Occupational Safety and Healthand Home Care

2017 2017

Guidance on the Safety, Health and Welfare at Work (Reporting of Accidents and Dangerous Occurrences)

Regulations 2016

Occupational Safety and Healthand Home Care

2017 2017

Our Vision:healthy, safe and productive lives

Introduction 2

Objective 2

Occupationalsafetyandhealthinthecontextofhomecare 2

Managing occupational safety and health 3

Planning, delivery and review of home care services 4

Planninghomecareservices 4

Deliveryofhomecareservices 7

Stafftraininganddevelopment 7

Supervisionofstaff 7

Riskprofileandriskassessment 7

Review of home care services 11

Published in 2017 by the Health and Safety Authority, The Metropolitan Building, James Joyce Street, Dublin 1. ©All rights reserved.

Contents

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Occupational Safety and Health and Home Care

IntroductionObjective

Thisinformationsheetisaimedatemployersandemployeesprovidingformalcareforolderandvulnerablepeopleintheirownhome.InIreland,homecareservicesareprovidedbytheHSE,thevoluntarysectorandprivateproviders.

Definition

Home care: support provided (both short and long term) to people who require assistance to continue to live independently, outside of a hospital or residential care setting.

Homecareclientstendtobeolderpersons,personswithdisabilities,personswithchronichealthconditionsandanyonewhosequalityoflifecanbeimprovedbyhavingatrainedandsupervisedcareworkerintheirhome.

Thetypesofworkingenvironmentandworkingarrangementinvolvedintheprovisionofhomecareservicespresenttheirownuniquehazardsandrisks,whichmustbeidentifiedandmanaged.Thisinformationsheethighlightstheoccupationalsafetyandhealthissuesassociatedwiththeprovisionofhomecareandindicatescontrolmeasurestomitigaterisk.Itisnotintendedtocoverhomemaintenance,deliveredmealsortravelandescortingclients.

Occupational safety and health in the context of home care

Whileahomecareworkerisworkinginaclient’shomethathomebecomesaplaceofworkandtherelevantoccupationalsafetyandhealthlegislativerequirementsmustbemet.Meetingtheseobligations,however,shouldbedoneinasensitivewaythatrespectsthewaytheclientorganisesandwantstoliveintheirhome.

TheSafety,HealthandWelfareatWorkAct2005emphasisestheneedforemployerstomanagesafetyandhealthatworkinordertopreventworkplaceinjuriesandillhealth.Thisinvolvesaninitialreviewofthearrangementsinplacetosecuresafetyandhealth,identificationofstandardstobeachieved,settingoutthemethodofachievingthosestandardsandmonitoringandreviewingofperformance.

Thefoundationofthemanagementofsafetyandhealthisthewrittensafetystatement.Itwillreflectthesysteminplaceformanagingsafetyandhealthatwork.Thesafetystatementmustbebasedontheidentificationofhazardsandtheassessmentofrisk.

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Cyan 100%Magenta 76%Yellow 0Black 27%Managing occupational safety and health

Thekeyelementsofasafetyandhealthmanagementsystemareshownbelow.Safetyandhealthmanagementsystemsshouldbetailoredtosuittheneedsoftheorganisation.

Step 1 PLAN

n Saywhatyouwanttoachieve,whowillberesponsible,howwillyouraimsbeachievedandhowwillsuccessbe measured.Youmayneedtowritedownthispolicyandaplantodeliverit.

n Decidehowyouwillmeasureperformance.Thinkaboutwaystodothisthatgobeyondlookingataccident figures.Lookforleadingindicatorsaswellaslaggingindicators(e.g.competentoccupationalsafetyandhealth adviceavailable[employedorcontracted],writtenriskassessmentscompletedandimplemented,trainingplan anddelivery,staffconsultationandfeedback,resultsof[internaland/orexternal]audits).

n Remembertoplanforchangesandidentifyanyspecificlegalrequirementsthatapplytoyou.

Step 2 DO

n Identifyyourriskprofile

Assesstherisks:identifywhatcouldcauseharmintheworkplace,whoitcouldharmandhow,andwhatyouwill dotomanagetherisk.Decidewhattheprioritiesareandidentifythebiggestrisks.

n Organiseyouractivitiestodeliveryourplan

Inparticular,aimto:

n involveandcommunicatewithworkers,sothateveryoneisclearonwhatisneededandcandiscuss issues,andtodeveloppositiveattitudesandbehaviours;and

n provideadequateresources,includingcompetentadvicewhereneeded.

n Implementyourplan:

n decideonthepreventiveandprotectivemeasuresneededandputtheminplace;

n providetherighttoolsandequipmenttodothejobandmaintainthem;

n providetrainingandinstructiontoensureemployees’safety,healthandwelfareatwork;and

n supervisetomakesurethatarrangementsarefollowed.

