Robyn Gershon

Robyn R. M. Gershon, MHS, DrPH, a professor of sociomedical sciences and associate dean at Columbia University’s Mailman School of Public Health, explores the occupational hazards faced by home care workers.

As patients continue to leave hospitals “sicker and quicker,” home health care delivery is becoming more complicated. With patients needing more — and more complex — care, the workers in this “under the radar” health care setting face increased health and safety risks.

In addition to occupational hazards normally associated with health care delivery in general (e.g., contaminated sharps, heavy lifting, etc.), households can also present a wide range of potential occupational health hazards, from vermin to violence. Combined, these can put home care workers — including nearly 2 million direct-care workers — at risk of occupational injury and illness.

Data from a study (pdf) — conducted with my Mailman School of Public Health colleagues and published in the Agency for Healthcare Research and Quality‘s Advances in Patient Safety: New Directions and Alternative Approaches — indicate that home care can indeed be hazardous to workers in this highly unregulated setting.

Hazards of Providing Home Care

The most common exposures reported by 1,561 New York City home health and personal care aides who participated in the study included:

• violence (e.g., verbal abuse, neighborhood crime, threats, and weapons in the household);
• indoor air pollutants (e.g., animal hair, dust, and mold);
• vermin (e.g., mice, rats, and cockroaches); and
• slips/trips/falls hazards (e.g., loose rugs and clutter).

Injuries were not uncommon, with upper extremity injuries most prevalent.

Preventing Home Care Risks

Occupational health and safety programs are often minimal or nonexistent in home care. Many of the prevention strategies (e.g., security officers, safe needle devices, and sharps containers) that we take for granted in hospitals are simply not available in home care.

My co-authors and I urge that home care agencies, especially some of the smaller ones with limited resources, adopt lessons learned from more acute health care settings to help make home care safe and healthy — for both workers and patients.

A new easy-to-use checklist that aides can use in their patients’ homes was recently developed by the research team to spot and address unsafe conditions in home care. For more information on the checklist, contact the Study Office at (212) 305-1186 or via email at rg405@columbia.edu.

Robyn R. M. Gershon, MHS, DrPH
Associate Dean, Research Resources
Professor, Department of Sociomedical Sciences
Mailman School of Public Health, Columbia University