Caring for our Caregivers: an Evaluation of the Minnesota Safe Patient Handling Act

Abstract

Background Minnesota is one of 12 states to pass safe patient handling legislation aimed at reducing high rates of musculoskeletal disorders (MSDs) in health care workers.1 MSD rates are 2- and 3- times higher in U.S. hospitals and nursing homes, respectively, compared to the private sector average.2 Further, MSDs comprise almost half of all reportable injuries in these settings.2 State safe patient handling (SPH) laws generally require health care facilities to implement multicomponent safe patient handling programs. Studies of multicomponent programs in large health care systems show substantial reductions in reportable injuries and workers’ compensation claims, but few evaluations of statewide mandates have been conducted. The 2007 Minnesota Safe Patient Handling (MN SPH) Act requires each health care facility to obtain adequate assistive lifting equipment and create a written safe patient handling plan and committee. The effectiveness of the law in nursing homes is of particular interest due to the frequency of patient handling tasks, challenging physical environment, and unique workforce comprised largely of certified nursing assistants (CNAs). To evaluate the MN SPH Act and better protect Minnesota nursing home workers, studies are needed to characterize patient handling injuries by occupation, assess temporal trends in injuries following enactment of the MN SPH Act, and compare Minnesota’s experience to states without SPH legislation. Objective The overall objectives of this research are to provide a profile of patient handling injuries in Minnesota nursing home workers and to evaluate the effectiveness of the MN SPH Act in reducing workers’ compensation claims. Results will be used to inform future safe patient handling policymaking and to identify groups of Minnesota workers and types of facilities in need of additional state outreach and support. Manuscript 1: Aim: Compare workers’ compensation indemnity claim rates and severity among occupational groups in Minnesota nursing homes. Methods: Negative binomial and linear regression models with generalized estimating equations were used with 2005-2016 data from the statewide workers’ compensation database to model the effect of occupation on type of workers’ compensation indemnity claim. Minnesota Nursing Home Report Card data were used to calculate claim rates by occupation. Results: Claim rates were 3.68, 1.38, and 0.69 per 100 full-time equivalent workers in CNAs, licensed practical nurses (LPNs), and registered nurses (RNs), respectively. CNAs were more likely to experience musculoskeletal and patient handling injuries than RNs. However, their claims were less likely to result in temporary total disability or permanent partial disability benefits and more likely to result in stipulation settlements. Manuscript 2: Aim: Compare pre- and post-MN SPH Act trends in patient handling injury claim rates among Minnesota nursing homes and assess whether temporal trends are modified by facility-level staffing and retention. Methods: Negative binomial regression models with generalized estimating equations were used with 2005-2016 statewide workers’ compensation data matched to Centers for Medicare and Medicaid Services data to evaluate the impacts of time, staffing, and retention on patient handling injuries. Results: Compared to 3 pre-law years, the patient handling indemnity claim rate declined by 38% in years 7-9 following enactment of the MN SPH Act. Claims for all other injuries and illnesses declined by 20%. The association between time and patient handling claims was not modified by staffing or retention. However, across time, nursing homes with annual staff retention ≥75% (vs. <65%) had a 17% lower patient handling injury claim rate. Manuscript 3: Aim: Compare injury trends in Minnesota nursing homes, hospitals, and outpatient facilities to Wisconsin, a state without safe patient handling legislation. Methods: Mixed effects negative binomial regression models were used with 2005-2017 workers’ compensation data from a single large insurer. The effects of the MN SPH Act were evaluated by assessing the interaction between state and time period on workers’ compensation claim outcomes. Results: In both Minnesota and Wisconsin, patient handling injuries comprised the largest proportion of claims in nursing homes (54% and 45%, respectively) and smallest proportion in outpatient facilities (6% for both states). The change in mean annual facility-level patient handling claims from pre-law (2005-2007) to second post-implementation (2014-2017) did not differ between states. Further, changes in patient handling claims over time did not differ by healthcare setting. Conclusion Temporal trends in workers’ compensation indemnity claims suggest that the MN SPH Act may have successfully reduced patient handling injuries in Minnesota nursing homes. However, among health care facilities enrolled with a single large insurer, the change in indemnity and medical only workers’ compensation claims from pre-law to post-implementation did not differ between Minnesota and Wisconsin, a state without SPH legislation. Due to data limitations, including a small Wisconsin sample size, more research comparing Minnesota to states without legislation is needed. In Minnesota, state support of the law should target nursing homes with elevated claim rates, including those that have low staff retention, are non-profit, not affiliated with a hospital, or outside the Twin Cities metropolitan area. Further, additional support is needed to prevent and accommodate patient handling injuries among nursing home CNAs, an occupation with high patient handling and MSD injury rates and adverse workers’ compensation claim outcomes.