Keeping safe on the job

Sprains, strains, falls, accidents and psychological injuries arising from aggressive clients or family members are among the risks care staff face in their workplace – the client’s home. Experts tell Darragh O’Keeffe how care workers can avoid them. 

Every frontline care worker knows the positives that come from working in clients’ homes. They get to see the tangible benefits of the care they provide – it enables clients to remain living in their own home, staying close to family and friends, and it increases their independence and control of their healthcare.

However, each time the frontline care worker visits a client’s home they also confront a set of unique, often unknown and potentially hazardous factors – from unhygienic environments and clutter to pets and even firearms. Compounding that, they typically work alone, often attending to different clients over distances, in isolation.

For these reasons, community care workers are exposed to many risks in the course of their work that could impact on their health and safety.

This was borne out in the last national survey of the sector’s workforce, which found that 12 per cent of frontline care workers reported having a work-related injury or illness in the previous year.

The most commonly reported incidents were sprains and strains, chronic joint or muscle conditions, and stress or other mental conditions.

What’s more, half of the community care services surveyed reported one or more type of injury or illness in the previous three months, the 2012 Aged Care Workforce Census and Survey found.

When it came to the causes of these injuries, the workers nominated lifting, pushing, pulling and bending; a fall or repetitive movement; vehicle accident; and exposure to mental stress. Community care services identified the causes as lifting, pushing, pulling and bending; a fall; hitting or being hit or cut by a person, object or vehicle; and repetitive movement.

Unique environment

Given the potential risks and hazards within the client’s home, how can care workers operate to effectively to keep themselves safe?

To begin with, care workers need to be aware of the fact that when they go into a client’s home they are entering someone’s personal space, says Dr Rajna Ogrin, a senior research fellow with the RDNS Institute, the research arm of major community care provider RDNS.

“As the saying goes, your home is your castle. The home is a place where people generally feel they are in charge, and are more confident to make decisions; some of these decisions may not be what clinicians or care workers would prefer,” Ogrin tells Community Care Review.

Care workers must also be aware that they are invading this personal space, and in some ways turning the home into a healthcare space, potentially changing what that environment means to individuals. “This can be distressing for some individuals,” she says.

From an occupational health and safety aspect, the home needs to function such that care can be provided without risk to the personal safety of the care provider or client, Ogrin says.

Identifying key risks

When discussing what care workers need to be aware of when providing care in the home, Ogrin first points to the emotional impacts on the person.

“The client, family and caregiver autonomy and choice are at the forefront. The care worker can give health education and provide recommendations on strategies, but ultimately the clients will decide what they do.”

Often it can be distressing for clients to adjust to and cope with various elements of their health condition and the corresponding home care services, such as learning to manage medications, changes in their health status and medical technology. All of this must be considered, Ogrin says.

There are also many environmental risks, she says, citing hygiene, clutter, pets and firearms as among potential factors that need to be considered.

“The house itself can become dangerous for the client. Consider an elderly client, using a walker, and having to carry their oxygen tubes and then walk around the house… the house itself becomes a safety trap.”

Ogrin points out that not all houses are similar and because of those variations, some are not adaptable.

Further, other issues can arise from what is called the ‘fragmentation of care’. With multiple care workers and agencies delivering care into the one home, there can be difficulties in communication and coordination between them.

Psychological injuries

According to Travis Holland, a safety consultant who advises community care organisations, psychological risk factors are increasingly worrisome.

Holland’s firm conducted a survey of the community care workforce in 2013 and found that 36 per cent of respondents had experienced one or more incidents involving aggression and/or violence during the previous 30 days. Of these reported incidents, 30 per cent resulted in the worker reportedly suffering a psychological injury.

Some 85 per cent of the 1,059 respondents to Holland’s survey were direct care workers, with 52 per cent coming from community aged care, and the remainder from other community sectors such as disability.

When asked who was the source of the aggressive behaviour, most respondents said it was the client (58 per cent) followed by a colleague (19 per cent) and family member (15 per cent).

“In community care there is typically less aggression, because by the time a client becomes that aggressive they tend to move into residential aged care. However, the potential in community care for serious assaults, when there is no one there to back up the care worker if things go wrong, is a significant aspect of the risk,” Holland tells CCR.

Strategies to minimise risks

Holland suggests that care workers need to ensure they are sharing case notes with each other, so their colleagues can be aware of any potential triggers for aggressive behaviour in the client.

“That transfer of information is not very good in community care services,” he says. “Many care workers tell us they get given a client’s address, name and list of tasks to do for them, and they just take it from there. The organisation should have a care plan that outlines what the client likes, what their triggers are, the warning signs they’re becoming more agitated, and some strategies that work to settle them down.”

While organisations can be reluctant for staff to log and share this kind of information – typically due to privacy concerns – Holland argues that staff don’t need to know the client’s full history but they do need to know “current active triggers” that lead to aggressive behaviour, and what to do when incidents arise.

For Ogrin, preparing care staff for the diversity of the work environments they will encounter is of paramount importance. “Our organisation undertakes site assessments of clients’ homes, going over a checklist of common issues, to ensure staff safety. Any issues are worked out with the client and/or their family,” she says.

Ogrin says that having the resources to access information remotely, and access to equipment needed for care, is also imperative. For example, she points to antiseptic hand gels, and clients obtaining equipment through suppliers that deliver, negating the need for staff to have to carry supplies.

More broadly, Holland argues that care workers need to more frequently report “the smaller stuff” or incidents of minor aggression, rather than waiting for major issues to arise. This way, managers can gain an understanding of how behaviour is changing over time, and equip and support staff accordingly.

While most organisations have standard incident report forms, these can take up to 20 minutes to complete and so would likely be unsuitable for recording more minor issues. He recommends that organisations look at implementing a 60-second online report, where staff can quickly log key facts about an incident without going into detail. He suggests organisations try using SurveyMonkey, which is free, for a few months before investing in software.

Similarly, Ogrin says that mechanisms must be in place to ensure that, if issues arise, there are clear processes to address them in a timely way. RDNS has an electronic system in place to report any adverse event, or ‘near misses’ with clear processes in place to ensure they are followed up and addressed to prevent recurrence. “Communication is key,” she says.

Working in the home: key challenges and risks

Consideration of the person:

•  The home is a personal space, need to consider psychological component
• Care worker can make suggestions for care but ultimately the clients decides what they do
• Can be distressing for client to adjust to various elements of their health condition and home care services

Environment:

• Lack of uniformity compared to acute/clinic environments
• Homes are designed for living, not for providing healthcare.  The house itself can become dangerous for the client
• There can be cleanliness issues, clutter, furniture in the way
• May need to dispose of clinical waste
• There may be increased risks for falls for clientsMedication storage issues
• Access to support services issues
• Telephone access issues

Fragmentation of care:

• Multiple providers and multiple agencies delivering care in one home, difficulties in communication can arise

SOURCE: Dr Rajna Ogrin, RDNS Institute

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