Home healthcare workers provide care in client homes and may be exposed to safety and health hazards as part of their daily work routine. From infectious agents, patient lifting, and ice-covered sidewalks to violent patients, hostile animals, and driving hazards, these home healthcare workers may be faced with multiple situational factors that they have little control over. However, employers must ensure that these workers are protected from any recognized, serious hazards.
Home healthcare workers include a variety of professionals that place themselves at great risk to provide a seamless and convenient treatment plan for patients in their own homes. These workers include nurses, home health aides, hospice workers, physical and respiratory therapists, speech therapists, and many more. Home healthcare services range from providing medication and therapy to assisting with bathing or changing bandages.
Due to the wide range of services offered, home healthcare workers are exposed to a litany of hazards:
- Lifting and other ergonomic hazards
- Slips, trips, and falls
- Bloodborne pathogens and contaminated needlesticks
- Other disease-causing infectious agents
- Latex and other allergens
- Hazardous chemicals
- Electrical hazards
- Cooking and fire hazards
- Extreme heat or cold
- Severe weather
- Fatigue and stress
- Driving hazards
- Violent patients, family members, and/or visitors
- Animals that bite
- Poor water quality or no running water
- Pests like rodents, lice, scabies, or termites
- Other unsanitary conditions
- 29 CFR 1904 — Recording and reporting occupational injuries and illnesses
- 29 CFR 1910.22 — Walking-working surfaces
- 29 CFR 1910.37 — Maintenance, safeguards, and operational features for exit routes
- 29 CFR 1910.38 — Emergency action plans
- 29 CFR 1910 Subpart I — Personal protective equipment (PPE), including respiratory protection
- 29 CFR 1910.141 — Sanitation
- 29 CFR 1910 Subpart U — COVID-19
- 29 CFR 1910.1030 — Bloodborne pathogens
- 29 CFR 1910.1200 — Hazard communication
- 29 USC 654 — General Duty Clause of the OSH Act
- Administrative control: A type of workplace hazard control that uses procedures, policies, supervision, scheduling, and training as a means of protecting workers.
- Bloodborne pathogen: Pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).
- Ergonomics: The design of the work setting (including furniture, tools, equipment, and tasks) to help position the worker in a way that will reduce the possibility of injury when performing work tasks. An ergonomics approach optimizes the worker’s safety, health, and performance.
Summary of requirements
To protect home healthcare workers from safety and health hazards, employers must:
- Assess and monitor hazards to which workers may be exposed;
- Furnish to each worker employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to workers;
- Provide and ensure the use of appropriate PPE and protective clothing that shield workers from exposure; and
- Meet the requirements of OSHA regulations, such as the ones listed above, if applicable.
Home healthcare employers are recommended to also:
- Develop and implement a robust safety program that includes clearly written and understandable directives, emergency and first aid plans, security and animal response procedures, driving policies, mental health resources, and training;
- Provide home healthcare workers with adequate support and resources to isolate and respond to infectious disease outbreaks or violent situations;
- Have a zero-tolerance policy for violence toward workers and investigate all reported incidents;
- Provide ergonomic assistive devices when needed;
- Make restraint of animals a condition of giving home healthcare;
- Implement administrative controls such as specific patient handling procedures, limiting the number of patient moves or transfers, and handwashing requirements;
- Include lunch breaks and sufficient travel time in workers’ schedules and allow self-paced work;
- Implement safe work practice controls such as housekeeping protocols and materials handling, use, storage, and disposal procedures;
- Ensure that workers who drive for the job have valid driving licenses;
- Enforce mandatory seatbelt use while driving or riding for the job;
- Implement a worker reporting policy for exposure incidents, and ask workers to report each one, even if they think it won’t happen again or it might not be serious;
- Avoid assigning home healthcare workers to locations, homes, or situations in which their safety will likely be compromised;
- Develop and implement a lone or remote worker program to account for workers during and after shifts;
- Train workers on home healthcare hazards, exposure routes, hand hygiene, and other safety and health precautions; and
- Maintain related records.