December 31, 1996

Mr. Edward Stafford
New York State Health
Facilities Association
33 Elk Street, Suite 300
Albany, New York 12207-1010

Mr. Carl Young
New York Association of Homes
And Services for the Aging
33 Elk Street, Suite 301
Albany, New York 12207-1010

Dear Gentlemen:

This letter responds to your inquiry of August 27, regarding the Occupational Safety and Health Administration's (OSHA) Nursing Home Safety and Health Initiative. We regret the delay in providing this response.

The first concern stated in your letter regards the use of "scare tactics" in the publicizing of the initiative. It is never OSHA's intent to use scare tactics in any form. Our goal is to provide the data and information upon which our initiative is based. The Bureau of Labor Statistics data which were quoted in Secretary of Labor Robert B. Reich's announcement of August 3, lists the nursing home industry as having significantly higher employee injury and illness rates than many other industries.

As your letter points out, this data may be subject to different interpretations by interested parties. However, OSHA interprets this data to mean that nursing homes may have unaddressed hazards which are leading to unacceptably high injury and illness rates. Our publicizing of the Nursing Home Safety and Health Initiative would be remiss if we did not state that our concern is founded on data, and that the safety and health hazards causing the elevated rates need to be addressed. None of OSHA's concern is meant to cast any negative aspersions upon areas of nursing home operations beyond the scope of OSHA's mandate, the safety and health of the employees.

The second concern regards the outreach program's educational content and the resources devoted to this component. As part of the development process for this Initiative, OSHA determined to provide a one-day outreach session in each of seven states with a high number of nursing home facilities. In the development of the initiative, OSHA sought the input of stakeholders to ensure the development of an outreach program that would meet the needs of the nursing home industry. The American Association for Homes and Services for the Aging provided valuable information and insights about the characteristics of the industry as well as areas of concern for the industry. The Agency relied on this type of input in setting an agenda that is oriented around safety and health issues and OSHA policies and practices that effect nursing homes. Hence, the outreach program is presented by OSHA personnel. The mention of residents' rights in the outreach program is meant to recognize this aspect of the industry and is not meant to usurp other regulatory agencies' authority. OSHA is considering whether additional outreach sessions are necessary in the future based upon an evaluation of the seven sessions.

The Agency regards this initiative as a measured response to reduce the risk to employees by encouraging the development and implementation of comprehensive safety and health programs. The assertion that the industry is being held accountable to standards which were not in effect prior to this initiative or only introduced at the outreach sessions is unfounded. OSHA expects that employers are complying with all applicable OSHA regulations and the general duty requirement of the OSH Act to maintain a workplace free from recognized serious hazards. This information has always been publicly available. The information covered by the outreach sessions encourages a proactive approach wherein employers can address their hazards and sources of injuries and illnesses in a proactive manner. These employers will find that OSHA is a willing partner to assist them in their program.

The Agency recognizes that the outreach sessions and enforcement efforts are only a part of the solution to a very complex problem. Concerned organizations such as yours play a vital role in addressing the occupational safety and health issues facing the nursing home industry. I understand that your difficulties in contacting an OSHA representative to discuss the program have been resolved. If you have any further questions regarding the program, please contact your Regional Nursing Home Coordinator, Robert Garvey at (212) 337-2378. We look forward to continue working with you in the future. Thank you for your interest in safety and health.

Sincerely,

John B. Miles, Jr., Director
Directorate of Compliance Programs

August 20, 1996

Michael G. Connors
Deputy Assistant Secretary for
Occupational Health and Safety
U.S. Department of Labor
200 Constitution Ave. N.W.
Washington, D.C. 20210

Dear Mr. Connors:

We are writing to express our concerns with the "special emphasis program" that the Occupational Health and Safety Administration (OSHA) has developed for seven states including New York. We have objections in two areas: 1- the manner in which the program is being publicized; and 2- the programs educational component.

In the past week, both newspapers and radio stations have featured stories concerning the "hazards" of working in nursing homes. In fact, some media coverage has identified nursing facilities as being "the most dangerous place to work." Obviously these statements are based, at best, on data that is subject to wide ranging interpretation. While we do not believe it would be appropriate or beneficial to engage in debate on this topic, we nevertheless must protest the use of "scare tactics'' that denigrate the fine efforts made by this state's nursing homes to provide not only excellent care to their residents, but also safe working conditions for their employees. Equally, if not more distressing, is the information concerning the educational component of the program. Our original belief was that the "special emphasis program" was to be a joint effort between OSHA and the long term care industry that would result in making facilities even safer. Unfortunately, this does not seem to be the case.

We have been informed that the "educational component" of the program will consist of one seminar that will be held in a region of the State that is extremely inconvenient to reach for all but local facilities. We have been told that the reason for this sparse scheduling is that the program's budget only has funding for one seminar for each of the seven states. Budgetary shortfalls are not an acceptable explanation for inadequate training programs. This is especially true when, as in this case, facilities will be held countable for information dispensed at the seminar, and can actually be penalized for failure to perform in what OSHA believes to be an appropriate manner. It is an incontrovertible fact that proper training is the cornerstone for proper performance.

We are, therefore, requesting that the entire program be placed on hold until adequate and sufficient training seminars can be scheduled. As stated above, to do otherwise belies the purpose of the program and is unfair to the long term care industry it proposes to help. We would be more than willing to discuss the issue with you at your convenience.

Very truly yours,

Edward J. Stafford
NYS Health Facilities Association
Carl Young,
NY Association of Homes and
Services for the Aging