Slips, Trips, and Falls Among Home Care Aides: A Mixed-Methods Study

Occupational safety in homecare organizations: the design and implementation of a train-the-trainer program

Homecare workers face significant occupational risks, necessitating effective safety training programs. This paper presents a comprehensive Train-the-Trainer (TTT) program developed to enhance occupational safety in homecare organizations. Through an analysis of 229 reported safety events, the frequency and type of incidents, such as injuries during handling, road crashes, slips, trips, and falls, were identified and primarily attributed to human errors and violations. Based on the results, a TTT program was designed and implemented. The TTT successfully engaged Health, Safety, and Environment managers, fostering collaborative activities, knowledge sharing, and resource discussions. The program modules address critical areas, including distractions and inattentions, fatigue, time pressure, frustration and aggressiveness, and safety behaviors. This innovative approach provides valuable insights for organizations seeking to improve homecare workers' safety. The findings add to the broader comprehension of occupational safety in the homecare sector, proposing a pragmatic framework for future interventions.

Coaching Home Care Clients to Prepare Their Homes for Safe Care Visits: A Mixed-Methods Study to Evaluate a Nurse-Led Educational Intervention Process

Assuring home care (HC) workers' safety is challenging because the work environment is a private home. This paper presents the process evaluation for a proof-of-concept safety intervention study to assess whether nurse-led safety coaching, using motivational interviewing and a safety handbook, could enable HC clients to improve safety in their homes. The process evaluation objectives were to (i) document the intervention's implementation progress and (ii) assess the intervention's dose delivery, dose reception, and fidelity. Five agencies employing liaisons (n = 5) and nurse managers (NMs, n = 8) implemented this study's intervention and control arms. NMs assigned to the intervention arm (n = 6) coached 34 clients. Process evaluation metrics were assessed with mixed-methods data from (i) surveys completed by NMs during the intervention, (ii) postintervention audio-recorded and transcribed interviews (n = 6) with NMs and liaisons, and (iii) study progress tracking tools. The delivered dose efficiency was 85%, measured by the distribution of safety handbook copies to clients. About 94% of clients (n = 32) were considered "engaged" or "maybe engaged" during the safety coaching. Most coached clients (n = 30) were reachable for follow-up by NMs to assess intervention progress. Despite challenges, the intervention was implemented with good fidelity. Safety coaching can be applied in many HC contexts in larger populations.

Farm operations and slips, trips, and falls among corn farm workers in Thailand

Slips, trips, and falls (STFs) represent a main source of injury among farm workers. The purpose of this study was to evaluate the association between farm operations and STFs among corn farm workers. We conducted a cross-sectional study using a self-administered questionnaire among corn farm workers in Nan and Saraburi provinces, Thailand from July 5 to 23, 2022. Poisson regression analysis was used. Among 338 participants, 122 (36.1%) had experienced an STF in the previous 6 months. Conducting very frequent, frequent, or occasional pest management was associated with a higher incidence rate ratio (IRR) of STFs than never or rarely pest management (adjusted IRR 1.93, 95% confidence interval [CI]=1.23 to 3.04, p=0.004). People with marginal or unsatisfactory work break lengths had a higher incidence rate of STFs than those with satisfactory work breaks (adjusted IRR 1.40, 95% CI=1.03 to 1.89, p=0.030). We found that corn farm workers in our study often experienced STFs, which was associated with a high frequency of pest management practices and inadequate work breaks. Reducing the physical burden of pest management may be effective as an STF prevention strategy.

The effect of tread patterns on slip resistance of footwear outsoles based on composite materials in icy conditions

INTRODUCTION

Falls on icy surfaces are the leading cause of injuries for outdoor workers. Footwear outsole material and geometrical design parameters are the most significant factors affecting slips-and-falls. Recently, composite materials have been incorporated into outsoles to improve traction, yet the best design parameters are not fully understood.

METHOD

In this effort, based on Taguchi orthogonal array design, 27 outsole prototypes were fabricated with different tread pattern features using our patented composites and tested in a simulated winter condition.

RESULTS

An analysis of variance (ANOVA) showed that surface area (p = 0.041, Contribution = 15.63%) was the only factor significantly affecting the slip-resistance of our prototypes. The best performance was observed for the maximized surface area covered by our composite material with circular and half circular plugs laid obliquely, mostly in the forefoot area.

PRACTICAL APPLICATIONS

These findings suggest that some tread design features of composite-based footwear have a great role in affecting slip-resistance properties of composite-based footwear.

