December,
2002
LOHP Studies Home Care Workers
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LOHP
recently assisted the National Institute for Occupational
Safety and Health (NIOSH) in a research project to study
the job hazards facing home care workers.
In
January, 2001, NIOSH received a joint request from management
and labor to evaluate the safety and health problems of
home care workers in Alameda County, California. The problems
primarily involved musculoskeletal injuries and other ergonomic
issues, although there were also concerns about chemical
and biological exposures.
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May,
2003 Update
New
Home Care
Training Program
Following
the NIOSH study described here, LOHP developed a
pilot training program for home care workers to address
injuries and ergonomic
risks. In the spring of 2003, we conducted
training sessions in English, Spanish, and Chinese. Click
here for a report and photo gallery.
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Background
200,000
home care workers provide "in-home supportive services" to
low income elderly and disabled persons throughout California.
In Alameda County, most home care workers are persons of color,
female, and over 40.
These
workers have traditionally been considered "independent providers"
since they are hired, fired, and trained by the consumer whom they
assist. However, in 1993 a coalition of unions and consumer groups
pushed for state legislation to establish an "employer of record"
with which home care workers could deal collectively. After the
legislation passed, the Public Authority of Alameda County became
the "employer of record" for home care workers in the
county. The Authority reports to the County Board of Supervisors.
Similar
arrangements were put in place in other California counties, and
many groups of home care workers became involved in union organizing
drives. In Alameda County, home care workers launched a grassroots
organizing effort and selected Service Employees International Union
(SEIU) Local 616 as their representative.
The
Study
After
receiving the request from the Public Authority and SEIU, NIOSH
contracted with LOHP to develop innovative ways to collect and analyze
data. Goals of the study were to identify types and causes of injuries,
to associate injuries with specific job tasks, and to offer realistic
recommendations while taking into account possible obstacles to
implementing them.
Research
with this group of workers posed several challenges. Workers and
consumers speak multiple languages; workers are employed in many
locations; workplaces are private homes and each is unique; and
both workers and consumers are typically low-income people with
limited access to information and resources.
LOHP's
experience with "participatory research" methods provided
a useful model for this project. Participatory research involves
the subjects of the study as full participants. (See our In the
Spotlight section for stories about other LOHP research projects
of this type.)
LOHP
proposed and carried out a strategy that included focus groups,
interviews, and home visits.
Focus
Groups
LOHP's
Laura Stock leads focus group.
Home care workers recruited through
the union attended focus groups held in English, Spanish, and Cantonese.
These included both group discussion and structured activities such
as "body discomfort maps" on which workers indicated where
they had pain. Workers also discussed the amount of training they
had received and what equipment was available to them. They identified
their most physically stressful work tasks, which included unassisted
lifting and transferring of consumers, bathing, dressing, pushing
and pulling wheelchairs, lifting people who have fallen, cleaning
bathrooms, moving furniture, carrying groceries, cleaning floors,
making beds, climbing stairs, and prolonged standing.
 
Focus
group participants worked
on "body discomfort maps"
Interviews
Interviews
were conducted with workers, consumers, and other involved parties
such as home care agencies. Interviewees cited problems such as
a lack of training programs for workers, workers' difficulty in
obtaining needed equipment (rubber gloves, face masks, grab bars,
cleaning utensils, etc.), and workers' low income and need for more
work hours. Several people also mentioned that social workers are
expected to monitor the home environment to assure the safety of
both home care workers and consumers, but are limited due to their
case loads.
Conclusions
Among
the conclusions of the study were:
- Home
care workers are unprepared to protect themselves from safety
and health hazards.
- Not
all consumers are skilled at being employers.
- Most
consumers' homes are not well-equipped for the services they need.
- Hazards
of common housekeeping tasks are as important as those posed by
lifting and transfer tasks.
- Poor
communication between workers and consumers increases the hazards
of the job.
- It
is unclear what entity is responsible for protecting worker safety
and health.
Preliminary
recommendations included a comprehensive program for protecting
home care workers, with improved training and equipment, better
access to healthcare services for injured workers, and a surveillance
system for job-related injuries and illnesses. The researchers also
proposed instituting written contracts between home care workers
and consumers, and clarifying the roles of the Public Authority,
the consumer, and the home care worker in providing for safety.
A
final recommendation was to develop and circulate information for
consumers on how to ensure the health and safety of their workers.
LOHP
also advised that these changes would be more likely to be successful
if the benefits to consumers were better communicated. For example,
consumers would receive better services and there would be less
worker turnover.
LOHP
expects ongoing collaboration with the union and the Public Authority
to establish training programs and plan interventions.
For
more information, contact Laura Stock at LOHP: lstock@berkeley.edu.
Based on Health and Safety Risks for Home Care Workers,
a slide presentation by Laura Stock, LOHP;
Sherry Baron, NIOSH; and Daniel Habes, NIOSH.
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