Health and Safety Update- Research to Practice

1. Health and Safety Update-Research to Practice Quality Work, Quality Care: A State-of-the-Art, National Conference for Home Care Stakeholders, April 2, 2012, Washington, D.C.

2. Presenters • Drs. Rosemary Sokas and Jane Lispcomb • Dr. Sherry Baron • Drs. Margaret Quinn and PiaMarkkanen • Dr. Robyn Gershon • Dr. Linda Delp • Moderator: Dr. Joseph Zanoni

3. Participatory training and interventionsRosemary Sokas, MD, MOHsokas@georgetown.edu • Partnership between SEIU, Addus Homecare, U of MD and U of Illinois at Chicago SPH • Participatory training in small groups within large group setting • Union (peer educator), management, and academic facilitators • Labor-Management Safety Committee developed intervention tools • Follow-up training with role-play

5. Wallet Card Sharps Safety Used lancets, needles and syringes can pose a health risk to you, your client, and the public so please remember to: Have clients dispose of their own lancets, needles and syringes in a sharps container or other puncture proof container after every use. Ask clients not to dispose of lancets, needles and syringes in the household trash, coffee cans or containers made of thin plastic. Never touch your clients’ lancets, needles or syringes. For sharps disposal options, your client may contact his or her health care provider or pharmacist. If home waste disposal is the only option, seal, put duct tape over the cover and label the container “Do not recycle.” Contact Information *If your client needs a sharps container and does not have one, have him or her contact the local pharmacy to see if a free sharps container is available. If you experience any injury in a client’s home, or if you are expose to blood on the job, please contact your supervisor immediately. • Supervisor: ____________________________ • Phone number:_312-663-4647______ If your supervisor is not available please contact Sonia or Teresa. • Addus Healthcare, Inc., Local 880, Service • Employees International Union, • University of Illinois at Chicago, School of Public Health.

6. Refrigerator Magnet to give to Client \ Role play training and discussion to help workers practice the conversation

7. Implementation and evaluation of interventions for home care aides on blood and body fluid exposure in large group settings.  Amuwo, S., Sokas, R. K., Nickels, L., Zanoni, J., Lipscomb, J. (2011).   New Solutions, 21(2), pages 242-243

8. “Partnership for Safety” • A 5-year community-base participatory study • To create and evaluate materials that: • Emphasize the importance of worker safety to the overall quality of care • Empower home care workers and consumers to identify and reduce hazards in their workplace/home environment

10. Findings from the Program Evaluation • 60% of workers had been injured in the past year at work • Nonetheless, most workers felt that the risks were low for getting hurt while doing their work tasks: eg. needle sticks • Workers who received training and the handbook: • Increased their awareness of work hazards and were more likely to know where to find information to reduce those hazards • This was especially true for non-English speakers • 80% had attempted to apply at least one of the “tips”. Some examples: • “Don't bend down to clean the tub; use a longer brush instead” • “I have now applied to have continuous use of gloves while handling needles. I was not aware of Universal Precautions” Workers learn about how to use the handbook and role play how to talk about safety Comments from a participant: “I and my mom do not read. I asked other people to read it to me. I found this booklet very helpful in raising my awareness of safety issues.”

11. Contact Information:Sherry Baron, MD MPHNational Institute for Occupational Safety and Health Email: SBaron@cdc.gov Tel: 513 458-7159

12. Safe Home Care (HC) Project University of Massachusetts Lowell (UMass Lowell) Dr. Margaret Quinn & Dr. Pia Markkanen http://www.sustainableproduction.org/safehomecare

13. Safe HC Project – UMASS Lowell: introduction & background • Funded by NIOSH • Partners with Occupational Health Surveillance Program, Mass. Department of Public Health • In collaboration with the MA Executive Office of Elder Affairs, industry associations and agencies, SEIU, and community groups • Grew from an earlier Project SHARRP • Emphasizes HC worker-client safety & health linkages • Project objectives • qualitative & quantitative assessment of a broad range of OSH hazards & promising practices in home care • map out all the ways sharps medical devices enter & exit homes • identify and evaluate preventive interventions • develop educational materials

14. Safe HC Project – UMASS Lowell: pre-survey qualitative phase update • 12 focus groups: consisted 99 participants • Home health aides • Homemakers • Personal care attendants • Companions • 25 in-depth interviews • 13 home care agency directors/supervisors and labor union representatives • 12 home care clients • Methods • Focus groups & interviews audio recorded • Transcripts coded and analyzed with NVIVO 9.2 software

