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 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
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’

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?