Fact Sheet: Workplace Strategies for Avoiding Workers' Compensation Claims
Certified Nursing Assistants (CNAs) working at nursing homes experience some of the highest workplace injury rates in the United States due to insufficient training, heavy workload and a number of other factors.
Creating a safe working environment is essential to reducing workers’ compensation claims in senior living communities, and implementing smart workplace practices – hiring the right people for the right jobs and supporting them with resources and recognition – can help you do that. Below, we highlight the areas you can address and the steps you can take.
Limit exposure to industry vulnerabilities as much as possible. Seek out individuals who are able to safely perform the physical demands of the job, who do not use illicit drugs and who are familiar with your industry.
- Create job descriptions for all positions, ensuring the physical demands of the job are correctly detailed in each.
- Hire experienced staff who are familiar with the industry.
- Avoid candidates with frequent job changes (more than two per five years).
- Conduct post-offer, pre-employment screenings focused on the candidate’s ability to perform the physical demands of the position. (Physical demands are not the same as essential functions.) Make sure the examiner has the job description and is aware of the physical demands the candidate must be cleared to perform.
- Conduct post-offer, pre-employment drug screenings.
- Conduct post-offer, pre-employment workers’ compensation background checks (where allowed by law).
- Document your hiring practices and treat all candidates the same.
Inadequate staffing can contribute to employee and resident injuries, and it’s often the cause of dissatisfaction. Studies show the cost of an additional staff member is, in many cases, much less than the cost of an employee or resident injury.
- Attempt to meet or exceed industry staffing guidelines for long-term care facilities.
- Use alternate staffing resources to avoid mandatory overtime.
- Ensure work assignments minimize repetitive lifting and manual tasks.
- Rotate manual lifting tasks among staff if it will limit the frequency of those tasks.
- Bring in staff from sister facilities to supplement your team.
- Evaluate other staffing sources: Local nursing schools, companions to partner with staff, volunteers, etc.
- Consider using nonclinical resources whose roles involve companion-like services. This could help reduce some of the physical demands on other caregivers and may be available at a lower wage as well.
- Offer incentives to staff willing to work a flexible schedule.
Many studies focus on workplace culture and organizational health as a means to reducing employee injury and employee turnover. In fact, some studies indicate culture is the most important aspect to a healthy organization and happy employees. Improving workplace culture requires a sustained effort.
- Offer competitive wages.
- Create and maintain a supportive work environment. Demonstrate appreciation and good intent.
- Invest in employee training.
- Encourage employee participation on committees and in special projects.
- Recognize workers for their commitment, project outcomes and acts of kindness.
- Offer small incentives, like a $5 coffee shop gift card to employees with the highest audit scores.
- Celebrate positive outcomes, such as success with a resident, regulatory inspections, etc.
- Promote regulatory compliance.
- Establish a Minimal Lift policy.
In spite of a federal mandate that Certified Nursing Assistants (CNAs) receive at least 75 hours of training with a 16-hour clinical component1, many CNAs report “inadequate training” for the role. CNAs who feel ill-prepared for their jobs are more likely to be injured.
- Provide comprehensive training starting with onboarding and continuing with regular staff training during the course of employment.
- Schedule follow-up training sessions for new CNAs to offer additional support.
- Evaluate the effectiveness of the training provided through post-tests or return demonstrations.
- Pair new CNAs with preceptors.
- Maintain competency sign-off logs that not only document training topics, but also the employee’s comfort with performing the task proficiently.
In the workers’ compensation arena, documentation plays an integral part in minimizing worker injuries and reducing employer risk. Opportunities for documentation include:
- Consistent post-offer, pre-employment medical screenings, performed by a medical provider who is knowledgeable in occupational health principles, that document a worker’s ability to perform the duties of the position for which they have been offered.
- Training records containing the training provided, as well as the employee’s understanding of the content and his or her comfort with performing the task going forward.
- Medical care for workers’ compensation injuries provided through a licensed medical provider who is knowledgeable in occupational health principles and committed to identifying tasks a worker can perform (light duty) during their recovery period.
- Records that address events leading up to and following a report of injury, such as:
- Preventive measures
- Prior training
- Staff education
- Referral for medical care
- Injury investigation
- Hazard correction
- Occupational Safety and Health Administration recordkeeping requirements
- Overall compliance with regulatory entities and prompt response to any inquiries or recommended corrections.
There’s not one silver bullet for controlling risk. What’s needed is a system; a group of actions whose sum is greater than its parts. Each of the following components added to your safety program help grow that system, which helps you control injuries and losses.
- Worksite loss control surveys.
- Compliance with all regulatory entities.
- A limited lift program supported by adequate and appropriate lift devices.
- Appropriate personal protective equipment and supplies.
- A clearance process for employees returning from extended medical leaves.
Medical Claims Management
Understandably, there are some situations in which an employer is restricted from selecting a medical provider for an injured worker. In other situations, an employer is allowed to recommend a provider if the employee has not previously (prior to his or her injury), formally documented a provider of their choosing.
When providers are unfamiliar with the workers’ compensation system, they do not necessarily understand, nor embrace, the value early return to work has on the healing process. It’s like a heart surgeon not fully understanding brain surgery. They all have expertise, but using a provider with the specific expertise needed helps improve outcomes.
- Use medical providers with an understanding of occupational medicine and risk management principles.
- Select providers willing to embrace light duty work as part of an injured workers rehab process.
- Select providers who consider non-opiate alternatives for treatment of pain after the acute period.
 Work-Related Injuries Among Certified Nursing Assistants Working in US Nursing Homes, G. Khatutsky et. al, RTI Press, April 2012,
© 2020 The GuideOne Center for Risk Management, LLC. All rights reserved.This material is for informational purposes only. It is not intended to give specific legal or risk management advice, nor are any suggested checklists or action plans intended to include or address all possible risk management exposures or solutions. You are encouraged to retain your own expert consultants and legal advisors in order to develop a risk management plan specific to your own activities.