Home Health & Hospice

Safe Patient Handling – Home Health & Hospice

In the last 30 years the delivery of health care in the United States has increasingly been shifted from hospitals to patients’ homes (Manangan et al. 2002).  Home care is one of the fastest growing sectors of the health care industry, ranked by the U.S. Bureau of Labor Statistics as the fourth largest growth occupation. The projected increase in the number of home care services workers is 55% from 2006-2016.

Home care includes home care workers, certified nursing assistants (CNAs), physical therapists, occupational therapists, and home health and hospice nurses, all of whom are exposed to safety related risks similar to those encountered by nursing assistants in a nursing home or other direct care workers in a hospital environment because they perform some common job tasks. However, studies of the home health service industry have documented inherent occupational hazards to home health workers due to the nature of the highly variable non institutional settings and “uncontrolled” work environments.

Home care aides for example, typically provide a variety of services which include housekeeping, and may include personal care (bathing, dressing) and assistance with moving and transferring (patient handling). All of these tasks are characterized by risk factors for musculoskeletal symptoms, including forceful exertions and awkward postures. Research indicates that patient handling is a significant risk factor for back pain and other musculoskeletal symptoms in home settings.

For several years, the overexertion injury rate for Home Health Care workers has been more than double the national rate for all industries, ranking among the 10 highest (Bureau of Labor Statistics [BLS], 2006).

The approach to implementation of safe patient handling (SPH) programs and use of lift equipment and other devices in home health varies from the approach used in hospitals and long term care. Variability in the design of the physical home environment, education of home health workers and client families and delivery and set up of some lift equipment have to be addressed for successful adoption of SPH equipment in the home environment.

Over the past decade other countries such as Canada and the Netherlands have implemented successful SPH programs in home health care sector. Fortunately, in the US home health care organizations are slowly beginning to address the risk for MSDs due to patient handling and other tasks in the home health environment. However, one of the greatest challenges to be addressed before SPH can be implemented on a national scale in home care environments is the lack of CMS reimbursement for powered patient lifting equipment.

Guidelines and Toolkits for Implementing SPH Programs in Home Care

ANA National Safe Patient Handling and Mobility Standards and Implementation Guide

Click the following  to access a variety of tools to assist with implementing a SPH program in Home Care and related topics from Work Safe BC:

NIOSH Hazard Review: Occupational Hazards in Home Healthcare NIOSH, Jan 2010. Publication No. 2010-125.

NIOSH Fast Facts Home Healthcare Workers: How to Prevent Musculoskeletal Disorders (PDF) NIOSH Feb 2012 Publication No. 2012-120.

Strains, Sprains, and Pains in Home Healthcare Working in an Uncontrolled Environment, NIOSH Science Blog, April 2010.

White Papers

The Need for Safe Patient Handling Programs in Home Health and Hospice (2009). Enos, L. A & Severson, L.  A summary of current literature and data about Safe Patient Handling related issues in Home Health developed for the Coalition for Healthcare Worker and Patient Safety (CHAPS).

Development and Evaluation of Models for a Home Care Ceiling Lift Program in BC. Yassi, A., et. al. Research Report WorkSafe BC. April 2008.

Home – The Best Place for Health Care (2011). A positioning statement from The Joint Commission on the state of the home care industry

Articles & Publications

The American Journal of Safe Patient Handling & Movement (SPHM) is the first journal of its kind in the USA devoted to the subject of safe patient handling and movement and provides a forum for the latest research and evidence on the how, why, and what in this area of practice.Article manuscripts can be emailed to the Editor-in-Chief at [email protected].New Jan 2013

An Exploratory Study of Motor Vehicle Use in Home Visiting Nurses (2002). Sitzman, K.L., Pett, M.A., Bloswick, D.S.  Home Health Care Nursing Journal, 20(12), 784-792, Dec 2002, and American Occupational Health Nursing , 50(12), 553-558, 2002.

Creative Use of Ergonomic Principles in Home Care (2002). Sitzman, K, and Bloswick, D. Home Healthcare Nurse 20(2), 98-103.

Decreasing Back Stress in Homecare. (2003). Owen, B.D., and Staehler, K. Home Healthcare Nursing Manual, 21(3):180-186

Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks.(2006). Nelson, A, et al. International Journal of Nursing Studies, August 2006, 43(6).

Developing and Evaluating a Nursing Bag System for Home Care Nurses Using a Participatory Ergonomics Approach (2006). Lee, E.., et. al. Home Healthcare Nurse,  24 (9): 591-597.

Evidence-Based Practices for Safe Patient Handling and Movement (2004). Nelson, A. & Baptiste, A. Online Journal of Issues in Nursing. Vol. #9 No. 3.

NIOSH research efforts to prevent musculoskeletal disorders in the healthcare industry (2006). Waters, T., Collins, J., Galinsky, T.L.,and Caruso, C. Orthopedic Nursing, 25: 380-389

Overexertion injuries in home health care workers and the need for Ergonomics (2001). Galinsky, T.L., Waters, T., and Malit, B. Home Health Care Services Quarterly, 20: 57-73.

