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Addressing Health and Safety Risks in Home Healthcare Settings

Home healthcare was one of the fastest-growing occupations of the last decade, and the expected demand for workers in this field will far outpace the sector’s growth.  Home healthcare workers encompass a variety of occupations, including aides, therapists, nurses, and social workers. Workers have little control over their work environment, which may contain several potentially severe hazards. Dangers include overexertion; stress; guns and other weapons; verbal abuse and other forms of violence in the home or community; bloodborne pathogens; latex sensitivity; temperature extremes; unhygienic conditions; hostile animals, and animal waste. Commutes from worksite to worksite also expose the home healthcare worker to transportation-related risks.  This article seeks to address safety concerns specific to Springbrook’s many SDS Workers, HCBS Aides, and others who may provide services in the client’s home and community.

All healthcare workers who lift and move clients are at high risk for a back injury and other musculoskeletal disorders.  Symptoms of musculoskeletal disorders include pain, stiffness, swelling, numbness, and tingling.  Home healthcare workers do many of the same tasks as workers in traditional healthcare settings, but conditions in the home setting can make the work more difficult. For instance, home healthcare workers most often perform heavy work, like lifting and moving clients, without assistance.  Individuals’ homes may not have the equipment to help with transfers, and home healthcare workers frequently endure long periods of standing or walking.  Whenever possible, use ergonomic assistive devices; however, home environments may present unique challenges such as resistance from individuals and their families, workers’ perceptions that equipment will be difficult to work with, and the cost of devices.  If a worker meets resistance to installing or buying an assistive device, the employer should inform the client about the risks involved in moving individuals without a device, including overexertion of the worker or improper handling that may result in harm to the client.  Workers should notify their employer if they believe that additional training or ergonomic assistive devices are necessary.

Occupational stress is another risk for home health care workers.  Job stress is the harmful physical and emotional responses that occur when the requirements of a job do not match the capabilities, resources, or needs of the worker.  Job stressors include job and task demands such as work overload, time pressures, lack of task control, role ambiguity, and organizational factors such as lack of support from management.  Also, home healthcare workers may have to deal with stressors that healthcare workers in traditional settings do not: solitary conditions, a lack of direct supervision, the possibility of visiting an unsafe work location, they may have to face alcohol or drug users, family conflict, and deal more frequently with commute-related stressors like bad weather and traffic.  There are some steps workers can take to reduce stress, like identifying effective coping strategies, developing supportive relationships with coworkers and others outside of the work environment, and performing relaxation exercises.  A study of nurses trained in relaxation techniques reported a significant increase in their ability to cope with stress at work.  Workers may also benefit from speaking with someone from an employee assistance program or other counseling services.  Employers can help manage workers’ stress by providing frequent, quality supervision, and staff support.  Another critical employer obligation is to provide adequate job training and preparation, including ongoing education.  Workers should attend regular staff meetings where they can discuss problems, frustrations, and solutions to issues they are facing.

Serving individuals in their homes is the essence of home healthcare.  However, the home setting makes providers more vulnerable to various types of violence, including threats, verbal abuse, and physical assaults.  Home healthcare workers face an unprotected and unpredictable environment each time they enter the client’s community and home. There are many recommended steps for employers to help lessen risks to workers, including encouraging reporting of every incident of violence, providing a written workplace violence prevention plan and related training, and conducting safety checks of locations before placing workers in assignments.  Assessments might be necessary for clients with a history of violent behavior on the potential for harm to the worker, and a social worker may evaluate the family and home situation.  Employers may establish a no-weapons policy in client homes, or at a minimum, require that weapons be disabled, removed, and stored before providing service. Workers can increase their safety by scheduling visits in high-crime areas during daylight hours, whenever possible.  Workers should remain alert and evaluate each situation for potential violence, including signals of an impending assault, such as verbally expressed anger, threatening gestures, or the presence of weapons.

Other safety and health hazards to home healthcare workers include animals, temperature extremes, poor hygiene, allergies and other reactions to conditions or substances used or encountered in the client’s home.  If a worker is concerned about an animal in the house, they may request that the employer make restraint of animals a condition of providing care.  Workers unexpectedly encountering animals may wait outside until the pet is restrained, and if fleas or other pests are an issue, discuss appropriate control measures with the client’s family.  If a home is unsanitary or infested with pests, workers may consider bringing clean pads with plastic on one side to place underneath equipment and supplies.  Workers should take in only necessary equipment and supplies and avoid setting items like bags or purses on carpets or upholstered surfaces.  When a worker encounters a home with high temperatures that cannot be adjusted, they should open windows, use fans, and drink plenty of water.  If a worker believes the client is at risk from the heat, they should ask the employer to contact the appropriate social service agency for help.  For clients whose homes may lack adequate heating, local resources may be available to help pay heating bills.  If a client or their family are not receptive to making changes, workers may ask the employer to involve social service agencies for assistance in mitigating hazardous or unhealthful conditions.

Workers who serve clients in the community and clients’ homes should feel empowered to report safety concerns and seek help addressing unsafe conditions.  To take care of service recipients while providing services, employees must also take care of themselves by asserting their right to a healthful, safe work environment, no matter where they work.  If you have questions or concerns about hazards in your work environment or ideas for improvements, you are encouraged to speak with your supervisor.  The Safety Committee also welcomes all suggestions.  Please send them to safetyideas@springbrookny.org.

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