HOME HEALTHCARE WORKERS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Home Healthcare is an important field in California.  Many individuals require in-home services for a variety of medical conditions.  Home Healthcare Workers (HHCW) can be employed in a variety of ways including through the State.

This article will discuss Home Healthcare Workers, their tasks, and the occupational risks of HHCWs.

What Are Home Healthcare Workers? 

Per the United States Department of Labor, “[h]ome healthcare workers provide hands-on long-term care and personal assistance to clients with disabilities or other chronic conditions. These workers, who may be home health aides, personal/home care aides, companions, nursing assistants or home health nurses, are employed in patients’ homes and in community-based services such as group homes.”

What Tasks Do They Perform?

“Depending on their training and job duties, they help patients with activities of daily living such as meals, bathing, dressing and housekeeping, and may perform clinical tasks such as medication administration, wound care, blood pressure readings and range of motion exercises.”  USDL

What are The Home Healthcare Hazards?

Home Healthcare Workers are subject to a large variety of hazards.  They include bloodborne and biological pathogens, latex sensitivities, ergonomic hazards, violence, hostile animals, dangerous conditions and unhygienic conditions.

How Do These Problems Occur?

Bloodborne and Biological Pathogens: This can include saliva, urine and feces.  These can occur while performing injections or changing bags such as urostomy bags.

Latex Sensitivity: This can arise out of the use of gloves. Glove use can result in contact dermatitis.

Ergonomic Hazards:  This can arise from working at a patient’s home which is not set up in an ergonomic fashion.  For example, lifting may be required in an awkward position.

Violence: This most commonly arises in patients that suffer from dementia.  They have the capacity to act out in a violent fashion.  This can include being bitten, kicked, pinched, punched, scratched, or shoved.

Hostile Animals: This most commonly relates to aggressive family pets who may bite or jump on workers.  Additionally, they can be tripping hazards as well.

Dangerous Conditions: These conditions can arise from physical defects on the premises as well as exposures to drug residues, infectious agents and cleaning chemicals..

Unhygienic Conditions: Unlike hospitals, home settings may not have proper disposal of biological waste. This can result in transmission of pathogens.

Travel: Home Healthcare Worker may service more than one patient in a day.  Thus, there duties may include travel from one location to another

Environmental Hazards: This can include second-hand smoke, exposure to asbestos, exposure to lead paint and exposure to allergens such as dust and mold.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for over 28 years. Contact us today for more information.

 

NURSES: DOES YOUR WORKING SHIFT MATTER?  MUSCULOSKELETAL INJURIES, SHIFT CHOICE AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Nurses are at risk for work-related musculoskeletal injuries (WMSD.)  A study addressed whether a Nurse’s Work Shift impacted WMSDs.

This article will discuss Nursing, Nursing Shifts, and how particular Shift Work may impact industrial injuries.

What Are Nursing Duties? What Makes Nurse at Risk for Injury?

Nursing Duties are physically demanding.  Patient care can require individuals to work in awkward positions and deal with individuals whose weight can shift at any moment.

“WMSDs(work-related musculoskeletal disorders) in nurses are mainly caused by shifting patients (which includes helping patients turn over or get in and out of bed), routine treatments in nursing, poorly designed work environments, and remaining active for prolonged periods of time.4 The physiological loads created by these nursing activities are all risk factors of WMSDs in nurses.” Chang WP, Peng YX. Differences between fixed day shift nurses and rotating and irregular shift nurses in work-related musculoskeletal disorders: A literature review and meta-analysis. J Occup Health. 2021 Jan;63(1):e12208. doi: 10.1002/1348-9585.12208. PMID: 33682989; PMCID: PMC7938703.

Likewise, “cllinical nurses must deal with daily routine work in busy wards, patient care and treatment, and correspondence for various matters. Their jobs are time‐consuming, complicated, and full of stress, and they are often on tight schedules, all of which are associated with WMSDs.” Supra.

What Musculoskeletal Body Parts Do Nurses Injure?

Nurses are susceptible to injury for every body part imaginable.   This includes the neck, shoulders and back.

Nurses are prone to WMSDs in the lower back, shoulders, neck, back wrists, knees, and ankles. Supra.

What are Shifts?

Hospitals and other medical facilities provide 24 hours a day service for 7 days a week.  Thus, the facilities have various work shifts.  Some facilities may have 8-hour shifts, some 10-hour shifts, and others 12-hour shifts.    

What Shifts are There?

Within an 8-hour format, there is generally a morning shift, an evening shift, and an overnight shift.

How Do Nurses’ Shifts Vary?

Nurses can have regular fixed shifts.   Also, there are Nurses who have rotating or irregular shifts.

What was the Study About?

