Occupational Safety and Health Administration (OSHA)

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OSHA Issues New Rule on Employee Representation During OSHA Inspectionhttps://publish.ahcancal.org/News-and-Communications/Blog/Pages/OSHA-Issues-New-Rule-on-Employee-Representation-During-OSHA-Inspection.aspxOSHA Issues New Rule on Employee Representation During OSHA Inspection4/10/2024 4:00:00 AM<p></p><div>Last week, the Occupational Safety and Health Administration (OSHA) issued its <a href="https://www.osha.gov/worker-walkaround/final-rule" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Final Rule</a> “clarifying” that third-party, non-employees may accompany the OSHA Compliance Safety and Health Officer (CSHO) during the walkthrough inspection of a workplace. The new rule, which goes into effect on May 31, 2024, has caused concern for employers, but much of the impact will depend on how OSHA chooses to implement the regulation and on a CSHO’s individual judgment. </div><div><br></div><div><span style="font-size:11pt;">As background, OSHA allows employees to have a representative during the walkthrough inspection of a workplace. Typically, that representative is an employee, but here, the discussion is about whether a non-employee may act as the employee’s representative. The old version of OSHA’s employee representation regulation began with the premise that an employee representative “shall be an employee(s) of the employer.” 29 CFR 1908(c). But it also allowed for participation of a “third party who is not an employee of the employer (such as an industrial hygienist or a safety engineer)” if that person was “reasonably necessary.” 29 CFR 1908(c). The provision was frequently interpreted to limit third-party involvement to expert industrial hygienists and safety engineers, and as such, CSHOs rarely used the provision.  </span></div><div><br></div><div><span style="font-size:11pt;">The new regulation states that “the representative(s) authorized by the employees may be an employee of the employer </span><em style="font-size:11pt;">or a third party</em><span style="font-size:11pt;">.” 89 Fed. Reg. 22601. It then limits the representation by a third party to instances where “good cause has been shown why accompaniment by a third party is reasonably necessary to the conduct of an effective and thorough physician inspection of the workplace." 89 Fed. Reg. 22601. Thus, in OSHA's words, the new provision “clarif[ies] that the representative(s) authorized by employees may be an employee of the employer or a third party.” 89 Fed. Reg. 22558.  </span></div><div><br></div><div><span style="font-size:11pt;">The question then becomes, who is the third-party representative and how are they selected, if one is selected at all. For union workplaces, the employee representative should be selected by “the highest-ranking union official or union employee representative on-site.” OSHA Field Operations Manual, Chap. 3, Sec. VII.A.1. For a non-union building, however, the CSHO has wide latitude to determine who is an employee representative, and OSHA has refused to create a specific process by which non-union employees select a representative. The very few parameters expressed by OSHA are so vague that they say almost nothing. For example: there "is no requirement" that the employee representative must be approved by a majority of employees;  </span></div><div> </div><blockquote style="margin:0px 0px 0px 40px;border:none;padding:0px;"><div><span style="white-space:normal;">“in a workplace with more than one employee, [the approval of] more than one employee would be needed to authorize the walkaround representative;” and “[i]f the CSHO is unable to <span style="white-space:pre;"> </span>determine with reasonable certainty who is the authorized employee representative, the CSHO will consult with a reasonable number of employees concerning matters of safety and health in the workplace.” 89 Fed. Reg. 22590.  </span></div></blockquote><div> </div><div>As such, if OSHA indicates that a non-employee third party will be involved in the inspection, the employer should ask questions about how the representative will be (or has been) selected at the outset of the inspection.  </div><div><br></div><div><span style="font-size:11pt;">For employers who want to limit access of third parties to the premises, they will likely need to rely on the language of the regulation itself. OSHA must show by </span><em style="font-size:11pt;">“good cause”</em><span style="font-size:11pt;"> that the third party is </span><em style="font-size:11pt;">“reasonably necessary</em><span style="font-size:11pt;"> to the conduct of an </span><em style="font-size:11pt;">effective</em><span style="font-size:11pt;"> and </span><em style="font-size:11pt;">thorough</em><span style="font-size:11pt;"> inspection of the workplace.” 29 CFR 1903.8(c). Further, if a third-party representative deviates from their role to provide expertise for purposes of the OSHA inspection—for example, if a third-party representative begins to encourage unioniza</span><span style="font-size:11pt;">tion during the inspection—the CSHO should terminate the representative’s access to the inspection. 89 Fed. Reg. 22582–83. It should also be noted that the employee representative does not have the right to participate in employee interviews, unless invited by the employee, and should not be involved in any document production or review. The new rule only allows participation in the walkthrough portion of the inspection. Finally, the employer should know their rights under the Fourth Amendment and may want to consult an attorney about requiring OSHA to obtain a warrant before entering the site with an outside third-party representative. </span></div><div><br></div><div><span style="font-size:11pt;">At this point, it is hard to predict the scope or magnitude of the impact of the new regulation because so much is left to the discretion of the CSHO. OSHA may also implement new guidance at the national, regional, or local levels that will affect how CHSOs choose to implement the regulation. In short, while the regulation could significantly change the landscape of an OSHA inspection, it will take time to determine the impact. Employers should be aware of this development and understand their rights if OSHA knocks on their door.  </span></div><div> <br></div><p>​</p>Last week, the Occupational Safety and Health Administration issued its Final Rule “clarifying” that third-party, non-employees may accompany the OSHA Compliance Safety and Health Officer during the walkthrough inspection of a workplace.
