Nursing home assistants among Ohio’s most dangerous occupations: A Critical Choice
Nursing home assistants among Ohio’s most dangerous occupations: A Critical Choice
CLEVELAND, Ohio – As she neared the 13th hour of a double-shift as a nursing assistant, Sheena Arnold and a co-worker struggled to move a 400-pound man in a Sandusky nursing home.
That’s when a burning pain shot through the 130-pound nursing assistant’s back. She suffered a serious strain. It was in August 2016, and Arnold hasn’t worked in a nursing home since.
“I have major back pain,″ Arnold said. “I fear that if I go back [to being an assistant] I will hurt myself really bad.
“We had to care for 40 people, and we only had four aides. We would try to get help when we needed it, but sometimes we had to do things by ourselves.
“This is a dangerous job.″
For the more than 75,000 residents of Ohio’s 960 nursing homes, nursing assistants provide nearly all of the hands-on care. It is a job that requires dedication, passion and empathy.
It is also a job that comes with a serious cost: It has one of the highest reported rates of injury in Ohio and across the nation, according to researchers and government reports. Nursing assistants are injured three times more often than the average worker, data show.
The rate of injury among nursing assistants is similar to the rate among construction workers, police and firefighters, according to 2016 data from the U.S. Bureau of Labor Statistics.
State and federal officials have issued reports on injuries at nursing homes, dating back to 1999. The studies found that the lifting and moving of residents and the nonstop pace necessary to meet residents’ needs have caused thousands of Ohio nurses and nursing assistants to suffer injuries from overexertion and falls.
A Plain Dealer online survey received 81 responses from people who identified themselves as working or having worked as a nursing assistant in Ohio. Among those respondents, injury forced some of them out of the job for good, while others reported being absent for weeks or months. More than two of every three respondents said they had witnessed colleagues get hurt on the job.
High injury rates, low pay
Arnold and other former employees say the stresses of the job have a direct impact on the care of residents.
“It’s brutal; I don’t know how else to describe it,″ said Anne Mueller, who worked for 17 years in nursing homes in Wooster and Parma before leaving the industry because of the working conditions.
“It’s a major problem, and it’s going to continue to be a major problem until someone steps in and does something. My lower back bothered me all the time.″
Police officers had a rate of injury of 481 per 10,000 workers in 2016, according to the U.S. Bureau of Labor Statistics. Nursing assistants had a rate of 337.Firefighters had a rate of muscular-skeleton disorders of 182 per 10,000 workers in 2016, the federal records show. Nursing assistants had a rate of 181.In the last five years, nursing home employees filed 9,927 claims with the Ohio Bureau of Workers’ Compensation. Of those, 3,425, or one in three, stemmed from overexertion.
Couple the difficulties of the work with average pay that hovers between $10.50 to $13 an hour, and it is easy to see how even the most dedicated assistants can burn out quickly, advocates for nursing home residents said.
The pay in Ohio has trended downward for more than a decade, according to the Paraprofessional Healthcare Institute, a New York watchdog group that advocates for nursing assistants and home health-care workers. In 2006, their average wage was $12.80 an hour. In 2016, it was $11.96.
Advocates for nursing home residents said the drop could stem from several reasons, including the recession of 2008, which prompted nursing homes to cut wages.
“It’s appalling,″ said Toby Edelman, the senior policy attorney for the Center for Medicare Advocacy in Washington, D.C. “That’s not a living wage for anyone.″
More than half the Plain Dealer survey respondents said they made $12 an hour or less. The most any respondent reported earning was $15.16 an hour. The state’s minimum wage is $8.30 an hour.
The low pay and the physical demands of the job result in an unusually high turnover rate. In Ohio, that rate was 54 percent for nursing assistants at nursing homes in 2015, the most recent data available, said John Bowblis of the Scripps Gerontology Center at Miami University in Oxford.
Registered nurses and licensed-practical nurses had a turnover rate of 41 percent, Bowblis said. That compares to about 18 percent for the overall workforce, published reports say.
“This is a gargantuan problem in nursing homes,″ said Brian Lee, who leads a Texas-based national advocacy group for nursing home residents called Families for Better Care. ”[Nurses and nursing assistants] are overworked, short-staffed and underappreciated. The burnout, the frustration, the injuries. They can all be prevented if employers just hire more people.″
In Ohio, understaffing is a problem that drastically affects the well-being of nursing assistants and residents, researchers said.
During the third quarter of 2017, about 80 percent of the state’s nursing homes were staffed below what researchers say is necessary to provide safe, compassionate care, according to the Long-Term Care Community Coalition. The New York City agency monitors nursing home care. It studied data from the Centers for Medicaid and Medicare Services.
