A list of the most dangerous jobs in Rhode Island must look something like this: factory worker; construction worker; trucker; fisherman. Right?
Those jobs are indeed unsafe, according to occupational health and safety data for Rhode Island – but there’s another occupation that has them beat. You want truly harrowing and risky work? Try being an aide in a nursing home in Rhode Island.
Nursing aides, orderlies and attendants top the list of the most dangerous jobs in Rhode Island, in terms of sheer numbers of workdays lost because of injury and illness.
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Of 9,169 total workdays lost to injury or illness in Rhode Island in 2000, 619 days were recorded for nursing aides and others who work in nursing homes, according to the U.S. Occupational Safety & Health Administration.
The danger of working in nursing homes doesn’t only exist in Rhode Island. Nationally, the rate of injury and illness in the nursing care industry is about 21/2 times that of all other general industries.
OSHA doesn’t break down this data to the state level, but other statistics here roughly reflect the national numbers. Earlier this year, when OSHA informed 157 employers in the Ocean State that their injury and illness rate is too high, 43 of the businesses contacted were skilled nursing care facilities – that’s 36.5 percent of all workplaces in Rhode Island considered too dangerous by the federal government.
"This is a hazardous industry. It’s a concern to our members and to the older adults that they serve," said Bruce Rosenthal, spokesman for the American Association of Homes and Services for the Aging, in Washington, D.C. "When people see the numbers they don’t understand why an indoor job has such high rates of injury. What throws people off, generally, is they don’t think of it as a chemical facility or a mining job, or what have you. People think, ‘it’s an indoor job. How can it be dangerous?’"
A combination of factors makes working in a nursing home so dangerous, according to OSHA data: Nursing aides and other attendants most often hurt themselves lifting people. They routinely trip, slip or fall. They get tuberculosis and sometimes HIV at higher rates than in any other occupation. And rarely, but at higher rates than in almost any other job, they get pinched, punched, stabbed or shot at.
The dangerous nature of work in nursing homes is so great that the federal government is trying to fix the problem. On July 15, OSHA announced a new national program to focus outreach efforts and begin inspections nursing homes with high rates of injury and illness nationwide. As part of the program, this year OSHA will be in Rhode Island inspecting nursing care facilities that had 14 or more injuries or illnesses resulting in lost work days for every 100 full-time workers.
An OSHA spokesman would not release the names of the facilities on the program’s list. But 43 nursing homes here recorded at least eight workdays lost per 100 workers to injuries or illnesses, according to OSHA. According to data from the Bureau of Labor Statistics, the national average lost workday rate because of injury and illness in private industry was 3. Nationwide, nursing and personal care facilities experienced an average rate of 7.9.
The federal inspections of nursing homes here will start on Sept. 17, said an OSHA spokesman.
Seventy-two percent of all injury cases involving days away from work in the nursing home industry resulted from lifting someone, according to national data. Just over 53 percent of injuries involve some other form of overexertion, and 18.6 percent result from slips, trips and falls.
And workplace violence is a recognized hazard in nursing and personal care facilities. In 2000, data from the U.S. Bureau of Labor Statistics recorded 3,702 occupational injuries involving days away from work in the industry that were attributable to violence inflicted on staff. From 1992 – 2000, there were 29 homicides in the industry.
David Cookson, supervisor in loss prevention for The Beacon Mutual Insurance Co., which insures more than half of all nursing care facilities in Rhode Island, said that insurance claims from nursing aides for injuries from some form of physical abuse are second only to injuries involving lifting patients.
"Direct care-giving to Alzheimer patients and other people who are physically resistant can often lead to injury," he said.
Lastly, employees working in the nursing care industry have been identified by the Centers for Disease Control and Prevention as having a high incidence of exposure to tuberculosis, HIV and other pathogens.
Some in the industry say workplace conditions have actually improved in nursing homes in recent years, with an increased focus on safety. Today more than ever, nursing aides are using hydraulic lifts and pivot discs to move patients, and using safety needle systems and wearing disposable gloves and goggles when administering shots.
"In the last couple of years, there’s been a lot more awareness. It’s a problem much less than it used to be," said Deborah Medeiros, director of nursing at Crestwood Nursing Convalescent Home in Warren. "Twenty five years ago, we just used to lift people up and put them in a chair. Now we use hydraulic lifts. I can remember needle sticks quite a few years ago, but I can’t think of a single needle stick in the last four or five years."
Still, the very low level of occupational health and safety in the nursing and home care industry is a problem that threatens the health of the entire industry, said Rosenthal.
In recent years, the industry has experienced a decrease in staffing and an increase in the number of patients under nurse’s care. Lost workdays because of injury just compound a critical shortage of caregivers in nursing homes, he said.
"Everybody’s harried, running to keep up with our work load. I think they’re overworked," said Gen Francis, administrator and owner of Bay Towers Nursing Center, Inc., in Providence. Francis said she is at work each day at 4:30 a.m., and usually leaves work about 4:30 p.m.
"It’s a tough job, and it’s getting tougher," she said.
