NAHC Comments on ANA Proposed Standards

The American Nurses Association (ANA) drafted the “National Safe Patient Handling and Mobility Standards” that reflect many of the provisions of the 2000 OSHA Ergonomics final rule that OSHA was required to remove from the Code of Regulations in 2001 as a result of Congressional disapproval. These multi-disciplinary were drafted to provide evidence-based and outcomes-focused standards of care to be applied by all disciplines across all settings where health care services are provided.  Included are health care institutions, as well as educational and residential settings, community settings and individual homes. The standards would apply to “the health care organization, agency, system, corporation, business or person that employs or contracts with health care workers.” Health care workers are defined as nurses, assistants, aides, therapists, radiology technologists, morgue personnel, emergency medical technicians, transporters, physicians, teachers and para-educators.

The draft standards and instructions for comments can be found at: Comments were due by Nov. 30, 2012. The National Association for Home Care & Hospice (NAHC) urged all individuals and organizations that may be affected by the finalization of “Safe Patient Handling Standards” are urged to review the draft standards and submit comments, with attention to the legal and financial impact of these standards on individuals and organizations as employers, and their potential for posing a barrier to care for certain individuals.   Although voluntary, there is intent to use these standards to inform accreditation bodies and regulators for potential Safe Patient Handling and Mobility (SPHM) standard requirements.

NAHC submitted comments, expressing concern about their impact on both providers of services in the home and beneficiaries who may be denied access to care. These concerns included:

  • The majority of home care agencies are small businesses, therefore a SPHM program as outlined in the standard will be expensive to implement without funding sources.
  • Home care providers do not have the same controls with patient and caregiver compliance as in inpatient settings
  • Home care providers have limited control over a patient’s environment
  • Home health providers do not and cannot be expected to supply SPHM equipment for their patients.
  • Equipment installation is the responsibility of the supplier and not the agency
  • The agency cannot be held accountable for the maintenance and repair of equipment that is not the owned by the agency.
  • Competency and training standards do not fit the structure of home care.
  • The standards could have unintended consequences in access to care for patients who need SPHM technologies. Liability concerns for complying with the standards will result in community health organizations to not accept certain patients on service.
  • Protections for the health care worker seem to overshadow the rights of consumers of health services.
  • Since the standards are aimed at protecting employees, how are the standards to be applied in a self directed care situation where the employer is the patient or family?
  • Members of the working group do not appear to represent all affected entities. Only one provider representative is noted and there was no consumer representation.

NAHC also pointed to the fact that, although our comments were tailored towards community-based settings, there are several general concerns that should be considered which could negatively impact all affected parties and settings that the standards are intended to apply. The proposed SPHM standards will be an added expense for most organizations, many of whom are already experiencing financial difficulties. Discriminatory practices could result if the rights of the staff are not balanced with rights of the patient. NAHC will monitor and report on the status of the Safe Patient Handling standards.

from the NAHC Report article