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Strains, Sprains, and Pains in Home Healthcare: Working in an Uncontrolled Environment

Categories: Ergonomics, Health care, Women

nurse bends man's legYou hope the discharge planner was a good one. You hope the doors aren’t too narrow for the wheelchair and the bed is higher than knee-level. Even then, as likely as not, your work area will be the size of a crawlspace and strewn with clutter and medical equipment.

Welcome to life as a home healthcare provider. In 2007, America’s 896,800 home healthcare workers reported a staggering 27,400 injuries.1 Some of these resulted from unintentional needlesticks, latex allergies, and violence against providers. However, the most common injuries were sprains, strains, and other musculoskeletal injuries related to lifting and moving patients.

The rate of patient lifting injuries in 2007 was 20.5 per 10,000 healthcare workers.2 In homes, the lifting equipment and adjustable beds that are often available in hospitals are conspicuously absent. Also, nurses, aides, hospice care workers, and other in-home care providers tend to work alone. Moving a patient without help, in cramped quarters, and without assistive equipment is a recipe for injury. In fact, research indicates that if any caregiver is required to lift more than 35 pounds of a patient’s weight, assistive devices should be used for the transfer.3

Ergonomic Assistive Devices
Here are just a few examples of equipment that can be used to improve safety for workers and patients:
  • A hoist should be used for lifting patients who don’t have enough strength to stand and walk on their own.
  • A rolling toileting and showering chair can reduce six transfers (from bed to wheelchair to toilet to wheelchair to bathtub to wheelchair to bed) to two (from bed to chair and back to bed).
  • Grab bars, adjustable beds, and raised toilet seats can improve leverage and prevent the need for awkward and unsafe postures.
  • Slip sheets and other friction-reducing devices cut back on the effort needed to move a patient.

Recommendations

The work environment shifts drastically from home to home and conditions fall outside the control of both employer and worker. However, there are methods for reducing musculoskeletal injuries. The best of these is prevention through ergonomics designing work tasks so that they aren’t beyond workers’ strength and abilities. In healthcare, ergonomics involves using equipment and methods to decrease strain and increase safety when lifting and moving patients.

Employers

  • Consult with a professional in patient-care ergonomics to determine when assistive devices are necessary and to provide training on proper use of the equipment.
  • Provide ergonomics training for workers.
  • Evaluate each patient-care plan to determine whether ergonomic assistive devices or more than one care provider are needed.
  • Reassess the training, the care plan, and the assistive devices once installed and in use by the caregiver.

Workers

  • Use ergonomic assistive devices if they are available.
  • When it’s not possible to avoid manual patient handling:
    • Stand as close to the patient as possible to avoid reaching, bending and twisting. To avoid rotating the spine, make sure one foot is in the direction of the move.
    • Keep your knees bent and feet apart.
    • Use gentle rocking motions to move a patient.
    • When pulling a patient up from an adjustable bed, lower the head of the bed until it is flat or down. Raise the patient’s knees and encourage the patient to push.
    • Don’t stand in one place. Move around the patient’s bed so you can position yourself in a safe posture rather than stretching, bending, and reaching.

In applying these recommendations, keep in mind that workers can be injured from lifting too much weight, regardless of whether they use proper body mechanics.

Nurses and other home healthcare providers should not have to fear becoming patients themselves; however, many safeguards may appear prohibitive because of cost, organizational inertia, lack of training, the difficulty of using devices, resistance from families, and so forth. It is important for employers, workers, patients and families to work together to try to overcome these problems.

Resources – Ergonomics in Home Healthcare
Employers and workers should gather as much information as they can about ergonomics in home healthcare, starting with the resources listed below:

Please share the information in this blog with any home healthcare providers you know, including friends and family members who provide care for their loved ones. As always, leave your comments, safety tips, and thoughts on safety roadblocks.

Look for future home healthcare blog entries on latex allergies, bloodborne pathogens and needlestick injuries, stress, and violence.

Dr. Galinsky (Captain, U.S. Public Health Service) is a research psychologist in the NIOSH Division of Applied Research and Technology.

Mr. Burnett is a health communications specialist in NIOSH’s Education and Information Dissemination Division.

References

    1, 2. NIOSH Hazard Review: Occupational Hazards in Home Healthcare, NIOSH Publication No. 2010-125. January 2010.3. Waters TR, When is it safe to manually lift a patient, American Journal of Nursing, 2007.

