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Safe Resident Handling       Long Term Care

Did you know?      

That in 2007 nursing aides, orderlies, and attendants had a Musculoskeletal Strain Disorder (MSDs) rate of 252 cases per 10,000 workers, a rate more than seven times the national MSD average for all occupations in the USA. In 2010, nursing and residential care facilities continued to experience one of the highest rates of lost workdays due to injuries and illnesses of all major American industries that is 2.3 times higher than that of all private industry as a whole. The data further indicate that an overwhelming proportion of the injuries within this sector were attributed to overexertion as well as to slips, trips and falls (OSHA, 2012).

In Oregon:

MSDs accounted for half of all accepted disabling claims (ADCs) in Oregon health care between 2001 and 2005.  Patient handling MSDs made up 27.4% of total ADCs. Nurse aids comprised 32.6% of total ADCs, registered nurses 14.2% and other health aides 5.9% from 2001 through 2005 (Accepted Disabling Claims in Health Care, Oregon, 2001-005,” Oregon DCBS, IMD, July 2007)


Back injuries due to manual patient handling are the #1 injury cause of MSDs in Long Term Care. Workers in nursing homes are twice as likely as other workers to be injured on the job (OSHA, 2009).


Are Retention and Recruitment of Caring and Experienced Direct Care Staff Important to You?   Then a safe and healthy work environment should be one of your top priorities.


According to the The Future Supply of Long-Term Care Workers in relation to The Aging Baby Boom Generation Report to Congress, May 14, 2003,  Factors associated with shortage and recommendations include: “Working Conditions: Hours, Paperwork, Respect, and Safety:  Workers in many long-term care settings complain about long hours, high case loads, burdensome paperwork, lack of respect, and potential dangers to their own health and safety. Improving these working conditions has the potential to improve the retention of workers in long-term care settings and to make these occupations more attractive to new workers.


In April, 2012 the U.S. Department of Labor's Occupational Safety and Health Administration OSHA)  announced a new National Emphasis Program (NEP) for Nursing and Residential Care Facilities to protect workers from serious safety and health hazards that are common in medical industries. Through this NEP, OSHA will target nursing homes and residential care facilities in an effort to reduce occupational illnesses and injuries. OSHA will target facilities with a days away, restricted, transfer (DART) rate of 10 or higher per 100 full-time workers. For information go to http://www.osha.gov/SLTC/nursinghome/enforcement.html


Oregon OSHA State Emphasis program which has been in effective since Dec 2011 is now converted to the Federal OSHA NEP. To view the Oregon OSHA directive go to http://www.orosha.org/pdf/pds/pd-284.pdf


This page provides resources for you to develop a Safe Resident/Patient Handling program for your Long Term Care Facility including Nursing Homes, Assisted Living Facilities, Adult Foster Homes and Care Centers

On this page:

Guidelines & Toolkits for Implementing SRH Programs

White Papers


Other Resources

Also refer to Resources on the Bariatrics Pages

Guidelines and Toolkits for Implementing SRH Programs

 ANA National Safe Patient Handling and Mobility Standards and Implementation Guide


Guidelines for Nursing Homes: Ergonomics for the Prevention of Musculoskeletal Disorders 2003 (rev 2009.) from Federal OSHA. This publication provides recommendations for nursing home employers to help reduce the number and severity of work-related musculoskeletal disorders (MSDs) in their facilities.


 Preventing back injuries in nursing homes (2004).  Case studies from NIOSH


Safe Lifting and Movement of Nursing Home Residents from NIOSH.

     This website and associated publications provides recommendations for nursing home owners, administrators, nurse managers, safety and health professionals, and workers who are interested in establishing a safe resident lifting program.

