Challenging Realities of Home-Care Moving & Handling for Community Based Support Workers

1. Challenging Realities of Home-Care Moving & Handling for Community Based Support Workers

2. McIsaac Caregiving Agency • ACC funded home support for seriously injured spinal cord & brain damaged people • 2/3 are tetraplegic • 3/4 clients are male • Care from 12-24 hours • Aged from 5 to 82 years • Usually only 1 female Support Worker

3. Code of Practice for Manual Handling “Safe handling means making it safe for both carer and patient. When the load is another person we need to eliminate the thinking that a lift will be involved.” Occupational Safety and Health (OSH) Accident Compensation Corporation (ACC) 2001

4. Moving and Handling Training • Orientation & Induction information on body care • Education on Health & Safety Employment Act 1992/02 and ACC’s LITEN UP Approach • Client specific moving and handling advice from spinal unit physiotherapists for new clients • In-house training and support from supervisor: • Use of appropriate equipment & safety • Incident reporting & team de-briefs

5. Hospital Handling Training

6. ACC NZ Patient Handling Guidelines • Set in a hospital / rest home environment • Always using appropriate equipment • Environment safe and uncluttered • Reduced distractions and hazards • Compliant clients and family • Utilizing 2 or more staff

7. Health & Safety Employment Act 1992 • Employer’s Responsibilities: • Proactively prevent harm to employees • Provide safe equipment & work areas • Assess & control hazards which can cause harm • NZ Standard 4121:2001 outlines safe ergonomic facility design for disabled people, yet not for client’s homes

8. Health & Safety Employment Act 2002 • Employee’s Responsibilities: • Take all practicable steps to ensure; • Their own safety at work • That no action or inaction while at work causes harm to any other person

9. Client’s Responsibilities? • Acknowledge SWs are Agency employees & are subject to employment law & OSH regulations • However… clients can refuse to have or use appropriate safe equipment in their homes • Homes are full of environmental & social hazards that make the SWs care duties unsafe

10. 1 Support Worker in Homes

11. Home Based Hazards • Razor, toothbrush charger • TV, DVD, Lap Top, Stereo • Electric bed/fan/heater • Phone, gaming station • Fish tank, lamps • Hoist & chairs

12. Home Based Hazards • Cats climbing up legs • Dogs attacking staff • Toys scattered • Child minding • Thick carpet • Wet floors • Shoeless

13. Handling Around Hoarding

14. Social Hazards • Alcohol misuse • Marijuana smoke • Domestic disputes • Positioning clients for physical relationships • Clients, friends & family sexually harassing staff

15. Ageing Issues • Medical advances prolonging life 30-40 yrs • Increase in co-morbidities • Cognitive decline faster • Body ages faster

16. Sizing Issues • Clients becoming obese • Cervical paralyzed people are ‘heavier’ • Difficulty assisting in their own transfers

17. Turning Bariatric Clients

18. Equipment Size Vs Home Space

19. Functional Furniture

20. Community Issues • Staff assist clients in community activities • Many do not allow for safe moving/handling • Results in repetitive strains/injuries for staff

21. Unsafe Handling Techniques • ACC Patient Handling Guidelines state these techniques as unsafe → • And… • ‘To be eliminated immediately as can cause significant injuries’ • Orthodox Lift • Cross Arm Lift • Top & Tail Lift • Underarm Drag • Flip Turn on a Bed • Front Assisted Transfer • Australian Shoulder Lift

22. Health & Disability Commission (HDC) • Code of Rights for people with disabilities states: • Right to care and support that suits them • To make choices about their health or disability • HDC Code does not override other legislation e.g. Health and Safety in Employment Act 2002 • “Nothing in the Code requires providers to act in breach of a duty”

23. HDC Code of Rights vs DoL 2002 Law? • Clients can remove staff from workplace if staff refuse to move them in an unsafe way • ROCK vs HARD PLACE: • RISK INJURY? • LOSE JOB?

24. ACC’s LITEN UP For Whom? • LITEN UP Approach: “…eliminate thinking that a lift will be involved…” • Who is responsible for changing client’s thinking that they will be lifted?

25. Whose Rights Are Right? • Whose human rights are more important? • The disabled client’s or family’s wishes? • Or staff’s long-term safety & well-being?

26. Supporting Support Workers • Coercion of SW into moving unsafely has a personal cost to staff: • Vocational • Financial • Familial • Sexual • Social

27. Assigning Responsibility

28. Safety for Community Staff • ACC to review clients ability to remove staff: • To prevent clients dismissing staff for refusing to move them unsafely • ACC to support Agencies in upholding 1992/02 Health & Safety in Employment Act: • Rather than financially penalizing them in a home situation for client non-compliance

29. Safety for Community Staff • ACC to review client’s functioning every 5 years: • To assess for cognitive and physical decline and possibility of more SW hours/support • Homes to have compulsory use of safe equipment & environment: • Ceiling hoists, electric beds, appropriate flooring, mobility cars

30. Safety for Community Staff • Financial penalty for clients/family: • When repeatedly coercing staff into unsafe moving and handling practices • Clients to be moved to rest/group home if work environment is repeatedly hazardous for staff: • Unsafe environment, harassment & coercion

31. Community Focused Guidelines ACC to THINK about STAFF SAFETY & modify their Patient Handling Guidelines for staff in client homes: • 1 Support Worker manual handling, not 2 • Inappropriate flooring and cluttered spaces • Refusal of clients to use appropriate equipment • Non-compliant clients & family with safe practice

32. Legislation or Just A Dead Tree? • Moving and Handling Guidelines to become Legislation • Clients & family to be legally accountable to uphold them

33. Future of Moving & Handling?