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Occupational Safety and Health and Home Care

Step 3 CHECK

n Measureyourperformance:

n makesurethatyourplanhasbeenimplemented–theevidencetoprovethatwhatissaidin documentationisactuallyachievedinreality;and

n assesshowwelltherisksarebeingcontrolledandifyouareachievingyouraims.Insome circumstancesformalauditsmaybeuseful.

n Investigatetherootcausesofanyaccidents,incidentsornearmisses.

Step 4 ACT

Reviewyourperformance.

Learnfromaccidentsandincidents,ill-healthdata,errorsandrelevantexperience,includingfromotherorganisations.

Revisitplans,policydocumentsandriskassessmentstoseeiftheyarestillfitforpurpose.

Takeactiononlessonslearned,includingfromauditandinspectionreports.

Planning, delivery and review of home care servicesPlanning home care services

Planninghomecareserviceswilltypicallyincludeanassessmentoftheclient’seligibilityfortheserviceandtheclient’sneeds.Occupationalsafetyandhealthissuesneedtobeconsideredatvariousstagesofplanning:

n atthereferralstage(thefitbetweentheneedsoftheclientandtheserviceofferedbytheprovider);

n attheclient’scareneedsassessmentstage(impactsofwhichinputintothe‘careplan’);

n whenassessingtheriskswithinthehomeenvironment(i.e.thesuitabilityofthedwellingasaplaceofwork),as partoftheoverallmulti-disciplinarySingleAssessmentTool(SAT);and

n whenidentifyingtheequipmentrequiredtomeetcareneeds.

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Organisationsthatprovidehomecareservicesshouldestablishreferralpoliciesandprocedurestotakeintoaccountrelevantoccupationalsafetyandhealthissueswherepracticable.

Theassessmentofaclient’seligibilityandneedforsupportservicesistheinitialcareplanningstepandisdesignedtoensureclientsreceiveappropriatetypesandlevelsofservicestoenablethemtomaximisetheirindependentlivingcapacity.Relevantinformationmayinclude:

n personaldetailsandcircumstances,

n currentcommunity/home-supportservicesused,

n Currentdiagnosisandmedical/mentalhealthsummary,

n multi-disciplinaryassessments(SAT),and

n homeenvironmentinformation(e.g.pets,geographicallocation,livingarrangements,family/friends/ neighbours).

Asoundassessmentprocesswillnotonlyresultinthedeliveryofappropriateservicesbutalsoidentifyanyoccupationalsafetyandhealthissuesthatmayneedtobemanaged(e.g.patientmovingandhandlingneeds,challengingbehaviours).

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Occupational Safety and Health and Home Care

Inadditiontoplanningforthesafedeliveryofservices,thehomeenvironmentinformationservestobeginarelationshipwiththeclientaboutbuildingasafeandhealthyenvironmentforbothworkerandclient.Thekeyitemscontainedwithinthehomeenvironmentassessmentinclude:

n general(visualinspection);

n accesstothehome–parking,pathways,steps,lighting,gates,pets,entrydoor,etc;

n internalconditions(general)–firesafety,stairs,floorsurfaces,electricity,equipment,housekeepingand hygiene;

n bathroom/toilet–accessibilityand ergonomicsuitability,availabilityof showeringfacilities;

n bedroom–accessibility,heightofbed, spaceandergonomicsuitability;

n clientaidsandequipment–wheelchair, showerseat,liftingequipment(including maintenance)withadequate accessibilityandergonomicdesign;and

n other–smoking,potentialweapons, etc.

Equallyimportantistheprovisionandmaintenanceofsuitableequipmenttomeetcareneeds.Therangeofequipmentincludesliftingandmobilityaids,healthcareriskwastebags/bins,cleaningequipmentusedbythehomecareworker,vehiclesfortransportationofclients,etc.Equipment,whetherprovidedbytheclientorthehomecareorganisation,mustbesuitablefortheneedsoftheclientandtheprotectionofthehomecareworker.Rolesandresponsibilitieswithregardtotheprovision,maintenanceandrepairofequipmentneedtobeclarifiedbetweentheclientandthehomecareprovider.

Occupational Safety and Health and Home Care

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Delivery of home care services

Centraltotheemployer’sdutyistheneedtoensurethataworkplaceundertheemployer’scontrolandmanagementismaintained,sofarasisreasonablypracticable,inaconditionthatissafeandwithoutriskstohealth.TheSafety,HealthandWelfareatWorkActdefinesaplaceofworkasany,oranypartofany,buildingorstructureinwhichworkiscarriedonwhetheroccasionallyorotherwise.Therefore,aprivatehomeinwhichanemployeeisworkingisthatemployee’sworkplaceandtherequirementsofparts2,3and4ofthe2005Actapply.