Assessing Motor Function in Frail Older Adults in Their Home Settings: Challenges, Strategies and Recommendations

Assessing motor competence is essential for evaluating the effectiveness of physical activity interventions that aim to maintain or improve older adults' function. However, assessing motor competence in older adults who have difficulties walking or standing is challenging, because few instruments or guidelines are appropriate for these frail older adults. This article aims to describe challenges in evaluating motor function among frail older adults, discuss strategies for adapting motor function assessments to their home settings, and provide recommendations for future clinical trials so that older adults with ambulatory difficulties can benefit from motor function assessment and physical activity programs. Data came from the baseline assessment of 116 participants of an ongoing clinical trial, "Promoting Seniors' Health with Home Care Aides (Pro-Home)". Our results demonstrated that the Pro-Home study involved participants who would be typically excluded from clinical trials and that the two instruments selected or developed for Pro-Home (Short Physical Performance Battery, Pro-Home Ankle Range of Motion Measure) captured a wide range of lower extremity motor competence with no or few missing data. Recommendations for future studies include knowing the target population thoroughly, developing trust and rapport with all parties involved, and continuously collaborating with interviewers who conduct assessments.

Effects of the Labour Inspectorate Authority's regulatory tools on psychosocial and biomechanical work factors in Norwegian home care services: a cluster randomised controlled trial

OBJECTIVES

This study aimed to determine the effects of the Labour Inspectorate Authority's (LIA's) regulatory tools on psychosocial and biomechanical work factors in the Norwegian municipal home care services.

METHODS

A cluster-randomised controlled trial conducted in the home care services with employee questionnaire data on work factors at baseline, and 6 and 12 months after the interventions. In total, 96 eligible municipalities were randomly assigned to either the control group or one of two interventions: (1) labour inspection visits, based on the LIA's standard inspections; and (2) guidance-through-workshops, where the participating services highlighted issues and trained labour inspectors provided guidance based on existing labour laws and regulations.

RESULTS

No favourable intervention effect was observed for the inspection intervention. No effects were observed for most of the variables in the guidance intervention, although an effect was observed for the following psychosocial factors: decision control, control over work intensity and empowering leadership. However, after adjusting for multiple testing, none of the observed effects were statistically significant.

CONCLUSION

Labour inspections did not affect psychosocial and biomechanical work factors in the home care services. A favourable effect of the guidance intervention on psychosocial work factors was observed. However, this was not evident after adjusting for multiple testing. Further research is needed to elaborate on how labour inspections and other regulatory tools can impact psychosocial and biomechanical work factors.

TRIAL REGISTRATION NUMBER

NCT03855163.

An Examination of Washington State Workers’ Compensation Claims for Home-Based Health Care Workers, 2006 to 2016: Part 1. Description of Claims and Claimants

Home-based health care can be physically and emotionally demanding, resulting in injury or illness. Washington State’s workers’ compensation compensable claims between 2006 and 2016 were analyzed to describe the characteristics of injured home-based health care (HBHC) providers and the burden created by these injuries. Comparisons were made with clinical health care (CHC) providers, as well as between all compensable claims and work-related musculoskeletal disorder (WMSD) claims. Over 90% of claimants for both HBHC and CHC were female. The mean age of all compensable HBHC claimants (45.7 years) was significantly older than for CHC, with the majority (54.5%) between the ages of 40 and 59. However, HBHC claimants with WMSDs were younger, overall. Across health care type and claim type, the majority of injured care providers were overweight or obese (BMI ≥ 25). The highest mean age occurred among claimants injured from falls, either on the same level or to a lower level (HBHC: 48.3-48.6 years, CHC: 46.1-48.1 years). This same group also had the highest BMIs. WMSDs accounted for 47.3% of HBHC compensable claims and 50.3% for CHC. Falls on the same level were the second most common injury event among HBHC claims. For both HBHC and CHC, back injuries were the most common body part for both claim types (all compensable claims: 28.8% HBHC and 23.9% CHC, WMSD claims: 60.8% HBHC and 47.5% CHC). Overexertion was the injury event most attributed to WMSDs (HBHC: 82.6%, CHC: 71.6), overexertion during lifting being the most prevalent overexertion type (HBHC: 27.8%, CHC: 19.6%).

Home care workers' experiences of work conditions related to their occupational health: a qualitative study

Background

The need for home care workers (HCWs) is rapidly growing in Norway due to the increasingly growing elderly population. HCWs are exposed to a number of occupational hazards and physically demanding work tasks. Musculoskeletal disorders, stress, exhaustion, high sick leave rates and a high probability of being granted a disability pension are common challenges. This qualitative study explored the views of HCWs on how working conditions affect their safety, health, and wellbeing.

Methods

A descriptive and explorative design was utilised using semi-structured individual interviews with eight HCWs from three home care units in a middle-sized Norwegian city. Interviews were conducted in the Norwegian language, audio-recorded, and transcribed verbatim. The data was analysed by systematic text condensation. Key data quotes were translated into English by the authors.

