Lone Working Safety in the Home

An Australian report found that 69% of home care workers have felt unsafe in a client’s home (Skatssoon 2019).

Furthermore, 45% have been injured at work, and 60% have experienced workplace abuse (Skatssoon 2019).

As a home care worker, you will often find yourself alone in diverse and unpredictable environments. Home care presents a unique set of challenges and risks, ranging from dangers in the client’s home environment to car accidents while travelling between work locations.

In order to stay safe while working, it is essential to be aware of potential risks and appropriately manage difficult and dangerous situations. Although you have a duty of care to your clients, you also have a duty of care to yourself (QLD Gov 2018).

And, as the client’s home is considered a workplace, the client also owes you a duty of care and is expected to disclose any hazards they become aware of (WorkSafe TAS 2020).

The Risk Management Process

There are four steps:

1. Identify hazards: Determine what has the potential to cause harm.
2. Assess risks: Determine the harm that could be caused by the hazard, how serious the potential harm could be and how likely it is to occur.
3. Control risks: Implement appropriate control measures. The following hierarchy of control measures lists possible strategies from most effective to least effective:
   1. Eliminate the risk.
   2. Either:
      • Substitute the hazard;
      • Isolate the hazard; or
      • Implement engineering controls
   3. Reduce exposure to the hazard using administrative controls.
   4. Use PPE.
4. Review control measures: Assess the effectiveness of the control measures.

(Safe Work Australia 2018; 2019)

Identifying Hazards in Home Care

It is important to remember that clients are generally receiving home care because illness, age or other factors are causing them to have difficulty managing certain tasks on their own. For this reason, their homes may be unclean, unmaintained or deteriorating. Generally, they will not be in the same condition as a normal, regulated workplace (Ogrin 2014).

This is in addition to the client’s home being an unfamiliar environment.

Below are some of the potential hazards encountered by home care workers.

Manual Handling

Read: Manual Handling: An Overview

Manual handling is any work that requires lifting, lowering, pushing, pulling, carrying, moving, holding or restraining. It is the biggest cause of workplace injuries in Australia (WorkSafe VIC 2020).

Manual handling tasks do not necessarily involve large or heavy objects; even using a keyboard is considered manual handling (WorkSafe VIC 2020).

Not every manual task has the potential to cause harm, but you are at risk if the work involves:

• Repeated or sustained application of force;
• Awkward posture;
• Repeated movements;
• The use of high force;
• Sustained vibration;
• Handling people or animals; or
• Handling unstable, unbalanced or difficult to grasp loads.

(WorkSafe VIC 2020)

Manual tasks can become riskier in residential environments, as most homes are not designed for healthcare purposes and may have confined spaces that make tasks more challenging (QLD DoH 2018).

Common manual handling tasks in home care include:

• Transferring, bathing or dressing clients;
• Pushing wheelchairs;
• Loading and unloading from vehicles;
• Moving furniture;
• Gardening and maintenance;
• Cleaning (e.g. vacuuming, mopping);
• Making beds;
• Transporting clients; and
• Other domestic tasks.

(QLD Gov 2018; WorkSafe VIC 2011)

Injuries from hazardous manual handling can occur suddenly or develop gradually. In some cases, it may lead to long-term musculoskeletal disorders that significantly impede on quality of life (QLD Gov 2018; WorkSafe VIC 2020).

Violence, Abuse and Aggression

Read: Responding to Violence and Aggression in the Workplace

This relates to any incident at work wherein you are abused, threatened or assaulted by either the client, other members of the household or the general public (WA Gov 2019). This may include:

• Biting, spitting, scratching, hitting or kicking;
• Throwing objects;
• Pushing, shoving, tripping or grabbing;
• Verbal threats;
• Sexual assault; or
• The use of weapons such as knives or guns.

(WA Gov 2019)

Violent behaviour poses a significant risk to home care workers, as they often work alone and after dark, and may result in physical or psychological harm (QLD Gov 2018; WA Gov 2019).

Clients may become aggressive for a variety of reasons including medication, illness and cognitive impairment. You may accidentally trigger a behavioural response from a client you are unfamiliar with. The layout of the client’s home may also make it difficult for you to remove yourself from the situation (WA Gov 2019).

Biological Hazards

Home care workers may be exposed to infectious diseases or body substances through tasks such as:

• Performing health and personal care for clients;
• Handling items and equipment around the home;
• Cleaning (including spills and body substances);
• Laundry;
• Handling sharps; and
• Food handling and storage.

(QLD Gov 2018)

Slips, Trips and Falls

A significant number of injuries in community care are caused by slips, trips and falls. Hazards in the client’s home may include:

• Spills;
• Objects on the floor (e.g. plastic bags);
• Slippery floor surfaces, particularly in bathrooms and toilets;
• Uneven flooring;
• Cluttered walkways;
• Loose mats or tiles;
• Electrical cords;
• Poor lighting or visibility;
• Stairs and ladders; and
• Space and design of the home.

