Home Health Care Workers

The rewards are great, although how many nurses have to keep an eye open for vicious dogs while taking someone's temperature?

Faye Morris, RN, spent 15 years working as a hospital nurse, an often stressful and exhausting job by anyone's standards. But that wasn't the job that broke her back.

Three years ago, Morris, 45, left hospitals behind to start a new career as an in-home nurse with Alacare Home Health Services in Birmingham, Alabama. One afternoon in the summer of 1999, she stepped out of a patient's house into the teeth of a thunderstorm. Juggling a clipboard, a bag of medical supplies, and an umbrella, she slipped on an uneven step and hit the sidewalk with enough force to fracture her spine. After back surgery and four weeks of rest, she was able to return to work.

Shoddy steps and cloudbursts are rare in hospitals, as are vicious dogs, rotting floors, and household clutter stacked to the ceiling. But all of these things are facts of life for home care workers, says Rhonda Berlin Jarrell, RN, a former home nurse who now works as an injury prevention consultant in Alexandria, Virginia.

Home nurses and aides are exposed to many of the dangers that hospital workers face -- from tuberculosis to needlestick injuries -- but are working in completely uncontrolled environments, Jarrell says. As a result, nearly one in 20 home health workers has a job-related illness or injury every year -- a rate approaching that for construction workers, according to the Bureau of Labor Statistics.

House calls

Back strain is by far the most common injury among home health workers. In 2007, among the 55,440 reported injuries that resulted in nurses, psychiatric and home health aides having to miss work, more than 21,000 involved back injuries. The risks are particularly high for health aides who have to lift patients from their beds, chairs, toilets, and bathtubs. Nurses usually don't do as much heavy lifting, Morris says, "but when I find somebody at home who's bed-bound and soiled, I definitely try to move him."

Moving patients around in their home can be a challenge, and not just because of stairs and clutter, Jarrell says. Many patients don't have the equipment -- such as lifts and adjustable beds -- that can ease the burden on caregivers. And home workers, unlike hospital staff, can't just call a coworker down the hall for help with a particularly heavy load.

Home aides and nurses can protect their backs by encouraging patients and their family members to invest in lifts and adjustable beds. Even more important, Jarrell says, workers should learn the proper body mechanics for lifting, preferably through annual training sessions. "I've seen a 90-pound aide move around 350-pound patients, and she never had a problem," Jarrell says. "She knew how to lift and how to move."

Here are some of Jarrells other safety tips for home health workers:.

  • Be wary of heated family disputes and other potentially violent situations, especially during the first few visits to a new house. Your local law enforcement agency may offer a training program for prevention and management of violent attacks.
  • Learn how to protect yourself from infectious diseases. Your company should offer regular training on infection control, respirators for tuberculosis prevention if applicable, annual screenings for tuberculosis and hepatitis B, and vaccinations against hepatitis B.
  • Use gloves, gowns, and face protection when handling hazardous medication, especially chemotherapy drugs.

As any home care veteran can tell you, there's one hazard that's almost impossible to avoid: stress. Home nurses and aides see their share of heart-wrenching cases, and it can be particularly distressing to see how some of the patients live, Jarrell says, noting that some patients' homes are cluttered, infested with roaches, or littered with extension cords and unsafe appliances. The stress is heightened by the fact that home health workers often keep a tight schedule, and have to rush from house to house. And if there's an emergency, home workers are completely on their own.

Most home health workers find ways to manage the stress and anxiety, and those who stick with it usually find deep rewards, Jarrell says. Home visits last anywhere from 30 minutes to several hours, far longer than the average visit from a hospital nurse. "In home care, you can do 15 things for one patient, instead of one thing for 15 patients," she says. "It was definitely the best nursing I ever did."

And during months or years of care, home health workers can forge a lasting bond with their clients. "You get to know them in a way that enhances both of your lives," Jarrell says. And the bond doesn't end when the patient dies. Jarrell has attended many of her patients' funerals, sitting, by invitation, with the family.

Further Resources

International Health Care Worker Safety Center at the University of Virginia, http://www.healthsystem.virginia.edu/internet/epinet/

This Web site has information on safety devices, infection control, and other topics. National Association for Home Care and Hospice

http://www.nahc.org/home.html

Centers for Disease Control and Prevention

http://www.cdc.gov

References

Bureau of Labor Statisics, Nurse, Psychiatric and Home health aides: Number of nonfatal occupational injuries and illnesses involving days away from work (1) by selected worker and case characteristics and occupation, All U.S., private industry, 2003 2007

Bureau of Labor Statistics. Incidence rates of nonfatal occupational injuries and illnesses by industry and case types, 2005. October 2006.

Home Health-Care Workers Have Few Legal Protections, University of Iowa press release, Dec. 26, 2006.

Beltrami EM, McArthur MA, McGeer A, Armstrong-Evans M, Lyons D, Chamberland ME, Cardo DM. The nature and frequency of blood contacts among home healthcare workers. Infect Control Hosp Epidemiol. 2000 Dec;21(12):765-70.

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