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

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

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

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

Hospital Handling Training

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

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

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

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

1 Support Worker in Homes

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

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

Handling Around Hoarding

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

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

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

Turning Bariatric Clients

Equipment Size Vs Home Space

Functional Furniture

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

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

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”

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?

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?

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?

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

Assigning Responsibility

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

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

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

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

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

Future of Moving & Handling?