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Nursing home aides experience increase in serious injuries.

Physically impaired and socially isolated, many residents of nursing homes greatly depend on nursing aides and other employees; in providing care the workers themselves incur disabling injuries, often to the back

As the proverb implies, living longer can be a mixed blessing, especially for those so chronically ill or frail that they require round-the-clock assistance with the basic functions of daily living. Absent alternative care, many of these dependent elderly become residents of nursing and personal care facilities, where their physically demanding needs are both a challenge and a hazard to nursing aides and other caregivers.(1) In recent years, such circumstances have led to nursing home employees sustaining, with increasing frequency, serious workplace injuries.

This article-covering private nursing homes(2)--is the first in a Bureau of Labor Statistics series focusing on "high-impact" industries, defined as those with the largest numbers of workplace injuries and illnesses, although not necessarily the highest incidence rates.(3) According to a 1988 BLS survey, nursing homes--with 15 1,000 cases-ranked sixth behind eating and drinking places, grocery stores, hospitals, motor vehicle manufacturing, and trucking in total recordable injuries and illnesses. Only nine industries, the survey shows, reported at least 100,000 cases that year, (See table 1.) These industries, however, accounted for one-fourth of the 6.4 million cases reported nationwide in 1988. Clearly, if industries with high case counts become safer, more healthful workplaces, then the national figures will reflect these gains in addition to those stemming from improved working conditions in "high-rate" industries.

While nursing homes did not rank among "high-rate" industries, the industry's incidence rate of 15.0 workplace injuries and illnesses per 100 full-time workers was well above that for private industry as a whole (8.6), for hospitals (8.7), and for all health services (7.3) in 1988.(4) And, as is evident from chart 1, the year 1988 marked the sixth consecutive annual increase in nursing home rates-one indication of the industry's persistent safety and health problem.

Through the years, the severity of accidents in nursing homes has disrupted day-to-day work schedules. In 1988, for example, a clear majority of the industry's injuries were serious enough to require workers to take time off from work or to be restricted in work activity.(5) Many of these disabling injuries took the form of back sprains and other strains incurred by female employees (primarily nursing aides) who were lifting or otherwise assisting residents in their care. As often as not, the injured employee had relatively short tenure (1 year or less) in the nursing home at the time of the accident.(6) The following sections examine some characteristics of nursing homes and, for purposes of comparison, a few features of hospitals; analyze the injury and illness record of nursing homes in more detail; and summarize ongoing efforts to improve working conditions in these homes.

The industry at a glance

Nursing homes primarily provide inpatient nursing and health-related personal care. Such homes differ from residential care facilities, such as homes for the aged, in that they typically provide health care services delivered or supervised by registered or licensed nurses.(7) The National Center for Health Statistics estimated some 19,000 nursing homes provided care for about 1.5 million residents in 1985, about nine-tenths of whom were 65 years or older.(8) Interestingly, the 600,000 oldest residents (at least 85 years of age) constituted one-fifth of the Nation's population in that age group.

Certain characteristics of residents, as reported in the comprehensive Federal study,(9) help explain why their care poses special problems for nursing home employees. Residents typically are: very old (median age, 82), mentally disoriented, and functionally dependent in several activities of daily living (such as getting in and out of bed or chair, bathing, and using the toilet). Moreover, immediately preceding admission to the present nursing home, most residents required medical or other nursing care at hospitals or other health facilities.

Although designated as health care facilities, nursing homes have obvious limits to the kinds of medical services they provide. Often, such facilities are staffed to monitor and treat chronic health conditions of the elderly, as by administering prescribed drugs and catheterization to help with urinary incontinence.(10) For acute episodes of illness (such as infection or anatomic obstruction), however, nursing homes temporarily transfer residents to hospitals which provide diagnostic services and extensive medical treatment (surgery, for example) in addition to continuous nursing services. (11) Some nursing homes and hospitals, in fact, have reciprocal arrangements to cover the appropriate health care needs of their patients.

