To the Editor: In their Contempo Updates article about home care, Dr Levine and colleagues did not discuss the safety of home health care workers. The Bureau of Labor Statistics (BLS) projects that the number of home health care workers will increase by 60% during this decade, making it one of the fastest-growing US employment sectors. The BLS reported an injury rate in home health workers of 474 lost-work day cases per 10 000 workers, which is 50% higher than the injury rate among hospital workers and 70% higher than the general work force. The increasing number of workers at risk and the personal, social, and economic consequences of workplace injury make it critical to consider labor and health and safety issues connected with the growth in home health care. The risks to home care workers may be less visible for several reasons: their workplace is not subject to the same oversight and legislation as health care facilities; the physical layout and psychological milieu are highly variable from site to site; workers may take on home care as moonlighting; wages are lower, benefits often nonexistent, and negotiating power limited for unskilled home care workers; and a significant immigrant population and "informal sector" fills the need for supportive services in the home. Ergonomic risks are associated with caring for immobile patients in poorly arranged spaces, especially in the absence of coworkers or mechanical devices for assistance. Bloodborne pathogens, tuberculosis, and other biological agents may cause infection. At present, the Occupational Safety and Health Administration does not hold employers responsible for providing safety syringes or tuberculosis surveillance to home care workers. The physical environment may contain faulty electrical wiring, hot stoves, inefficient heating and cooling, presence of pets, uncooperative patients, and violent relatives. Patients may live in violent neighborhoods, in poorly maintained buildings, and up flights of stairs. Motor vehicle crashes, the most common cause of work-related mortality, account for approximately 25% of the excess risk in home care workers more than those who work in health care facilities. Shift work, unstable work environments, lack of control of the workplace, caring for severely disabled patients, low wages, and poor benefits may lead to psychological stress. Protection of home care workers requires a redefinition of "home" as "workplace" and "home care" as "health care." This would help ensure greater safety and workplace quality for this vulnerable employment sector.
Health-care; Health-services; Health-care-personnel; Workers; Work-areas; Work-capability; Work-capacity; Work-environment; Injuries; Risk-factors; Safety-measures; Safety-practices; Physical-capacity; Physiological-effects; Physiological-factors; Psychological-factors; Psychological-stress; Humans; Men; Women;
Author Keywords: home care services; occupational exposure