Ergonomics Best Practices for Extended-Care Facilities from the Ohio Bureau for Workers Compensation

Injury Prevention Resources for Health Care - Patient Handling WorkSafeBC  Extensive resources related to patient handling in Acute Care, Long Term Care and Home Health. Includes video and PowerPoint training tools New Jan 2013

Click here to access a variety of tools to assist with implementing a SPH program from the VA Sunshine Health Care Network - VISN 8 Patient Safety Center of Inquiry, Tampa, FL such as:

  • Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement.

  • Algorithms for Patient Handling

  • Safe Patient Handling Guidebook for Facility Champions/Coordinators

  • Safe Patient Handling Unit Binder for Peer Leaders & Staff

  • Comprehensive Safe Patient Handling Bibliography - Articles Published by the VISN 8 Patient Safety Center of Inquiry Staff, Tampa, FL

HealthCare Wide Hazards Module -Ergonomics from Federal OSHA


Safe Resident Handling Program Guide for Long Term Care Facilities (2009). Oregon OSHA. The purpose of this guide is to provide step-by-step instructions to assist long term care facilities in developing an effective and sustainable SRH program.


Worker Safety in Hospitals a resource from OSHA to prevent worker injuries, help patients and save resources for hospitals. Click here for more information.


Success Stories

Wyandot County Nursing Home in Upper Sandusky, Ohio, has implemented a policy of performing all assisted resident transfers with mechanical lifts, and has purchased electrically adjustable beds. According to Wyandot no back injuries from resident lifting have occurred in over five years. The nursing home also reported that workers' compensation costs have declined from an average of almost $140,000 per year to less than $4,000 per year, reduced absenteeism and overtime have resulted in annual savings of approximately $55,000, and a reduction in costs associated with staff turnover has saved an additional $125,000.

Click here for more information-Scroll down to Appendix - A Nursing Home Case Study

Follow this link to discover what else is happening in Oregon with Safe Resident Handling in nursing homes

In 2010 the OCHE conducted a survey to 'Investigate the Status of Safe Patient Handling Programs in Acute Care and Safe Resident Handling Programs in Long Term Care facilities in Oregon'  View the results of this survey here

Ergonomics -manual handling of people in the healthcare sector. ISO (the International Organization for Standardization) technical report ISO/TR 12296:2012 on  Click here for an edited summary of the report from the Gettinge Group.  


Safe Patient Handling: A Summary of the Issue and Solutions: The Evidence Base (2009). Enos, L. A summary of current literature and data about Safe Resident/Patient Handling related issues developed for the Coalition for Healthcare Worker and Patient Safety (CHAPS). Note: Information about CHAPS is housed on the 'Work Injured Nurse Group' website.


Oregon Nursing Facilities Bariatric Survey Report - September 2009. The purpose of this brief survey was to find out if Nursing Facilities in Oregon accept bariatric residents into their facilities and if they do, is equipment available to accommodate the physical needs of bariatric residents. The survey is provided courtesy of Oregon Health Care Association (OCHA).


Mechanical Lifts Using lifts in Residential Care and Assisted Living in Facilities. Administrator Alert June 2008. Oregon DHS Seniors and People with Disabilities.  


Articles & Publications

The American Journal of Safe Patient Handling & Movement (SPHM) is the first journal of its kind in the USA devoted to the subject of safe patient handling and movement and provides a forum for the latest research and evidence on the how, why, and what in this area of practice. Article manuscripts can be emailed to the Editor-in-Chief at hmonaghan@americanjournalofsphm.com.New Jan 2013


Back Injury among Healthcare Workers: Causes, Solutions, and Impacts. (2004). W. Charney & A Hudson. CRC Press.


The Illustrated Guide to Safe Patient Handling and Movement (2009).  Nelson, A.L., Motacki , K, Menzel, N. New York, NY. Springer Publishing.


Safe Patient Handling and Movement: A Practical Guide for Health Care Professionals (2006). Audrey Nelson Editor. Springer Publishing


An evaluation of a ‘best practices’ musculoskeletal injury prevention program in nursing homes (2004). Collins, J., Wolf, L., Bell, J. and Evanoff, B. Injury Prevention, 10.


Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks (2006). Nelson, A, et al. International Journal of Nursing Studies, August 2006, 43(6)


Developing a Safe Patient-Handling Program for Long-Term Care: A Case Study (2010). Bartko, D.W., Hamann, K., and Severson, L.  ASSE, Interface 3(3):6-18.  


Evidence-Based Practices for Safe Patient Handling and Movement (2004). Nelson, A. & Baptiste, A. Online Journal of Issues in Nursing. Vol. #9 No. 3.


Impact of publicly sponsored interventions on musculoskeletal injury claims in nursing homes (2009). Park, R., et. al.American Journal of Industrial Medicine. 52(9):683-697.  


Implementing a Resident Lifting System in an Extended Care Hospital Demonstrating Cost–Benefit. (March, 2002). Speigel, J; Ronald, L. A.; Tate, R. B.; Colby, T. AAOHN Journal, (50)3.


Link between Safe Patient Handling and Patient Outcomes in Long Term Care. (2008). Nelson, A, et. al.  Rehabilitation Nursing. Vol 33. No. 1.


Preventing Back Injuries in Healthcare Settings (2008) from the National Institute for Occupational Safety and Health (NIOSH).


Staffing and Worker Injury in Nursing Homes (2005). Trinkoff, A et. al. Am J Public Health. 2005 July; 95(7):1220–1225.  


Violence at the workplace increases the risk of musculoskeletal pain among nursing home workers(2010). Miranda H, Punnett L, Gore R, et al. Occup Environ Med published online September 27, 2010


When is it Safe to Manually Lift a Patient? (2007). Waters, T.R. American Journal of Nursing, 107(8): 53-59.

Work productivity impairment from musculoskeletal disorder pain in long-term caregivers (2009). Gucer, P.W., Oliver, M., Parrish, J.M., & McDiarmid, M. J Occup Environ Med. 51(6):672-81.

Work-Related Injuries Among Certified Nursing Assistants Working in US Nursing Homes.(2012). Khatutsky,G, Wiener, J.M., Anderson,W.L., and Porell, F.W. RTI Press publication RR-0017-1204

Compliance Assistance Quick Start: Health Care Industry.

     This web site provides eight quick steps to assist the health care industry in complying with the Department of Labor, Occupation Safety and Health Administration’s requirements and guidance for the prevention of work place injuries


Comprehensive Ceiling Lift Program in Continuing Care at Queen's Park Care Centre and other SPH program tools from WorkSafe BC

Ergonomics & SPH Demonstration Projects for Residential Care and Skilled Nursing facilities from WA State Dept of Labor and Industries - Scroll down this page until you see 'Healthcare Industry'

Lifting Patients/Residents/Clients in Health Care, Washington State 2005 the final report from the WA State Lifting in Health Care Task Force that contains case studies and data from Long Term Care facilities in the state. Note: The link is to the report summary only, please contact SHARP for the entire report - Phone: 1-888-66-SHARP (toll-free) or 360-902-5667 or E-mail SHARP@Lni.wa.gov

 Long-Term Effectiveness of “Zero-Lift Program” in Seven Nursing Homes and One Hospital (1999). Garg, A., from the National Institute for Occupational Safety and Health (NIOSH)

OSHA and NADONA/LTC partner to promote workplace safety. Nursing Home News Notes - Occupational Safety and Health Administration, National Association of Directors of Nursing Administration in Long Term Care - Brief Article, Nursing Homes 2003.

Safe Patient and Resident Handling: Acute and Long Term Care Sectors Handbook

A Practical Guide to Resident Handling and Reference Guidelines for Safe Patient Handling  from the Occupational Health & Safety Agency for Healthcare in British Columbia (OHSAH)

The Miracle of Lifting Technology (2006). Joliff, J. Nursing Homes. Sept 2006.

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