Reflecting their unique health care roles, nursing homes and hospitals differ markedly in their characteristics. Unlike hospitals, a large majority of private nursing homes are propriet% (operated for profit) institutions;(12) and, they operate with smaller work forces (typically 20 to 250 full-time and part-time workers) than do hospitals commonly employing a minimum staff of 250).(13) But more to the point of this article, it is differences in patient care needs and work responsibilities, especially for nursing jobs, that account for much of the difference in nursing home injury and illness rates (15.0 per 100 full-time workers in nursing homes and 8.7 in hospitals).

In contrast to hospital services, the nature of patient care in nursing homes calls for substantially more nursing aides than licensed or registered nurses. Traditionally, aides in nursing homes are responsible for almost all of the heavy lifting and other bed-and-body work" often required in caring for those incapacitated. Many hospital services, in contrast, are provided on an outpatient basis, thereby reducing the need for inpatient personal care and its attendant hazards to nursing personnel. The following tabulation further reinforces how differences in patient care requirements can lead to contrasting staffing patterns for the two industries:(14)
 Percent of
 homes Hospitals
 All occupations 100 100
Nursing aide and attendant 42 7
Licensed practical nurse 10 7
Registered nurse 7 24
Clerical and administrative
 support 4 17
All other 37 46

To summarize, nursing aide, by far the most numerous job in nursing homes, is a "high-risk" occupation.(15) Thus, it is not surprising that nursing homes have the highest injury rates of all health services industries.(16)

Safety and health measures

As part of its annual survey of occupational injuries and illnesses, the Bureau of Labor Statistics expanded coverage of the service-producing sector in 1980 by developing separate estimates for nursing homes, hospitals, and many other fast-growing industries. (17) Since then, the Bureau's basic measure of workplace safety and health-its injury and illness incidence rate for all recordable cases-has risen somewhat for health services in general but has climbed sharply for nursing homes in particular. The following tabulation illustrates this point, using total case rates per 100 full-time workers:
 1980 1984 1988
 Health services 6.4 6.3 7.3
 Nursing homes 10.7 11.6 15.0

The 1988 incidence rate for nursing homes was 40 percent higher than the 1980 rate; this compares with a 1980-88 increase of 15 percent for all health services. In sum, nursing homes remain a hazardous workplace setting, with an injury and illness rate double that for all health services.

Other Bureau measures that gauge the severity of workplace incidents consistently show that lost worktime incidents are a serious problem in nursing homes. (See appendix for definitions.) In 1988, such disabling incidents accounted for nearly three-fifths of the industry's cases (about 88,000 out of 151,000 injuries and illnesses). This translates into 8.7 lost workday cases per 100 full-time workers, double the private industry average. When seriously injured that year, nursing home workers were away from their regular job, on average, 21 days per case; this was 2 days higher than the private sector's figure for average number of lost workdays per case.

Between 1980 and 1988, the lost worktime problem had worsened in nursing homes. The following tabulation tracks the industry's upward trend over that period:
 1980 1984 1988
 Lost workday case
 rate 5.6 6.5 8.7
 Lost workdays rate 85.5 121.3 180.6
 Average lost workdays
 per case 15 19 21

Of special note in nursing homes, the number of lost workdays per 100 full-time workers doubled between 1980 and 1988, as the frequency and duration of such cases increased sharply.

Injury and illness characteristics

The Bureau's annual survey identifies industries with high case counts or high case rates, but it does not provide information about characteristics of the occupational injuries and illnesses. Such information is available, to some extent, from another Bureau program-the Supplementary Data System (SDS)-based on the State workers' compensation systems. Unlike the annual survey, the SDS does not produce nationwide estimates and lacks a uniform treatment among States of what is a compensable workplace injury or illness.(18) However, despite several analytical and statistical limitations, the SDS does help in spotting general patterns (or a lack thereof) in the characteristics of work-related injuries and illnesses involving lost worktime.

