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COVID-19 Among Nursing Care Facility Workers: Occupational Injuries and Illnesses

November 02, 2023 (4 min read)

By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board

Early in the COVID-19 pandemic we learned that nursing care facilities (i.e., nursing homes, skilled nursing facilities, assisted living facilities and the like) were especially vulnerable to the disease. Based on our current knowledge of COVID-19, the susceptibility of employees in such facilities to the infection is not a surprise. The residents of nursing care facilities are predominately older individuals, many with underlying co-morbidities, who live near one another and require frequent assistance from the workers employed by the facilities. In the earliest days of the pandemic, images of family members “visiting” a loved one by standing outside the window of a nursing care facility became ubiquitous. News coverage of the pandemic reported on outbreaks occurring at various nursing care facilities, but the significance of scope of such outbreaks was never fully appreciated. The impact of COVID-19 on occupational injuries and illnesses among nursing care workers is the subject of a recent study conducted by researchers from the University of California San Francisco and Laguna Honda Hospital and Rehabilitation Center. The study, which is published in the American Journal of Industrial Medicine, used claims data from California’s Workers’ Compensation Information System (WCIS) in pre-pandemic and post-pandemic periods and compared the data between nursing care facilities and other settings. The findings illustrate the magnitude of the impact and identify healthcare workers’ psychological stress and mental health as an area of concern that must be addressed in any future pandemic.

Before the COVID-19 pandemic, nursing care facilities were infamous as workplaces with a high risk of occupational injuries and illnesses. In fact, 2019 data from the Bureau of Labor Statistics confirms the incidence rate of occupational injuries and illnesses in nursing care facilities was twice as high as the incidence rate in all other industries. This makes sense because the job of caregiving to older, often infirm residents who need assistance with performing activities of daily living can be quite physically demanding and require frequent close physical contact between residents and care staff. In fact, as the study reports, these factors increased the risk of COVID-19 infection and transmission in nursing care facilities. Although there have been several studies concerning the mental health impacts of the COVID-19 pandemic on healthcare workers, this study’s researchers found scant research on exactly how the pandemic affected those workers’ risks of occupational injury. That lack of information was the impetus for the study.

The researchers obtained claims data from WCIS using the required “First Report of Work Injury” forms filed between 2019 and 2021. This dataset was then categorized by occupational code as either nursing care facility, other healthcare, or nonhealthcare. COVID-19 claims of injury were identified by specific codes that identified the claim as a COVID-19 infection or COVID-19 related claim. Where the code provided was ambiguous, the researchers manually reviewed the narrative injury descriptions to corroborate the injury as a COVID-19 infection.

The study’s findings confirm that nursing care facilities were more severely affected by the COVID-19 pandemic than other healthcare settings or non-healthcare settings. In the beginning of the pandemic (2019 to 2020), the number of work-related injury claims in nursing care facilities increased by 64% due to COVID-19-related claims, which was more than two times higher than the percentage increase in other healthcare facilities and as much as twelve times higher in non-healthcare industries. These findings make sense given that healthcare workers were considered “essential workers” and remained on the job, while many workers in non-healthcare related industries were able to telework or did not work at all. Other factors that might explain why COVID-19 claims were so much higher in nursing care facilities than other settings might be the limited understanding of the virus, the lack of control measures, and the shortage of personal protective equipment (PPE).

Although between 2020 and 2021, COVID-19 claims rates in nursing care facilities showed a reduction, the rates were still significantly higher in nursing care facilities than other settings. During this period there was also an increased use of PPE, such as masks, gloves, face shields, respirators, and protective garments which may explain the decline in COVID-19 claims in nursing care facilities. Notwithstanding this decline in COVID-19 infection claims, there was one type of industrial claim by nursing care workers that increased during the first two years of the pandemic: stress/mental disorder claims. The shortage of PPE, the high death rate, and staffing shortages were some of the contributing factors. Other factors identified in previous research included fears of contracting a COVID-19 infection and/or transmitting it to family members; “burnout” due to staffing shortages and increased workloads; and the emotional burden of caring for elderly residents. The researchers emphasize that the increase in stress and mental disorder claims during the first few years of the pandemic is substantiation of the enormous psychological burden on nursing care facility workers and a clear indication of the need to address psychological stress and mental health during a pandemic among healthcare workers, especially those in vulnerable settings like nursing care facilities. You may read the full report here: Impact of Covid-19 on Occupational Injuries and Illnesses Among Nursing Care Facility Workers: Analysis of California Workers’ Compensation Data, 2019-2021

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