Staff training and development

Tocomplywiththelaw,employeesneedtohavetheskills,knowledgeandexperiencetocarryouttheirdutiessafely.Organisationsthatprovidehomecareservicesmusttakeintoaccounteachemployee’scapabilitiestoensurethatthedemandsofthejobdonotexceedtheirabilitytodotheworkwithoutrisktothemselvesorothers.

Traininghelpspeoplegaintheskillsandknowledge,andultimatelythecompetence,tocarryouttheirworksafelyandwithoutrisktotheirhealth.Inductiontrainingshouldcoverthekeyelementsofthesafetystatement,includingthesafesystemsofworkrelevanttotheemployee’stasks.Jobanalysisandwrittenriskassessmentsshallidentifyallspecifictrainingrequired(e.g.patienthandling,managingchallengingbehaviours,careoftheolderperson,loneworking,sharpsawareness).Updateandrefreshertrainingmayberequiredatintervals.Trainingrecordsshouldbemaintained.

Supervision of staff

Directsupervisionisdifficultwheretheworkplaceissomeoneelse’shomeandwhereemployeesareoftenworkinginisolation.Itisessential,therefore,thathomecareworkers’activitiesaresupportedbyasystemofworkthatclearlyallocatesresponsibilitiesformanagingthehazardsandthewaytheworkisdone.Suchasystemshouldinclude:

n communicationarrangements,particularlyforemergencycontacts;and

n arrangementstofacilitateregularcontactbetweenstaffandsupervisors.

Risk profile and risk assessment

Section19ofthe2005Actrequiresemployerstoidentifyhazardsinworkplacesundertheircontrol,assesstheriskspresentedand,takingaccountofthefindingsoftheriskassessment,takestepstoimplementimprovementsconsiderednecessary.

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Occupational Safety and Health and Home Care

Listedbelowaresomeofthekeyoccupationalhazardsthatcanoccurinhomecareandsomeofthecontrolmeasurestoavoidorreducetherisk.MoredetailedinformationisavailableontheAuthority’swebsite (www.hsa.ie).

Manual and people handling

Theterm‘manualhandling’isusedheretomeanboththemanualhandlingofinanimateloadsandpeoplehandlinginvolvingclientswithrestrictedmobility.Employersmustensurethatthereareproceduresinplacetomanagetheriskfrommanualhandlingatwork.Safetyandhealthlegislationrequiresthatwheremanualhandlingofloadsinvolvingariskofinjury(particularlytotheback)ispresent,theemployermusttakemeasurestoavoidorreducetheriskofinjury.

Whenundertakingamanualhandlingriskassessment,considerthefollowingriskfactors:

n thetask–therequirementsoftheactivitysuchasnumberoflifts,carryingdistances;

n theindividual–theemployee’sphysicalsuitability,trainingandknowledge;

n theload–thecharacteristicsoftheloadsuchasweight,sizeanddimensions;and

n theenvironment–availablespace,unevenorslipperyfloors,etc.

Whenpeoplehandlingactivitiesarebeingassessed,theriskassessmentshouldalsoinclude:

n thetypeofhandlingactivitiesthatarelikelytoberequiredandtheclient’sabilitywithregardtoeach (e.g.repositioninginthebed,toileting,walking);and

n peoplehandlingriskfactorsrelatingtotheclientforexampletheclient’sabilitytounderstand instructionandcommunicate,historyoffalls,weightandheightetc.

Basedontheriskassessment,identifycontrolstoavoidorreducetherisk.Controlmeasuresmayincludetheuseofequipmentsuchasmobilityaids,hoists,showerchairs,grabrails,etc.Aclienthandling/mobilitycareplancanbedevelopedfollowingriskassessment.Riskassessmentsandcareplansmustbereviewedandrevisedifnecessary.

Challenging behaviours and potential for work-related violence and aggression

Forthepurposesofthisguidance,work-relatedaggressionandviolenceisconsideredtobeanyincidentwherestaffareverballyabused,threatenedorassaultedincircumstancesrelatingtotheirwork,involvinganexplicitorimplicitchallengetotheirsafety,well-beingorhealth.

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Wherework-relatedviolenceandaggressionisidentifiedasahazard,theassociatedriskmustbeassessedandmanagedtoensurethatthecontrolsinplaceareeffectiveandtoidentifyanyfurthercontrolsthatmayberequired.

Whenidentifyingthepotentialforviolenceandaggression,considerthetriggers,situationsandworkactivitiesthatmakeaggressivebehaviourmorelikely.Withregardtoclientswhohaveaggressivebehaviour,theassessmentofriskmayincludeaclinicalassessmentofaclient’sbehaviourandtheidentificationofappropriateinterventionstohelpreducetherisk.

