The demand for home health care, HHC, services is escalating with the aging population, resulting in an ever-growing number of paid caregivers providing in-home services for individuals with illnesses and disabilities. The number of home health aides and personal attendants is expected to increase by about 50% between 2008 and 2018, substantially more than the average increase for all other occupations. The unique physical environment of each home offers significant challenges when providing health care to clients while protecting caregivers’ health and safety. The Oregon Home Care Commission (2008-2010) indicated that HHC providers in publicly funded programs incurred 352 lost-time injuries per 10,000 full-time workers (Polivka et al., 2015).
Multiple types of home hazards have been identified by diverse HHPs, including nurses, aides and technicians, administrators, social workers, physical therapists, and occupational therapists (Polivka et al., 2015). Homes can harbor a variety of hazards, including throw rugs, pests, tobacco smoke, mold, sharps, inadequate lighting, cluttered hallways and rooms, and inaccessible bathrooms (Polivka et al., 2015).
Despite high rates of work-related injuries and the identification of various hazards, scant research describes hazards by specific locations in the home. Hazards also negatively affect job performance, job satisfaction, and health (Polivka et al., 2015). In the only published study describing specific locations in the home of injuries incurred by HHC providers, researchers found that 60% of home health aide injuries occurred inside client homes, with the most common locations being the bedroom (24%), bathroom (18%), and kitchen (9%) (Polivka et al., 2015).
Half of the injuries were associated with client handling, 8% with specific objects (e.g., needles, pets), 8% with cleaning, 4% with lifting objects, 2% with trash disposal, and 28% were unspecified. Client-handling tasks that resulted in injury included moving clients in bedding, bathing, and transferring clients (Polivka et al., 2015).
This case study explored environmental health and safety hazards encountered by HHPs in clients’ homes and specific rooms within those homes (Polivka et al., 2015). Consistent with other studies, trip/slip/lift hazards were the most commonly identified hazards, and the specific sources for these types of hazards varied, a key finding with implications for enhanced HHP training (Polivka et al., 2015). Sprains and strains, commonly attributable to lifts, slips, and trips, have previously been documented as the most frequent lost work time injuries to HHC providers, resulting in almost one month of lost work time (Polivka et al., 2015).
Recommendations to reduce exposure to trip/slip/lift hazards include making changes in the work environment (e.g., removing throw rugs, securing cords, providing adequate lighting), using assistive devices such as transfer or gait belts, participating in ergonomics training, and wearing sturdy shoes with slip-resistant soles (Polivka et al., 2015).
These and other recommendations can be incorporated into specific training for HHPs on assessing and managing trip/slip/lift hazards, especially for home health aides who have the most exposure. Exposures to potential biohazards, such as human or pet waste and blood-borne pathogens, were commonly expressed concerns in this study and other researchers (Polivka et al., 2015).
OSHA regulations require agencies to have an exposure control plan and annual blood-borne pathogen training, but neither a control plan nor training is required for other biohazards (Polivka et al., 2015). Most participants in this study (73%) indicated they received training on standard precautions and were supplied with gloves but not other forms of PPE, such as face shields, goggles, or protective clothing. These findings highlight the need for agency- and policy-level changes to ensure HHPs have the PPE necessary for personal safety (Polivka et al., 2015).
Air quality and allergen exposures from tobacco smoke, mold, and inadequate ventilation were considered highly hazardous by participants with asthma and allergies. Several participants commented that their agency had a tobacco smoking policy in which clients agreed not to smoke (nor allow others to smoke in their home) while the HHP was there (Polivka et al., 2015).
Although helpful, not all agencies have this type of policy, and not all HHPs insist their agencies’ policies be followed. Although the consequences of exposure to secondhand tobacco smoke are well known, the NIOSH does not include this hazard in its 2010 Occupational Hazards in Home Care publication. The findings of this study highlight the need for policy- and individual-level interventions to reduce the risk of exposure to secondhand tobacco smoke (Polivka et al., 2015).
The US Surgeon General has stated that no risk-free level of exposure to tobacco smoke exists, so NIOSH and OSHA must develop a standardized smoke-free policy template that can be adapted and implemented by home health agencies to protect their workers. Participants in this study identified the most hazards in the kitchen, followed by the bedroom and the bathroom. These locations were also the primary locations where studies reported injuries to home health aides. However, trip/slip/lift hazards were the most common hazard type reported in each room in the present study, except for throw rugs, which pose a hazard in every room; the specific types of risks differed (Polivka et al., 2015).
Water and grease spills were described frequently on kitchen floors; tight spaces and missing bathroom equipment; clutter, tight spaces, and lifting hazards in the bedroom; electrical cords and oxygen tubing in the living room; and clutter in the hallway. Similar differences in the types of biohazards encountered in each room were identified (Polivka et al., 2015).
Pet droppings were key biohazards in the kitchen and living room; human waste was commonly noted as bathroom and bedroom hazards (Polivka et al., 2015). The rooms in clients’ homes where HHPs work vary by type of HHP and clients’ needs. For example, nurses may not go into a client’s bedroom or kitchen if client care is provided in the living room (Polivka et al., 2015).
By contrast, home health aides are often in all rooms if they provide cleaning, meal preparation, and personal care services. A key implication of these findings is that healthcare agencies should provide tailored training that addresses the hazards HHC providers are likely to encounter by room, also considering HHC provider job descriptions and client needs (Polivka et al., 2015).