"If they trust you...": Strategies to reduce ergonomic risks to workers and clients in home care

The rapidly growing home care industry, currently employing more than one million Home Care Workers (HCWs), is projected to become one of the nation’s largest in the next decade. HCWs assist clients in managing intimate, essential acts of daily living (ADLs), e.g., bathing, toileting. This physically, emotionally challenging work places HCWs at risk for ergonomic injury; yet, they typically receive little formal job training and may lack assistive devices. Objective: In this NIOSH funded pilot project HCWs were asked to describe ergonomic risk factors in caregiving and housekeeping tasks and identify problem-solving strategies to improve ergonomic conditions. Methods: In 2012, 46 HCWs recruited by their local union, Service Employees Healthcare Illinois/Indiana, participated in ergonomics focus group discussions. The primarily female middle-aged African American participants were experienced in assisting clients with limited mobility. Findings: Transcript analysis revealed that an open, respectful communication approach can affect clients’ behavior; it may help HCWs reduce ergonomic risks to themselves and increase clients’ physical independence of movement. Conclusions: HCWs’ close observation and interaction with clients help them understand how clients’ self-perception and  moods may affect mobility capabilities. They use that knowledge to determine how to work with clients in navigating ADLs. HCWs may act as coaches, cheerleaders, educators, negotiators, becoming trusted companions who clients depend on for physical and emotional support. HCWs’ behavioral insights, self-developed communications skills and caring demeanor should be recognized as a valued strategy and explored as an element of ergonomic injury prevention in home care.