LTC Best Practices for Compliance with OSHA's Employee-Centric Infection Control Regulation: Part IIhttps://publish.ahcancal.org/News-and-Communications/Blog/Pages/LTC-Best-Practices-for-Compliance-with-OSHA's-Employee-Centric-Infection-Control-Regulation-Part-II.aspxLTC Best Practices for Compliance with OSHA's Employee-Centric Infection Control Regulation: Part II4/3/2024 4:00:00 AM<p>​<span style="font-size:11pt;">The previous article <a href="/News-and-Communications/Blog/Pages/OSHA-Regulation-of-Infectious-Disease-in-Long-Term-Care.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Infectious Disease in LTC Part 1</a> looked at the regulatory landscape surrounding the Occupational Safety and Health Administration’s (OSHA) oversight of infectious disease management in long term care (LTC) settings. While there isn't yet a specific infectious disease standard tailored to LTC providers, OSHA's <a href="https://www.osha.gov/healthcare/infectious-diseases" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">existing standards and guidelines</a>, coupled with forthcoming regulations, necessitate strict infection control measures. </span></p><div><span style="font-size:11pt;"><strong>Implementing Best Practices </strong></span></div><div> </div><div>Many providers have established <strong>resident-centered</strong> infection prevention and control policies. These best practices are intended to mitigate <strong>employee</strong> exposure to infectious disease, but they may already be addressed by your existing infection prevention and control policies—often employee and resident-focused infection control are two sides of the same coin that can be addressed together. </div><div><br></div><div><ol><li><strong>Comprehensive Risk Assessment: </strong>LTC centers should conduct thorough hazard assessments to identify potential sources of infectious disease transmission to employees. For example, facilities can assess the risk of respiratory infections by considering factors such as resident mobility, communal living spaces, and staff interaction. Based on this assessment, targeted interventions can be implemented to mitigate risks. <br><br></li><li><span style="font-size:11pt;"><strong>E</strong></span><span style="font-size:11pt;"><strong>ngineering Controls:</strong> Employ engineering solutions to minimize the risk of exposure to infectious diseases. For instance, optimizing ventilation systems and airflow can help dilute and remove airborne pathogens. <br></span><br></li><li><span style="font-size:11pt;"><strong>Training and Education:</strong> Provide comprehensive training to staff on infection control protocols, including proper hand hygiene, personal protective equipment (PPE) usage, and environmental cleaning procedures. Conduct regular training sessions and drills to ensure staff competency and readiness to respond to infectious disease outbreaks. For example, conducting simulated outbreak scenarios can help staff practice effective communication, coordination, and infection control measures in real-time. <br></span><br></li><li><span style="font-size:11pt;">Personal Protective Equipment (PPE): Ensure that adequate PPE is available for all staff members who may encounter infectious agents. Establish protocols for PPE use, disposal, and replenishment to maintain a safe working environment. Consider implementing a buddy system or peer monitoring to ensure proper PPE adherence and provide immediate feedback or assistance when necessary. <br></span><br></li><li><span style="font-size:11pt;"><strong>Respiratory Protection:</strong> In addition to standard PPE, implement respiratory protection measures where airborne hazards are present. This may involve the use of N95 respirators or equivalent respiratory protection devices, as dictated by OSHA's Respiratory Protection Standard. Conduct fit testing and provide training on proper respirator use and maintenance as required by the Standard.<br> </span><br></li><li><span style="font-size:11pt;"><strong>Recordkeeping and Reporting:</strong> Maintain records of infectious disease incidents, employee training sessions, hazard assessments, and corrective actions taken. Implement reporting protocols to promptly notify relevant authorities of any outbreaks or significant incidents. Regularly review and analyze incident data to identify trends, areas for improvement, and opportunities to enhance infection control measures. <br></span><br></li><li><span style="font-size:11pt;"><strong>Utilize Available Resources:</strong> Take advantage of OSHA's resources and guidance documents to support your infection control efforts. Engage with industry associations, peer networks, and public health agencies to stay informed about emerging infectious disease threats and best practices. Collaborate with local health departments and epidemiologists to develop outbreak response plans and coordinate surveillance efforts. </span><br></li></ol></div><div><br></div><div><span