Don’t let back and neck injuries ruin your aides’ or your agency’s health

Workers faking’ injuries are not as common as some think

Back and neck injuries can ruin the home care career of home health aides and can be financially draining for the private duty agency as well.Private Duty Homecareasked several experts what they advise to reduce the prospect of back and neck injuries. Here are some of their responses:

Train staff before they go out in the field.

"We have yearly training on body mechanics, safety in movement," says Maggie Darlington, RN, administrator at Lake County Home Health and Hospice in Polson, MT.

Defensive driving also is a good training topic, especially in metropolitan areas where winters can be harsh, says Jacob Stone, executive vice president of FutureComp, a wholly owned company of Palmer Goodell Companies in Springfield, MA.

One of Darlington’s LPNs found this out the hard way. While making field visits, she was in her car waiting at a stoplight when she was rear-ended by another car. "It caused whiplash and back injury. She was also pregnant at the time," says Darlington.

The LPN was unable to return to the field, even after the birth of her baby. Fortunately, the LPN had an interest in working with information systems, and the agency’s needs were developing in that area. The local vocational rehabilitation department provided computer training. "We made accommodations for her and supported her education, and now she is an in-house [information systems] manager. It was a perfect fit."

Stone, whose company conducts training and education programs for preventing injuries in the workplace in addition to adjudicating and managing claims, advises agencies to train managers and supervisors, not field staff.

"We found early on that when we trained staff, we had to come back and do it again and again," he explains. "But if we worked on a follow-up basis with a focal person in human resources, then it was more cost-effective for the employer. And the employees responded better when they were trained by someone they knew and trusted rather than this outside person."

Ensure that an employee is both physically and mentally able to do the job.

"I think most organizations do a good job of screening applicants’ credentials and making sure they are the kind of people who understand what home care is and who care about being part of that industry," says Stone.

"Most of the serious claims we’ve seen in the home have been as a result of someone not physically being up to the task to begin with. It’s a good idea to have a post-offer pre-employment physical certifying that the applicants are capable of doing the jobs."

Protocol needed to determine capabilities

Agencies need a protocol within the company to determine the physical capabilities of the employee, saysJ. Sherrod Taylor, JD, senior partner with Taylor, Harp and Callier in Columbus, GA. If the employee cannot physically handle the client, the employee should be given another duty. "From the prevention standpoint, the employer needs to be cognizant of both the physical capabilities of the staff and the physical demands of the clients."

Have an occupational therapist evaluate the needs of the client.

"If the nurse assesses that the client is difficult to move, then we will send an occupational therapist in to evaluate what needs to be done for the safety of our staff," Darlington says. "One time, we had to send two CNAs [certified nursing assistants] into a home so that one CNA wouldn’t be injured moving a client.

"The client has a right to services," she adds, "but our staff also have the right to a safe environment. If those two conflict, we discuss it with the client and say, We can’t come in here unless you help us stay safe.’ If they refuse the Hoyer [lift] and there’s a safe way to complete the care, we’ll do that. But we can’t jeopardize our staff and their abilities to work either."

"An employer has the duty to provide the employee a safe place to work," adds Taylor. "That means you must have adequate staff to perform whatever the function is. If the nurse or home health aide knows — or should have known — that they are dealing with a patient that a single nurse or attendant could not effectively lift, then the employer has not given adequate staffing to perform that function."

If an injury does occur, Darlington and other professionals recommend you report the injury promptly. "When we have any injury or incident, we submit a report so the injury goes on record immediately," she says. That way, the payer and workers’ compensation office can begin investigating the claim right away.

Experts also recommend agencies have a thorough profile of a private duty employee so if he or she is injured, a claim can be more easily investigated. In addition to the employee’s medical information, here are some tips on other information you should have:

• interviews with co-workers about the injury itself and how the employee has interacted with them;

• interviews with family and friends about the injury, symptoms, and the employee’s current activity levels;

• records about the employee’s past illnesses or injuries that had similar symptoms;

• observations about the employee’s behavior in a variety of settings;

• a review of the employee’s existing work records.

Lingering doubts

Everyone has heard about cases where the employer doubts that an employee receiving long-term disability benefits is actually disabled. For example, an aide who says she strained her back might be seen working outside in her yard.

In this case, the agency may think the employee is malingering. In general terms, a malingerer is someone who feigns symptoms of injury in an effort to achieve some kind of external incentive or goal, such as gaining financial compensation or not having to work. (For information about people who may be prone to chronic pain, see related story, at right.)

Malingering often is raised in the context of workers’ compensation in an effort to deny benefits to the employee, says Taylor. It’s also used in tort defense to deny compensation and to paint the claimant as an unworthy recipient of any reward.

Taylor wrote about exaggeration of symptoms in an article published in the journal NeuroRehabilitation.1 The studies that he cites in the article indicate that while there is a high perception among physicians that malingering may be occurring — at least in brain and spinal cord cases, malingering doesn’t happen that often.

"That doesn’t mean that it should be ruled out — in some cases malingering does occur, and to the extent that you can discern it, you need to make every effort to do so," he says. Providers debate, however, whether malingering can even be determined and to what extent.

Check out employee’s history

If the injured private duty employee is taking more time to recover than expected and you question the validity of the claim, you may check for these possible indications of malingering:

• Employee has a history of multiple claims.

• Employee hires an attorney with a poor reputation.

• Employee has been treated by multiple providers.

• Employee has received different diagnoses from different providers.

• Employee had initial improvement but the condition then worsened.

• Employee reported symptoms out of proportion to the reported incident.

Still, Taylor concludes, "From the standpoint of paying the claim, the smart insurance company or employer would operate under the assumption that the claimant is telling the truth until proven otherwise."


1. Taylor JS. Neurorehabilitation and neurolaw. NeuroRehabilitation 1996; 7:3-14.