Taking the pain out of home health care
Injury severity is higher than in nursing homes
The life of a home health nurse is filled with variety, independence, flexibility and all too often, back pain. While hospitals are implementing safe lifting programs in their facilities, the home health nurse or aide travels from home to home and faces hazards the floor nurse couldn't imagine.
Aggressive dogs. Unprotected sharps. Domestic violence. If the nurse avoids those potential hazards, she faces yet another: the task of moving patients without lift equipment and without any other health care workers to aid her.
"The hazards faced by home health care workers are much greater than the hazards faced by those who work in long-term care facilities or hospitals," says ergonomics expert Arun Garg, PhD, CPE, UWM and Wisconsin Distinguished Professor and director of the Center for Ergonomics at the University of Wisconsin-Milwaukee. Garg spoke recently about home health hazards at the Safe Patient Handling & Movement Conference sponsored by the VISN 8 Patient Safety Center of Inquiry at the James A. Haley VA Hospital in Tampa.
The rate of serious back injury in home health care is about the same as at hospitals 56 cases with days away from work or restricted work per 10,000 full-time workers in 2006, according to the Bureau of Labor Statistics. But the back injuries in home health can be severe. An analysis of workers' compensation claims found that the average severity of injuries in home health care was higher than for nursing homes, which are among the most hazardous workplaces in the United States.
The problems are numerous. Postures in home health care are awkward, and in a cramped or cluttered house or apartment, the home health nurse may have no way to improve the environment. For example, a nurse may need to sit on the floor to examine the feet of a patient who is sitting on a sofa. An aide may bend over to help a patient with bathing. And the beds are usually normal household beds, without any height adjustments. "There's a lot of bending and reaching involved in moving these patients," says Garg.
The National Institute of Occupational Safety and Health (NIOSH) has focused attention on home health care hazards. Although data still are being analyzed, a recent study showed a link between patient handling in home health and musculoskeletal discomfort.
While hospitals are increasingly addressing patient handling hazards, home health has not made similar advances, notes Tom Waters, PhD, research safety engineer in the NIOSH Division of Applied Research and Technology in Cincinnati. "The barriers are very unique in that environment," he says.
Improving safety for home health nurses requires creativity and collaboration with the patient and family. Some solutions to home health hazards are relatively simple and inexpensive. For example, a nurse could bring a low stool to sit on to avoid bending. She could place the patient's leg under pillows or a pillow wedge to raise it to an acceptable height while performing a procedure, such as wound care.
If the patient is physically dependent, he or she needs a lift in the home, says Garg. It should be provided by Medicaid, Medicare or private insurance, he adds. "We do provide wheelchairs. We do provide canes and other devices. So why not provide the lift?"
In addition to preventing caregiver injuries, the lifts may improve the quality of care to the patient and reduce their risk of injury, as well, Garg says. "The patients may not get the type of care they would get if the lifts were available. You have to balance the costs of these lifts against [the risk of] injury and [the quality of] care," he says.
Bringing a portable lift to patients' homes is not a practical option, says Garg. The lifts may not fit in a home health worker's trunk, and they would be difficult to carry up stairs or on icy walkways.
Patients could benefit from other assistive devices, such as sliding boards, which are less expensive than lifts. Still, the home health nurse can't carry them from one house to another, he says. "If you carry something with you and you use it on a patient, you've got to sanitize it before you use it on another patient," he says. "So whatever you use, it has to be in the home. You can't take it with you."
Home health nurses may need to educate the patients and family members about the importance of patient handling devices, says Traci Galinsky, PhD, a research psychologist with the Division of Applied Research and Technology at NIOSH in Cincinnati who conducted a home health study. "It's possible the patients don't realize they can get [assistive devices]. [They should] explore what benefits are available and fully utilize whatever benefits are available."
Meanwhile, home health workers need to regularly assess patients for their mobility needs, says Garg. They also need training related to safe patient handling and use of equipment.
Employers should establish clear policies about safe patient handling in home health care, says Garg. "You need to avoid manually lifting and transferring of patients in a home environment at any cost," he says.
In some cases, safe patient handling may require two health care workers even with assistive devices. If there are no assistive devices, the policy should state that a single caregiver should not lift a patient manually, he says.
The life of a home health nurse is filled with variety, independence, flexibility — and all too often, back pain. While hospitals are implementing safe lifting programs in their facilities, the home health nurse or aide travels from home to home and faces hazards the floor nurse couldn't imagine.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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