style="font-size:11pt;"><strong>Possible Infection Control Practices in LTC Settings </strong></span></div><div><br></div><div><ol><li><strong>Isolation and Cohorting: </strong>A LTC provider may implement proactive isolation and cohorting strategies during an outbreak to prevent the spread of infection. By promptly identifying and isolating residents with suspected or confirmed cases of COVID-19 or other infectious diseases, a center may contain outbreaks and minimize transmission within the center. <br><br></li><li><span style="font-size:11pt;"><strong>E</strong></span><span style="font-size:11pt;"><strong>nvironmental Cleaning: </strong>A LTC setting may benefit from environmental cleaning protocols, including more frequent disinfection of high-touch surfaces and communal areas. By prioritizing thorough cleaning and disinfection practices, a center may reduce the risk of surface transmission and maintain a clean and safer environment for residents and staff. <br></span><br></li><li><span style="font-size:11pt;"><strong>Staff Vaccination Campaigns:</strong> A LTC setting may implement comprehensive staff vaccination campaigns to increase COVID, influenza, and similar vaccination rates among employees. Through education, motivations, and on-site vaccination clinics, a facility may achieve a higher vaccination coverage rate among staff, reducing the risk of influenza or other outbreaks and protecting vulnerable residents. </span><br></li></ol></div><div><br></div><div><span style="font-size:11pt;"><strong>Looking Ahead </strong></span></div><div><br></div><div>As OSHA continues to develop and refine its infectious disease standard for health care providers, it is essential for providers to remain proactive in their approach to infection control. By implementing comprehensive policies, procedures, and training programs, LTC providers can safeguard the health and safety of both staff and residents. <br><br></div><p><br></p>The previous article Infectious Disease in LTC Part 1 looked at the regulatory landscape surrounding the Occupational Safety and Health Administration’s oversight of infectious disease management in long term care settings.
OSHA Regulation of Infectious Disease in Long Term Carehttps://publish.ahcancal.org/News-and-Communications/Blog/Pages/OSHA-Regulation-of-Infectious-Disease-in-Long-Term-Care.aspxOSHA Regulation of Infectious Disease in Long Term Care3/26/2024 4:00:00 AM<p></p><div>While the Occupational Safety and Health Administration (OSHA) does not currently have a specific infection prevention standard tailored for long term care facilities, it regulates employee exposure to infectious disease through the <a href="https://www.osha.gov/laws-regs/oshact/section5-duties" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">OSHA General Duty Clause</a> and existing standards, like the <a href="https://www.osha.gov/bloodborne-pathogens/standards" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Bloodborne Pathogen Standard</a>. OSHA is also drafting and expected to issue a more comprehensive infectious disease standard.  </div><div> <br></div><div><strong>Current Regulation Status</strong> <br></div><div> </div><div>Traditionally, OSHA has focused on disease transfer through blood or other potentially infectious fluids because the Bloodborne Pathogen Standard narrowly addressed those modes of transmission. Years before the emergence of COVID-19, however, OSHA began to look at the spread of infectious disease more broadly, and it continued those efforts throughout the pandemic.  </div><div> </div><div>Currently, OSHA requires health care providers to continue following the Bloodborne Pathogen Standard and also implement known and feasible methods of preventing the spread of infection through contact, droplet, and airborne transmission. OSHA has published <a href="https://www.osha.gov/healthcare/infectious-diseases" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">guidelines on infection control</a>, many of which may already be used by health care providers to address patient or resident safety. OSHA enforces compliance with those guidelines through the General Duty Clause as discussed previously in <a href="/News-and-Communications/Blog/Pages/Ergonomics-201-Controls-State-Regulations-and-Resources.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Ergonomics 201: Controls, State Regulations, and Resources</a> and <a href="/News-and-Communications/Blog/Pages/Addressing-the-Challenge-Workplace-Violence-in-LTC-Setting.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Workplace Violence in LTC</a>. Within those standards and guidelines, providers should also be mindful of related OSHA standards, like the <a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Respiratory Protection Standard 1910.134</a> which is triggered when addressing airborne hazards, or the <a href="https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.132" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">1910.132 - PPE General Requirements</a> which includes other precautions, like gloves, gowns, and eye protection.  </div><div><br></div><blockquote style="margin:0px 0px 0px 40px;border:none;padding:0px;text-decoration:underline;"><div dir="ltr" style="text-align:left;"><span style="font-size:11pt;">​<strong>State OSHA Standards</strong></span></div></blockquote><div><br></div><div><span style="font-size:11pt;">Some states have their own Occupational Safety and Health (OSH) programs as identified in the <a href="/Survey-Regulatory-Legal/Documents/A%20Roadmap%20to%20OSHA%20Requirements.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Roadmap to OSHA Requirements</a>, which may introduce additional regulations or standards surpassing federal OSHA requirements. For example, California's Cal/OSHA program has implemented specific regulations under the Aerosol Transmissible Diseases (ATD) standard, mandating stringent measures to prevent the transmission of infectious diseases in health care settings, including long term care facilities. </span></div><div><br></div><blockquote style="margin:0px 0px 0px 40px;border:none;padding:0px;text-decoration:underline;"><div><span style="font-size:11pt;"><strong>Temporary Standards</strong></span></div></blockquote><div><br></div><div>During public health crises, like the COVID-19 pandemic, OSHA may also issue temporary standards and specific guidance to address the evolving safety concerns in workplaces, including long term care centers.  </div><div> </div><div>These guidelines offer tailored recommendations to protect workers from exposure to infectious diseases and ensure their safety amidst challenging circumstances. These precautions are enforced either through an Emergency Temporary Standard, as was used with COVID-19, or through the General Duty Clause. </div><div><br></div><div><span style="font-size:11pt;"><strong>Proposed Infectious Disease Standard </strong></span></div><div> <br></div><div>While there is no broad infectious disease standard for long term care centers currently, OSHA is developing more comprehensive regulations. The new standard is likely to address critical aspects, such as airborne and droplet precautions, engineering control measures, personal protective equipment (PPE), respiratory protection, hazard assessment and control, training and education, recordkeeping, and reporting. As with other OSHA standards, many of the requirements for the new infectious disease standard may already be addressed in providers’ resident or patient care policies, but there will almost certainly be new documentation and similar requirements. </div><div> </div><div>Resources, such as regulatory agenda items, Requests for Information (RFI), stakeholder summary reports, and Small Business Advocacy Review Panel (SBAR Panel) Final Reports, serve as valuable references in understanding OSHA's initiatives on infectious diseases in the workplace: </div><div><span style="font-size:11pt;"><br></span></div><div><ul><li><span style="font-size:11pt;">Regulatory agenda item (Spring, 2017) which explains more about OSHA's Infectious Diseases efforts: <a href="https://resources.regulations.gov/public/custom/jsp/navigation/main.jsp" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">https://resources.regulations.gov/public/custom/jsp/navigation/main.jsp </a><br><br></span></li><li><span style="font-size:11pt;"><a href="https://www.regulations.gov/document?D=OSHA-2010-0003-0001" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Infectious Diseases RFI</a> and comments to the RFI (<a href="https://www.regulations.gov/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">www.regulations.gov</a> - Docket #OSHA-2010-0003). <br><br></span></li><li><span style="font-size:11pt;"><a href="https://www.regulations.gov/document?D=OSHA-2010-0003-0236" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Infectious Diseases Stakeholder Summary Report </a><br><br></span></li><li><span style="font-size:11pt;"><a href="https://www.regulations.gov/document?D=OSHA-2010-0003-0239" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Small Entity Representative Background Document ​</a></span></li></ul></div><div><br></div><div><span style="font-size:11pt;">With infectious disease, regardless of the method of transmission, employee safety is tied closely with the safety of residents and patients. OSHA’s current standards and guidelines certainly place an additional regulatory burden on health care providers, but the basic principles of infection control remain the same.  </span></div><div> </div><div>In an upcoming blog, AHCA/NCAL will provide additional insight and best practices to help long term care providers comply with OSHA’s employee-centric infection control regulation.  </div><div><br><br></div><p>​</p>While OSHA does not currently have a specific infection prevention standard tailored for long term care facilities, it regulates employee exposure to infectious disease.
