At our annual workers compensation insurance audit recently, the auditor made an interesting comment: she remarked that our worker injury rate was far lower than other home care companies. Her observation made us feel validated in our conscious efforts to minimize such injuries—efforts that are not always easy.
Many of our clients have impaired mobility due to stroke, Parkinson’s disease, ALS, advanced dementia and other causes. Our Home Care Aides are called upon to lift and transfer such clients from their beds, chairs, toilets or bath tubs. Even for a trained, able-bodied aide, the physical demands can pose serious risks of musculoskeletal injury. Clients are also at risk from being dropped, sustaining skin tears, and experiencing shear injury leading to pressure sores. The growing obesity epidemic in the United States has only aggravated these risks.
Families often approach us with the request that we provide a strong aide. “Dad is a big man and even my sister and I together have difficulty getting him out of bed”, a daughter might say. “We want a strong male aide to care for him.” This is a natural instinct, but assigning the most physically powerful aide is never a good solution. Consider these facts:
- Rates of back and other musculoskeletal injuries due to overexertion in health care are among the highest of all industries.
- These injuries can result in life-altering, career-ending disabling conditions.
- The Virginia Department of Labor and Industry lists “Nursing Aides, Orderlies and Attendants” as the fourth most hazardous occupation. The only occupations cited as more dangerous are truck drivers, construction and non-construction laborers.
- The single greatest risk factor for overexertion injuries in health care is the manual lifting, moving or repositioning of patients.
- Home Care Aides are at higher risk than others because in a home setting there is usually no one to help and they may feel pressured to go beyond what is safe.
The problem is serious enough that researchers at the University of Virginia have labeled this a “crisis in healthcare” and are among the many who have called for a “safe patient handling – no manual lift” policy to be enacted nationwide. Numerous states have passed legislation or created regulations to protect workers from lifting injuries. In 2013, The Nurse and Healthcare Worker Protection Act was introduced in the U.S. Congress. Regrettably it has not seen passage, leaving our country behind others like England and Australia which have had “No Lifting” policies in effect since the 1990’s.
Safe Patient Handling (SPH) programs have been proven to markedly reduce lifting injury. Key components include the active involvement of direct care nurses in evaluating lifting safety, visible administrative support and “no manual lift” policies. Most importantly, however, such programs always call for wider use of mechanical aides such as gait belts, sliding transfer boards and mechanical lifts. Relying on body mechanics is not a solution. Thirty-five years of research has shown no evidence that body mechanics alone will protect workers when manually lifting patients.
At Ready Hands, our full-time Registered Nurse Supervisors try to appraise objectively each care recipient’s lifting needs and introduce methods for keeping all parties safe. One result is that the use of gait belts and lifts is relatively common in our company. Sometimes a “lift team” approach, which incurs more costs for the client, has been the only alternative to the client remaining in bed. Admittedly we have not always succeeded in achieving the best evidence-based solutions, especially when costs or client resistance have been factors. However, we will continue to approach this issue with the seriousness which it deserves.