In 1987, nearly 31,000 current cases in private nursing homes were reported to 24 State agencies and the Virgin Islands, the participants in the SDS program that year. (Current cases are injuries or illnesses which involved at least 1 lost workday and which either occurred in 1987 or were reported to the State agencies that year.(19)) Separate analysis of nursing home cases and of all SDS cases in the private sector points up several similarities and differences in case characteristics. (Such comparisons, however, are subject to the same types of limitations previously ascribed to the SDS.)

In terms of principal physical characteristics, sprain and strain is, by far, the leading category under nature of injury or illness, constituting seven-tenths of the SDS-recorded cases in nursing homes and two-fifths of those in all private industry. A second injury characteristic is the part of the body affected, most often the back and other portions of the trunk abdomen, shoulder, and so on). Injuries to the trunk were slightly more than one-half of all nursing home cases and about one-third of the private sector total. Taken together, the "nature/part" category of back sprain was two-fifths of all SDS cases in nursing homes, double the corresponding proportion for private industry as a whole. No other injury cross-classification of this type, such as ankle sprain or serious finger cut, was as much as one-tenth of either case total.

Ironically, the major source of injury and illness in nursing homes is the resident, whom the employee was trying to help. The official SDS classification "person, other than injured" accounted for slightly more than one-half of all nursing home cases; this source was uncommon outside of health services industries. The leading type of accident or exposure was overexertion (primarily while lifting), constituting three-fifths of the nursing home cases and one-third of the private sector case total. Cross-tabulating source and type, the category overexertion while caring for residents best describes the injury-producing event for one-half of the nursing home case total. An additional one-eighth of the cases were classified as falls to a floor or other working surface, in line with the corresponding figure for the private sector.

Predictably, nursing aide was the dominant occupation of the injured or ill worker, accounting for about seven-tenths of the SDS-recorded cases in nursing homes. Compared with their two-fifths share of the industry's work force, nursing aides clearly are a disproportionate share of the total nursing home cases. In contrast, licensed and registered nurses, taken together, are about one-sixth of employment but about one-twentieth of SDS-recorded cases in nursing homes. A variety of service occupations, including cooks, janitors, laundry workers, and maids, accounted for most of the industry's other recorded cases.

Not unexpectedly, nurses and aides sustained back injuries with greater frequency than did other nursing home workers. The following tabulation points up the variations in part of the body affected by injury or illness for three nursing jobs (nursing aide, licensed nurse, and registered nurse) compared with all other nursing home jobs.
 Three nursing All other
 jobs jobs
All body parts (percent) 100 100
 Trunk 61 38
 Back 46 27
 Legs and lower
 extremities 11 17
 Arms and upper
 extremities 12 24
 All other parts 16 22

Other SDS data also highlight the somewhat unusual characteristics of nursing home workers. They show that nine-tenths of the injured were women workers and that, at the time of their accident, slightly more than one-half of the injured had worked 1 year or less in the nursing facility.(20) In contrast, a clear majority of injured hospital workers had been employed at least 3 years.

Previous research has shown that short tenure and high labor turnover-characteristics common to nursing aides in nursing homes-are correlated with occupational safety and health problems.(21) Comparatively low pay, especially for nursing aides, contributes, in part, to the turnover problem in nursing homes. Based on two dozen large metropolitan areas studied, the Bureau of Labor Statistics reported that full-time nursing aides in nursing homes commonly averaged between 4 and $5 per hour in the fall of 1985; pay levels for their hospital counterparts, in contrast, usually were at least 40 percent higher. (22)

Accident prevention

During the 1980's, the issue of stress-related injuries in nursing homes and other health care facilities has drawn international attention.(23) In this country, the National Institute for Occupational Safety and Health continues to conduct and sponsor high-priority research and feasibility studies on how to reduce musculoskeletal injuries resulting from load handling and related activities in health care settings. Illustrative of this research, a brief description of the patient-handling problem facing nursing personnel in nursing homes follows.

