Home care workers reluctant to report risk

In-home carers often form a unique bond with clients and this can make them reluctant to report workplace health and safety risks, a conference has heard.

Unlike residential care, the in-home carer provides services in the client’s own home, which presents a unique set of requirements and challenges.

“There’s a certain way a client does things, and this has lots of implications for in-home carers,” Aideen Gallagher, co-founder of OHS consultancy Risk Managed, told the ACSA summit on Tuesday.

A carer can also become integrated into the client’s family culture, with many viewing their clients as a “mum or dad”.

Ms Gallagher said about 20 per cent of people have difficulty with daily tasks including personal care, which mostly involves intimate activities such as getting out of bed, toileting, showering and dressing.

“Manual handling is a necessary part of providing care,” she said. “In-home providers are in the business of providing manual handling services, because that’s what your staff do all the time.”

Yet manual handling is also one of the biggest risk areas in home care, and the cause of almost one in three injuries to carers.

“The biggest scourge I see in the in-home care industry is unnecessary manual handling,” Ms Aideen said.

Filling the gap

Risk occurs when a carer steps in to fill a client’s loss of ability, she told delegates in Melbourne. The carer is reluctant to say no, and like a frog in boiling water, they often don’t realise the risk until too late.

In-home carers know personal boundaries but they can get sucked into a “personal vortex” as a client’s independence moves from ability to disability.

“The biggest predictor of risk is a caregiver filling the gap for loss of client function,” Ms Gallagher said.

“That’s where the injuries are happening – when a care giver tips over the edge by unnecessary moving and handling.”

Assistive technology can also be poorly prescribed or mismatched to needs. For example there were 38 reported falls to the TGA from a standing hoist in 2018, a figure Ms Gallagher said is probably “massively under-reported”.

Reluctance to report

All of this presents challenges for service providers, who have to fulfill safety legislation, meet quality standards, attract clients and make a surplus.

To do this, providers have to be smart, Ms Gallagher says, but they rely on their workers reporting inefficiencies, safety issues and lack of quality – something they are too often reluctant to do.

She said there are numerous reasons home care workers don’t report. In many ways reporting goes against the nature of caring because it risks breaking the bond of trust between a client and a carer.

In addition, the reporting process is long and complicated, and a general culture of care workers not recognising risk, or not wanting to report, can foster a wider reticence in the industry.

OHS requirements versus person-centred care

Ms Gallagher said the new aged care quality standards mean that work place health and safety and person-centred care can sometimes work in two different directions.

“What we do in person-centred care is we ask the client what they want. And then when they tell us what they want we say we can’t do it for OHS reasons,” she said

However Ms Gallagher says this can be prevented by establishing guidelines from the outset.

She said home care providers can encourage workers to report by giving them tools to recognise risk, support them in talking about risk with clients, taking a team approach to risk reporting, providing sound risk management systems and streamlined processes, and being clear about the difference between screening and assessment.

For providers, encouraging a culture of reporting can help them meet legisltative requirements and community standards, as well as improving efficiency and lifting quality of care.

“If all the funds as wasted on personal care there’s nothing left to use for other areas, including the “small tasks that can transform existing to living”.

Ms Gallagher is currently writing a book on safe and efficient manual handling, Smart Care, which will be available from Risk Managed in 2020.

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