Special report: staff injuries in aged care

Aged care workers are at a high risk of injury from performing manual handling tasks such as transferring or moving residents. In 2012, more than three-quarters of aged care facilities reported a work-related injury or illness in the previous three months, according the latest aged care workforce census.

Due to the seriousness of the injury more than half of facilities had one or more employees on Workcover, which was 20 per cent higher than the previous census in 2007.

Compounding the negative impact of injury and illness on staff is the financial cost to the sector, which the Australian Bureau of Statistics has estimated to be around $59 million in 2012.

The impact of physically demanding work on the retention of aged care staff, particularly older women, was also highlighted by a recent study conducted by Curtin University.

Sprains and strains caused by activities such as lifting, pushing, pulling and bending are by far the greatest contributor to the overall injuries suffered by aged care workers.

National campaign

To reduce the rate of staff manual handling injuries, the Heads of Workplace Safety Authorities (HWSA) conducted a national inspection program this year targeting health and safety compliance in residential aged care facilities.

The campaign was led by the Victorian WorkCover Authority but also involved work health and safety regulators in Tasmania, the Northern Territory, Western Australia and South Australia. Results from more than 350 workplace audits have been collated and a national report is currently being prepared for HWSA.

The workplace visits assessed compliance in five main areas including the management of risks associated with manual tasks, review of risk controls; incident reporting and investigation; manual task policies and procedures and emergency response procedures.

State snapshot

Kathryn Jones, senior inspector with WorkSafe WA, told Australian Ageing Agenda that the risks for manual handling injuries were overall well managed by the 25 metropolitan facilities that were audited within the state.

Only three improvement notices were issued by WorkSafe WA, as the majority of minor breaches could be resolved quickly through education and advice.

Jones said the best performing area was in the risk controls for manual tasks followed by policies and procedures, while the greatest area in need of improvement was in reporting and investigation of safety incidents, where the majority of providers were only minimally compliant.

Inadequate investigations

Jones said the incident investigations that were reviewed often did not consider many factors other than staff actions and postures as the cause for a workplace injury.

Facility design, workload, accessibility of equipment, staffing and supervision, repetition of tasks and work organisation are some of the other contributory risk factors that should be considered in an investigation, she says.

To support facilities in their investigation of manual task incidents, WorkSafe WA has distributed an investigation tool to help staff better identify the environmental, staffing and work systems-related risk factors at play.

“Most facilities do need to improve how well they report and investigate manual task hazards and examine the risk factors to control them in the future.”

Facility design

High performing facilities in the WA audit were physically designed to support the use and accessible storage of lifting equipment.

“The more recently the facility was built, the more likely it was to have doorways that took in all of the equipment, and included smooth flooring so as not to limit staff using mobility equipment,” said Jones.

She said storing and accessing equipment should be a key consideration for organisations when designing new facilities or refurbishing existing ones.

Other positive work practices identified by inspectors included having strong communication between facility management and staff on safety issues, asking clients if they can walk or move themselves before engaging in a lift or transfer, and training external agency staff in facility procedures and the location of equipment.

Jones said that while policies and procedures are helpful, they are only as good as how well they are communicated to employees. “If the employees didn’t know or understand the policy, it really didn’t matter if it was there or not.” This is why manual task policies that use simple English and easy to understand pictures are particularly effective.

Following the audit, Jones said WorkSafe WA will be conducting education sessions with aged care providers across the state including regional areas to share best practice and advice for improvement.

The importance of staff wellbeing

More broadly, when it comes to improving employee safety in aged care it might be wise to think outside the box, according to a new study conducted by research firm the Voice Project and Macquarie University organisational psychologist Dr Allan Bull.

The research concluded that while traditional approaches, such as focusing on upgrading facilities, investing in training and polices are important, they alone are not sufficient to improve employee safety and reduce workers compensation claims.

The study pointed to the importance of broader work characteristics such as employee psychological wellbeing and a culture of respect, as equally vital considerations for employers.

The research, which analysed changes in employee survey results, safety incidents and workers compensation claim rates within a large aged care organisation across two years, reported that employee psychological wellbeing is the greatest predictor of changes in safety incident rates.

It was also one of only two significant predictors of changes in workers compensation rates, the other being the extent to which the organisation discouraged bullying and harassment.

Indeed, marginal improvements in psychological wellbeing reduced safety incident rates by 11 per cent.

Changes in role clarity, staff involvement in decision making, the quality of supervision and the presence of a respectful culture free of bullying and inequality also led to changes in safety incidents.

However, changes in employee ratings of the condition of facilities, the efficiency of processes, the organisation’s safety climate and staff engagement did not predict changes in safety incident rates.

“Whilst you have to have safety processes and good design in place, just focusing on improving them wasn’t going to drive significant improvements above the baseline level of safety that the organisation was achieving,” Carly Adams, consultant with the Voice Project, told AAA.

Adams said that employee psychological wellbeing was important because it influenced a person’s cognitive capacity, behavioural responses and emotional state at work.

“Stress increases cognitive load, so it depletes the resources staff have to cope with any additional strain or situation that arises,” she said. “It means that staff are likely to engage in more workarounds and it also impacts on things like sleep and fatigue which also leads to more performance deficits.”

Adams said making sure that staff feel supported, and have the ability to control their workload and manage their stress levels is going to be an important area of focus for organisations looking to improve workplace safety.

A respectful culture also matters, she added, because in a team where there is harassment, bullying or discrimination, staff were less likely to speak up and added stress was placed on staff.

“If we really want to design a workplace that is going to support safety then we have to think more broadly about what are the work and management practices that can help drive that and can support what aged care providers are already doing.”

Based on these findings, the study estimated that an increase of 4.4 per cent in staff wellness across the sector would reduce the likelihood of safety incidents and workers compensation claims by 10 per cent respectively. If realised, this could generate an average saving of $6.1 million per year.

The study concluded that organisations wanting to improve employee safety and reduce workers compensation claims should also prioritise interventions which support staff psychological wellbeing through reward and recognition culture, flexible workplaces; discourage bullying and harassment and maximise equality for staff; and ensure staff clearly understand what is required of them.

Interventions should also promote staff involvement in decision-making processes, encourage staff to provide feedback, and emphasise the importance of supportive and approachable supervisors and management, the study found.

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