Most Americans can go to work each day with confidence because their workplace is regulated for safety, but this is not the case for those who work in a private home. There are currently no provisions to address workplace safety for home care workers, and that makes it difficult to create a stable and predictable work environment. No wonder home health care and personal care always rank among the occupations with the highest rates of job-related injuries on Bureau of Labor Statistics reports.
An unsafe workplace not only endangers the aides who work there but undermines their ability to support the client. For example, home care workers often face scenarios like this:
- Pathways are cluttered, increasing the risk of falls.
- Secondhand smoke and other allergens make breathing difficult, especially if the client or the worker has asthma, COPD or another respiratory illness.
- Cigarettes are lit and smoked near an oxygen tank, creating the risk of an explosion.
- The client needs help in the bathroom, but the bathroom is too small for two people, a walker and a tub bench to easily fit, making it difficult for the aide to guide the client’s walker or assist the client without injuring herself.
Before we can solve a problem, we have to know what we are dealing with, so I designed a survey to investigate workplace safety for home care workers. The survey lists 22 potential hazards gathered from the home care safety literature. Respondent were prompted to consider the homes that they had visited in the last 2 weeks and then rate the survey questions on a scale from 1 to 5 (1=never, 2=rarely, 3=sometimes, 4=often, and to 5=always). I mailed the surveys to members of the American Occupational Therapy Association who identified their practice area as home and community health and their primary workplace as home health. While the respondents to my survey were occupational therapists who work in home care, the results will come as no surprise to any veteran home healthcare care worker.
The 106 responses revealed the following:
- 91% reported that their workplaces had an inadequate level of cleanliness.
- About half (48%) reported that smokers are at least sometimes present when oxygen is being used.
- Allergens were present 80% of the time.
- About 91% reported that the arrangement of furniture in the home interfered with safe mobility or functional activity.
Nine areas of potential risk had an overall rating of three or greater, indicating that risk was encountered more often than not:
- The client’s bed was non-adjustable
- The client was obese.
- There was a lack of bathing equipment.
- There was inadequate bathroom space.
- The furniture arrangement interfered with safe mobility or functional activity.
- There was inadequate cleanliness.
- The client had personal preferences that are potentially unsafe.
- The pathways were cluttered.
- There were allergens in the home.
These conditions can all endanger both worker and client. For instance, assisting a client in a non-adjustable bed often leads to sprains, strains, or worse, not to mention the daily discouragement of knowing that you will be required to lift and bend in awkward positions. If the client is obese, the risk of injury is exacerbated.
So can be done about these hazards?
Agencies have a professional responsibility to provide employees with a workplace free from recognized hazards that are likely to cause serious injury or death. If these obligations were met industry-wide, is unlikely that the home care profession would rank as high as it does in injury and illness. Regulations to establish and enforce minimum safety standards would also be helpful.
I hope that this research will promote awareness of the difficult conditions that home care workers commonly encounter. Larger and more comprehensive surveys to measure those risks would be a good initial step toward creating a safer work environment for these vital workers.