Heavy lifting and other manual exertions associated with patient handling are difficult to execute safely in nursing homes, in part because the recommended lifting techniques for objects and materials (bent knees and load close to body, for example) often are impractical to apply when singlehandedly lifting unstable residents. One possible solution-getting assistance from a second employee-is encouraged in spirit and, to some extent, in practice; but, to provide two-employee lifting on a large scale would be considered too expensive by many nursing homes.

Another potential approach to reducing back sprains and related injuries in health-care settings is the use of patient-handling devices. A recent study of 120 nursing homes in Wisconsin found that certain mechanical devices, such as gait belts fitted on residents, were used very often for transferring patients and generally had received endorsements from nursing staff.(24) A subsequent study identified the 10 most back-stressing tasks of nursing aides;(25) then, in a laboratory setting, these researchers found that pulling/pushing patients using assistive mechanical devices can effectively eliminate the more stressful activity of patient lifting for all 10 of these tasks.(26) Ergonomic avenues such as these attempt to reshape the job to fit the worker.

Besides accidents related to the physically demanding tasks of resident care, nursing and other personnel incurred other disabling injuries and illnesses that are clearly preventable. Exposure to temperature extremes and contact with caustic agents or biological contaminants, for example, often can be avoided by improved ventilation, proper use of personal protective equipment, and better communication to employees of hazardous conditions and substances. Some government standards specifically address these types of workplace safety and health problems.(27)

On a somewhat optimistic note, a recently enacted Federal law upgrades staff requirements in nursing homes certified by medicare or medicaid. The law mandates that by 1990 such homes provide for licensed nursing services during all hours and that nursing aides complete at least 75 hours training in nurses' skills and residents' rights.(28) While primarily directed at the quality of care for nursing home residents, the new law also draws attention to the nursing aide-the pivotal job in delivering enhanced resident care. To supplement this law, though, nursing homes still need a plan for training nursing aides and others in the most promising of the job safety techniques and devices currently under study.


1 Many research works have drawn attention to quality-of-life issues for the institutionalized elderly. See, for example, Technology and Aging in America, OTA-BA-264 (Washington, U. S. Congress, Office of Technology Assessment, 1985); and National Research Council, The Aging Population in the Twenty-First Century: Statistics for Health Policy, Dorothy M. Gilford, ed. (Washington, National Academy Press, 1988). Both of these contain extensive reference listings. For an account of what nursing home residents value most in nursing aides and other staff, see Institute of Medicine, Improving the Quality of Care in Nursing Homes (Washington, National Academy Press, 1986).

2 Throughout this article, the terms "nursing and personal care facilities" and "nursing homes" are used interchangeably, as are the terms resident" and "patient."

3 For an account of industries with high rates of workplace injuries and illnesses, see Martin E. Personick and Katherine Taylor-Shirley, "Profiles in safety and health: occupational hazards of meatpacking," Monthly Labor Review, January 1989, pp. 3-9. 4 Incidence rates represent the number of injuries or illnesses, or both, per 100 full-time workers, and were calculated as:
 NIEH x 200,000
 N = number of injuries and/or illnesses;
 EH = total hours worked by all employees of
 the industry during the calendar year;
200,000 = base for 100 full-time equivalent workers
 (working 40 hours per week, 50
 weeks per year).

A variety of useful incidence rates may be computed by making N equal to the number of injuries only, or the number of lost workday cases, or the number of lost workdays, and so forth. In each instance, the result is an estimate of the number of cases or days per 100 full-time workers.

5 According to the Bureau's 1988 annual survey, 58 percent of all nursing homes cases involved days away from work or restricted work activity. By comparison, the corresponding figure was 46 percent in all private industry and also in hospitals.

6 This composite of the typical characteristics of injured nursing home employees is drawn from the Bureau's Supplementary Data System (SDS). The SDS is described in footnote 18.

