Decreasing the number of strains and sprains in the health care setting has been a goal for ergonomists and health care providers throughout the last decade. Progress towards making “zero-lift” policies the standard in acute care and long-term care facilities plays a large part in reaching this goal. These no manual lift policies are considered best practice for reducing musculoskeletal injuries caused by patient-handling risk factors such as forceful exertions (lifting or pushing) and awkward and prolonged postures. Fortunately, advances in lift equipment design and the feasibility of getting them placed in institutional settings makes “zero-lift” policies possible for many workers. But what about healthcare that takes place in the home by home care providers or emergency medical service (EMS) workers? They face the same patient handling risk factors, yet the feasibility of implementing “zero-lift” policies is out the window.
In the last 30 years the delivery of health care in the United States has increasingly been shifted from hospitals to patients’ homes. One of the fastest growing sectors of the health care industry, the U.S. Bureau of Labor Statistics ranks home care as the fourth largest growth occupation. Over 12 million people receive some sort of care in their home, and the population of people over 65 is expected to double over the next twenty years.
Health care employees who work in an individual’s home have little control over the environment in which they work. They encounter safety hazards for slips and falls such as clutter, worn/torn carpet, slippery surfaces, and dangerous stairways. They also contend with tight spaces such as small bathrooms and narrow hallways where patient handling is difficult if not impossible. Often beds and chairs are too low or too high promoting awkward postures for the worker. Most homes do not have lift devices, even though there are models suited for in-home use. Health care workers undoubtedly need ergonomic solutions that work in the home environment. What are best practices in an environment where zero-lift is not possible, or not practical? What recommendations can be made to improve current practices while researching long-term solutions?
Ergonomics Training for Caregivers and EMS Workers
Caregivers, paid or unpaid, receive little or no training on any topic, including ergonomics. What training is offered to workers may discuss lifting and transfers, but often this information includes unsafe practices. For example, one handout from a caregiver training program recommended that caregivers attempt to stop someone from falling. To quote the OSHA Back Prevention Guide for Health Care Providers – “stopping falls is a sure way to get hurt.” The OSHA guide recommends that the worker guide the person to the floor slowly, without trying to prevent the fall.4 Making sure that appropriate and accurate information gets provided to these workers is essential. EMS workers, on the other hand, have required skills training but very little ergonomics or manual patient handling training. A good place to start would be to re-design their certification curriculum to incorporate ergonomics into the skills training and then provide ergonomics training to EMS and fire departments on a regular basis.
Most community based health care workers, if they have had any ergonomics training, may not have received comprehensive instruction. Due to the lack of resources (such as time, appropriate equipment, number of personnel) in the community-based setting, emphasis for ergonomics training for these workers in the past has been behavioral – focusing on topics such as proper body mechanics. Although well received by the workers, these practices have the lowest effectiveness for mitigating risk factors. It would be more beneficial to place emphasis on longer-term strategies that are more effective such as eliminating the risk, obtaining proper equipment and job organization. Such strategies require an ergonomics program.
Training for agencies that provide home care workers, as well as for fire and EMS departments,5 should cover topics such as elements of an ergonomics program, how they are applied to the home setting and strategies for working towards them. Such topics might include how to assess a worker’s musculoskeletal risk exposure and how to start with practical, smaller solutions while building up to the more difficult problems (e.g. handling obese patients). In addition, topics such as home safety communication, identifying unsafe job practices, identifying and obtaining appropriate equipment for use in the home setting should be discussed. The ergonomics program must involve both management and workers collaborating to find appropriate solutions.
Since the patient or home care consumer controls the home environment, it is crucial to find ways to educate the clients as well as the workers. A home care or EMS worker can do little about clutter, unsafe lighting or other environmental concerns if the patient/consumer is unwilling to allow the change.
Workplace Safety Assessments
Clearly, OSHA is not going to inspect homes. But social workers, case managers and agency supervisors should assess home environments with worker safety in mind, and recommend changes to the patient/consumer. Some agencies will refuse to send a worker if the changes are not made. While it is important to maintain a person’s independence in making decisions, safety issues must be considered for both the worker and the client.
Home Modifications and Durable Medical Equipment (DME)
Finding funds for home modifications such as the installation of guardrails, ramps, widening doorways, etc. is an option in many instances. Occasionally insurance will cover lift equipment, durable medical equipment such as lightweight, strong wheelchairs, transfer assist devices, and adjustable beds, but will be limited and completely linked to the patients’ medical condition. There should be a way to fund equipment that protects the worker from injury before an injury occurs.
Ongoing communication among policy makers, home care providers, EMS and other health care providers fosters ergonomic solutions. A common example: an emergency or “911” call to move or lift an uninjured person by a community-based health care worker. An ergonomic solution for the home care worker results in a solution for an EMS worker. Collaboration between all stakeholders reveals the barriers of each group and uncovers possible solutions to the problem of patient handling in the home.
Just as we begin to make great strides in reducing musculoskeletal injuries for health care workers in institutions, it is time to bring it home. Addressing musculoskeletal injury prevention research and ergonomic solutions is a must for the community-based health care industry.
* Healthcare Ergonomics Conference – www.orosha.org.
* Feasibility of National Surveillance of Health-Care-Associated Infections in Home-Care Settings, Lilia P. Manangan, Michele L. Pearson, Jerome I. Tokars, Elaine Miller, and William R. Jarvis
* Centers for Disease Control and Prevention, Atlanta, Georgia, USA Vol. 8, No. 3 March 2002
* Consumer-Directed Services At Home: A New Model For Persons With Disabilities, A.E. Benjamin, Health Affairs, November/December 2001
* According to the CDC study “10 Leading Causes of Nonfatal Unintentional Injury,
This article originally appeared in The Ergonomics Report™ on 2005-10-19.