Results

HCWs reported that meaningful work-related interactions and relationships contributed to their improved wellbeing. Challenging interactions, such as verbal violence by consumers, were deemed stressful. The unpredictable work conditions HCWs encounter in users’ homes contributed to their exposure to environmental hazards and unhealthy physical workloads. This was the case, although the employer promoted ergonomic work practices such as ergonomic body mechanics when mobilising and handling of clients, using safe patient handling equipment. HCWs perceived high level of individual responsibility for complying with company safety policies and practices, representing a health barrier for some. Organisational frameworks created unhealthy work conditions by shift work, time pressure and staffing challenges. Performing tasks in accordance with HCWs professional skills and identity was perceived as health-promoting.

Conclusions

This study suggests that unpredictable working conditions at users’ home can adversely affect the safety, health, and wellbeing of HCWs. The interaction between the unpredictable environment at users’ homes, HCWs’ perceived high level of individual responsibility for complying with company safety policies and practices, and staffing challenges due to sickness-related absences upon the workplace creates tense work conditions with a negative influence on HCWs health.

Healthy Aging Requires a Healthy Home Care Workforce: the Occupational Safety and Health of Home Care Aides

PURPOSE OF REVIEW

To identify important home care (HC) aide occupational safety and health (OSH) hazards and examine how addressing these can improve aide health and the delivery of HC services overall. Specifically, this review seeks to answer: Why is HC aide OSH important? What are the most significant OSH challenges? How can improving HC aide OSH also improve the safety and health of their clients? What implications do the findings have for future research?

RECENT FINDINGS

HC is one of the fastest growing US industries. Aides comprise its largest workforce and are increasingly needed to care for the rapidly aging population. There is an aide shortage due in part to instabilities in HC work organization and to serious job-specific hazards, resulting in aides losing work time. Recent social, economic, and technological factors are rapidly changing the nature of HC work, creating OSH hazards similar to those found in nursing homes. At the same time, aides are experiencing social and economic inequities that increase their vulnerability to OSH hazards. These hazards are also a burden on employers who are challenged to recruit, retain, and train aides. OSH injuries and illness interrupt the continuity of care delivery to clients. Many OSH hazards also put HC clients and families at risk. A new framework and methodologies are needed to assess aide and client safety together in order to guide future HC research, policies, and practices. Government, industry, and labor commitment is needed to fund and coordinate a comprehensive, multidisciplinary research program.

Home health aides' experiences of their occupational health: a qualitative meta-synthesis

Home health aides (HHA) have high sickness absence while the need for home care services is rapidly growing. The aim of this study was to derive new conceptual understandings by identifying, describing and interpreting key concepts across qualitative studies on how HHA experience their occupational health related to their working conditions.A qualitative ethnographic meta-synthesis was used as a method to analyze 27 articles included from systematic searches in CINAHL, MEDLINE and PsycINFO.HHA experience physical strenuous work task demands in combination with unfortunate organizational conditions in an uncontrolled and ever-changing psychosocial and physical working environment as the main obstacle to their occupational health, although many positive presence factors with opposite effects were reported.More research is needed to investigate whether physical demanding work tasks can have positive effects on HHA's occupational health by reorganizing their work while preserving patients' empowerment at their home.

Reducing fall risk for home care workers with slip resistant winter footwear

Falls on icy surfaces are the leading cause of occupational injuries for workers exposed to outdoor winter conditions. Slip resistant footwear has been shown to reduce the risk of falls for indoor workers but until recently, there was no accepted standard for evaluating the slip resistance of winter footwear on icy surfaces. Our team recently developed a lab-based testing protocol for measuring footwear slip resistance. This protocol, called the Maximum Achievable Angle (MAA) test, measures the steepest ice-covered slope that participants can walk up and down without experiencing a slip in a simulated winter environment. This lab-based protocol has found there is wide variability in the performance of commercially available winter footwear. In particular, we have found that a new generation of footwear that incorporates composite materials in the outsole, performs much better than most other footwear. The objective of this project was to investigate whether the footwear that performed well in our lab-based testing would reduce the risk of slips and/or falls in real-world winter conditions. One hundred and ten home healthcare workers from SE Health were recruited for this study and were asked to report their exposure to icy surfaces along with the numbers of slips and numbers of falls they experienced each week using online surveys over eight weeks in the winter. Fifty participants (the intervention group) were provided winter footwear that were among the best performing in the MAA test. The remaining sixty participants (the control group) wore their own footwear for the duration of the study. A total of 563 slips and 36 falls were reported over the eight-week data collection period. The intervention group consistently reported fewer slips (127 vs 436) and fewer falls (6 vs 30) compared to the control group. We found the slip rate in the intervention group was between 68.0% and 68.7% lower than the control group. Similarly, the fall rate was between 78.5% and 81.5% lower in the intervention group compared to the control group. These findings demonstrate that footwear that performs well in the MAA test can reduce the risk of both slips and falls in real-world winter conditions.