Health Care

Safety & Health Assessment & Research for Prevention (SHARP) — Research for Safe Work

Health Care in the Home Environment

Health care delivery is increasingly moving to the home environment. There are several factors fueling this change including:

  • The population is aging. Life expectancy is increasing.
  • In-home care has been shown to be more cost-effective than institutional care.
  • In-home care can maximize independence while minimizing the effects of disability and illness.
  • In-home care contributes to increased quality of life for care recipients.

However, the occupational environment in which health care in the home environment is delivered and the risk to those providing that care has only recently become a focus.

A recent SHARP study of Washington workers’ compensation claims from 2010-2014 revealed that injured home health aides averaged 358 days of time loss per claim. WMSDs accounted for 55% of all lost-time claims, while rotator cuff syndrome was the most frequent WMSD medical-only claim. Injured backs averaged 4,186 days/10,000 full time employees.

The Home Health Aide Study: Identifying Risk of Musculoskeletal Disorders Washington’s Home Health Care Industry

SHARP is conducting a 5-year study to understand the risk factors that may contribute to work-related musculoskeletal disorders to home health aides. We hope the information gathered will be used to prevent these types of injuries.

The study has several phases including:

  1. Reviewing workers’ compensation data to understand trends.
  2. Interviewing injured home health aide to understand how their injuries occurred.
  3. Administering an industry-wide survey of home health care aides.
  4. Performing on-site observations of home health aides tasks.

Current Study Activities

The research team is collaborating with home health care businesses to perform on-site observations of home health aide tasks to learn more about the working environment and physical factors involved in daily tasks.

Home Health Aide Publications

Current report

The aim of this report, updated periodically, is to identify the types of workers' compensation claims that are being filed by specific home care services groups in Washington State.  Employers, industry associations and labor representatives may use these data to better understand the types of injuries that are occurring among this working population and use this knowledge to help guide injury prevention efforts.

Previous reports

Safe Patient Handling (SPH)

Preventing injuries and illnesses from patient handling

Patient handling-related injuries and illnesses in hospitals are a serious and costly problem. In March 2006, Washington State Governor Christine Gregoire signed new legislation requiring hospitals to implement a safe patient handling program (ESHB 1672) (

In response to ESHB 1672 (, a Safe Patient Handling Steering Committee organized to help hospitals implement safe, cost effective patient-handling program. The goal of the steering committee is to assist with and disseminate information about every aspect of the implementation of the new legislation.

Washington State's Safe Patient Handling Report: Implementation of Safe Patient Handling in Washington State Hospitals, Report to the Legislature December 2010. An evaluation of the impact of the Washington Hospital Safe Patient Handling Law (ESHB 1672) four years after its' implementation. Final Report: Safe Patient Handling.

SHARP has also begun an exciting new project aimed at evaluating the effectiveness of these safe patient handling programs to prevent work-related injuries. Initial site visits to Washington hospitals were completed in 2007. Findings from the research will be posted as they become available, but please also see the reports below from past SHARP studies on patient handling-related injuries.

Barriers and solutions to safe patient handling

Watch this short video: The Caretaker Crisis: Investigating Work-Related Injuries in Healthcare:

Manual handling of patients is hazardous for both healthcare staff and patients. The Washington State House of Representatives Commerce and Labor Committee asked the L&I to form a task force with representation from labor and business to examine issues related to safe patient handling in healthcare. Sectors of the healthcare environment included in this study were:

  • Hospitals.
  • Nursing homes.
  • Home health care.
  • Home care.
  • Hospice.
  • Pre-hospital medical services.

SHARP reviewed the literature on patient and staff safety related to handling patients, as well as Washington State workers' compensation claims data for related injuries, rates and costs. We also visited several facilities in each healthcare sector to obtain information about successes and barriers to implementing safe lifting programs.

There is a close relationship between patient safety and staff safety. Patients are increasingly older, heavier and often sicker. These patients are being cared for by skilled healthcare workers who are also getting older. This has contributed to the problem of recruiting and retaining qualified or experienced staff. Musculoskeletal injuries, especially of the back, also continue to be a problem in this industry.

A review of the 2003 compensable back injury claims rates from the Washington State Workers' Compensation data found:

  • The workers' compensation healthcare sector insured by L&I had a rate 3.9 times greater than the rate for all other industry sectors combined.
  • The self-insured healthcare sector had a rate 1.5 times higher than the rate for all other industry sectors combined.