The study focused on Nurses who worked rotating and irregular shifts. The theory of the study was that “working rotating and irregular shifts, which causes the physiological burden of disrupted circadian rhythms in the body, may also exacerbate muscle tension and pain.” Differences between fixed day shift nurses and rotating and irregular shift nurses in work-related musculoskeletal disorders: A literature review and meta-analysis. J Occup Health. 2021 Jan;63(1):e12208. doi: 10.1002/1348-9585.12208. PMID: 33682989; PMCID: PMC7938703.

What Were the Results?

The study “indicated that RS (rotating shifts) + IS (irregular shifts) nurses are more likely to experience back pain associated with WMSD than are FDS (fixed day shift) nurses.”  Differences between fixed day shift nurses and rotating and irregular shift nurses in work-related musculoskeletal disorders: A literature review and meta-analysis. J Occup Health. 2021 Jan;63(1):e12208. doi: 10.1002/1348-9585.12208. PMID: 33682989; PMCID: PMC7938703.

In sum, Nurses working irregular shift are more likely to experience musculoskeletal disorders.

As a Lawyer, Are There Any Reasons That May Cause the Higher Rate?

In my opinion, irregular shifts can include irregular routines.  Nurses who have regular shifts may have better understanding of their shift’s physical requirements.   Also, they may be more familiar with their surroundings.   Thus, they are able to take better precaution to prevent injury.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for over 28 years. Contact us today for more information.

JANITORS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

A large part of the labor market is the occupation of Professional Cleaners.  They are also referred to as Commercial Janitors.  The Janitorial Occupation is susceptible for a variety of work injuries and occupational illnesses. Janitorial work presents unique risks for work injuries for those within the field.

This article will discuss Janitors, Janitorial Tasks, Industrial injuries and Occupational Illnesses that are prevalent within the Occupation, and the barriers that Janitors have with respect to filing claims.

What are Janitors?

Janitors perform a variety of maintenance tasks a variety of facilities. They use a multitude of tools and chemicals to perform their jobs.  They can engage in a large variety of repetitive physical tasks, ie. sweeping or mopping.

Janitors can work at institutions such as schools, hospitals, parks, and prisons.

Janitors can work in commercial buildings such as shopping malls, and they can work in residential properties.

What Are Janitor’s Risks of Industrial Injury?

Each type of facility can present unique risks of work injury for Janitors.

For example, hospitals and medical facilities can have significant amounts of potentially infectious biological material present.  Schools can have issues relating to mold exposure.

Further, the physical activities of being a Janitor may cause work injury.

What Types of Injuries Do Janitors Sustain?

There are a variety of work-related orthopedic injuries. These injuries relate, in part, due to the fact that “Janitorial work is repetitive and requires bending, twisting, and other motions that can lead to or exacerbate musculoskeletal disorders, such as arthritis” Using Behavioral Risk Factor Surveillance System Data as an Occupational Health Profile Washington State Janitors, 2011 to 2017 Anderson, Naomi J. MPH; Marcum, Jennifer L. DrPH Journal of Occupational and Environmental Medicine: September 2019 – Volume 61 – Issue 9 – p 747-753 doi: 10.1097/JOM.0000000000001652

Also, Janitors may sustain respiratory injuries relating to the cleaning chemicals that they use.  Further, they may sustain dermatological injuries due to wet work.

What Are the Injury Rates for Janitors?

In a Washington State Study, it was noted that “[t]he prevalence of self-reported work-related injuries in the past year was higher than that of all others …. Analyses of WC data indicate that work-related injury risk may be higher for the industry group containing Janitors than other industries2 overall and in several injury types, with women at particularly high risk.” Using Behavioral Risk Factor Surveillance System Data as an Occupational Health Profile Washington State Janitors, 2011 to 2017 Anderson, Naomi J. MPH; Marcum, Jennifer L. DrPH

Journal of Occupational and Environmental Medicine: September 2019 – Volume 61 – Issue 9 – p 747-753 doi: 10.1097/JOM.0000000000001652

Thus, the workers’ compensation industry both has a concern over janitorial injuries as well as an understanding that work injuries are common.  Thus, Risk Management handling Janitorial claims will work hard to manage these claims.  This can be done with respect to reporting requirements.  It can also be done with respect to return to work issues which can include modified work.

Do Janitors Have Emotional Issues?

Yes. Janitors, in the study, reported “being diagnosed with a depressive disorder ..significantly higher and has been reported previously.    Using Behavioral Risk Factor Surveillance System Data as an Occupational Health Profile Washington State Janitors, 2011 to 2017 Anderson, Naomi J. MPH; Marcum, Jennifer L. DrPH Journal of Occupational and Environmental Medicine: September 2019 – Volume 61 – Issue 9 – p 747-753 doi: 10.1097/JOM.0000000000001652

While this finding did not address work-relatedness, it is possible that the depressive disorder may be in party work-related in nature and give rise to a workers’ compensation claim.

