The federal Occupational Safety and Health Administration recently sent letters to 13,000 companies nationwide, telling them that their rates of worker injury and illness are dramatically higher than the national average.

In the Buffalo Niagara region, 110 businesses got those letters, and 32 were nursing homes. No other industry came close to getting that many such notifications locally.

That's no big news to nursing home employees such as Hanna Granger, who works at Manor Oak Nursing Home in Warsaw, which got an OSHA letter. They know that in today's modern service-sector economy, no job involves more heavy lifting - and thus more back injuries, shoulder strains and other ailments.

"I'm not surprised at all," said Granger, who recently missed more than three weeks of work with a severe shoulder strain. "You're lifting people all day long, and you're tired at the end of the day, and that makes it easier for you to get hurt."

Union officials and physical therapists say other factors contribute to the high injury rate. Just as understaffing and cost-cutting can make nursing homes dangerous for residents - as detailed in a recent Buffalo News series - it can make them dangerous for workers, too.

Granger, 36, found out just how dangerous in early January, when she and a co-worker tried lifting a 180-pound man from a chair to a wheelchair. She immediately felt something snap in her shoulder.

Before long, there was more.

"It was a constant pain, almost like a toothache," she said. "It was unbearable."

Granger went to her doctor, and he told her to get physical therapy and stay away from work. She went back to her job after a little more than three weeks, though, because she needed the money.

Such anecdotes are common throughout nursing homes both in Western New York and nationwide, occupational health experts say.

"Basically, the nursing home industry has about double the average injury-illness rate nationwide," said Roger Cook, director of the Western New York Council on Occupational Safety and Health. "The back injury rates are just out of sight."

That fact isn't lost on OSHA, the federal agency charged with maintaining workplace safety standards. For years, the federal agency has had a special initiative to try to reduce nursing home injuries. And yet when the agency released its latest list of companies with unusually high injury and illness rates in 2000, nursing homes again made up a huge share of the companies listed.

Statewide, for example, 25 percent of the 735 companies listed were nursing homes. The second-most-dangerous industry, food manufacturing, accounted for 7.6 percent of the listings.

Included on the list were companies that reported eight or more serious worker injuries or illnesses per 100 workers in 2000. The national average is three such illnesses or injuries that result in lost workdays.

"Our goal is to identify workplaces where injury and illness rates are high and to offer assistance to businesses so that they address the hazards and reduce occupational injuries and illnesses," said OSHA Administrator John L. Henshaw.

The letters went to companies that replied to a mandatory survey last year.

The Buffalo Niagara region is home to nearly one in seven of the New York companies with high injury and illness rates, even though the area includes only one-sixteenth of the state's population.

Injury and illness rates in other upstate metro areas were similar to those in Buffalo but were dramatically lower downstate.

Two factors appear responsible for Buffalo's relatively high number of companies with high injury rates. For one thing, Cook said, the region simply happens to be home to a lot of older heavy manufacturers that are traditionally prone to worker injury.

Second, whereas nursing homes comprised only 19 percent of the companies nationwide with high injury rates, they made up 29 percent of the Buffalo area companies on the list.

Nursing homes and other companies with high injury rates can get free advice through the state Department of Labor's Division of Safety and Health, said Ronald Williams, acting director of the Buffalo OSHA office. Federal inspections may be in store for some of them, too.

Not surprisingly, many manufacturers make the OSHA list. About 15 local food manufacturers had high injury and illness rates, and union officials say it's for much the same reason that nursing homes did.

"In the food industry, you get a lot of back injuries and tendinitis," said Angelo Vellake, area director for the United Food and Commercial Workers. That's because of heavy lifting and repetitive motion.

"You get a lot of accidents involving kids who are on their first job," he said.

Despite such continuing problems, many manufacturers are seen as making good progress toward improving conditions for workers. For example, Ford Motor Co.'s Buffalo Stamping Plant in Hamburg, which paid $232,125 in fines for safety violations in 1999, has since dramatically improved its safety record.

"Locally, we've done very well," said Paul Gannon, president of Local 897, United Auto Workers, which represents hourly workers at the plant. "We've driven our injury rates down. We meet with the company on a weekly basis to talk about this sort of thing and work out what we can do to improve things."

Nevertheless, Ford got one of those OSHA letters - as did 38 other Buffalo companies that have been fined for serious federal safety violations since January 1999. While seven local nursing homes have paid such fines, most of the companies fined were manufacturers.

Gannon said a higher level of problems can be expected at manufacturing plants such as Ford, which has an older work force and a lot of heavy equipment.

Several similar facilities appear on the list of companies that got the letters, including American Axle and Trico Products Corp. Both have had serious OSHA violations in recent years.

Yet Cook, of the Western New York Council on Occupational Safety and Health, said many such large companies are at least investing in ways to improve worker safety by switching to safer chemicals or machinery.

In contrast, service industries that involve a lot of heavy lifting - and especially nursing homes - are reporting more and more worker injuries.

"More times than not, nursing homes don't have the staff to do what needs to be done," said Barbara Clark, an official with the Service Employees International Union, which represents workers at several local nursing homes.

Ronald Zito, president of the New York State Health Facilities Association, said nursing homes aren't dangerously short-staffed. But he added that with many nursing homes running at only a 2 percent profit margin, most can't afford to add employees.

Nurse's aides often can only blame themselves for getting hurt, said Zito, administrator of Delaware Heights Healthcare Center in Buffalo, a nursing home that got a warning letter from OSHA.

"Staff members get into this Superman complex and feel they have to try to do something they shouldn't do," he said.

They'll try to lift a heavy patient themselves, or with only one other person assisting. The result is an epidemic of back, shoulder and neck injuries.

"It's more difficult than industrial lifting," because it involves elderly patients who sometimes don't want to be moved, said Allan Resman, a physical therapist in Williamsville. "You never had a box fight back," he said.

Many of those injuries are sprains that heal with a few weeks of physical therapy, but workers often hurt themselves again as soon as they return to work.

"You can get rid of the symptoms, but the problem is that these people go back to the same situation and put themselves at risk again," said Kenneth Kurtz, a physical therapist in Williamsville.

The only solution, physical therapists say, is one that few nursing homes have tried: investing in lifting equipment that makes things safer for patients and workers alike.

Schoellkopf Health Center in Niagara Falls has done that, instituting a "no-lift policy." Paula Pless, rehabilitation coordinator at the facility, said she couldn't be more pleased with the results.

Since buying about 20 pieces of lifting equipment, the nursing home has cut its workdays lost to injury from 364 in 2000 to 52 last year.

Meanwhile, in one year, the facility saved nearly $82,000 in workers' compensation - more than the cost of the lifting equipment.

"We had to do something," Pless said. "The staff was getting hurt."

Granger said that should serve as a lesson to other nursing homes.

A 15-year employee of Manor Oak - a nursing home with persistent problems, according to state inspection reports - Granger has nothing but kind words for the facility and its patients. But she said nursing homes have to get new lifting equipment so that all the strain of moving patients isn't placed on the shoulders of nurse's aides.

"I love the residents a bunch," she said. "You try to do all you can for them. But it's backbreaking work."

News Washington Bureau Assistant Agnieszka Dembinska contributed to this report.