7 The nursing and personal care facilities industry has been designated number 805 in the Standard Industrial Classification Manual, 1972 edition, 1977 supplement of the U.S. Office of Management and Budget. It covers two situations: (1) skilled nursing care facilities (number 8051) that provide care and treatment for patients who require continuous health care (including a licensed or registered nurse on duty round-the-clock) but not hospital services, and (2) intermediate or other nursing care facilities (number 8059) that employ a licensed or registered nurse on at least one work shift.

The same manual classifies the residential care industry (number 836) as part of social services rather than in health services.

8 The National Nursing Home Survey: 1985 Summary for the United States, DHHs Publication No. (PHS) 89-1758 (National Center for Health Statistics, 1989), tables I and 17. Strictly speaking, the estimates include a relatively small number of government-owned facilities-about 1,000 homes with 126,000 residents-that are outside the scope of the Bureau's study of private nursing homes. As a practical matter, the estimates still provide the most complete profile available of nursing home and resident characteristics.

9 Ibid., tables 18, 28, 36, and 41.

10 In its 1985 comprehensive study of the elderly, the U.S. Congress, Office of Technology Assessment conducted an indepth review of five chronic health conditions: dementia (such as Alzheimer's disease), urinary incontinence, hearing impairments, osteoporosis thinning bones), and osteoarthritis (degenerative joint disease). See Technology and Aging in America, ch. 3, pp. 61-116, for basic discussions of these diseases and many references to journal articles on each condition.

11 About one-fifth had at least one hospital stay while a resident in a nursing home. See The National Nursing Home Survey: 1985 Summary for the United States, tables 20-21.

12 Ibid., table 1. Of the 19,100 facilities (3 beds or more) covered by the National Center for Health Statistics survey, three-fourths were proprietary, one-fifth were voluntary nonprofit, and the rest, government-owned. By comparison, the American Hospital Association reported about 5,600 short-term general hospitals in the following ownership categories: three-fifths are not for profit, one-fourth are State/local government, and one-sixth are investor (for profit). See Hospital Statistics, American Hospital Association, 1988 edition (Chicago, American Hospital Association, 1988), table 5A.

The "privatization" of the American nursing home industry dates back to colonial times when, for a fee, some indigent elderly were boarded out to private households. This practice grew somewhat in the depression years of the 1930's when, of necessity, some homeowners (unemployed nurses, in particular) took in and cared for small numbers of the elderly. Also in the same era, the Bureau of Labor Statistics counted more than 1,000 nonprofit homes for the aged (homes sponsored by private and public organizations); these homes commonly employed resident nurses and had in-house infirmaries. For the first systematic survey of these homes, see Care of Aged Persons in United States, Bulletin 489 (Bureau of Labor Statistics, 1929).

During the mid-1950's, the building of proprietary nursing homes accelerated, largely spurred by new construction loans and loan guarantees from the Federal Government. These and other public policy issues, including the evolution of medicaid as the primary reimbursement mechanism for nursing home care, receive a thorough airing in Bruce C. Vladeck, Unloving Care: The Nursing Home Tragedy (New York, Basic Books Inc., 1980).

13 County Business Patterns, 1986: United States, CBP-86-1 (Bureau of the Census, 1988), table lb.

14 Occupational data, which cover private and State and local government hospitals for April 1986 and private nursing homes for April 1987, are available upon request from the Office of Employment and Unemployment Statistics, Bureau of Labor Statistics.

15 Several other studies have found that nursing aides rank high among occupational groups experiencing disabling back disorders. See, for example, B. P. Klein, R. C. Jensen, and L. M. Sanderson, "Assessment of workers' compensation claims for back strains/sprains," Journal of Occupational Medicine, vol. 26, 1984, pp. 443-48; and R. C. Jensen, Disabling back injuries among nursing personnel: research needs and justification," Research in Nursing and Health, vol. 10, 1987, pp. 29-38. The latter work also found an especially high rate of disabling back injuries, specifically for aides in nursing homes.

16 In addition to hospitals and nursing homes, the health services industry includes offices of physicians, medical laboratories, outpatient care facilities, and other health and allied services (such as blood banks).