Can Shift Work Impact Janitors?

Yes. Shiftwork has been connected to various medical conditions.

Shiftwork can cause issues of inadequate sleep.  Inadequate sleep can lead to other health issues.

Do Janitors Have Barriers in Filing Workers’ Compensation Claims?

Yes. There is some concern as to whether all janitor work injury claims are filed.  As noted in the study, “[l]ow-wage, immigrant, and/or Hispanic worker populations, including many Janitors, may also not be aware of the WC system (or how to navigate the system, if they lack internet access) or of their right to seek medical care for an occupational injury or illness. Janitors may also face barriers to reporting an injury to their employer, such as fear of consequences.    Using Behavioral Risk Factor Surveillance System Data as an Occupational Health Profile Washington State Janitors, 2011 to 2017 Anderson, Naomi J. MPH; Marcum, Jennifer L. DrPH Journal of Occupational and Environmental Medicine: September 2019 – Volume 61 – Issue 9 – p 747-753 doi: 10.1097/JOM.0000000000001652

If a Janitor is concerned about their employment situation if they claim a work injury, it is important for them to seek legal counsel to discuss their concerns to make a determination as to whether they should file the claim.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

THE QUEBEC BACK PAIN DISABILITY SCALE AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

For both workers’ compensation treatment and evaluation, Injured Workers are frequently asked to fill out surveys concerning their medical conditions. The Quebec Back Pain Disability Scale (QBPDS) is one of those surveys.

This article will discuss how and why such scales are used within the workers’ compensation system, what is the Quebec Back Pain disability Scale, what questions are asked within the scale, how the scale is scored? and what it can mean to a workers’ compensation claim.

What is the QBPDS?

This questionnaire is one that addresses back pain.  It inquires as to the daily activities that impacted by Back Pain.

Why are Surveys and Scales Used?

Surveys and Scales which ask the Injured Worker to self-report on their conditions are helpful to both treating doctors and evaluators.  First, they are a cheap quick method of getting some insight into the Injured Worker’s complaints.  Second, they can give the doctor or evaluator a sense of how serious the worker perceives their injury.  Third, they can give some insight as to whether someone is exaggerating with respect to the complaints. Fourth, if the same scale is administered over time, it can reveal some insight as to the course of the injured Worker’s condition.  Repeated testing may show whether the Injured Worker sees their pain improving, staying the same, or getting worse.

What are the QBPDS Questions Asked?

There are twenty questions asked within the inventory. The questions are about getting out of bed, sleeping through the night, turning over in bed, riding in a car, standing up for 20-30 minutes, sitting in a chair for several hours, climbing one slight of stairs, walking a few blocks, walking several kilometers, reaching up to high shelves, throwing a ball, running one block, taking food out of the refrigerator, making your bed, putting socks or pantyhose on, bending over to clean the bathtub, moving a chair, pulling or pushing heavy doors, carrying two bags or groceries, and lifting and carrying a heavy suit case.

Note: The questions are interesting in that they include activities that an individual may rarely or never participate in.  For example, there are some people who do not throw balls or handle suit cases.

How Are the Responses Scored?

There are five responses that can be made. They are not difficult at all, minimally difficult, somewhat difficult, fairly difficult, very difficult, and unable to do.  They are scored from 0-5.

Note: The responses address ability to perform activities as opposed to the individual’s pain experience.

What Do the Scores Mean?

A higher score represents a greater level of perceived functional disability.  A lower score represents a lower level of perceived functional disability.

Is The QBPDS Helpful for Treating Evaluators and Physicians With Respect to Permanent Disability Assignment?

In California Workers’ Compensation Law, Activities of Daily Living are a basis for making impairment assessments.  Impairment assessments render a Whole Person Impairment which then translates into a Permanent Disability Percentage. The QBPDS can be helpful to an evaluator on their assessment.  The Activities of Daily Living based upon the AMA Guides 5th Edition are Self-care: urinating, defecating, brushing teeth, personal hygiene combing hair, bathing, dressing oneself, and eating,  Communication:  writing, typing, seeing, hearing, and speaking, Physical activity:  standing, sitting, reclining, walking, and climbing stairs, Sensory Function: hearing, seeing, tactile feeling, tasting, smelling, Nonspecialized Hand Activities: grasping, lifting, tactile discrimination,  Travel: riding, driving, flying, Sexual Function: orgasm, ejaculation, lubrication, erection, and Sleep: restful and nocturnal sleep pattern.

