Health hazard evaluation report: HETA 2001-0139-2930, Alameda County Public Authority for In-Home Support Services, Alameda, California.
On January 19, 2001, the National Institute for Occupational Safety and Health (NIOSH) received a request from the Alameda County Public Authority (PA) for In-Home Supportive Services and the Service Employees International Union (SEIU) local 616 to evaluate working conditions and make recommendations regarding the prevention of musculoskeletal disorders and other safety and health problems among the approximately 10,000 publicly funded homecare workers (HCWs) in Alameda County, California who are represented by SEIU. Alameda County, like all of the California In-Home Supportive Services (IHSS) HCW, uses a consumer directed model in which the recipient of the home care services recruits, hires, trains, directs, and fires their own workers. Because of the unique nature of a consumer directed service model, the PA and SEIU asked NIOSH to evaluate the health and safety issues of HCWs in Alameda County. The evaluation utilized multilingual HCW focus groups, key informant interviews, analysis of injury data and an in-home site visit. Findings indicated that housekeeping tasks were as physically demanding to workers as client lifting and transfer tasks, that workers largely did not have adequate tools and equipment to complete their required tasks, and that most consumers' homes were not equipped and/or configured to allow for efficient delivery of needed services. The evaluation also found that most HCWs had little or no formal training on how to safely perform home care tasks prior to beginning work and few opportunities existed for in-service training during employment. Interviews with individuals and groups involved with homecare in the Alameda County area, consumers, consumer groups, and IHSS social workers indicated that there were additional problems with the consumer-client relationship, such as the lack of a clear understanding of whose responsibility it was to provide for the safety and health of the HCW, and lack of a clear definition of what a HCW was required to do for their consumer. In general, it was found that there was poor communication between consumers and HCWs, and inadequate means for resolving disputes that arose. Recommendations were made for the establishment of a comprehensive safety and health program that could be overseen by a union and management joint committee. NIOSH investigators conclude that the current program for delivering consumer-directed home care services in Alameda County could lead to health and safety problems for homecare workers. Lack of training, inadequate resources, and poor communication between consumers and caregivers contributes to health risks. Recommendations to improve safety and health for home care workers are contained in this report.