The summary report, Lifting Patients/Residents/Clients in Health Care: Washington State 2005 (66 KB PDF) is available online. Please contact SHARP for a copy of the entire technical report.

Study findings for handling patients, residents and clients in the Washington State healthcare industry

Review of literature and workers' compensation data

Nursing staff have among the highest back and shoulder injury rates of any occupational group in Washington State. The incidence and cost of patient lifting-related injuries among healthcare workers remain high.

In 2003, the incidence rate for compensable back injuries insured by L&I was 162.5 claims/10,000 FTEs compared to 41.4 claims/10,000 FTEs for all other L&I insured employers.

Based on the Washington workers' compensation data and cost benefits from other studies of no-lift programs reported in the literature:

  • The average annual workplace musculoskeletal disorders (WMSD) claim costs for hospitals and nursing homes is approximately $32.8 million.
  • A 53% reduction in claims rates (the median reduction of the studies reviewed) would save about $17.4 million in direct claims costs per year.

Selected findings from the study site visits

Lifting patients in hospitals
  • The challenge of retaining staff stems from the aging of current registered nurses and the inadequate numbers being trained to meet future demands.
  • Most hospitals visited in the study had at least one ceiling lift. The advantages of ceiling lifts were: easy availability, space saving, smoother handling of patients, and reduction of staff turnover.
  • Both management and employees interviewed recognized that while mechanical patient handling equipment was essential, it was not sufficient without an integrated program or process.
Lifting residents in nursing homes
  • The biggest barriers to attracting and retaining staff included inadequate wages and benefits and the heavy physical work.
  • An increasing challenge to handling residents is the increasing number of obese and bariatric (extremely obese) residents. Some of the nursing homes did not have the capacity to admit bariatric residents.
  • All the nursing homes visited in the study had some type of mechanical patient handling devices including sit/stand devices and total body lifts.
  • There were no ceiling lifts observed in any of the nursing homes visited.
Lifting clients in the home sector (home healthcare, home care and hospice)
  • Workers in the home sector face unique challenges in that the home is not often designed for ease of client assisted transfers.
  • Home sector workers often work alone and must transfer clients by themselves.
  • Insurance rarely covers transfer devices. These might be the very thing that allow clients to remain in their home and not be moved to long-term care facility.
Lifting patients by pre-hospital medical services (paramedic, ambulance service and firefighter/emergency medical technician)
  • Staff have no control over the environment where they pick up patients (e.g. individual homes, nursing homes).
  • The risk from transferring patients is being transferred to emergency medical services when nursing homes call to have residents lifted.
  • Manual handling of medical equipment, as well as non-medical equipment like fire hoses, contribute to the overall physical load.

Selected study conclusions

  • All hospitals and nursing homes visited were working to implement a no-lift program of some form with the intent of reducing staff and patient injuries. This was less evident in other sub-sectors.
  • The literature review of facilities with no-lift programs showed reduced:
    • Injuries to patients and staff.
    • Time loss.
    • Costs.
    • Staff turnover.
  • A clear barrier to implementing no-lift programs is lack of funding to purchase mechanical lifting equipment despite the relatively high return on investment.
  • Home and pre-hospital medical services sectors present some unique but not insurmountable challenges to minimize manual lifting.

Nursing homes

Nursing home workers are at high risk for musculoskeletal disorders, particularly back and shoulder disorders. The majority of these disorders are related to resident handling activities.

SHARP began working with a local nursing home to develop a prospective study of those combinations of resident handling loads that may predict back and shoulder disorders. SHARP received a NIOSH NORA (National Institute for Occupational Safety and Health National Occupational Research Agenda) grant to evaluate the effectiveness of several different kinds of interventions to reduce back and shoulder disorders due to resident handling activities.

Using industry wide surveys and selected site visits at baseline and follow-up, SHARP assessed whether implementing a "zero-lift" environment reduces these resident handling related disorders. This study continued until 2001 in order to evaluate short-term and long-term effects.

The summary report, Getting to Zero in Washington State Nursing Homes: Final Report on Intervention Effectiveness (14 KB PDF) is available online. Please contact SHARP for a copy of the entire technical report.

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