The QBPDS does not explore self-care and sexual function. Therefore, it is not fully comprehensive to render an ADL assessment.

As an Injured Worker, What Should I Do When I Fill Out These Scales?

When fill out these scales, try to be accurate as possible. Sometimes, I personally roll my eyes when I see scales in which every answer is the highest.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

 

 

 

UPPER EXTREMITY WORKERS’ COMPENSATION SURGERIES: WHAT YOU NEED TO KNOW

Studies about workers’ compensation as always of interest to Injured Workers.   A lot of these studies tell us how and why insurance companies, employers and doctors act in particular ways.   A study addressing upper extremity surgeries provides us such insight. The study compared the results of industrial versus non-industrial upper extremity surgeries.

This article will discuss, upper extremity surgeries, issues relating to upper extremity surgeries, and the results of the study.

What Are Upper Extremity Surgeries?

 With respect to upper extremities, there are a variety of surgeries that are done on an industrial basis.  Upper extremity surgeries can range from shoulders to finger tips. Parts operated on can include areas such as the shoulders, biceps, elbows, forearms, wrists, and fingers.

For shoulders and elbows, there operations can include fracture surgeries, total shoulder replacements, shoulder arthroscopies, rotator cuff repairs, tennis elbow, golfer’s elbow, and elbow arthroscopy.

For the wrist, operations can include fracture surgeries, carpal tunnel releases, wrist arthroscopies, wrist joint replacements and wrist fusions.

How Are Workers’ Compensation Upper Extremity Surgeries Different Than Non-Industrial Upper Extremity Surgeries?

Approval:  Unlike Health Insurance Company approval for surgeries, Workers’ Compensation surgeries are subject to utilization review and independent medical review. Thus, there are guidelines and algorithms that must be met in order for surgeries to get authorized.  This can lead to delays in getting approval.

Medical Providers:  For many Injured Workers, they are constrained to using hand surgeons and upper extremity surgeons within the workers’ compensation insurance medical provider networks. Thus, the quality of the surgeon is subject to the insurance company’s dedication to having good providers.

Total Temporary Disability Benefits: For Injured Workers, they receive benefits is they remain symptomatic. Therefore, it is necessary that the voice all of their problems.

Permanent Disability Benefits: For Injured Workers, they need to be critical of the results of the surgery and be able to describe them.  Therefore, the result is viewed with this mindset.

What Was the Study’s Conclusion?

 The study “found that patients receiving WC[workers’ compensation] had worse postsurgical results after upper extremity surgery and demonstrated less pre- vs postoperative improvement than uncompensated patients regardless of which outcomes were measured. However, this effect was not uniform among different types of outcomes. Functional measures, such as AOM or grip strength, were least likely to demonstrate a significant difference between compensated and uncompensated patients. The same was true in studies that measured pre- vs postoperative improvement rather than only assess patient postoperatively.” Fujihara Y, Shauver MJ, Lark ME, Zhong L, Chung KC. The Effect of Workers’ Compensation on Outcome Measurement Methods after Upper Extremity Surgery: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2017;139(4):923-933. doi:10.1097/PRS.0000000000003154. It was noted that this analysis was aware that compensated patients can result in artificial reduction of the therapeutic effect which may lead to incorrect conclusions. Supra.

The study noted that “.. the effect of WC on surgical outcome is not solely an issue of malingering Americans. Compensation systems that do not incentivise feigning impairment, also observe worse outcomes associated with WC. Rather, this may indicate that increased impairment among workers receiving WC may be a result of psychological effects on patients caused by a sense of victimization or injustice .” Fujihara Y, Shauver MJ, Lark ME, Zhong L, Chung KC. The Effect of Workers’ Compensation on Outcome Measurement Methods after Upper Extremity Surgery: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2017;139(4):923-933. doi:10.1097/PRS.0000000000003154

In sum, it would appear that Injured Workers have poorer post-operative results.   There are factors of income, malingering, psychological effects of victimhood and injustice may be the factors lead to a poorer workers’ compensation result.

Knowing these Results, How Will an Injured Worker Be Treated?

 Insurance Companies, knowing the surgery result may be poor, may want to avoid providing for it.  This can be done in two ways: one, settling the case before surgery, two, contesting the need for the surgery.

Doctors take pride in their work.  Doctors like to have good results.  Therefore, doctors may not thrilled with Injured Workers because there will be some level of dissatisfaction and representations that the surgical result was not optimal.

Employers, like Insurance Companies, may not be happy with surgeries with poor results.  For them, they are faced with a costlier claim as well as possible issues with respect to return to work.   Return to work issues would involve either qualified Injured worker status or the need to provide alternative or modified work.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

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