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. April 19, 2010 at 8:05 am ET  -   Frances Ziesmann

    Some concerns about the practice of rocking a patient and standing them as unexpected movements can happen and the patient may become off balance.
    This can be dangerous

    Suggest the following instructions (usually taught by physiotherapists)

    ◦have the patient move to the edge of the bed or chair and if they have diffulty doing this position yourself in front of the client, bend your knees & hips, keep back straight, position hands on either side of the pelvis and instruct the patient to wiggle to the edge of the bed (assist the movement)
    ◦while caregiver then stands to the side of the patient ask the patient to place their hands on the arm of the chair or bed ready to push up off the bed – care giver may assist the patient to stand from the side (use a gait or transfer belt if the client is unsteady)
    ◦instruct the patient to lean forward and bring their head over their knees – their buttock will automatically lift off the bed (this is safer than rocking and mimics the normal mechanics of sitting to standing)
    ◦if the patient has weak quadricepts – stand in front of the patient and block their knees to perform a pivot transfer
    Frances Ziesmann RPT, BSc BScPT DOHS
    Oakville, Ontario
    Canada

    Link to this comment

    • AUTHOR COMMENT April 20, 2010 at 1:01 pm ET  -   Traci Galinsky

      Thank you for your comment. I would like to clarify that the statement you referenced — “Use gentle rocking motions to move a patient” — was not intended to refer to helping a patient stand but to assist with lateral movements such as helping a patient move toward the edge of the bed.

      Link to this comment

  2. July 30, 2010 at 1:39 am ET  -   valliere McGinnis

    When an agency take 4 cna/hha worker to vista a client in a nursing home. and the physical therapist a strong man was showing us how to transfer her. It took him one hour and the he called in a second p/t to help him.

    This client has polio for 40 yrs. and can’t stand on her own, She had one hip and shoulder removed and a pinch nerve in her neck. My boss said that the nursing home would release her only if she has CNAS to help her. Tell me why my agency did not get her a hospital bed, a bed rail, portal-potty or a side board to help her and the CNAS to mover her in a safety way and the CNA. In her bathroom her spouse made 2 poles from top to bottom on the side of the toilet. The bathroom was same and the wheel chair barely fit..

    Why done the agency help these people more. I fall back words and trip over the lip of the shower that was filled with all kind of stuff. I truly fill if these agency would put more safety equipment in homes, their would be lest accent.

    Link to this comment

    • AUTHOR COMMENT July 31, 2010 at 10:28 am ET  -   Traci Galinsky

      Whether the patient is in the home or in a long-term care nursing facility, it is important to ensure that she can be assisted in a manner that is safe for both herself and her caretakers. Safety concerns should be discussed among all concerned parties, including the patient, the caretakers (family members and health-care professionals), and management personnel from the nursing home or home health care agency, in order to make any changes in the patient’s care plan that are necessary to ensure safety during patient handling.

      Link to this comment

  3. August 2, 2010 at 9:31 pm ET  -   nancy newton

    home care is really difficult especially if you’re a woman and your patient is a man bigger than you..thanks for all the recommendations, ergonomics devices can really help a lot.

    Link to this comment

  4. September 11, 2010 at 7:39 pm ET  -   Gavin

    As a physical therapist I have done home health care. The most dangerous part of home health is transferring the patients from sitting and/or lying to standing. this can cause severe damage to one’s low back if they are not experienced in using safe body mechanics when transferring patients.

    The other crucial factor is maintaining good core and low back strength.

    Without good strength and sound lifting mechanics a home health care worker is likely to hurt his or her back while treating patients.

    Link to this comment

    • AUTHOR COMMENT September 13, 2010 at 4:17 pm ET  -   Traci Galinsky

      Research has demonstrated that training on body mechanics has not been an effective approach for preventing overexertion injuries from most patient handling tasks. Biomechanical analyses using the NIOSH Lifting Equation indicate that even under ideal circumstances in which a patient is cooperative and unlikely to make sudden movements, the maximum recommended weight limit for manual lifting of a patient or a part of a patient’s body (e.g., a leg or an arm) is 35 pounds (Waters, 2007). Strength training and body mechanics can benefit health and fitness and may help prevent injuries from loads of 35 lbs or less during manual patient handling. However, research evidence shows that safe patient handling programs using ergonomic equipment and methods are necessary for preventing overexertion injuries from heavier patient handling tasks.

      Waters, T. (2007). When is it safe to manually lift a patient? American Journal of Nursing, 107, 53-58.

      Link to this comment

  5. September 13, 2010 at 5:19 pm ET  -   venessa

    I think home care is very much helpful for senors who are independent.I think the home care can Preserve their physical and mental health.

    Maintain a balanced nutrition regime

    Have moral support and are involved in exciting conversations to remain sharp and interested Are actively monitored for their own safety and well-being.

    Link to this comment

  6. July 27, 2011 at 2:22 pm ET  -   Arthur Marks

    As a physical therapy marketing and physical therapist. I have numerous patients incurring injuries that are under home healthcare. I agree to Gavin that transferring the patients from sitting and/or lying to standing. This should be done really carefully and the home healthcare service provider should be well trained

    Link to this comment

  7. June 21, 2012 at 4:54 am ET  -   Michele

    Thanks so much for taking time to show compassion to all of us bloggers.

    Link to this comment

  8. August 31, 2012 at 5:20 pm ET  -   Family First Home Care

    Another assistant device is a transfer belt also known as a gait belt. This device allows for better grip when transferring your patients.