Thepotentialforchallengingbehavioursandwork-relatedviolenceandaggressionfromfamilymembers,friendsandotherscanalsoexistandshouldalsobeassessedwhereappropriate.

Lone working

Manyemployeesinthissectorareloneworkers(forthepurposeofthisguidance,loneworkersaredefinedaspeoplewhoworkbythemselveswithoutcloseordirectsupervision).Loneworkerscanbeatincreasedriskandthismustbetakenintoaccountbytheemployerintheriskassessment.Clienthistorywillbeimportantinassessingtherisk.

Controlmeasurestobeconsideredinclude:

n ensuringloneworkershaveameansofcommunication(e.g.mobilephone)andsupportifrequired;

n Informationandtrainingforloneworkerstoensurethattheyareawareofthehazardsandcontrolsto mitigatetherisksassociatedwithloneworking;

n havingplansinplaceintheeventofanemergency;and

n planninginadvancethesystemofcommunicationbetweentheemployerandemployee.

Slips, trips and falls

Slips,tripsandfallsareoneofthemaincausesofinjuryreportedfromthehealthandsocialcaresector.Safetyandhealthlegislationrequiresthatthereissafeentryandexitintotheworkplace.Floorsmustbeingoodconditionand,asfarasisreasonablypracticable,notslippery.Placesofworkmustbekeptinacleanstate.Accumulationsofdirt,refuseandwastemustbefrequentlyremovedbyasuitablemethodtomaintainanappropriatelevelofsafetyandhealth.

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Occupational Safety and Health and Home Care

Considerthefollowingcontributingfactorswhenmanagingtheriskofslips,tripsandfallsatwork:

n stairsandlevelchanges;

n floorsurfacecondition(wet,uneven,clutteredfloorsincreasetherisk);

n environmentalaspects(e.g.poorlighting,wetandicyconditions);

n personalbehaviour(e.g.lackofconcentration,riskybehaviour);and

n footwear(wearingsuitablefootwearfortheenvironmentandworkactivitiescanhelpreducetherisk).

Biological hazards

Thereisthepotentialforhomecareworkerstocomeintocontactwithanumberofsourcesofinfectioneitherthroughdirectcontactwithclientsorwithcontaminatedmaterials,includingwaste,laundry,contaminatedsurfacesandsoon.Identifyingthespecificinfectiousagent(ifknown),itssource(e.g.blood,healthcareriskwaste)androutesoftransmissionwillfacilitatetheselectionofappropriatecontrols.

Thecontrolmeasuresrequiredbysafetyandhealthlegislationmayalreadylargelybeinplaceaspartofinfectionpreventionandcontrolpolicies.Infectionpreventionandcontrolpoliciesshouldbeinkeepingwithnationalguidelinesandshouldtakeaccountofstandardprecautionsandtransmission-basedprecautionswherenecessary.

Controlmeasuresmayinclude:

n hygienemeasuresthatpreventorreducetransferoftheagent(e.g.handwashing);

n maintainingtheworkenvironmentinacleanandhygieniccondition;

n havingplansinplacetodealwithaccidentsinvolvingbiologicalagents(e.g.needlestickinjuries, cleaningofbloodspills);

n useofpersonalprotectiveequipment(e.g.gloves,aprons);and

n safehandlingofinfectiousspecimens,sharps,waste,contaminatedlinenandothermaterial.

HealthcareriskwastemustbestoredinappropriateUN-approvedcontainers(bagsorbinsdependingonthenatureofthewaste).Thesecontainersaredesignedtopreventleakageandarepermanentlymarkedwithahazardandspecificcontentlabel(maximumexemptedquantityis333kgs).

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Review of home care services

Aneffectiveoccupationalsafetyandhealthsystemmustdealwithchangesintheworkingenvironmentthatmaycreatenewrisks.Forexample:

n changesinclient’shealthandassociatedneedsassessmentandcareplan,

n changesinthelevelofserviceprovided,

n changestothehomeenvironment,and

n learningoutcomesfromanyincidentsoremergencies.

Ineachcaseasuitableresponsetomeettheclient’sneedsandtoreassessoccupationalsafetyandhealthriskswillberequired.

Reviewingoccupationalsafetyandhealthperformanceinvolvessettingupaneffectivemonitoringsystem,backedupwithsensibleperformancemeasures(i.e.thefeedbackloop),theaimofwhichmustbecontinualimprovementandlearninglessonssoastopreventthereoccurrenceofnegativeoutcomes.

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Occupational Safety and Health and Home Care

Notes

healthy, safe and

productive lives

Health and SafetyAuthority

978-1-84496-239-6 HSA0460