15. Safe HC Project – UMASS Lowell: pre-survey qualitative phase update Most frequently coded OSH concerns among aides: • Back injuries from various client care tasks • Verbal abuse • Clients on oxygen addicted to smoking • Exposure to bloodborne pathogens & other infectious diseases • Long-distance driving • Psychosocial stress • low pay • lacking benefits • feeling being taken for granted by the society

16. I have a client that is on oxygen and she smokes while she has it on… she doesn’t want to stop, she has had social workers, nurses, everybody you can think of going in there to tell her to stop. I actually see sparks on her nose. So now, when I go in I just tell her, you can’t smoke. Some days I’m there an hour and a half, some days two hours. So she has to go two hours without smoking a cigarette.

17. UMASS Lowell Safe Home Care Project: qualitative findings Most frequently requested practices Other requested practices

18. UMASS Lowell Safe Home Care Project: qualitative findings

19. Health and Safety Update-Research to Practice Quality Work, Quality Care: A State-of-the-Art, National Conference for Home Care Stateholders, April 2, 2012, Washington, D.C. Robyn Gershon, MPH, DrPH Tara McAlexander, MPH Lourdes Hernandez-Cordero, DrPH

20. Risk Management of Household Hazards • Building upon risk assessment studies • Next step was to develop a tool to easily identify household hazards as a first step towards remediation • Wanted a checklist that was: • easy to use by care-givers, recipients, patients • inexpensive • tech light • easily translatable • would serve as a simple guide to intervention

24. Findings from the Health Homes, Healthy Seniors Study *(N=105 households) Hazards Identified • 41% Low lighting • 36% Excessive dust/peeling paint • 33% Mice/rodents • 31% Loose rugs/uneven flooring • 29% Vermin • 28% Mold • Elderly Householder Injuries • 26 people had 42 falls in previous 12 months (83% were alone), 12 resulted in injury, 8 required treatment, 3 required hospital stay. • 102 people had one or more burns (total of 118 burns). *HUD Funding, 2011

25. Making Home Care a Better Job Job stressors and Job Satisfaction in California’s In-Home Supportive Services Workforce Linda Delp, PhD UCLA Labor Occupational Safety & Health Program (UCLA-LOSH) Quality Work, Quality Care Conference, Washington, D.C. April 2, 2012

26. In Home Supportive Services Characteristics: • Over 200,000 workers statewide • Consumer-directed model • Worker can be a family member • Personal care not health care services • Workers represented by a union Research Objectives • Identify job stressors, control and support • Analyze relationship with job satisfaction and health care status

27. Data Collection & Analysis • 1,614 Questionnaires (English, Spanish) • Phone interviews conducted by trained home care workers • Multivariate regression analysis • 6 Focus Groups 71 workers • English (3), Spanish (2), Mandarin Chinese (1) • Taped, transcribed, translated • Content analysis – ID recurring themes

28. LA IHSS Workforce • 86% women • Mean age: 52 • 51% married/living together • 67% HS grad (49-83) • 45% Hisp, 32% Af-Am, 23% White • 53% immigrant (2-94) • 59% renters • Mean income: $10,700 (6,500-18,500) • Average hours worked: 34 hrs/week • Relative: 71% relative (52% same home)

29. What determines job satisfaction? • Stressors (-) • Emotional demands – abuse • Schedule – unpaid overtime, >1 consumer • Financial strain – unable to see doctor due to cost • Job insecurity – worry about losing wages & health benefits • Satisfaction (+) • Ability to provide quality physical and emotional care • Social support – friends, spouse, relatives • Active in union

30. Significance for Home Care Policy • Health care access – benefits, respite care • Prevent adverse physical & emotional health effects – clarify responsibility for worker protection (training, equipment) • Wages & job security • Key to policy change – unified worker and consumer voice to support program/rally against cuts

31. Stress… and Satisfaction too • They are able to stay in their homes…That’s the main goal of home care. • You don’t get the fulfillment and the satisfaction out of a check…it’s what you do. You look around this world and say, ‘ She used to be my client’…You can see the improvement. • You did this. You made a difference in this person’s life…We allow them to live longer, healthier lives and happier lives.

32. Questions and Responses? • Thanks for your participation!