graphical header showing various types of workers

Enterprise Outcomes: Making the case for Total Worker Health for the low-wage workforce

The 3.5 million workers in the U.S. nursing home industry are at exceptionally high risk of chronic disease and occupational injury. A focus on the nursing home industry is a high priority because the industry disproportionately employs groups identified by NIOSH as at-risk for occupational health disparities: 49% of the workforce includes underrepresented minorities, while 70% earn low-wages. 

PI: Cassandra Okechukwu, ScD, MSN

There is a significant knowledge gap about the degree to which the nursing home industry's existing programs, policies, and practices align with NIOSH's Total Worker Health® (TWH) approach. It will also be important to demonstrate whether implementation of TWH approaches is associated with reductions in occupational injury and improvements in patient outcomes.

Our goal is to protect and promote the safety and health of low-wage workers in the nursing home industry as well as other industries that employ disproportionate numbers of low-wage workers.

We propose a small-scale 36-month study starting in Fall 2017. The study will use the Center's Indicators of Integration tool to evaluate the degree to which existing programs, policies, and practices in about 500 nursing homes reflect Total Worker Health approaches. The Harvard Center for Work, Health, & Well-being validated the Indicators tool as a worksite level measure of TWH implementation in our last funding cycle.

Our specific aims are to:

  • Describe the degree to which nursing homes implement TWH approaches, as reflected in their scores on the Indicators of Integration tool, and determine whether ownership and features of occupational health programs are associated with TWH scores.
  • Determine associations between nursing home implementation of TWH approaches and annual rates of occupational injury and indicators of patient care quality.