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:
Identify hazards: Determine what has the potential to cause harm.
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.
Control risks: Implement appropriate control measures. The following hierarchy of control measures lists possible strategies from most effective to least effective:
Eliminate the risk.
Substitute the hazard;
Isolate the hazard; or
Implement engineering controls
Reduce exposure to the hazard using administrative controls.
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 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;
The use of high force;
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;
Loading and unloading from vehicles;
Gardening and maintenance;
Cleaning (e.g. vacuuming, mopping);
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).
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;
Pushing, shoving, tripping or grabbing;
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).
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);
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:
Objects on the floor (e.g. plastic bags);
Slippery floor surfaces, particularly in bathrooms and toilets;
Loose mats or tiles;
Poor lighting or visibility;
Stairs and ladders; and
Space and design of the home.
(WA Gov 2019; QLD Gov 2018)
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 road conditions;
Distractions (e.g. mobile phone, the client);
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;
(QLD Gov 2018)
Implementing Control Measures
The following table outlines strategies for dealing with hazards in clients’ homes.
Ensure all equipment is suitable, well-maintained and easily accessible
Ensure you are appropriately trained to use all equipment
Follow no-lift policies
Adjust bed heights during bed making to minimise bending
Alternate between heavier and lighter manual tasks
Use equipment such as extendable shower heads that minimise stretching
Use trolleys, aids and lifting devices etc. when required
Violence, Abuse and Aggression
Ensure potentially aggressive clients are identified
Remove yourself from a situation immediately if you feel unsafe
Make the environment more secure by removing potential weapons, establishing barriers etc.
Carry a personal alarm
Avoid carrying money, valuables and jewellery into client homes
Use de-escalation strategies
Seek counselling if required
Follow standard precautions
Follow transmission-based precautions if the client is suspected to be infectious
Avoid walking on recently-cleaned floors until they are dry
Use the right amount and type of cleaning product when cleaning floors
Remove moss, slime and leaves from outdoor walkways
Ensure lighting is adequate while working
Check and replace light bulbs when required
Take care when carrying loads or using ladders
Wear appropriate non-slip footwear
Implement measures such as anti-skid tape and contrast strips
Ensure vehicles are safe and properly fitted with safety accessories
Ensure vehicles are insured
Record any incidents
Avoid driving in poor conditions
Ensure you only drive when fit to do so
Allow adequate time for travel to avoid rushing
Reduce driving time
Maintain contact with your supervisor
(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.
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;
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).
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.