Nationally, 82 percent of the nation’s nursing homes were below that level, the agency found.
To offer quality care, staffs at nursing homes should provide an average of 4.1 hours of care for a resident each day, researchers said. Ohio nursing homes averaged about 3.5 hours per day, the Long-Term Care Community Coalition found. That ranked Ohio 15
lowest in the country.
“A large proportion of people in nursing homes need two [assistants] to help them move, and many nursing homes just don’t have enough staff to offer that,″ said Charlene Harrington, a professor emeritus of nursing at the University of California at San Francisco and an expert on nursing home staffing. “The better the staffing in nursing homes, the better the care and the less likely workers will get injured.″
The federal government and most states, including Ohio, do not require staffing ratios for nursing homes. Maine, on the other hand, has a law that requires one nurse or nursing assistant for every five residents during the day and one for every 10 residents during evenings.
Most of the nursing assistants who responded to The Plain Dealer survey said they care for about 10 to 25 residents per shift. Eleven said they cared for more than 30 either on a typical shift or the last shift they worked. One claimed to have 52 residents.
State and federal safety officials, however, have pushed other ways to keep assistants safe.
In recent years, the Ohio Bureau of Workers’ Compensation and the U.S. Occupational Safety and Health Administration have stressed the use of mechanical lifting devices in nursing homes to minimize the effort of nurses and assistants in moving residents.
State and federal agencies have provided training programs and safety grants to make nursing homes safer. The Ohio Bureau of Workers’ Compensation, for instance, will pay $3 for every $1 that a business invests in safety, up to $40,000.
But advocates said many nursing homes have few mechanical devices, forcing the nursing assistants to lift or move the residents manually.
Sheena Arnold, the assistant who hurt her back lifting the 400-pound resident, is one example, so is Lisa Flinner.
Arnold, of Sandusky, hurt her back while working back-to-back shifts at the Lutheran Memorial Home in Sandusky. The nursing home, owned by Genacross Lutheran Services of Toledo, closed last year. It cited a years-long decline in the number of residents and an outdated facility that required too much renovation at too high a cost.
Flinner, of New Philadelphia, worked 10 years at nursing homes in Holmes, Tuscarawas and Stark counties. She said lifting residents seriously hurt her back and forced her to go on permanent disability. The lifting also caused her to suffer carpal tunnel syndrome, she said.
She said the facilities where she worked had few, if any, lifts to help nursing staff move residents.
“If you have 20 to 25 residents, and you are working by yourself, you have to lift them,″ Flinner said. “Who is going to help you? There is no one. You are on your own.″
Arnold and Flinner’s experiences mirror those of nursing assistants who responded to The Plain Dealer survey: 83 percent said facilities where they worked were always or frequently too short-staffed to meet residents’ needs. Nearly half of the 81 who responded said they had to work back-to-back shifts at least once a week because of short staffing.
‘Not only a human-safety issue’
Peter Van Runkle is the executive director of the Ohio Health Care Association, an agency that represents for-profit and nonprofit nursing homes. For years, he has pushed safety in the work place. He said most care centers have policies in place to prevent injuries.
“It’s not only a human-safety issue,″ Van Runkle said. “It’s also a financial issue. Nursing homes do not want to see workers get hurt, as it is a cost to them.″
Van Runkle said staffing remains an issue for nursing home owners and cited the economy. He said as the numbers of unemployed shrink and the state nears full employment, there are fewer candidates for jobs at nursing homes. He also said many potential employees cannot pass a drug test or a background check.
The issue of short staffing could grow worse.
The Paraprofessional Healthcare Institute, the New York watchdog that seeks quality care for older residents and those with disabilities, estimates that one in four nursing assistants and direct care workers is an immigrant. With the Trump administration’s crackdown on immigration, many researchers fear the staffing shortages for nursing assistants could be severely affected.
In Ohio, 6 percent of the nursing assistants and direct care workers are immigrants, or about one in 18. There are about 35,000 nursing assistants in the state, according to estimates.
Advocates for residents in nursing homes said there is a lot more to be done, including increasing the pay and the safety of workers. They said written policies are seldom effective without greater staffing. And until staffing increases, they said, nursing homes will remain places where workers get hurt.
“I’ve never worked as a lumberjack, and I’ve never worked in the mines, but [working as a nurse’s assistant] is absolutely one of the most dangerous jobs out there,″ said Genevieve Gipson, the executive director of the National Network of Career Nursing Assistants.
“I have yet to find anyone who works with patients in the long-term care industry who doesn’t have some form of an injury.″