17 See Occupational Injuries and Illnesses in the United States by Industry, 1980, Bulletin 2130 (Bureau of Labor Statistics, 1982), table 1, pp. 11-13.

18 The Supplementary Data System (SDS) is not statistically representative of the Nation as a whole because the data cover only the jurisdictions participating in the system. In 1987, the latest year for which detailed information is available, these were the Virgin Islands and the following 24 States: Alaska, Arizona, California, Colorado, Hawaii, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Michigan, Mississippi, Missouri, Nebraska, New Mexico, Ohio, Oklahoma, Oregon, Tennessee, Virginia, Washington, Wisconsin, and Wyoming.

States differ, moreover, in the kinds of cases they require by law to be reported to workers' compensation agencies. While some States require reports for all occupational injuries and illnesses, regardless of the length of disability, others require reports only for cases of sufficient duration to qualify for indemnity compensation payments, and still other States require reporting of cases involving a specific number of lost workdays, regardless of the indemnity waiting period." Thus, the SDS file is not a complete census of all "disabling" injuries and illnesses in the jurisdictions studied.

The SDS, however, does standardize the classification of data using the 1972 Standard Industrial Classification Manual, the 1980 Census of population, Alphabetical Index of Industries and Occupations, and the 1962 American National Standards Method of recording Basic Facts Relating to the Nature and Occurrence of Work Injuries, published by the American National Standards Institute ANsi) and often referred to as the Z16.2-1962 Standards, or simply, Z16.2.

19 The total for the 25 SDS jurisdictions is two-fifths of the annual survey estimate of 79,000 lost workday cases in nursing homes in 1987. See footnote 18 for some limitations pertaining to the range of cases included in SDS.

Directly reflecting increased workers' compensation claims, the number Of SDS-recorded cases in nursing homes has risen sharply in recent years. For 13 States permitting comparison over this period, for example, the combined total of 18,600 cases in 1987 was about 46 percent higher than the 12,700 SDS-recorded cases in 1981.

20 Proportions for sex of injured worker are based on the full 1987 SDS case file; those for work experience, defined here as time with employer (or on the job) when injured, relate to cases in the 16 SDS jurisdictions recording such data.

21 For example, see Norman Root and Michael Hoefer, "The first work injury data available from new BLS study," Monthly Labor Review, January 1979, pp. 76-80.

22 Industry Wage Survey: Nursing and Personal Care Facilities, September 1985, Bulletin 2275 (Bureau of Labor Statistics, 1987); and Industry Wage Survey: Hospitals, August 1985, Bulletin 2273 (Bureau of Labor Statistics, 1987).

A forthcoming BLS study, White-Collar Pay in Private Service-Producing Industries, March 1989, will show that, nationwide, salary levels for full-time nursing assistants were about two-fifths higher in private hospitals than in private nursing homes.

23 For a comprehensive compilation and summary of some six dozen articles on back injuries to nursing staff (including several on the "lifting process"), see R.C. Jensen, D. Nestor, A.H. Myers, and J. Rattiner, Low Back Injuries Among Nursing Personnel: An Annotated Bibliography Baltimore, The Johns Hopkins University, 1988). More recently, the Industrial Commission of Ohio's Division of Safety and Hygiene studied this problem in that State, as detailed in S. Valles-Pankrantz, "What's in back of nursing-home injuries?" Ohio Monitor, February 1989, pp. 4-8.

24 B. D. Owen, "Patient Handling Devices: An Ergonomic Approach to Lifting" in F. Aghazadeh, ed., Trends in Ergonomics/Human Factors V (North-Holland, Elsevier Science Publishers, 1988).

25 B. D. Owen and A. Garg, "Patient handling tasks perceived to be most stressful by nursing assistants," in Anil Mital, ed., Advances in Industrial Ergonomics and Safety I (New York, Taylor & Francis, 1989). Professors Owen and Garg found the most stressful tasks to involve transferring patients from one location to another, such as from toilet or bathtub to chair.