    Link to this comment

    • September 14, 2012 at 4:14 pm ET  -   Traci Galinsky

      Thank you for your comment. Here is a description to elaborate on gait/transfer belts:
      Gait belts are wide, fabric belts worn around the patient’s waist, with sewn-in fabric handles that are grasped by the caretaker. They are helpful assistive devices for some patient handling tasks, but they are not designed for lifting patients. Gait belts, as their name suggests, were designed to help stabilize weight-bearing patients during ambulation. In addition, patient handling algorithms developed by the Veterans’ Administration Patient Safety Center include the use of gait belts to assist with transfers in some circumstances. For example, they can be used to assist partially weight-bearing patients to stand and pivot or to assist a non weight-bearing patient who has upper extremity strength while s/he is initially learning to do a seated transfer with a seated transfer aid, such as a transfer board. The algorithms can be found in the document “Assessment Form and Algorithms” under “Algorithms for Safe Patient Handling and Movement” at the following website:

      http://www.visn8.va.gov/patientsafetycenter/safepthandling/

      Link to this comment

  9. September 20, 2012 at 5:43 pm ET  -   Ann Mullen

    I work with an in-home health care agency and the information you provided for helping a bed-bound person get is is invaluable. Thank you for offering that to people who don’t receive proper training.

    Link to this comment

  10. June 21, 2013 at 9:26 pm ET  -   K Yong

    I would like to request permission to copy and share this blog information for home health professionals at a public professional education seminar and printed as part of the manual vs. referencing the information as a source they can access via website.

    Please let me know if that will be OK and if you need further information of the seminar specifics.

    Thank you.

    Link to this comment

    • June 25, 2013 at 4:18 pm ET  -   Traci Galinsky

      Thank you for your interest in the NIOSH Science blog. You may reprint the information for use at your seminar, we just ask that you please include the NIOSH Science Blog title and include a notation that NIOSH was not a seminar sponsor. You may also want to order free copies of the NIOSH Hazard Review: Occupational Hazards in Home Healthcare (publication number 2010-125) and Safe Lifting and Movement of Nursing Home Residents (publication number 2006-117) for dissemination at your seminar. You can do so online at http://wwwn.cdc.gov/pubs/niosh.aspx, by calling 1-800-CDC-INFO, or from the National Technical Information Service at http://www.ntis.gov/.

      We are interested to learn more about your seminar such as the title, location, and date. If possible, any additional information such as number of attendees or seminar materials would also be greatly appreciated. Please send to Traci Galinsky at:tgalinsky@cdc.gov.

      Link to this comment

  11. July 5, 2013 at 3:23 am ET  -   Rina Walsh

    This is very informative post i am new in health care services and right now getting trained in a health care agency but i don’t think so person who is trying to train me do even know any of these words because he never told me any of this before. I will show his this post. Very nice work keep it up.

    Regards,
    Rina Walsh
    First Care of New York, Inc

    Link to this comment

  12. February 17, 2014 at 10:24 am ET  -   Lisa

    Great to see some info on the website. It is very hard to come by specific Home Health information.I work in Employee Health and Safety for a large healthcare organization that includes Home Care Services. We do not see a large number of injuries but the ones that do occur are often severe. One component of our patient assessment includes determining if moving the patient is necessary. For example, if a patient does not have equipment and it is not safe to bathe the patient in the shower or tub, a bed bath can be given instead. I thought I had seen somewhere that NIOSH was requesting volunteers from the Home Health realm to look at Safe Patient Handling. Will there be any updated resources and tools available as a result of this work or am I mistaken?

    Link to this comment

  13. February 26, 2014 at 5:51 pm ET  -   Anonymous

    Hi friends, its great piece of writing CDC – NIOSH Science Blog – Strains, Sprains, and Pains in Home Healthcare: Working in an Uncontrolled Environment on the topic of cultureand completely explained, keep it up all the time.

    Link to this comment

  14. March 4, 2014 at 3:57 am ET  -   ccorrales

    Great article! I used to be a volunteer firefighter and an EMT and have lifted and transferred many patients. Many of those times I used bad mechanics and should have had more people around to help or should have used different equipment. As a result of this I now have a bad back. This is a great article for raising awareness for both the worker and the patients safety.

    Link to this comment

  15. March 5, 2014 at 3:11 pm ET  -   ccorrales

    Hoping to add safety information to my home health aide site very soon. I’ll definitely be linking back to this page when I do.

    Link to this comment

  16. May 6, 2014 at 4:16 pm ET  -   Paul Soh

    Thanks for your sharing this blog post.I really like this article.
    Thums up!

    Link to this comment

  17. November 28, 2014 at 2:48 pm ET  -   Vegas Home Health Care

    Thanks for these wonderful home health care tips. I’m going to have to link to this page and show a few of my family members this. My mom works in the home care industry in Las Vegas and is always having pains and cramps from moving the ladies around constantly. Maybe this will help her, atleast I hope it does. Thanks again.

    Link to this comment

  18. December 10, 2014 at 10:55 am ET  -   Jo Williams

    These are great tips and some that we can pass on to our staff to use when the visit home help for out elderly clients & sports physiotherapy

    Link to this comment

  19. December 10, 2014 at 11:04 am ET  -   Dominic Zagen

    Everything is very open with a really clear description of the issues. It was truly informative. Your site is very useful.

    Link to this comment

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