April 29, 1997

The Honorable Christopher Bond
United States Senate
Washington, D.C. 20510

Dear Senator Bond:

This is in response to your letter of January 17, requesting information regarding the Occupational Safety and Health Administration (OSHA) Nursing Home Health and Safety Initiative. Please accept my apology for the delay in this response.

The news release and press conference on August 8, 1996, by Secretary of Labor Robert B. Reich, announced OSHA's Nursing Home Health and Safety Initiative. In the news release, OSHA stated that it "will begin offering free, comprehensive safety and health seminars, specifically designed for nursing home employers, in seven states: Florida, Illinois, Massachusetts, Missouri, New York, Ohio and Pennsylvania." The seven states were included in the Initiative based upon each having more than 500 nursing home facilities and being covered by federal OSHA jurisdiction. The State of Texas would have also qualified under these criteria but was excluded as a resource consideration. The Agency did not use workers' compensation data as a selection criteria for targeting specific states or individual establishments in the Nursing Home Initiative. This may be a point of confusion with another OSHA program, the Cooperative Compliance Programs.

The Agency believes that the information covered by the outreach sessions encourages a proactive, programmatic approach. Employers can address their hazards and sources of injuries and illnesses in a manner consistent with the resident's rights and dignity protected by the Omnibus Budget Reconciliation Act of 1989.

The Agency used its discretion in setting an outreach agenda which was oriented around OSHA's concerns and programs which would affect nursing homes. The seminars conducted by OSHA focused on the implementations of safety and health programs for the nursing home industry that would address a variety of hazards known to cause injury in this industry. The seminars did not focus entirely on back injuries. Some examples of potential nursing home hazards that OSHA addressed in the seminars included slips and falls; workplace violence; risks from bloodborne pathogens, tuberculosis and other infectious diseases; and back injuries from incorrect and/or strenuous lifting of residents. In the case of back injuries resulting from patient lifting, the outreach efforts presented a variety of controls for patient lifting and was offered as one of many control suggestions for a variety of potential hazards. The assertion that the industry is being presented with new obligations under this Initiative, or that the program is requiring controls without regard to the patient rights set out in the 1987 Omnibus Budget Reconciliation Act of 1989 is unfounded. OSHA expects that employers are complying with their obligations under the OSH Act both to comply with safety and health standards and to maintain a workplace free from recognized safety and health hazards.

To date, the Agency has conducted eight, one day long seminars in the seven targeted states reaching approximately 3300 attendees. Evaluation responses from the attendees were generally favorable and specific comments received from the American Association of Homes and Services for the Aging, the Service Employees International Union and the United Food and Commercial Workers representatives indicated that the material presented was germane and helpful. The material used during the outreach seminars has also been made available on the Internet at the address www.osha-slc.gov under the New Initiatives section. The Agency will consider whether future outreach sessions are necessary based upon local needs and resources.

In addition to the outreach approach outlined above, OSHA will fulfill its primary mission by enforcing the provisions of the Occupational Safety and Health Act in nursing home facilities. The Agency has full jurisdiction over the safety and health of employees who work in these establishments. The high injury and illness rate for the nursing home industry argues for enforcement activity. OSHA initiated programmed inspections in March, to verify that the employees are being adequately protected. The Agency will attempt through administrative means to focus these inspections towards facilities with poor safety and health records.

The Agency regards the Initiative as a measured response to reduce the risk to employees by encouraging the development and implementation of comprehensive safety and health programs. The Agency recognizes that the outreach sessions and enforcement efforts are only a part of the solution to a very complex problem.

I hope this response is of assistance. Please feel free to contact Stephen Mallinger, Acting Director of the Office of Health Compliance Assistance at (202) 219-8036 ext. 35, should you have any additional questions regarding the Initiative.

Sincerely,



Greg Watchman
Acting Assistant Secretary




January 17, 1997

The Honorable Greg Watchman
Acting Assistant Secretary
Occupation Health and Safety Administration
200 Constitution Avenue, N.W.
Washington, DC 20210

Dear Mr. Watchman:

We are writing to express our concern and that of our constituents about the Special Emphasis on Nursing Home program recently developed by the Occupational Health and Safety Administration (OSHA) for seven states, including Missouri. We support the concept of special emphasis programs because we believe that OSHA's resources are best utilized by focusing on industry-specific safety problems, but we question certain aspects of the nursing home program.

Our understanding from several nursing home employers in Missouri is that OSHA conducted only one training seminar for all Missouri facilities. We are concerned that this training may be inadequate. The appropriate level of training particularly is important for this program because nursing home facilities will be held accountable for information dispensed at the seminar. In addition, we understand that the training seminar focused on patient lifting and that OSHA recommended using mechanical means without regard to the patient rights set out in the 1987 Omnibus Budget Reconciliation Act of 1989. We think that it is important that this issue be addressed in further training seminars.

We also want to inquire about the basis for Missouri's inclusion in this special emphasis program. We particularly are concerned about OSHA's use of workers' compensation data without regard to the nature and severity of injuries and claims. We believe that the more appropriate way to choose participating industries and states is to look at the severity rather than number of injuries.

We are hopeful that these important questions can be answered before implementation of the programs continues.

Sincerely,



Senator Christopher S. Bond
Senator John Ashcroft
Congressman James Talent