How modified work affects disability outcomes in long-term care

There is some evidence that modified work for injured workers in Ontario’s long-term care sector was associated with a lower burden of disability, according to an Institute for Work & Health (IWH) study.

In other words, the researchers found that a greater amount of modified work days lowered the number of disability days. Disability days were estimated as the sum of days of wage replacement benefits plus the number of days of modified work reported by the facility administrators.

The health-care sector has one of the highest rates of lost-time claims in Ontario. Nearly 60,000 health-care providers in Ontario work in more than 600 licensed long-term care facilities. The risk of work-related disability for these providers is high. Heavy workloads and the physical demands of patient lifting and repositioning can create health problems for caregivers.

Previous published research shows that organizational commitment to preventing disability, early offers of workplace accommodation of modified work, and communication during a worker’s disability episode may shorten or prevent absence.

The IWH study examined the differences in modified work and disability management outcomes – such as number of disability days or disability compensation expenditures – in the long-term care sector.

Led by IWH President and Senior Scientist Dr. Cameron Mustard, the research team published the study’s results in the May 2010 issue of Journal of Occupational Rehabilitation (e-pub ahead of print: DOI 10.1007/s10926-010-9248-2).

Data for this study was collected in the course of the Ontario Patient Lift Evaluation Study (OPLES), which measured the process of adopting patient lift equipment in the long-term care sector.

The researchers collected information about disability and modified work arrangements from a sample of 32 licensed long-term care facilities for two consecutive years, 2005 and 2006. The study

used information provided by facilities and administrative records from the Ontario Workplace Safety and Insurance Board (WSIB) to estimate total disability days and disability compensation expenditures per 100 full-time staff.

The study estimated that the average annual number of disability days for work-related conditions in long-term care facilities was 922 per 100 full-time equivalent workers in 2005 (889 disability days per 100 full-time equivalent workers in 2006). Disability compensation expenditures, combining wage replacement benefits provided by the WSIB and wage payments received from employers in the course of modified work duties, averaged $75,332 per 100 full-time staff in 2005 and $64,619 in 2006.

The study tested several hypotheses related to disability management outcomes. One was that facilities that adopt modified work practices will have more no-time-loss claims relative to time-loss claims. Another hypothesis was that facilities that offered modified work arrangements would have lower compensation expenditures per 100 full-time equivalents.

First, the researchers found some evidence that facilities that adopted modified work practices had a higher ratio of no-time-loss claims to time-loss claims. Second, across facilities, the researchers did not find strong evidence that modified work was associated with lower disability costs.

In the course of this study, we determined that about 60 per cent of disability days were managed by modified work arrangements, says Mustard. However, in this setting, the disability days managed by modified duty arrangements were not accurately documented in workers’ compensation claim records.

Mustard also notes that, Across facilities in the sample, there was a wide variation in the number of disability episodes and in the frequency of disability days. Given the similar working conditions in this important sector, this variation points to the potential influence of organizational policies and practices in shaping work-related health outcomes.

Source: At Work, Issue 62, Fall 2010: Institute for Work & Health, Toronto