Patient Safety and Quality in Home Health Care in Patient Safety and Quality: An Evidence-Based Handbook for Nurses Chapter 13 (2008). Agency for Healthcare Research and Quality (AHRQ).

Suggestions for preventing musculoskeletal disorders in home healthcare workers. Part 1: Lift and transfer assistance for partially weight-bearing home care patients(2006a). Parsons, K., Galinsky, T.L., and Waters, T. Home Healthcare Nurse, 24, 158-166.

Suggestions for preventing musculoskeletal disorders in home healthcare workers. Part 2: Lift and transfer assistance for non weight-bearing home care patients(2006b).  Parsons, K., Galinsky, T.L., and Waters, T.  Home Healthcare Nurse, 24, 227-234.

Taking Safe Patient Handling to the Home Front (2009). Trossman, S. The American Nurse, Nov/Dec, 2009.

The Human Factors of Home Health Care: A Conceptual Model for Examening Safety and Quality Concerns  2009).  Henriksen, K., Jospeh, A., and Zayas-Cabán, T.  Journal of Patient Safety, 5(4):229-236.

There’s No Place Like Home: A Qualitative Study of the Working Conditions of Home Health Care (2007). Markkanen, P., et Al.  Journal of Occupational and Environmental Medicine, 49(3), 327-337.

When is it Safe to Manually Lift a Patient?(2007). Waters, T.R. American Journal of Nursing, 107(8), 53-59.

Work-system risk factors for permanent work disability among home-care workers: a case-control study(2003). Dellve, L., Lagerstrom, M., Hagberg, M.  Int Arch Occup Environ Health 76, 216–224.

Workplace Variables and Their Relationship to Quality Client Outcomes in Home Health (2004). Kroposki, M and Alexander, J. Public Health Nursing 21 (6); 555–563.

carer and elderly lady

On this page:

Guidelines & Tookits for Implementing SPH Programs in Home Care
White Papers
Other Resources
Other resources for Consumers related to Home Care

Other Resources

A Back Injury Prevention Guide For Health Care Providers from the Californian Division of Occupational Safety and Health (Cal/OSHA).

NIOSH Fast Facts Home Healthcare Workers: How to Prevent Violence on the Job. NIOSH Feb 2012 Publication No. 2012-118..

Handle With Care, Patient Handling and the Application of Ergonomics Requirements and other SPH program tools from WorkSafe BC.

Health and Safety Guidelines for Home-Based Health Care from the Occupational Safety & Health Service Department of Labour, New Zealand

Lifting Patients/Residents/Clients in Health Care, Washington State 2005 the final report from the WA State Lifting in Health Care Task Force that contains home health data. Note: The link is to the report summary only, please contact SHARP for the entire report - Phone: 1-888-66-SHARP (toll-free) or 360-902-5667 or E-mail [email protected]

Safety Manual for Homecare Workers (PDF) developed with the assistance of a number of partners: SEIU Local 503, SAIF Corporation, the Department of Human Services, and the Labor Education and Research Center at the University of Oregon. The core information was adapted from a safety manual developed by the Washington State Home Care Quality Authority.

Washington State Dept. of Labor and Industries Ergo Ideas Bank – Search for healthcare -Topics include patient handling and more.

Success Stories

Good Shepherd Medical Center, Hermiston, OR

A pilot Safe Patient Handling Program that includes implementation of SPH equipment and processes in thehome health and hospice environment is currently being developed in Oregon.

This project is part of larger SPH pilot program that is being implemented and evaluated in a rural acute care critical access health care system, Good Shepherd Health Care System in Hermiston, OR and in a long term care facility, Dallas Retirement in Dallas, OR. Oregon's Occupational Safety and Health Division (Oregon OSHA) awarded grants to both facilities that enabled them to purchase SPH equipment and devices. These facilities will become 'Facilities of Choice' in Oregon and will share their SPH program experience with health care organizations throughout the state.

SPH equipment is provided to Good Shepherd Home Health and Hospice home care clients following evaluation and order by a home health nurse. A comprehensive home evaluation, equipment delivery process and training and client compliance program was developed by home health and hospice staff.

Equipment that has been approved by home care staff for practical and safe use in a wide variety of home environments includes: portable ceiling lifts; compact folding powered floor lifts; non powered sit to stand aids; friction reducing sheets; transfer boards and gaitbelts; one way slider inserts for chairs and seated transfer discs. In addition, nurses and local EMS will have access to air assist mats and a powered air device to easily and safely lift clients who have fallen to the floor.

The home care staff at Good Shepherd hopes to develop this program into a community wide effort, where SPH equipment is available on a loan basis to nursing homes, adult foster care and assisted living facilities as well as home care and hospice. They are inspired by the programs developed in Denmark and other areas of Europe where SPH equipment is available on a loan basis from a central warehouse within a community.

For more information about tools developed for this program please contact Lynda Enos at [email protected]

For more information about the SPH program at Good Shepherd Hospital contact: Vicki Horneck, MS, RN, Nurse Manager & SPH Coordinator. Email: [email protected]