The nation’s nursing homes can expect to spend a lot more — in excess of $177 million, to be more precise — on assessment and compliance costs under a possible new federal program designed to prevent workplace violence.

The Occupational Health and Safety Administration released on Monday a lengthy draft document detailing what healthcare facilities would need to consider when developing assessments and trainings, and what kind of preventive and safety equipment they might need. Many nursing homes would have to spend tens of thousands of dollars to launch such a program and invest an average of more than $10,000 annually afterward to sustain it. 

Facilities would have to perform regular hazard assessments based on their records but will be able to identify for themselves potential hazards and mitigation plans. 

“OSHA believes this approach would provide more flexibility with decreased training requirements, and more flexibility in the required engineering and administrative controls for establishments with lower rates of workplace violence,” the agency said. “Employers would have flexibility to tailor the plan and its implementation to specific workplace conditions and hazards.”

Earlier this year, OSHA indicated that the violence prevention regulatory framework would be built around five components: 

·      A workplace violence prevention program

·      Workplace violence hazard assessments

·      Control measures

·      Training

·      Violent incident investigation and record keeping

The 251-page draft delves deep into detailed costs of what facilities should anticipate adding into their budgets. The agency makes a number of assumptions about how many employees would require training — 45% of a facility’s staff for nursing homes — and breaks down costs into three general facility categories: large, small and very small.

For this article, McKnights Long-Term Care News considered the costs for large facilities, which the agency estimates have 92 employees who are involved in direct patient care or contact occupations.

The 10-year annualized per-facility cost for nursing homes trailed only psychiatric and substance abuse hospitals and other hospitals. Continuing care retirement community costs were expected to average about $6,500 annually.

What it will take to address workplace violence

Finalizing the workplace violence rule is just one of many initiative attorneys at Fisher Phillips on Tuesday said could bring increased safety and training scrutiny to providers this year. In a webinar covered by McKnight’s Senior Living, experts predicted the agency would target industries with high turnover and issue aggressive citations if new employees do not receive key training. 

Facilities would be required to maintain a log of all workplace violence incidents, regardless of whether they meet OSHA’s definition of a reportable incident. 

Nursing homes also will be required to create a written Workplace Violence Prevention Program that OSHA estimates will take each nearly 30 hours’ labor to develop. The total plan cost for large facilities would be $4,305 for the first year and then $861 each year thereafter. The plan would have to be reviewed and updated at least annually. The agency expects that the labor burden to create these plans would cost $3,084 initially. 

Engineering redesigns and equipment purchases needed for compliance with the new federal program would vary for each facility, and the draft lists everything residential care facilities would need to be considered in compliance. For example, the agency estimated that only 69% of residential care facilities provide mental health services, and only those facilities would need to have a handheld weapons detector.  Other new protective equipment costs range from an estimated $40 for personal panic devices to $8,000 for deep-service counters.

As part of their workplace violence planning, facilities would be required to assess areas determined to be high-risk for violent incidents to ensure the physical layout does not have any sight barriers and includes surveillance systems or other visual aids, such as mirrors, lights and alarm systems or other “effective” means of communication if there are any sight barriers.

Employees would need unobstructed access to alarms and exit doors, and facilities would have to remove or fasten down any objects that could be turned into weapons.