In 2003 the Bureau of Labor Statistics identified nursing homes as the fourth most dangerous workplaces in the United States. They were ranked just behind certain manufacturing sites, busy streets and landfill operations in an 84-workplace sample.

The physical hazards for caregivers? In "Ergonomics: Guidelines for Nursing Homes," OSHA identifies work-related musculoskeletal disorders (MSDs) that include low back pain, sciatica, rotator cuff injuries, epicondylitis and carpal tunnel syndrome. It isn’t difficult to pinpoint why MSDs are such a problem. Nursing home employees care for residents who are disabled by frailty, stroke, fractures, Alzheimer’s disease and other conditions. The work involves heavy lifting, often in confined and awkward spaces.

The OSHA publication also mentions added risk from residents who strike their caregivers, and the problems they share with health workers in general. The list includes infectious diseases, radiation, chemicals used for sterilization of instruments and shocks from electrical equipment.

The disproportionate amount of heavy and awkward lifting is one characteristic of nursing home work. The other is short staffing. In July 2000 a report to the US Senate from a Special Committee on Aging noted that "54 percent of nursing homes have less than the minimum staffing level for nurses aides. … For less than 7 dollars an hour, nurses aides feed and bathe patients, and turn them prevent bedsores. They sometimes have 15 to 30 residents per shift."

A review of the pay scale for nursing home staff around the country indicates little has changed since 2000: the work is still too poorly paid to rectify staffing shortages, while caregiver injuries are still a serious problem in the industry.

OSHA’s guidelines for the nursing home industry hold some potential for change. The publication makes a convincing case for taking the recommendations seriously, stressing the financial benefits of good ergonomic standards in nursing homes. Profitability is a persuasive argument in any industry.

And persuasion could come from the December meeting – the White House Conference on Aging. The so-called baby boom generation is high on the agenda. The Americans in this group – born in large numbers in the immediate aftermath of World War II – are about to retire. This post-war bulge in the birthrate soon will cause a corresponding bulge in the resident population of nursing homes around the country. The experts may decide the only wrong direction is the present course, and urge legislators to add muscle to the OSHA recommendations.

Sources: US Department of Labor Bureau of Labor Statistics; Occupational Safety and Health Administration; US Department of Labor's Bureau of Labor Statistics Occupational Outlook Handbook