Home environment design & safety evaluation. Home environment design is important for patient and worker safety; care for the disabled and elderly is not systematically included in building design. Before admitting a new client, home care agencies should conduct safety evaluations in the client’s home that also include worker safety assessment. Safe patient handling devices. Installation and use of safe patient handling devices in the home care setting is essential. Mechanized equipment for patient handling and transfer tasks needs to be refined and adopted for home use. Financial assistance for low income families is needed for routine implementation of ergonomic tools and equipment regardless of patient’s socioeconomic status. Training. Annual in-service training for home care aides will reinforce safe client handling and transfer practices. Conclusions. Despite safety and health hazards, particularly those related to patient handling, the majority of home care aides like their jobs because of the meaningful relationships with patients and families as well as the autonomy home care allows. Patient handling interventions in home care should reduce hazardous exposures among workers while preserving or enhancing the meaningful aspects of their job.

Findings

�With respect to patient handling, homes have important differences from institutional settings such as hospitals and nursing homes.

• Home care aides work in isolation with no one to assist in patient handling situations.

• Home care aides often feel compelled to lift or assist patients in a manner that increases their risk of injury.

• Most homes have no safe patient handling devices.• Many existing patient handling devices have limitations for home use. • Aides often are not provided with appropriate tools to carry out

patient transfers safely.

The use of patient handling equipment is a prime opportunity to address the direct link between health and safety for home care aides and their clients.

Conclusions & Recommendations

I have a private client I take care of who’s ALS [amyotrophic lateral

sclerosis], right now he’s a quadriplegic. When I first started with him,

he was able to stand, and I would stand him in the shower, he would insist

upon it…I have to lift him up to standing position. I kept saying, “I need

a shower chair; I can’t do this.” Well, the day came, I almost dropped

him three times in that shower. And that’s when he said, oh, maybe I need

a shower chair. And he got one. And so, I put him in the shower chair,

and give him a shower. And that’s it. So it’s much easier.”

H o m e c a r e a i d e f o c u s g r o u p pa r t i c i pa n t

1 Markkanen P, Quinn M, Galligan C, Chalupka S, Davis L, and Laramie A. (2007). There’s No Place Like Home: A Qualitative Study of the Working Conditions of Home Healthcare Providers. Journal of Occupational and Environmental Medicine 49(3): 327–337.

2 Quinn M, Markkanen P, Galligan C, Kriebel D, Chalupka S, Kim H, Gore R, Sama S, Laramie A, Davis L. (2009). Sharps Injuries and Other Blood and Body Fluid Exposures among Home Healthcare Nurses and Aides. American Journal of Public Health 99(S3): S710–S717.

3 National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. (2010). NIOSH Hazard Review: Occupational Hazards in Home Healthcare. Available at: http://www.cdc.gov/niosh/docs/2010-125/

Most frequenty mentioned practice

Other mentioned practice

Never lift fallen client—

call 911

Showering or bathing not allowed unless safety devices are installed

Training in client’s home

Do not manually lift bed-bound

clients

Report changes in client’s condition

Building design

Two aides on duty for client

handling and transfer

SPH devices (see graph to right)

Initial client assessment

In-service training

Safe patient handling (SPH) in home care:

interventions & practices

Depends on the family’s resources

�…I have handicapped brothers, [in] wheelchairs. Handicapped entrances,

the standard is …supposed to be a certain pitch. And when they put in,

and government buildings are notorious for doing this, too, they’re not

always the standard they’re supposed to be. If that pitch is wrong, it’s very

difficult to either push or if they’re manipulating the wheelchair them-

selves, the ramp and sometimes the turns are wrong or the handholds are

the wrong area. I don’t know, it just seems like it’s all over the place what

they call a handicapped entrance, and that makes it difficult for the person

transporting them and the person trying to, that seems to be an area

where there could be improvements.”

— H o m e c a r e a i d e f o c u s g r o u p pa r t i c i pa n t

Background. Home care is one of the fastest growing industries and home care aides are one of the fastest growing occupations in the Unit-ed States.1,2,3 Still, little consideration has been given to the home as a workplace or to occupational safety and health hazards of home care aides. The Safe Home Care Project at the University of Massachusetts Lowell is designed to address this gap by systematically identifying oc-cupational safety and health hazards among home care aides, quantify-ing occupational safety and health risks aides face, and identifying pre-ventive interventions. The Safe Home Project is partnering with the Massachusetts Department of Public Health’s Occupational Surveil-lance Program, home care agencies, labor unions, and government agencies. This study was supported with funding from the National In-stitute for Occupational Safety and Health (NIOSH) Grant 5R01OH008229-06.

Objectives. This presentation reports on phase one of the Safe Home Care Project: a qualitative assessment of the occupational safety and health issues related to patient handling and transfer by home care aides. We qualitatively characterized occupational safety and health hazards, promising practices, preventive interventions, and how safe patient handling practices protect both home care workers and clients.

Methods. We conducted 12 focus groups of home care aides as well as 18 face-to-face, in-depth interviews of aides agency managers, trade association directors, union representatives, and home care clients. Focus group and interview transcripts were coded using QSR NVivo 9.2 soft-ware to obtain a comprehensive analysis of occupational safety and health themes as well as specific safety and health hazards, interven-tions, and promising practices. Three graphs in this presentation are based on most coded nodes of transcribed focus groups and interviews.

pia markkanen, margaret Quinn, catherine galligan, Laura punnett, susan sama, anila Bello

Department of Work Environment, University of Massachusetts Lowell, Lowell, MA USA

angela Laramie, Letitia davis Occupational Health Surveillance Program,

Massachusetts Department of Public Health, Boston, MA USA

Safe Home Care Project www.sustainableproduction.org/safehomecare

Grab bars

Hospital bedWalker

Shower chair & hand-held

shower

Wheelchair

Gait belt

Slide board/sheet

Safe patient handling (SPH) devices

in home care: promising practices

Safe Home CareProject

A Qualitative Assessment of Occupational Safety and Health Hazards Among Home Care Aides:

Findings on Client Handling and Transfer

Most frequenty mentioned practice

Other mentioned practice

Mechanized lifts

House not designed for an

elderly or disabled person

Regular bed versus

hospital bed

Bending to sponge bathe a client in the bed

Catching a falling client

Client transfer tasks

Hoyer lift characteristics

Aide working alone

Difficult to use alone: pushing lift with one hand and holding client with

another hand

Into and out of shower

Client injury risk: falling off of Hoyer

lift straps

Into and out of bed/wheelchair

Bath tubs, stairs, lack of grab

bars and other devices

Family does not make home

modifications

Client handling challenges in

home care

Overweight/ obese clients

Stand pivot transfer

Most frequenty mentioned practice

Other mentioned practice

p H o t o : w w w. e a r L d o t t e r . c o m

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