Home health looks for 'backup' plan

HCWs face patient handling challenge

Call it the perfect storm: Patients with dementia or serious chronic illness being treated in the home. Rising levels of obesity. Aging health care workers. A lack of safety equipment.

Safe patient handling is a challenge in a hospital setting. But when someone's home is the workplace, how can you make it safe for the worker?

Safe patient handling experts have been turning their attention to home health care, which is the fastest-growing segment of the health care profession. According to 2008 data from the U.S. Bureau of Labor Statistics, home health care has about twice the rate of serious injuries from "overexertion" (those involving days away from work) as in general industry (53.9 injuries per 10,000 full-time workers compared to an overall average rate of 27.9.)

The Nurse and Health Care Worker Protection Act, or HR 2381, the safe patient handling bill that is pending in Congress, would include home health workers. And the National Institute for Occupational Safety and Health (NIOSH) is developing "tip sheets" to help home health aides identify and reduce a variety of hazards, including patient handling and bloodborne pathogens.

"It's definitely a forgotten group. Out of sight, out of mind," says Sherry Baron, MD, MPH, coordinator for occupational health disparities and a medical epidemiologist with the National Institute for Occupational Safety and Health in Cincinnati. "It's very challenging to set up people's homes to follow all the safe handling requirements."

Few home health workers have access to hoists or other lift equipment and few of them use equipment. In a NIOSH study of 744 home health workers, those who helped patients transfer in and out of bed or with other movements or repositioning were significantly more likely to report back, shoulder/neck and leg/foot pain.1

"[Lift devices are] an intervention that appear to be underused," says co-author Traci Galinsky, PhD, research psychologist with the human factors and ergonomics research section of NIOSH in Cincinnati and a captain in the commissioned corps of the U.S. Public Health Service. "Home health care workers could benefit from them, but our data indicate that only a small percentage of workers are actually using them."

One problem: Medicare and some insurance companies only reimburse for mechanical lifts, and under certain circumstances. Patients need to be aware of what is covered, Galinsky says.

There actually are devices for the home health market that have improved portability. For example, track-mounted lifts function similarly to ceiling-mounted lifts and some track models have frames that can be repositioned or disassembled. Also, some devices have detachable motors and lift mechanisms that can be easily transported for use in multiple homes.

Nurses or aides can take nonpowered sit-to-stand devices, transfer boards and collapsible portable floor lifts in their cars, says Lynda Enos, RN, MS, COHN-S, CPE, nursing practice consultant/ergonomist with the Oregon Nurses Association in Tualatin.

In one pilot study, a home health provider in Oregon is storing equipment in a community-based warehouse. Nurses assess patients for their mobility and the need for equipment, and families can then borrow necessary devices, she says.

Yet it also is critical for home health providers to invest in equipment for their employees, Enos notes. "The home health equipment is already available," she says. "We've got to get over the [challenge] of how to get it to the home."

The potential risk of working without equipment is great. While hospital employees may be able to ask for help with a manual lift, the home health worker often is on his or her own.

"'Manual patient handling by an individual caretaker should be limited to situations in which the patient has a lot of weight-bearing capability and doesn't have dementia," says Galinsky.


1. Waters T, Collins J, Galinsky T, et al. NIOSH research efforts to prevent musculoskeletal disorders in the health care industry. Orthop Nurs 2006; 25:380-389.