this measure last year, debate, court cases and additional legislation over the matter will surely continue.

For the home health care industry, the changes to the workers' compensation system were long overdue. In an industry where patient well being is seen as primary to worker safety, workers' compensation costs are sometimes ignored. The issue will become more important as baby boomers age and utilize more health care services. As our utilization of home health workers increases, we need to explore now why the well being of home health care workers isn't a priority, and what we can do to ensure their safety and reduce workers' compensation costs.

The home health care industry is one of the fastest growing, with the number of home health care workers expected to grow by 70 percent by 2014. Workers' compensation claims will also increase along with growth in the industry, and dealing with safety issues in private residences will be of great concern.

With more and more Americans requiring long-term care, and in-home health care workers being employed to take care of them, are appropriate measures being implemented to take care of the caregivers? Not so, according to research conducted by the University of Iowa.

Peggie Smith, a University of Iowa law professor and an expert in employment law, has found that home health care workers are protected by few of the federal labor standards that other workers in America take for granted. Because of the difficulty in trying to regulate the workplace standards of a private home, government agencies largely ignore home health care workers.

Although the risks and exposures of home health are not unlike those of hospitals or other facilities, standardizing and managing a private residence is extremely difficult, if not impossible. Long-term care and home health workers spend a great amount of energy lifting clients into and out of their beds. This activity can lead to severe musculoskeletal injuries, and represents the No. 1 cause of workers' compensation claims in health care facilities. Smith also cites a study that shows home health workers experience back injuries at a rate nearly three times that of nursing aides in hospital or nursing home settings.

Because workers in nursing homes or hospitals can gain assistance from their co-workers and have access to lifting devices, workers' compensation claims are less frequent. Unfortunately, some hospitals and other facilities that can afford lifting devices do not use them. Experts advise that in order to ensure that lifting devices adequately protect health care workers and that the investment has been worthwhile, health care facilities must make certain that staff members are trained, equipment is properly maintained and the program is monitored. California lawmakers approved a bill in 2006 that would have made lifting equipment mandatory, but it was vetoed by Gov. Schwarzenegger, since many hospitals already have such equipment.

For hospitals and nursing homes that can afford expensive lifting equipment, workers' compensation savings can be significant. A 2004 study cited by the National Institute of Occupational Safety and Health found it cost $160,000 to install lifting equipment and train staff, but the facilities recouped the costs in less than three years in the form of lower workers' compensation payments.

Another way to help curb workers' compensation costs in the home health and long-term care industry is exercise. A recent study of hospital staff and industrial workers suffering from chronic injuries measured the success of different interventions including workplace adjustments, biofeedback, relaxation, exercise and other adjustments. The results concluded that exercise appeared most helpful to people suffering from chronic complaints of the arm, neck or shoulder. Although workplace and other ergonomic adjustments are also important, home health care workers who do not have the luxury of an adjustable workplace may see the most improvements from exercising and proper lifting techniques.

Although many of the legislative changes are outside the control of risk managers, it is important to realize that proper safety equipment, lifting techniques and exercise can help lower your total cost of risk. Ultimately, as the population ages and the demand for quality home health care increases, risk managers will also have to address a growing concern over workers' compensation claims.

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