Addressing the Challenge: Workplace Violence in LTC Settinghttps://publish.ahcancal.org/News-and-Communications/Blog/Pages/Addressing-the-Challenge-Workplace-Violence-in-LTC-Setting.aspxAddressing the Challenge: Workplace Violence in LTC Setting3/20/2024 4:00:00 AM<p></p><div>Long term care (LTC) centers have always served as a place of comfort and safety for the elderly and individuals with disabilities, providing essential support and care in their daily lives. Unfortunately, in recent years, the issue of workplace violence in health care has gained increased national attention, and LTC centers are not immune. This article will cover some of the practical and regulatory issues with workplace violence in LTC settings, exploring its history, expectations, and anticipated action for prevention and intervention. It is essential that we understand this challenge and implement proactive measures.  </div><div><br></div><div style="text-decoration:underline;"><span style="font-size:11pt;"><strong>History:</strong></span></div><div><br></div><div><span style="font-size:11pt;">The Occupational Safety and Health Administration (OSHA) does not have, and has never issued, a formal workplace violence standard. Instead, since the late 1980s and early 1990s, OSHA has used the General Duty Clause to cite employers that do not follow basic workplace violence precautions. The clause states that “all employers have a duty to provide a place of employment “free from recognized hazards that are causing or are likely to cause death or serious injury.” </span></div><div><br></div><div><span style="font-size:11pt;">Traditionally, even in LTC settings, workplace violence has always been thought of in terms of active-shooter scenarios or domestic violence extending into work, but increasingly, OSHA is focusing on a much more common occurrence: resident-on-employee violence. OSHA is currently in the process of creating a formal regulation to address resident behaviors in health care (the RFI is available <a href="https://www.federalregister.gov/documents/2016/12/07/2016-29197/prevention-of-workplace-violence-in-healthcare-and-social-assistance" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">here</a>). However, because the timing of this new standard is not yet known, OSHA is trying to reduce instances of resident-on-employee violence by applying its General Duty Clause, which was previously covered in a <a href="/News-and-Communications/Blog/Pages/Safe-Resident-Handling-and-Prevention-of-Musculoskeletal-Injuries-Ergonomics-in-Long-Term-Care-Communities.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">previous article</a>. Like in ergonomics, OSHA’s enforcement of the General Duty Clause for workplace violence is based on OSHA’s guidelines and expectations. As such, it is important to understand OSHA’s current expectations for prevention of workplace violence and anticipated action going forward. </span></div><div><br></div><div style="text-decoration:underline;"><span style="font-size:11pt;"><strong>C</strong></span><span style="font-size:11pt;"><strong>urrent expectations: </strong></span></div><div><br></div><div><span style="font-size:11pt;">OSHA defines workplace violence broadly to include “any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. It can affect and involve workers, clients, customers, and visitors. [workplace violence] ranges from threats and verbal abuse to physical assaults and even homicide.” To reduce incidence of workplace violence, OSHA’s first recommendation is to develop a “zero-tolerance policy” covering staff, patients, visitors, and others, but that recommendation is difficult, if not impossible, to implement in most LTC settings. A more achievable expectation is to create a “Workplace Violence Prevention Program” to include a hazard analysis, control measures, training, and continued program re-evaluation.  </span></div><div><br></div><div><span style="font-size:11pt;">Hazard analysis can be completed on multiple levels, including as an entire facility, by unit, or by individual resident or patient. Facility-wide hazards might be, for instance, low lighting in certain areas or limitations for communication between staff. Resident-specific factors might include a history of violence, behaviors, or volatility. Fortunately, many LTC centers already complete resident-specific care plans that often identify a history of behaviors and implement interventions to address those behaviors. For all hazard assessments, OSHA recommends involving both facility management and staff. </span></div><div><br></div><div><span style="font-size:11pt;">Controls will be highly dependent on the facility and resident population and, therefore, cannot be identified by a comprehensive list. </span></div><div><br></div><div><span style="font-size:11pt;">Some examples from the hierarchy of controls might include: </span></div><div><br></div><div><ul><li><span style="font-size:11pt;"><span style="text-decoration:underline;">Substitution</span>: While it may not always be possible, OSHA suggests that a facility’s best control might be “transferring a client or patient to a more appropriate facility” that is better suited to care for the resident and protection of others.  <br><br></span></li><li><span style="font-size:11pt;"><span style="text-decoration:underline;">Engineering</span>: One control often mentioned in OSHA enforcement documentation is improving communication with other employees to call for help. In many instances, this might be a phone system, while in other high-risk settings, a panic button might be recommended. Additionally, OSHA often notes that improved monitoring and visibility can help reduce injuries due to violence, including surveillance cameras and positioning nursing stations in areas with high visibility. Like other controls, these engineering controls are highly facility specific and may not be necessary with certain resident populations. <br><br></span></li><li><span style="font-size:11pt;"><span style="text-decoration:underline;">Work-practice and administrative</span>: The primary work practice controls are resident-specific interventions, likely using care plans or trauma informed care. Additionally, staffing levels and turnover are frequently recognized risk factors. OSHA’s expectation is for a facility/community to have adequate and trained staff, possibly including security guards, to respond to a workplace violence event to minimize the potential for injury. Often, OSHA’s expectations for staffing can simply be having another employee within the area for easy communication to respond to a workplace violence event. <br><br></span></li><li><span style="font-size:11pt;"><span style="text-decoration:underline;">Training</span>: The most significant control for workplace violence is likely employee training. Training might include recognizing patient-specific risk factors, de-escalation techniques, and understanding when to call for help. In LTC centers with a population of mentally declining or incompetent individuals, including those with dementia, training on strategies to understand the patient’s mindset and challenges, like Hand-In-Hand training, might also be included in the Workplace Violence Prevention Program. </span></li></ul></div><div><br></div><div><span style="font-size:11pt;">In addition to hazard analysis and controls, OSHA recommends implementing a system for employees to report incidents and for those incidents to be investigated to determine the root cause. From those reports and investigations, further interventions or controls might be added to your Workplace Violence Prevention Program. </span></div><div><br></div><div><span style="font-size:11pt;">More information on OSHA’s <a href="https://www.osha.gov/workplace-violence" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">current expectations on workplace violence</a> and <a href="https://www.osha.gov/hospitals/workplace-violence" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">worker safety in hospitals</a> can be found on OSHA’s website, and in the following publications: </span></div><div><br></div><div><ul><li><span style="font-size:11pt;"><a href="https://www.osha.gov/sites/default/files/publications/osha3148.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers </a></span><span style="font-size:11pt;">​</span></li><li><span style="font-size:11pt;"><a href="https://www.osha.gov/sites/default/files/OSHA3828.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Workplace Violence Prevention and Related Goals: The Big Picture</a> (includes state specific regulation)</span><span style="font-size:11pt;"> </span></li></ul></div><div><br></div><div style="text-decoration:underline;"><span style="font-size:11pt;"><strong>Anticipated Action:</strong></span></div><div><br></div><div><span style="font-size:11pt;">As stated above, OSHA is working through the “notice and comment” process to promulgate a workplace violence regulation specific to health care employers. That said, OSHA has not released an estimated date of issuance. In the meantime,<strong> the best preparation is likely to begin implementing a formal Workplace Violence Prevention Program, using the controls and interventions most appropriate for your facility.</strong> Those should create a solid foundation for any future OSHA regulation. </span></div><div><br></div><div><span style="font-size:11pt;">Workplace violence in long term care settings demands attention and proactive measures. By prioritizing prevention, intervention, and support, facilities/communities can immediately create awareness, which fosters a safer environment for residents and staff.  This may include anything from implementing comprehensive violence prevention programs to simply training employees and encouraging a culture of safety. Operators should begin a process where long term care centers minimize the threat of workplace violence, ensuring that residents receive quality care and staff can fulfill their roles with confidence and security. </span></div><div>      <br></div><p>​</p>Long term care centers have always served as a place of comfort and safety for the elderly and individuals with disabilities, providing essential support and care in their daily lives.