26 A. Garg, Patient-handling devices used for the health-care industries," paper presented at the Annual American Industrial Hygiene Conference, St. Louis, mo, May 1989. To filter these experimental methods through a "prism of pragmatism," nursing aides in nursing homes were asked to try these new patient-handling procedures; a report on the outcome is expected in 1990.

27 See, for example, General Industry: OSHA Safety and Health Standards (29 CFR 1910), OSHA 2206 (Occupational Safety and Health Administration, Rev. 1981). Based on 1987-89 safety and health inspections conducted by the U.S. Department of Labor, some nursing homes had one or more problems addressed in OSHA standards; these usually related to improper waste disposal (Standard 1910.141 A04), deficiencies in personal protective equipment (Standard 1910.132 A), or gaps in communicating the potential hazards of chemicals (Standard 1910.1200, various sections).

28 See the Omnibus Budget Reconciliation Act of 1987, P. L. 100-203, Subtitle C: Nursing Home Reform. APPENDIX: Work injury definitions In this article, definitions of occupational injuries and illnesses and lost workdays conform to the recording and reporting requirements of the Occupational Safety and Health Act of 1970 and Part 1904 of Title 29, Code of Federal Regulations. Supplemental information pertaining to these definitions is in the booklet, Recordkeeping Guidelines for Occupational Injuries and Illnesses (Bureau of Labor Statistics, 1986).

Recordable occupational injuries and illnesses are:

1. Occupational deaths, regardless of the time between injury and death, or the length of the illness; or

2. Nonfatal occupational illnesses; or

3. Nonfatal occupational injuries which involve one or more of the following: loss of consciousness, restriction of work or motion, transfer to another job, or medical treatment (other than first aid).

Occupational injury is any injury, such as a cut, fracture, sprain, amputation, and so forth, which results from a work accident or from exposure involving a single incident in the work environment.

Occupational illness is any abnormal condition or disorder, other than one resulting from an occupational injury, caused by exposure to environmental factors associated with employment. It includes acute and chronic illnesses or disease which may be caused by inhalation, absorption, ingestion, or direct contact.

Lost workday cases are cases which involve days away from work, or days of restricted work activity, or both. 1. Lost workday cases involving days away from work are those cases which result in days away from work, or a combination of days away from work and days of restricted work activity. 2. Lost workday cases involving restricted work activity are those cases which result in restricted work activity only.

Lost workdays-away from work are the number of workdays (consecutive or not) on which the employee would have worked but could not because of occupational injury or illness.

Lost workdays-restricted work activity are the number of workdays (consecutive or not) on which, because of injury or illness:

1. The employee was assigned to another job on a temporary basis; or

2. The employee worked at a permanent job less than full time; or

3. The employee worked at a permanently assigned job but could not perform all duties normally connected with it.

The number of days away from work or days of restricted work activity does not include the day of injury or onset of illness or any days on which the employee would not have worked even though able to work.

Implementation of labor market policies

In the early 1980's, rising unemployment was so widespread across OECD countries and all the labor markets within them that regional differences tended to attract little special attention. Interest focused more upon developments in the world-wide economic situation. However, in the subsequent period of steady economic growth and relative stabilization of the areawide unemployment rate, many of the significant changes in labor markets have been localized to particular countries, and even to particular regions. At the same time, continued caution in macroeconomic policy has led to increased emphasis on the improvement of labor market structure, often involving a reduced role for central government compared with local bodies. Policies based upon education and training, upon tackling the particular problems of displaced workers and other groups at high risk of unemployment, and upon encouraging the virtuous circle of growth and entrepreneurship at the local level, require implementation at the local level. However, local initiatives are inevitably more energetic and successful in some areas than in others, and can increase regional differences as well as counteracting them. Special attention may therefore be necessary to the way particularly disadvantaged regions can generate growth.

OECD Employment Outlook, July 1989

(Washington, OECD Publications and

Information Center, 1989), p. 98.
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Author:Personick, Martin E.
Publication:Monthly Labor Review
Date:Feb 1, 1990
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