(WA Gov 2019; QLD Gov 2018)

Driving

Throughout the day, you may need to drive between a variety of locations. These can include client homes, your facility and other destinations (when transporting clients) (QLD Gov 2018). Hazards when driving include:

• Poor weather;
• Poor road conditions;
• Fatigue;
• Rushing;
• Distractions (e.g. mobile phone, the client);
• Unfamiliar vehicles;
• Client behaviour;
• Disregarding road rules;
• Changes to usual routes;
• Driving in remote or isolated areas.

(QLD Gov 2018)

Other Potential Hazards

• Isolated or remote work;
• Hazardous substances and chemicals;
• Electrical hazards;
• Latex Allergy;
• Stress; and
• Fatigue.

(QLD Gov 2018)

Implementing Control Measures

The following table outlines strategies for dealing with hazards in clients’ homes.

(WA Gov 2019; QLD Gov 2018)

General Safety Tips for Home Care Workers

• Always wear shoes in the client’s home. If the client objects to this, disposable surgical shoe covers or a clean pair of shoes solely for wearing inside may be a suitable alternative.
• Never touch the client’s pets. Ask for them to be kept away while you visit.
• Confirm the visit with the client before you arrive.
• Ensure you have detailed directions to a new client’s home.
• Leave your bag in the boot of the car and keep the doors locked.
• Ensure somebody knows where you are at all times.
• If you ever feel uncomfortable or scared for your safety, remove yourself from the situation and call your supervisor and emergency services. Trust your instincts and never put yourself into a situation that makes you feel unsafe.

(Malugani 2006)

Being Aware of Changes

It is important to remember that the client and their home may change between visits. Even if their home environment was safe previously, you cannot assume that it will still be in the same condition next time. In order to minimise the risk of harm, ensure you assess for hazards and changes every visit (QLD Gov 2018). Take note of:

• The client’s health status;
• The placement and positioning of furniture;
• Electrical equipment;
• New furniture or equipment;
• New people or animals;
• Spills or leaks;
• Obstructed areas; and
• Changes to the service being provided.

(QLD Gov 2018)

When to Report Incidents

You should report any incidents that resulted in injury to yourself or the client, an emergency situation or a near-miss (QLD Gov 2018).

Conclusion

Home care workers are required to care for clients in diverse and changing residential environments that are not subject to the same regulations as traditional healthcare workplaces. You must be able to recognise and control various hazards around the home to protect yourself and your clients from harm.

Furthermore, the solitary and independent nature of this work means that you must remain vigilant and able to manage challenging situations on your own. Being familiar with the risk management process and being able to mitigate any identified risks is essential in personal safety.

Additional Resources

• QLD Gov, A Guide to Working Safely in People’s Homes
• Safe Work Australia
• WA Gov, Home Based Care Information and Checklist
• WorkSafe Victoria
• Introduction to Occupational Health and Safety (OHS)
• Manual Handling: An Overview

References

• Malugani, M 2006, Safety Tips for Home Healthcare Workers, Monster, viewed 27 August 2020, https://www.monster.com/career-advice/article/safety-tips-for-home-health-workers
• Ogrin, R 2014, The Client’s Home as a Workplace, Australian Association of Gerontology, viewed 27 August 2020, https://www.aag.asn.au/documents/item/440
• Queensland State Government 2018, A Guide to Working Safely in People’s Homes, QLD Gov, viewed 27 August 2020, https://www.worksafe.qld.gov.au/__data/assets/pdf_file/0018/82503/community-working-safely-in-peoples-homes.pdf
• Safe Work Australia 2019, Identify, Assess and Control Hazards, Safe Work Australia, viewed 28 August 2020, https://www.safeworkaustralia.gov.au/risk
• Safe Work Australia 2018, Model Code of Practice: How to Manage Work Health and Safety Risks, Safe Work Australia, viewed 28 August 2020, https://www.safeworkaustralia.gov.au/book/model-code-practice-how-manage-work-health-and-safety-risks#4-step-3how-to-control-risks
• Skatssoon, J 2019, ‘Home Care Workers Suffering Abuse, Injuries’, Australian Ageing Agenda, 17 October, viewed 27 August 2020, https://www.australianageingagenda.com.au/executive/home-care-workers-suffering-abuse-injuries/#:~:text=Forty%2Dfive%20per%20cent%20of,the%20delivery%20of%20quality%20care.
• Western Australia State Government 2019, Home Based Care Information and Checklist, WA Gov, viewed 27 August 2020, https://www.commerce.wa.gov.au/sites/default/files/atoms/files/home_based_care_2019.pdf
• WorkSafe Tasmania 2020, Domestic Tasks in Home Care, WorkSafe TAS, viewed 27 August 2020, https://worksafe.tas.gov.au/topics/Health-and-Safety/hazards-and-solutions-a-z/hazards-and-solutions-a-z-pages/c/carers/domestic-tasks-in-home-care
• WorkSafe Victoria 2020, Hazardous Manual Handling Health and Safety Guide, WorkSafe VIC, viewed 27 August 2020, https://www.worksafe.vic.gov.au/hazardous-manual-handling-health-and-safety-guide
• WorkSafe Victoria 2011, Home Care - Occupational Health and Safety Compliance Kit, WorkSafe VIC, viewed 27 August 2020, https://content.api.worksafe.vic.gov.au/sites/default/files/2018-06/ISBN-Home-care-occupational-health-and-safety-compliance-kit-2011-06.pdf