Home Healthcare Best Practices Guide for Risk Management.


        Home healthcare is one of the fastest growing segments in the healthcare industry. People are living longer, they desire to stay in their homes as long as possible, and the medical system encourages them to do so. According to an excerpt from First Research’s profile on home health care:

  • Home healthcare places an unsupervised individual in the home of a person who may have significant physical and/or cognitive problems. What would be regarded as a minor injury in a healthy individual can be catastrophic to some patients?
  •  The Home healthcare worker provides personal and/or professional services in an environment they do not control and has access to personal information and valuables.
  •  Home healthcare workers 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.)

Additional inherent risks exist due to the nature of the work done. Any work with patients, particularly in a non-hospital environment presents exposure to claims of negligence, abuse or theft. Losses under these circumstances can be significant, particularly when the patient suffers a significant injury that exacerbates existing health problems. Loss costs associated with injuries occurring to persons with compromised health, such as a paraplegic falling from a wheelchair, can be huge. There are also additional risks when home care workers drive personal vehicles inadequate insurance, poor driving records, inadequate vehicle maintenance and drive patients to appointments.

        Non-medical home care duties associated with personal care/non-professional services can encompass everything from light housekeeping to transportation, running errands, preparing meals and assisting with the activities of daily living. Any of these activities can produce losses. Of particular concern are activities of daily living, which include bathing, getting dressed, personal grooming and using the toilet. Assisting with these activities often requires providing physical assistance up to and including transferring the patient to and from a bed, chair, toilet or vehicle.

        Even medical professionals (professional care services) working with patients in their homes are at risk for injury.

        Patient handling while providing physical therapy, checking for wounds or responding to events that occur during a visit, such as a patient needing to use the toilet. The reality is that patient handling and periodic transfers are a part of the job. 

  • Wound care exposes workers to blood borne pathogens, including MRSA , AIDS and other contagions
  • Needle sticks are fairly common and can be an additional source of exposure

        Both professional and non-professional employees can also be exposed to dangers associated with what is going on in and around the patient homes. These are environments that are not under the control of the HHC agency. They may include exposures to: 

  • Trips and falls as a result of physical conditions at the property and weather. The possibility of falls also increases if patient transfers or handling are required
  • Contamination and exposure to any number of airborne contaminants
  • Family members and others. In some areas of the country, this can be the signal greatest threat to the safety of the home care worker
  • Animals